Credentialing Services

Credentialing Delays and Patient Care: The Underlying Impact

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Delays in medical credentialing and state licensing are more than just administrative hurdles. These prolonged wait times impede physicians and advanced practice providers, acting as barriers for patients in need of care. Provider credentialing is a valuable service offered by healthcare consulting companies, so here is what to know about the credentialing process and how your healthcare organization can benefit from outsourcing provider credentialing with PayrHealth.

The Waiting Game for Physicians

Physicians and healthcare providers have long grappled with significant delays in state medical licensing. It’s not just about the paperwork; it’s about the tangible impact on healthcare delivery. Unforeseen licensing timeline extensions often dampen the excitement of new providers eager to join a practice. Consequently, provider start dates get shifted, sometimes more than once. This domino effect culminates in extended waiting periods for patients, many of whom might have been anticipating their appointments for a long time. This can create only frustration all around, reducing the overall patient experience.

The 2020 Pandemic’s Role

COVID-19 added fuel to this already smoldering issue. While the pandemic accentuated the physician and healthcare provider shortage and introduced additional challenges to healthcare recruitment, its repercussions on patient care became glaringly evident. The credentialing process delayed valuable treatment for patients in an already dire global situation, putting extreme strain on patient access to healthcare organizations. This was true across the scope of the healthcare industry, from behavioral health providers to emergency departments to regular physicians.

State Licensing: A Complex Landscape

Acquiring a license is unique across states. Although licensing prerequisites largely resonate on common grounds nationally, most states mandate physicians to secure separate licenses for each state they operate in. Beyond state-centric licensing, physicians catering to multiple hospitals must navigate the labyrinth of individual hospital credentialing.

Delays in processing can stem from various causes, with limited state budgets and staffing shortages being recurrent culprits. Licensing isn’t solely a healthcare domain, either. Many states oversee the licensing of many professions, and not all have transitioned to digital processing of required documents. The relic of manual systems, reliant on fax or mail, further worsens delays.

The average physician anticipates a licensing period of around sixty days. However, this timeline can stretch to an agonizing six months or even longer in certain states. Such delays can put physicians into a state of professional limbo, compelling them to temporarily operate in locations where their credentials are valid, meaning patients relying on care from specific physicians must wait or potentially look outside of their coverage networks.

Historical Delays in Medical Licensing

Medical licensing delays have historical roots. In 2009, the California Medical Association raised concerns by filing a lawsuit. They claimed that the state-initiated furloughs significantly slowed the state medical board’s processing speed for physician licenses applications. Intriguingly, even before the initiation of the furlough program, California’s medical board was already grappling with a backlog of applications.

Fast forward to 2020, and the healthcare sector witnessed a palpable shortage of physicians, thereby restricting access to care. The advent of the COVID-19 pandemic added layers of complexity to this problem. It unmasked the inadequate preparedness of state licensure and hospital credentialing processes, especially when rapid recruitment of physicians became imperative to address soaring patient-care demands.

Adapting to Unprecedented Times

The public health emergency in 2020 coerced every licensing agency into a rapid adaptation mode. Notably, the Centers for Medicare and Medicaid Services (CMS) and almost all U.S. states made a strategic move by temporarily waiving the requirement mandating physicians to hold licenses in the states where their patients reside. Many states choosing to waive or modify their licensure prerequisites and renewal policies further bolstered this response. The goal was simple yet crucial: ensuring that physicians with licenses from other states could seamlessly practice in states experiencing a surge in hospital demands, allowing physicians and healthcare practitioners to provide valuable support where needed.

Did these strategies bear fruit? The answer is a resounding yes. Take, for instance, NYC Health + Hospitals. Positioned at the U.S. epicenter during the crisis, they successfully augmented their staff to cater to the emergent demands during the pandemic. This is a notable example of how reducing the strain of provider credentialing can only benefit patients and healthcare organizations as a whole.

The Role of the Interstate Medical Licensure Compact (IMLC)

The IMLC emerged as a beacon of hope during these trying times in 2020. This agreement, made between state boards of allopathic and osteopathic medicine, facilitated board-certified physicians from member states to expedite their licensure processes in other member states. The beauty of the IMLC lies in its simplicity: it mandates just a single application for physicians desiring to practice in multiple states. The result? A swift and streamlined licensing journey.

