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Tackling Redundancies in The Professional Credentialing Process: A Secure Exchange Among Hospitals Using Blockchain Technology

By Rod Moore

Most, if not all, Texas hospital leaders have experienced the painful and costly process of onboarding new physicians and other health care professionals. It takes months to complete, impedes access to care and delays potential reimbursement. The manpower required to gather and verify professional credentials, including state licenses, medical malpractice insurance or certificates, is an integral part of that onboarding process but is often the culprit behind delays.

New software is emerging in an industry rife with promises of disruption, but with each comes the inherent need to invest hundreds of hours worth of human resources. A shift in this paradigm is occurring with one leading company hoping to change the way credentialing teams store and research critical physician data.

While the credentialing process typically takes 90 to 120 days, in some extreme cases verification of academic and professional credentials can take many months to complete. Hospitals report nightmarish scenarios where credentialing has taken six months to a year.

With Professional Credential Exchange, known as ProCredEx, however, hospitals have a trusted, reliable means of exchanging credentialing data and documents between themselves and other entities. Pro- CredEx is professional credentialing exchange backed by Hashed Health, a company that provides health care blockchain solutions. The ProCredEx solution uses a combination of advanced data science, artificial intelligence and blockchain technologies to simplify the process. With it, hospitals will be able to get clinicians to the bedside and able to file claims under their own credentials quicker.

Begando
Begando
“I believe the No. 1 financial advantage (of the exchange) is just improving revenue forfeitures,” said Anthony Begando, CEO and co-founder, ProCredEx.

During this lengthy onboarding process, hospitals forfeit the opportunity to bill for care provided.

“The average daily net revenue for physicians is about $7,500, which is $150,000 a month,” said Begando.

“If you’re talking about a four- to six-month-long process, you're looking at anywhere from $600,000 to $900,000.”

Credentialing and enrollment software is a useful tool but doesn’t solve the main problem of obtaining and verifying the actual credentials. Many of the requests to verify credentials still require documents to be exchanged by fax machines or through mail delivery.

With new technology, however, comes new opportunities to disrupt traditional processes.

Untangling the Costly Onboarding Process

Although verifying professional records — which includes authenticating licenses, education, certifications and identification — is painstaking and requires many hospital administrative staff hours to complete, very few alternatives have been available to hospitals to expedite the process.

Each credentialing body has its own verification processes and requirements, making the process even more complex. As providers move among hospitals and health care systems, that set of credentialing data must be gathered and verified anew. While there are some variations in the set of data required by one hospital to another, redundancies abound. Over time, practitioners can easily accumulate redundant data sets with 12 to 25 different entities.

Yet because of a lack of external authentication, the new hospital will dedicate significant labor costs into the credentialing process because a more streamlined alternative hasn’t existed before now, said Begando.

For example, Begando explained, Hospital A may spend many staff hours to obtain and verify records related to a medical malpractice lawsuit in order to onboard a new physician. Yet, when the provider moves on to Hospital B, a new hospital credentialing professional will have to do the legwork to verify the malpractice suit all over again. Hospital A’s staff time investment is lost while Hospital B’s is stuck redoing work while losing revenue.

In the existing system of gathering and verifying credentials, there was no way for Hospital B to obtain the necessary records directly from Hospital A — and no means for Hospital A to profit from its own credentialing staff’s time investment.

ProCredEx is not a ‘credentialing system’ but rather a secure and reliable market for members of the health care community to trade verified credentials among themselves. The exchange does not replace but rather works alongside a hospital’s existing credentialing software. By simplifying what was once the analog legwork portion of a credentialing professional’s job with a fast and efficient way of gathering and sharing necessary documents, the exchange does not require hospitals to switch credentialing software.

Benefits of a Credentialing Exchange

By using blockchain technology, documents that previously have been verified by one organization can be shared with another quickly, safely and securely. As a result, Begando sees the entire credentialing process going from months to soon being measured in days.

Importantly, the advantage of blockchain is the preservation of trust. If even a single pixel changes on a document, the blockchain technology would break the document’s authentication (or “lock”), and it would be rejected.

Rische
Rische
Christian Rische, advisor, venture capital, Spectrum Health Ventures in Grand Rapids, Michigan, became an early supporter of ProCredEx when he was introduced to the program by John Bass, founder and CEO of Hashed Health, while at SXSW last year.

“If you look at credentialing within hospitals since the early '90s, nothing has changed,” Rische said. “People are using faxes and phone calls to do this work when it's really just documents. Once they're scanned in, we should be able to figure out a way to get them to people faster and easier.”

Rische is optimistic that hospitals using ProCredEx will be a success, given how much progress has been made with various work groups during early pilots to ensure the exchange syncs with existing onboarding systems in hospitals. The company has roots in the security and military community, and first used the techniques to speed up confirmations of various clearances and credentials needed for professionals within that environment

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THA HealthShare Solutions magazine

Professional Credentials Exchange has been an endorsed partner with the Texas Hospital Association since 2019. Contact Anthony Begando at 678/575-4495 or abegando@hashedhealth.com.

Learn more about Professional Credentials Exchange.