Will vendor credentialing snap competitive tug-of-war?
As seen on Healthcare Purchasing News
Within the last decade, the healthcare industry has yanked the concept of “vendor credentialing” back and forth in a competitive tug-of-war.On one end, provider organizations were accused of trying to restrict trade by complicating the virtually unfettered access to administrators and clinicians that sales representatives previously enjoyed. If reps didn’t comply with credentialing requirements, they were denied access. And if hospitals used an internal “home-grown” credentialing system instead of outsourcing to a third-party organization they were “profiteering,” too.On the other end, supplier reps were accused of taking unfair advantage of their access to clinicians by bypassing supply chain gatekeepers that strive to honor group purchasing contracts as well as prevent unapproved deals with physicians that could be used to influence C-suite decisions on their behalf.In the middle, credentialing advocates espoused the motivation of patient and healthcare worker safety and security. After all, hospitals and other healthcare facilities not only can be incubators for diseases, germs and illnesses that proper immunizations and protections could prevent from spreading, but they also represent confinement for a captive group of people that could be victims of malfeasance or negligence, and even violence.Based on human nature alone, it’s hard to argue against the safety and security justification, the prevailing motivation that resonates with many. Some organizations have tried to change and even soften the perception that “vendor credentialing” connotes by rebranding it “supplier management” or something more acutely direct, “compliance credentialing,” as in compliant with selected criteria and standards.
And therein lies the latest kerfuffle with vendor credentialing – standardization regardless of players. Even though the vendor credentialing industry has consolidated through mergers and acquisitions within the last five years with three to four key players remaining from more than a half-dozen at its competitive peak, industry observers contend that more efficiencies can and should be achieved.
With the proliferation of information technology horsepower and influence, as well as the emergence of varied infectious diseases, vendor credentialing software adoption and implementation continues to surge forward.
Chris Louma, Vice President, Product Management, Global Healthcare Exchange LLC (GHX), which acquired Vendormate in 2014, has seen considerable growth among hospitals to use third-party credentialing software and services “to support the overall, on-going process, easing the workload while meeting compliance requirements.
“The industry is evolving from simply implementing a representative credentialing tool to addressing the issue of risk across the entire vendor population, including at the company, contract and individual levels,” Louma said. “In the last year, there has been greater focus on how to drive standardization to streamline the process for suppliers and, in the process, drive higher compliance with health system requirements.”
Louma said he sees vendor credentialing becoming part of an overall “vendor management strategy where credentialing applies at both the rep and entity level.
“We are seeing the overall vendor onboarding process becoming streamlined to include credentialing. This is a path that many providers are pursuing to knock out two birds with one stone – efficiency and compliance,” he continued. “The demand for easy access to credentialing data when making vendor-critical decisions, such as contract renewals has also been on the rise. Finally, with the rise of infectious diseases, such as Ebola, credentialing requirements will continue to expand.”
For Justin Poulin, Vice President of Sales, Green Security, the spike in vendor credentialing adoption and implementation coincides with the competitive landscape among providers.
“As healthcare networks grow in size, they are looking to consolidate multiple service lines to achieve increased efficiencies, savings, and added value,” Poulin said. “Many hospitals have traditionally utilized disparate systems for visitor management, contractor access and vendor credentialing but are now looking to a single source to manage all non-employees entering healthcare facilities.”
Further, technological advances help ease acceptance, too, with mobile applications offering more convenience, Poulin added. “In this case, vendors and contractors no longer need to sign in with a username and password, but can instead check into the facility instantaneously with a simple scan,” he noted. “This is beneficial to vendors supporting surgical procedures with the added advantage of increasing uptime in the operating room.”
Additional advances emerging include software that enable hospital staff to instantly verify the identity of the vendor or contractor, validate zone level clearance, and identify relevant certifications or licenses within the facility,” according to Poulin. “This allows for improved management of vendors accessing patient care areas as well as service delivery personnel, contractors, equipment installers and sub-contractors who have traditionally exhibited significantly lower rates of participation in credentialing programs,” he added.
Vendor credentialing no longer is limited to hospital settings and just supplier reps either.
“Regulations and accreditation standards that drive vendor credentialing needs don’t segment based on point of care,” said GHX’s Louma. “Health systems need to manage compliance within their supply chain relationships regardless of where care is being delivered.”
