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Doctor's Note: Streamlining Credentialing For Health Care Providers

Streamlining Credentialing For Health Care Providers

My bill, SB365, streamlines the credentialing process for health care providers. As a doctor, I want to make sure any doctor or other health care provider who takes care of you is properly credentialed. There are many horror stories of “doctors” who work at a hospital for a period of time before background checks are completed. However, when the background check is done, the hospital finds out that the “doctor” lied about their medical education and credentials. This is what I want to prevent. I want to ensure that we have a secure, robust credentialing process to protect patients in Virginia. However, the tradeoff is that the credentialing process is expensive, and it takes a long time. This process also makes it difficult for providers to be available for patients because while they are waiting to be credentialed.

There are two credentialing processes that take place. One is credentialing for the hospital and the other is credentialing for the health care plans. They are virtually the same, with a few exceptions, but they have developed in separate isolated silos. Credentialing is challenging because you have to get a primary source reference for each step of your medical career. You must present a letter directly from your medical school, residency program, every job you have had, information about your licensure, and all other aspects of your training. This gets complicated, especially for doctors who served in the military. They may not have the same documentation as someone working in the private sector.

All of that aside, it is unnecessary to duplicate the process. Once you are credentialed by the hospital, which is your first step to practicing in a community, you then have to repeat the process for each of the healthplans. This repetition of the entire process causes an increased administrative burden on all involved which in turn raises the cost of healthcare.

Credentialing reform is one way we can adapt the system to make it more efficient, cut costs, and improve access to healthcare. My bill allows doctors to submit all of their documentation once to the hospital, with that file serving as the reference for all of the health plans. The bill will require the state to promulgate regulations to align the two credentialing processes. This will make the credentialing process simpler for doctors, but still ensures that they are properly qualified. Streamlining this process is really important for the new era of physicians, which includes hospitalists. Hospitalists often change jobs more frequently than a doctor, who may stay in the same private practice for 30 years.

The health plans were frustrated. I understand, change is uncomfortable even when the end goal is worthy. The sub-committee ended up with a vote of 2 in favor to 2 against the bill. I will be working to find a practical solution and build consensus on the idea between now and when it comes before the full Education and Health committee for a vote.

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