Can you connect these dots to suboptimal financial performance in your organization?
- Many hospitals, through merger/acquisition/integration, have a confusing governance structure where accountability and expectations are unclear. There are new and hold-over sets of overlapping bylaws and policies that are overly complex, duplicative, contradictory, or some combination thereof. And then there’s the org chart…
This is a common pain point with clinicians, hospitals and systems today. If no one knows who they are “accountable” to, and what they are “expected” to do, the compliance picture is indeed troubling. But beyond that, risks are higher and productivity is lower, which does not bode well for the financial health and sustainability of the organization. That’s not even accounting for the confusion among physicians, who are used to collegial partnerships, not business hierarchies. This “tiny fish, amorphous pond” frustration is a contributing factor to physician burnout. And turnover is expensive.
- A startling number of hospitals are
granting temporary privileges (or allowing practitioners to practice without privileges) as a norm, not an exception.
When hospitals grant (and extend) temporary privileges on a regular basis, there are risks to the organization on a number of levels. But it’s happening because there are forced workarounds in the process to get practitioners earning faster. Temporary privileging would be unnecessary if new applications took no more than 14 days (21 days at the outside) to complete and be ready for committee review or approval. Check out our turnaround time ROI calculator. In addition, enrollment with commercial payers should not take more than 60 days. If it does, the “claims write-off” zone is an expensive place to dwell, but it’s almost entirely preventable if delegated status can be achieved. At the very least, the internal process should be more closely aligned with what the payers require to begin with. And, if done right, the process should be as simple and painless as possible to minimize providers’ frustration. Did we mention turnover is expensive?
Both of these are big-bucket symptoms of what we call incomplete integration. The promise of integration – physicians joining groups, joining hospitals, joining systems, in the hopes of lowering administrative overhead and gaining some insulation from the uncertainty of payer requirements and national healthcare policy shifts… All of this can work, in theory. But the execution has fallen short. Hospitals need help to pick up the ball finish the run to the goal line.
Changing culture to simplify and communicate accountability and expectations is not easy, but it is necessary for the clinical, financial, and cultural integration to work and bear fruit.
This one is much simpler. Resolve to end temporary privileging as “the norm” and do these three things:
- Get to less than 21 days in credentialing application turnaround time.
- Achieve delegated status with at least your largest private payers.
- Explore opportunities to centralize verification, enrollment, and maybe even current competency data too.
Register for the free webinar on this Trifecta.
The goal is a streamlined credentialing, privileging, and enrollment process that is fully compliant with your bylaws, state and federal regulations, your accreditors, and your payers. The more efficient the process is, the more satisfied providers will be. Best of all, there is a direct, positive bottom line impact when risks are mitigated and providers are earning as soon as possible with minimal write-offs.
Do these sound doable?
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