Rick Pleczko, President and CEO, symplr, highlighted the growth and expansion of vendor credentialing by facility type and functional requests his firm has recorded.
“Initially, it was the larger IDNs and facilities that spurred adoption,” Pleczko noted. “We’re now seeing smaller organizations such as surgery center chains implementing vendor credentialing as a standard. Over the last year we’ve seen the requirement for credentialing expand beyond the traditional vendor rep population. We’re now seeing facilities implement credentialing for contractors, volunteers, IT consultants and a wider range of individuals who require access to patient care areas.”
Pleczko added that symplr’s “largest single area of growth” involves credentialing communities outside the hospital, such as urgent care facilities, surgery centers and even home health providers.
Beth Mahler, Vice President, Marketing, IntelliCentrics, acknowledged vendor credentialing’s move beyond acute care hospitals.
“It’s now mainstream for facilities of all types, from doctors’ offices to ambulatory surgery centers,” she observed. “Smart executives across the country are embracing compliance programs as part of patient safety initiatives to deliver healthcare excellence. In fact, we all play a role in patient safety, and vendors are an integral part of quality care.
“Compliance is just as relevant in the home, doctor’s office, or stand-alone emergency room,” Mahler continued. “Patients need to, and deserve to, have confidence that every person in the chain of care, from the service technician to the doctor, is qualified and understands the role they’re playing in providing a healthy outcome. Patients also need the information to understand how they can participate in the safety of their treatment. They, and their loved ones, are critical factors in minimizing the risk of exposure to infections and obtaining the best possible results from their care.”
But at least one provider organization indicated that resistance pockets have slowed growth.
“Due to a lack of understanding and the financial burden placed on vendors, it can be difficult for some vendors to see the rationale behind the stringent requirements for healthcare industry representatives to gain access to our hospitals,” noted Shane Hughes, CPSM, Supplier Access Program Manager, Intermountain Healthcare’s Supply Chain Organization.
Hughes lauded Intermountain Healthcare’s clinical vendors as having accepted and complied with the organization’s credentialing requirements.
“The challenge with vendor credentialing in healthcare are the non-clinical vendors such as contractors, consultants and other service providers who don’t always understand the need for the stringent requirements because they may not be in direct contact with our patients and clinical staff,” he said. “Working with the vendor credentialing companies and improving our communication to help vendors understand the requirements and expectations before entering our facilities will reduce risk to our patients, other suppliers, and our employees. Creating a process to credential these vendors/individuals without placing an unreasonable financial burden on them is critical to meet our safety and compliance goals and objectives.”
Still, Hughes sees the inherent value of vendor credentialing across the healthcare continuum.
“With telehealth and other homecare services coming to the forefront of patient care, vendor credentialing will be integral in verifying that the vendor that performs a service at a patient’s home is compliant with all applicable requirements,” he said. “With the assistance of mobile applications we will be able to assess where and when they check in, as well as verifying if they are compliant with the facility-specific requirements.”
Hughes also tied the credentialing process to the electronic health record and protected health information within and outside of traditional hospital settings.
“Healthcare providers will be required to manage and credential these individuals even without the representative stepping foot on our campus,” he added. “Credentialing these individuals will be necessary to protect and care for our patients and will be possible only through collaboration between vendors, healthcare providers and credentialing service providers.”
Peel back the layers of debate surrounding vendor credentialing’s costs and inconveniences and many agree that patient and employee safety and security trump all other concerns – short- and long-term.
“[Compliance credentialing] enables facilities to better manage their risk of infection and untoward incidents that may have adverse effects on patient care,” said symplr’s Pleczko. “As a side benefit, by helping manage vendor/provider schedules and interactions the software promotes efficiency for both the facility and the suppliers. These benefits are being realized today. Our goal is to make the credentialing process as fast and unobtrusive as possible.”
As such, symplr is deploying smart-phone software that allows reps in three seconds to complete credentialing check-in procedures and also exploring “geolocation on mobile devices” for “faster and more unobtrusive” credentialing, according to Pleczko.
Ideally, vendor credentialing software represents an intricate component of an organization’s business operations as well as its larger regulatory requirements, according to GHX’s Louma.
