by Robert Coombs

Baton Health

Founder & CEO

June 2024

In healthcare, behind-the-scenes processes like credentialing often go overlooked when considering downstream impacts on patients. Such is the case with credentialing, a process essential for ensuring quality care, yet virtually untouched by innovation because of its unsexy and complicated status. Let's explore why credentialing matters, its challenges, and how optimizing this process impacts healthcare access.

Understanding the Credentialing Conundrum

Credentialing is the process of verifying a healthcare provider's qualifications, including their education, training, licensure, and work history. It's a critical step in ensuring that patients receive care from qualified professionals. However, this largely manual process has become a point of frustration in the healthcare industry. 

Many companies have made unfounded claims about automating credentialing, leading to widespread skepticism. As a result, most people in the industry have resigned themselves to accepting delays and high costs as an unavoidable part of doing business. In an age where technology has streamlined so many aspects of our lives, it's surprising to find such an important process still stuck in the past.

The Impact of Inefficient Credentialing

The consequences of a cumbersome credentialing process extend far beyond mere inconvenience. Some key impacts include:

1. Delayed Access to Care: Credentialing delays significantly impact patient access to care, particularly for specialized services. According to the American Association of Provider Recruitment (AAPPR), prolonged medical credentialing and state licensing processes directly affect patient care. Deborah Baker, Director of Legal and Regulatory Policy for the American Psychological Association, emphasizes that inefficient processing of licensing applications is more than an administrative issue; it's a public health concern. The delays in credentialing can result in organizations adjusting provider start dates multiple times, leading to postponed appointments for patients who may have already been waiting for extended periods.

2. Workforce Mobility Challenges: The credentialing process poses significant challenges to healthcare organizations' ability to respond quickly to changing healthcare needs. Each state has its own licensing process, and physicians need to be separately licensed in every state where they practice. This requirement, coupled with the need for separate credentialing and privileging at each hospital for physicians performing services across multiple facilities, creates substantial barriers to workforce mobility. These challenges are exacerbated by varied processing speeds across states and professions, manual processing systems, and extensive paperwork.

3. Rural and Underserved Communities Hit Hardest: While specific data on credentialing in rural communities is limited, these bottlenecks broadly affect patient care and access. The lengthy credentialing process, which can take anywhere from 30 to 150 days, directly impacts a physician's ability to practice medicine legally and hinders patient care and access. These delays can be particularly detrimental in areas already struggling with healthcare access, such as rural and underserved communities. Streamlining these processes could help address the unique challenges faced by rural communities in recruiting and retaining providers.

4. Provider Burnout: The credentialing process contributes significantly to provider burnout through its administrative burdens. The paperwork-filled processes increase stress on providers, drain physician enthusiasm, and affect their work-life balance. A survey conducted by Andros reveals that time is the most critical factor in provider satisfaction during the credentialing process. The bureaucratic nature of credentialing, combined with the constant back-and-forth, frequent follow-ups, and uncertainty of the process, can be mentally exhausting for healthcare providers. This administrative burden adds to the stress and burnout already prevalent in the healthcare profession, as providers must juggle their clinical responsibilities with the demands of credentialing.

The Benefits of Optimized Credentialing

Improving the credentialing process isn't just about administrative efficiency; it has far-reaching benefits for healthcare as a whole:

1. Improved Access to Care: Faster credentialing means providers can start seeing patients sooner, reducing wait times and improving access to care.

2. Enhanced Provider Satisfaction: Streamlining administrative processes can help reduce burnout and improve job satisfaction among healthcare providers and the staff that support them.

3. Increased System Flexibility: An efficient credentialing process allows healthcare systems to respond more quickly to changing needs, whether due to local shortages or global health crises.

4. Cost Savings: Reducing the time and resources devoted to credentialing can result in significant cost savings for healthcare organizations, potentially allowing for reinvestment in other areas in need.

Looking to the Future

As we stand on the brink of a healthcare revolution, with telemedicine, AI-assisted diagnostics, and personalized medicine promising to transform patient care, it's crucial that we don't overlook the foundational processes that enable care delivery.

Optimizing licensure and credentialing is not just about efficiency; it's about creating a more responsive, accessible, and effective healthcare system. As we continue to innovate in medical treatments and technologies, let's not forget to also innovate in the processes that support care delivery.

By addressing the credentialing bottleneck, we can take a significant step toward a healthcare system that truly puts patients first, ensures provider satisfaction, and maximizes the impact of our healthcare resources.

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Robert Coombs is the Founder and CEO of Baton Health, which is working to eliminate manual data entry through their Universal Primary Source. With extensive experience in healthcare and fintech operations, Robert has a proven track record of scaling teams and improving processes in regulated industries. His background includes leadership roles at Andros, Medallion, and Vestwell.