More than a year ago, during the first waves of COVID-19, credentialing presented a significant challenge to fast, expedient delivery of talent that was needed to meet the crisis surge.
For facility staff pre-COVID, credentialing could take upwards of 20 hours per provider as they worked to check backgrounds, verify credentials, privileges, medical boards, education, and more. In addition, a slow credentialing process costs providers, facilities, and the industry at large. According to an Institute of Medicine study, providers lose income, facilities lose revenues, and the credentialing process contributes to half of the estimated $361 billion a year wasted on healthcare administration.
Threading the needle between “just in time” credentialing and licensure in order to quickly deploy desperately needed caregivers and ensuring that compliance and other safeguards are being met can be difficult – but as Cross Country Healthcare and other healthcare organizations have proved during the pandemic, it is not only attainable but a better, streamlined approach for the future.
A new normal for credentialing efforts.
During times of crisis, the staff is the hospital resource most at risk for inadequate supply. The COVID-19 pandemic required many facilities to review their credentialing policies to see if there was an expedited path for credentialing medical staff or considering creating one.
As Cross Country Healthcare worked alongside facilities to streamline and speed up the process, it uncovered powerful lessons learned to improve the “door to floor” process, including:
- Considering exceptions to some of the usual credentialing guidelines, such as replacing multiple committees with one to consider applications for privileges, limiting privileges given to a provider who went through expedited credentialing, or limiting the time in which those restricted privileges may be exercised.
- Identifying and establishing minimal credential requirements and deploying them rapidly nationwide, keeping in mind that each provision that is added can slow down the time to deliver healthcare talent to the bedside.
- Establishing rules for ongoing engagement and communication when revising and deploying new credential processes. View a case study with Northwell Health.
- Implementing healthy reporting practices and tracking to safeguard against any impacts on patient care quality or compliance using an expedited process.
In fact, Cross Country Healthcare has conducted extensive research and analysis of its proprietary crisis credentialing model to identify any impacts of the streamlined process on quality or compliance. The crisis credentialing model reflects changes to several aspects of the process, including the timing of drug screens, reference guidelines, and streamlining annual mandatory education testing. To date, the new, streamlined credentialing process has had no adverse effect on healthcare provider quality, performance, or compliance when compared to the pre-COVID credentialing process.
Reimbursement and regulatory changes.
In response to COVID-19, many temporary changes were made regarding reimbursements to help manage the pandemic. Telehealth reimbursement has increased dramatically in Medicare, commercial plans and Medicaid, though in many cases, these reimbursement changes may be temporary.
While traditionally, telehealth services have been reimbursed at a lower level than in-person visits, in March 2020, CMS allowed for more than 80 additional services to be furnished via telehealth and for providers to bill for telehealth visits at the same rate as in-person visits. With the waivers in place, almost anybody with broadband internet can access telehealth and can do so from their homes. This has allowed healthcare organizations to continue offering certain basic services that otherwise would be lost to them.
While CMS waivers will evaporate once the public emergency ends, elected officials will likely have reason to consider more permanent regulatory changes given telehealth's ongoing effectiveness in everything from primary care visits to behavioral health. Because so much of the industry is rapidly trending in this direction, it would be difficult to go back to pre-COVID telehealth reimbursement levels. Some service lines, such as telepsychiatry, would still be reimbursed at their current levels, but things like imaging and labs would see reimbursement cut by 60 percent to 70 percent.
For a lasting change in areas such as reimbursement and the ability to offer telehealth across state lines, an act of Congress will be required. On the surface, this seems like a tall order but there is more support than ever before for such a change.
Modernizing licensure requirements and processes.
The COVID-19 pandemic has forced federal and state policymakers, Republicans, and Democrats to acknowledge that clinician‐licensing laws block access to care. In a March 24, 2020, letter to governors, Secretary of Health and Human Services Alex Azar urged states, “To extend the capacity of the healthcare workforce to address the pandemic.” The recommendations included removing barriers to right‐skilling: “Relax scope of practice requirements for healthcare professionals, including allowing professionals to practice in all settings of care … [and] any requirements for written supervision or collaboration agreements”; “Allow physicians to supervise a greater number of healthcare professionals;” and “modify laws or regulations to allow medical students to conduct triage, diagnose, and treat patients under the supervision of licensed medical staff.”
By suspending such rules to improve access to care for COVID-19 patients, states have acknowledged that licensing prevents clinicians from providing services they are competent to provide. The patchwork of state licensing regimes has been one of the most challenging barriers to overcome. Some states have made temporary concessions concerning their control over licensure to support patients during the COVID-19 pandemic. However, while these measures have helped, a uniform national mechanism for licensure for telehealth across state borders would be much more effective.
Initiatives such as the Interstate Medical Licensure Compact (IMLC) make it easier for providers to become licensed in multiple states. Still, the IMLC has not been adopted in every state, and the process for providers to take advantage of this reciprocity is not automatic.
Many state responses to the COVID-19 crisis have included the availability of temporary, emergency, or fast-tracked licensure or the temporary waiver of certain licensure requirements. Although individual state-based measures can help increase physicians' availability, a unified response would allow the healthcare community to be more responsive to future healthcare crises.
One potential avenue for this is the Emergency Management Assistance Compact (EMAC). EMAC has been ratified by Congress and every U.S. state and territory. It provides state emergency management agencies with broad powers to cooperatively respond to emergencies, including liability waivers, license reciprocity, and reimbursement for costs.
The National Emergency Management Association supports the use of EMAC to implement uniform waivers to state licensure requirements for the provision of services via telehealth and has released a form executive order that Governors can use to achieve this result efficiently. If adopted, this order includes a broad waiver of in-state licensure requirements for physicians licensed in another jurisdiction and allows them to provide any services they could provide in their home jurisdiction via any remote telecommunications technologies. Universal adoption of such an order would let physicians treat patients anywhere in the country via telehealth and facilitate the efficient implementation of nationwide telehealth networks.
The latest movement in reducing complexity and ensuring compliance with licensure is also underway. Under current law, healthcare professionals must maintain licenses in each state they provide services. The bipartisan TREAT Act, introduced on August 4, 2020, would allow healthcare professionals licensed in good standing to provide in-person care or telehealth visits from any state in future national emergencies without jeopardizing their state licensure.
Shaping the Future.
Cross Country Healthcare has been at the forefront of leading change in the areas of credentialing and licensure. Several of its leading executives are engaged in spearheading efforts to evolve these practices both within client facilities and in the industry as a whole.
To learn more about the optimizing credentialing and licensure processes and other post-pandemic recovery efforts, download Cross Country Healthcare’s extensive, evidence-based guide – Forever Altered: Adapting to a Post-Pandemic Healthcare Landscape.