Patient safety may top the list for providers, but functionality polls high for suppliers, he insisted.
“From a more functional perspective, the goal is to have a tool that helps providers clearly communicate and satisfy their compliance needs and at the same time have the most minimal impact possible to a supplier’s business processes,” he said. “As providers and suppliers begin to maximize the tools available, both parties will be able to wrap compliance into their business processes ranging from contract execution to order management to invoice and payment. Done properly, compliance should be an inherent component of these processes and the systems supporting them, not a separate process and system that creates additional tasks. “
Louma noted that GHX Credentialed Exchange ties it all together.
“Knowing who a provider’s business partners are and which ones operate within a facility increases their ability to meet accreditation and regulatory requirements,” he said. “If a provider organization is audited, they must have a way to show that an acceptable percentage of vendors are in compliance with policies. Furthermore, the auditing agency will require that the provider demonstrate how it is managing its vendors.”
For example, the Joint Commission and the Center for Medicare and Medicaid Services conducts audits every three years that includes vendor management policies and procedures. As a result, GHX customers could use GHX Credentialed Exchange data to satisfy those requirements and demonstrate their focus on compliance, he added.
Managing vendor access to patient information and restricted areas within a facility remains the ultimate goal, Green Security’s Poulin insisted.
“When fully operational, hospitals should be able to control access to different departments within the hospital, manage large construction projects with multiple phases, monitor breaches in security and improve credentialing compliance,” he said. “With advanced reporting, monitoring activity and tracking access can be used for business management purposes, such as comparing vendor access rates with purchasing costs to determine any correlation.”
But organizations cannot limit the scope of vendor credentialing to clinical reps only but also what are known as “business associates.”
“Healthcare facilities are accessed by 10 to 20 times more contractors, service delivery personal, sub-contractors and equipment installers than what many institutions have traditionally considered as a vendor when implementing their credentialing program,” Poulin said. “Contractors who are unqualified or improperly trained can expose the institution to tremendous risk, and may result in large penalties from government agencies, tort liability from personal injury, and even criminal prosecution.”
The scope may seem profound, but it’s logical and necessary.
“In an ideal world, vendor credentialing would encompass any and all outside representatives providing services to the system,” Poulin continued. “Large scale construction projects are typically subcontracted several times and each company will vary in both size and sophistication with respect to their hiring practices. The requirements for pre-employment and ongoing employee screenings will vary significantly from one company to another which represents an unaddressed liability gap for the healthcare institution. This gap can be closed by incorporating all outside vendors and contractors into the credentialing program.”
Yet IntelliCentrics’ Mahler cautioned healthcare organizations about limiting this process to software alone. It has to include the corporate culture and general behavior.
“Changing the focus from vendor credentialing software to compliance begins with implementing universal industry standards, by role, based on researched best practices and results,” she said. “Software alone cannot achieve the highest levels of compliance at the lowest possible cost. It’s takes a community of professionals, patients and their families, and facilities working together. It starts with everyone understanding the role they play in creating a safe and secure environment. When we all play a role, security and safety are united with people, protocols, and locations. Then, more time can be devoted to quality patient care, mitigating the risk of infection and penalties.”
Intermountain Healthcare envisions a three-tiered or segmented approach to supplier access as idea, according to Hughes. The tiers would include direct patient access, clinical area access and general facility access.
“We envision vendors that have access to higher-risk areas, including patient care areas, require more stringent credentialing requirements,” Hughes noted. “Vendors that only access low-risk areas, such as office space or logistic management areas, would receive no-cost, customized credentialing to meet the standards.”
This tiered process helps the organization manage its various facilities more effectively and efficiently, Hughes reflected.
“When our hospitals diligently apply vendor credentialing software we can see when healthcare industry representatives enter and leave the facility in real time,” he said. “This also assists in a disaster mitigation plan to identify who is located in our facilities during a catastrophic event. In an ideal world, healthcare providers would receive real-time updates if a healthcare industry representative’s criminal background check status has changed. Most vendor credentialing software providers accept attestations from the representative’s company stating that a background check was executed when the individual was hired. Healthcare providers would benefit from receiving urine drug screens or criminal background check updates.”