Members Only | 10.24.22
Front of the Line
By K. Ann Shelley, CPMSM, CPCS
While working at an academic medical facility here in Cincinnati, I found it puzzling that the graduating residents and fellows don’t receive information on how to begin their career. I’m old enough to remember that in Home Economics, we learned how to balance a checkbook and manage our personal finances. Today, most everyone relies on their phone to tell them how much money they have. It is the same with our graduating residents and fellows: They don’t understand the intricacies of how to apply for privileges, how long the process takes and who is responsible for getting it done. Most members of the medical staff office (MSO) are used to being last in line when onboarding a provider. How many times have we heard, “Well, they have patients scheduled next week!” The frustration is almost palpable.
What I have come to understand is if I want to reduce the stress on my MSO team, increase the provider’s experience all while decreasing the hospital’s risk, then I need to first educate the applicant as to what is involved. I had to get in front of the students. I requested time during the oral-maxillofacial surgery grand rounds so I could present the credentialing process to the group. My presentation had all the MSO points on a multislide presentation with all the bells, whistles, transitions and cartoons. I was prepared. I was wrong. They didn’t have a clue what credentialing was, why it was needed and why we would even question them. They were set to graduate! I had to go back to the drawing board and realize that credentialing wasn’t a bad word – it was a foreign language. I went back to my desk and completely revised my approach. I updated my slides and removed the “why” portion of the message.
They don’t care about why we are asking these questions, they just want to know what they need to provide, how long it will take, when they will begin seeing patients and when will they start getting paid. I learned a lot from that first presentation, and I’m happy to say that I have had the honor of speaking to our future graduates on several occasions. I hope that it helps medical staff teams everywhere they go. But not all applicants are new grads, so what about the rest? The issues with experienced applicants is a bit different than the new grads. If we didn’t catch them while in residency or during their fellowship, then that leaves a large chunk of applicants the MSO is processing each year that probably know about credentialing but also do not look forward to the process. My latest revision to educating new applicants is to get the MSO included in the department’s onboarding meeting. This is my chance to explain what their specific responsibilities are and what belong to administration, and the expected timeline. For instance, at my facility, the expected timeline is 90 days from the date the complete application is received, not 90 days from when we send out the application link. And finally, I teach them what is informational and what is actionable.
During the department’s onboarding meeting business administration, the provider, the insurance enrollment team, department chair and now the medical staff office discuss the status of the application and what is still needed. After 15 meetings, we have found that they are beneficial for both the new graduates as well as the experienced providers. It is a chance to speak to the provider, review their requested privileges, discuss timelines and the steps before privileges are approved. We also ward off any questions prior to going to committee. The most beneficial piece of this process is that it brings credentialing to the front of the onboarding process, instead of to the end. The synergy of the meeting allows the applicant to put a name with a face and gives them a “go-to” person for questions and assistance.
Human Resources and the MSO historically play tug-of-war with the provider, and historically the MSO loses. The MSO has been the last to know but the first needing to be finished. Therefore, being proactive and getting in front of the applicants early helps everyone. With the inclusion in the onboarding meeting and teaching our graduating residents and fellows, our central verification office (CVO) has already seen a quicker turnaround time from when the applications are sent and when they are returned. In one month, we have reduced the amount of time from application sent to board approval received by 5 days. The true test will be once we are through our academic year in June, but it looks promising so far. I do know my staff has felt the benefit of being included in early communications with the applicant and that’s good enough for me.