A typical practicing physician contracts with a dozen or more health insurance networks and has privileges with several hospitals.
Yet, joining multiple networks and gaining hospital privileges often comes at a price: hours of paperwork to prove a physician's credentials-a process, in aggregate, that costs the U.S. healthcare system upward of $1 billion a year.
Several organizations are simplifying the credentialing process and moving ahead with regional and national initiatives to reduce paperwork and trim costs.
Physicians "get emotional about credentialing," says Robert Bunker, chairman, president and CEO of Aperture, a Louisville, Ky.-based credential verification organization (CVO). "It's tremendously redundant and costly."
The AMA pegged annual credentialing costs at $930 million back in 1997, assuming 620,000 practicing physicians had 12 contracts that required verification every other year at the cost of $250 per certification.
In early 2000, the AMA discontinued the American Medical Accreditation Program, its own money-losing attempt at national accreditation, after four years. It has thrown support behind a new effort by the Coalition for Affordable Quality Healthcare, which represents 26 payers and other managed care groups.
The Washington-headquartered coalition, founded in 1999, is building a database with credentialing information for 600,000 healthcare providers, available electronically to authorized health plans and hospitals. It recently launched the system in Colorado and Virginia and expects to have nationwide availability by mid-2003.
Physicians will be able to submit and update their personal information by fax or online and be required to confirm their data quarterly. Physicians and other practitioners will be allowed to retrieve the stored data to apply for credentials with organizations outside the coalition.
"The credentialing component is really . . . not uniform," says Chris McNamara, spokesperson for the American Association of Preferred Provider Organizations, a coalition member. "Your administrative staff is doing so many of these (applications) that it would be easier to fill out one standardized form."
While the AAPPO has been advocating a standardized form for at least three years, McNamara says the PPO trade association "is not dictating any standards."
Still, a single application is no magic bullet, according to Bunker.
"I don't believe a standard credentialing application is the solution to a provider's credentialing problems," he says. "Every health plan has different needs."
The Minnesota Medical Association has had a task force on uniform credentialing since 1997, but only recently has it made gains toward streamlining the time-consuming accreditation process.
Minnesota physicians joined with the Minnesota Hospital and Healthcare Partnership and the Minnesota Council of Health Plans to establish a statewide CVO, structuring it as a joint purchasing commission to avoid antitrust issues.
The CVO, the first of its kind in a single state, involves 10 major health plans and health systems and five large group practices in Minnesota.
"Membership is entirely voluntary," says Minneapolis internist Benjamin Whitten, M.D., chair of the MMA task force.
"We already had a uniform application, but what we wanted was a uniform process," Whitten explains. "A uniform application is not the same as a universal process. It not only saves the doctors and practitioners time, but it also saves the clinics and hospitals and health plans time, effort, money and
Though the Minnesota program represents an advance, it is far from universal.
One problem, Bunker says, is that a physician affiliated with 15 different health plans and hospitals has to earn 15 credentials.
"Say five (organizations) get together. He still would have to fill out 10 forms," Bunker says. "Even if a state mandates a form, (physicians) still have to fill out applications for each credential."
Aperture sponsors the Credentialing Alliance, a collaboration of the nine largest health networks in the New York metropolitan area that have agreed to honor each other's provider certifications.
Under the Alliance model, each physician only needs to be credentialed once to participate in all nine networks.
"We decided that all the overlapping providers were going to share the results with all the plans they belong to," Bunker says.
The effort relies on Aperture's App-One.com, an endeavor that is both an online-provider data-collection service and a secure, central repository.
With App-One, physicians and other healthcare practitioners input all of their personal data once, then select from a menu to generate an application in the format preferred by any one of several hundred health plans.
They then can sign forms electronically and submit them online.