Featured column: Credentialing and car care: Pay me now or pay me later

Fram, an after-market automotive parts manufacturer, once made a car care commercial that made this line famous: “You can pay me now, or you can pay me later!” The mechanic in the commercial explains to a customer that he can pay a small sum now to proactively maintain his car, or he can wait until the car breaks down and pay hundreds more.

I’m often reminded of this commercial when a medical staff credentialing committee vets physicians after the medical group or hospital has recruited him or her to a position. The story goes something like this:

Hospital administrators decide to recruit a gastroenterologist to bolster the new gastrointestinal disease center of excellence. The vice president of business development, who is in charge of physician recruitment, hires a search firm, and the firm identifies three candidates. Hospital personnel interviews all three candidates, but, unfortunately, both the chief of staff and the department chair of medicine have clinical responsibilities on the day the interviews take place and are, therefore, unable to meet with the candidates. The hospital extends an offer to Dr. X, who immediately accepts and signs a contract without meeting with the chief or staff or the department chair of medicine.

During the verification process—after the medical staff application is submitted—the medical staff discovers that Dr. X has a long history of disruptive behavior, as well as quality-of-care issues that led to his focused review at his previous facility. In one case, his behavior resulted in an external peer review that could have led to corrective action. The chairman of the credentials committee reports to the chief of staff that Dr. X’s past is questionable, and the CEO expresses great dismay when he receives this information.

How did this mess occur? There are two major factors at work: one more superficial and obvious and the other somewhat murkier.

The medical staff credentialing process, if done well, provides accurate portraits of human performance that lead to generally sound decision making. The medical staff and the organization usually know the type of person they approve for membership and privileges.

Generally, the recruitment searches conducted by non-healthcare professionals may not turn up critical information about an applicant. When recruiting practitioners, hospitals are wise to apply their medical staff credentialing process early. This generally leads to a better recruitment process that is both cost and time effective for all parties.

The second, murkier issue is the disconnect between the hospital and the medical staff regarding recruiting. If medical staff strategic development is a collaborative process, physicians like Dr. X won’t be recruited. When hospital organizations fail to use their medical staff credentialing process early, it represents a lack of cooperation between the physicians and the hospital.

Some argue that using the medical staff credentialing process early and frequently is a waste of time and money. I believe that pulling someone out of the application process late, or even after they have been accepted as a member of the medical staff, is a much greater waste of both scarce resources. Don’t be pennywise and pound-foolish.

At the end of the day, good credentialing is still the most effective way to ensure great physician performance. So, “pay me now” by engaging in the credentialing process early, and you won’t have to “pay me later.”

Wishing everyone a happy spring time,

Mark Smith, MD
Director of Credentialing
The Greeley Company