However, the pandemic also reshaped how physicians utilized the IMLC. Data from the American Academy of Dermatology offers a telling narrative: before 2020, a significant chunk of physicians, approximately 40%, leveraged the IMLC primarily for localized practices. They applied for licenses predominantly in neighboring states, with an average issuance of 1.6 licenses per application. Yet, post-pandemic, there was a marked shift. The demand for locum tenens and telemedicine surged, accounting for 66% of total applications.

The Future of IMLC and Multi-State Licensing

The IMLC’s journey continues. Delving into physician feedback, the American Academy of Dermatology unveiled a pressing concern: the challenge of maintaining multiple licenses, each with distinct renewal timelines and continuing education stipulations. Addressing this, the IMLC is innovating to design a unified platform. Physicians can effortlessly access, monitor, and manage all their licenses.

With its virtual medical consultations, telehealth witnessed a meteoric rise during the pandemic, predominantly to minimize exposure risks. Several states extended their telehealth licensing criteria during the COVID pandemic to cater to this demand. Telehealth has become an indispensable tool for certain specialties, bridging patient care gaps. The revamped licensure stipulations now empower providers to offer telehealth services across states, contingent on state and federal regulations. Enhancing this cross-state telehealth initiative are the IMLC, simplifying the process, especially for specialists in member states, as highlighted by the Federation of State Medical Licensing.

The Complexity of Credentialing

The credentialing process is more than just a bureaucratic process. For physicians, it’s the gateway to practicing medicine and providing care. Yet, these gateways can sometimes become roadblocks, affecting physicians and patients relying on them.

Every new venture for a healthcare provider, whether starting a practice, moving across state boundaries, or affiliating with a new healthcare institution, demands a rigorous credentialing process. It’s about more than just verifying qualifications. The process entails a comprehensive paper trail, with each state presenting its unique requirements for obtaining credentials.

While some states project a reasonable 30 to 60 days for traditional credentialing, others set estimates stretching from 90 to 150 days. Every day of delay can thwart a healthcare provider’s ability to practice medicine. And patients can be left without their healthcare provider of choice to continue to receive valuable care.

Counting the Costs of Inefficiency

Inefficient provider credentialing doesn’t just delay care; it also punches holes in the financial fabric of healthcare institutions. 2022 emerged as a challenging year for many hospitals and health systems, with finances stretched thin since the 2020 pandemic’s inception. Delving into the reasons, administrative waste is a significant contributor to excess health expenditure. Astonishingly, administrative spending devours 15 to 30 percent of a healthcare organization’s budget. A staggering half of this cost is attributed to uncoordinated and non-standardized administrative protocols, screaming inefficiency.

Towards a streamlined future

The healthcare industry is gradually shifting its focus, becoming more patient-centric. In this evolving landscape, physicians and healthcare providers must keep their credentials updated. The solution? Automation. Industry experts are championing the cause of an automated credentialing process, emphasizing its potential to infuse efficiency into the system.

Automation can drastically reduce the paperwork burden on physicians. A comprehensive physician profile can be rapidly generated across health system locations by fetching required information directly from primary sources like state licensing boards. This saves time and spares physicians the repetitive ordeal of paperwork every time they transition to a new setting – be it a state, hospital, or practice.

Centralized and automated credentialing systems can also elevate provider satisfaction, which, in turn, can positively influence patient care. It’s a win-win.

The challenges posed by physician licensure and credentialing procedures, intensified by the pandemic, have spotlighted the pressing need for reforms. Understanding the needs of the healthcare workforce and championing streamlined licensing and credentialing processes is not just essential; it’s urgent.

Key Insights

  • Credentialing delays can directly impact patient care and access.
  • Inefficient administrative procedures contribute significantly to healthcare costs.
  • Automating credentialing can revolutionize healthcare delivery, boosting provider satisfaction and patient care.

Provider credentialing with PayrHealth

Credentialing in healthcare is a big deal. It’s more than just a step; it shapes how healthcare providers treat patients. Right now, many things could be improved in how we manage credentialing. It’s often slow and full of challenges, leading to delayed medical services and higher costs. It can also make healthcare providers feel frustrated. But there’s good news: new technology and methods are being developed to make the credentialing process smoother and faster.

In the meantime, partnering with provider credentialing experts is a great way to free up resources and ensuring excellent patient access to providers within your healthcare organization. To learn more about how PayrHealth can help improve the overall efficiency of your organization, contact us through our online form today.

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