Redundancy. In recent years the term has acquired new respect. We expect our information technology departments to have redundant servers in place to protect our data, and we've learned that redundant expertise and training are the best protection against employee turnover.
But in thinking about the current situation concerning physician credentialing, I can't help but default to the traditional definition of the word: superfluous, needless repetition. The time has come to bring all involved parties to the table to eliminate the waste in the system.
Don't get me wrong. Credentialing is a vitally important activity and has always been integral to the National Committee for Quality Assurance's accreditation program. In 1991, when the NCQA launched its accreditation reviews, the healthcare system was very different from today's. Some health plans and hospitals did not routinely examine the credentials of physicians and others accepted insubstantial evidence of qualifications-copies of copies of licenses were not uncommon.
And there was a consequence: Most of us can recall media stories about untrained individuals successfully posing as doctors and seeing patients, even performing surgeries. The healthcare system needed discipline in credentialing, and it's come a long way since then.
But the past 11 years have been marked by a dysfunctional proliferation of regulations, standards and duplicative processes that have turned the simple, essential need to ensure that our doctors are qualified into an extravagant, resource-depleting exercise. Consider that many physicians and group practices contract with a half dozen or more health plans. Each plan requires the same information on its physicians. As a result, doctors, hospitals and health plans devote inordinate amounts of staff time and resources to verifying the same information.
Physician credentialing has become an expensive, wasteful, redundant process for physicians, hospitals and health plans alike-an exercise that diverts vital resources from more important quality-improvement activities.
We have made some progress toward easing the burden in recent years. The growth of a specialized credentials-verification industry has allowed health plans to outsource the task in many cases, saving time and money. And in recent months, the NCQA and the Joint Commission on Accreditation of Healthcare Organizations have aligned accreditation standards around credentialing, substantially reducing the need for disparate compliance systems.
Of course, the need to reduce or eliminate duplicative oversight is painfully obvious-healthcare resources are best devoted to providing healthcare. It's a mark of progress, for instance, that half of the states now recognize health plans that are privately accredited as meeting their own state requirements, and that the Medicare+Choice program and some state Medicaid agencies similarly recognize private accreditation. This approach eliminates redundant reviews, reduces administrative burden for regulated organizations and saves scarce public resources and taxpayer dollars without compromising public authority.
Private accreditation organizations have, in turn, demonstrated their own willingness to be flexible by aligning their own standards with public-sector requirements. For example, the NCQA is recommending changes to its accreditation standards for utilization review to conform to final regulations promulgated by the U.S. Department of Labor for health plans subject to the Employee Retirement Income Security Act. In coordinating oversight activities to eliminate redundant review and in promoting greater uniformity in health plan requirements, the public and private sectors have begun to demonstrate that creative solutions to complex problems are possible.
To solve our credentialing problem, we need a similar commitment from leaders in the public and private sectors and we need a broad plan. Our real shared goal should be to ensure that every physician is credentialed once, appropriately-and then again only as events warrant.
How do we get there? There appear to be two pathways: one regulatory and the other in the marketplace. In the latter, some innovation already is emerging. In Florida, a credentials- verification organization has begun to demonstrate a business model for one-time credentialing by establishing a common credentialing cycle for overlapping network providers and using a single application. Credentialing is done only once and the results are shared with several health plans, which all save costs. And the Coalition for Affordable Quality Healthcare has taken strides to consolidate credentialing for its member organizations. A similar initiative is under way on the hospital side.
I propose a full debate, convened by a coalition of state and federal governments, medical boards, the Federation of State Medical Boards, representatives of the credentials-verification industry, accreditors, provider groups and others. The desired outcome of such a stakeholder meeting would be a global solution to eliminate the waste in the current credentialing system-perhaps one or several designated credentialers and a mechanism to audit the work.
One thing is clear. Credentialing of physicians is important work but its relevance to the greater goal of quality improvement is limited. It's not necessary that it be done a dozen times over, at great expense and distraction. Better if those scarce resources could be directed to rewarding providers and health plans that deliver true quality and to developing more sophisticated systems for tracking and managing care. In this case, at least, redundancy makes no sense at all.
Margaret O'Kane is president of the National Committee for Quality Assurance, Washington.