The Ugly Truth about Credentialing & Privileging - Part I

Dear Doctor:

If you've been a practicing physician for more than about an hour, chances are you already know the ugly truth. If you're in medical school or a residency program, odds are good that you don't have a clue. Not to worry, as a fourteen-year veteran of the credentialing wars, I'm about to enlighten you.

(I feel I must preface this ominous tale with a disclaimer that I am a firm believer in the need for effective, thorough credentialing and privileging - more about that later.)

At last, you’ve completed your training and can begin to practice in your chosen field. You look forward to curing illness, cutting away disease, and finally earning some money so you can start paying back those lovely student loans you’ve accumulated.

Whether you join a large multi-specialty group or bravely hang a solo-practice shingle, you will no doubt need to apply for privileges at one or more hospitals, and perhaps a few ambulatory surgery or urgent care centers as well. If you hope to make even a small dent in those outstanding loans, you’ll also need to join various managed care panels.

How bad can it be, right?

You’re about to find out just how many ways you can be asked to document every place you’ve been, every job, license, certification or board you’ve ever held, whether or not you have any disabilities for which you’ll need accommodation, whether any professional privilege has ever been denied, revoked, limited or suspended, and whether to the best of your knowledge anyone is even thinking about denying, revoking, limiting or suspending anything of yours.

You’ll also need to produce the names, addresses, phone, and fax numbers of various individuals who will serve as your references. Some you’ll get to select, others may be prescribed. If you apply to a number of organizations all at once the people you name will get the joy of responding to multiple requests. If they don’t answer in a timely fashion you’ll be given the opportunity to prod them along. You may want to practice groveling, as nothing delays privilege approval quite as effectively as references who fail to respond.

Getting the picture? Verification of credentials is a huge, time-consuming, pain in the neck. Establishing that you’re currently competent to request and perform a vast array of delineated privileges only adds to the discomfort.

Unlike fine wine, the process does not become more palatable with age. The longer you’ve been in practice the more years of experience there are to verify, and the more proof you’ll need to produce to show that you’re still proficient at the ‘otomy, ‘ectomy and ‘ostomy that you learned way back in training.

There’s more, but I don’t want to discourage you overmuch with too many dark, dire warnings of a future decorated in red tape and dominated by writer’s cramp. (And we haven’t even touched on medical records documentation!)

Take heart - I have some tips to share on ways to make the credentialing process a slightly less bitter pill to swallow, so read "The Ugly Truth - Part II" to get your next dose of "Realdox."

Comments

[Lin]

Hello - I'm just a lurking blogger from SignalHealth (http://www.signalhealth.com/commentary). I've got more bad news: the NPI is coming - starts this January. Part of my company is helping docs file for this; perhaps I should take on credentialing, too!

Lin