Expedited versus fast-track credentialing

I became involved in hospital credentialing about 25 years ago.  At that time, the length of the credentialing process for a new applicant was usually six months---or more, if there was a problem in obtaining information.  In those cases, it wasn't unusual for the credentialing process to take eight or nine months.  Remember, this was pre-e-mail, pre-faxing, and pre-Internet verifications, etc.  (Of course, back then, new applicants often asked for, and were granted, temporary privileges almost immediately upon submitting their applications.) 

Six to nine months would obviously be unacceptable today.  There is now a tremendous push in many hospitals to get practitioners credentialed in a matter of weeks, not months.  A 2006 article in a healthcare magazine targeted at healthcare executives stated that the credentialing process can take "as long as six weeks." 

Hospitals have employed many strategies to shorten the amount of time it takes to credential new applicants, as well as those applicants for reappointment.  I often find that there is confusion over whether it is better to use "fast-track" credentialing versus "expedited" credentialing.  And, what about granting temporary privileges pending completion of the application process?

Let's take a look at how these strategies can be implemented carefully, to perform excellent credentialing, protect patients, and stay in compliance with accreditation requirements.

First of all, the Joint Commission standards do not recognize the term "fast-track" credentialing.  That doesn't mean, however, that fast tracking cannot be an option.  Organizations that fast track usually separate out the problem-free applications from those that have potential problems.  For example, a problem-free application might be one in which everything was easily verified, there is no history of loss of privileges or licensure, there is no unusual pattern of malpractice, references are universally positive, etc.  Problem-free applications are then fast tracked (in accordance with organization policies and procedures-it is very important that a clear policy/procedure explains how this is implemented). 

It is typical that in a fast-track environment, once the department chair reviews the application (and concurs that this is a fast-track file) and makes his or her recommendation related to membership and privileges, a designee of the credentials committee reviews the application and makes a recommendation on behalf of the committee.  The application then goes to the medical executive committee and board.  Applications that are not fast tracked go through the regular process.

Temporary privileges pending completion of the application processing (for initial applications) often works with fast tracking.  For example, once the department chair and the credentials committee designee review and approve the application and confirm that the application is eligible for fast tracking, temporary privileges might be granted, pending the recommendation of the medical executive committee and board decision. The JCAHO requires specific criteria to be met when temporary privileges are granted pending completion of the application process.  These criteria can be found in MS.4.100, EP 3 (JCAHO 2007 CAMH).

Expedited credentialing, however, is a term used by the Joint Commission to describe how the board, not the medical staff, expedites the credentialing decision for initial appointments, reappointments and requests for clinical privileges.  (See MS.4.35, 2007 JCAHO CAMH).  The standards allow the board to expedite the credentialing decision for applications that meet pre-determined criteria.

Therefore, whenever an organization wants to improve (i.e., shorten) the amount of time that it takes to get an applicant credentialed, the critical first step is to separate the applications into two piles: one pile that is problem free (and this is usually the biggest stack), and the other pile that has issues that need to be thoroughly and carefully considered.  In addition to potentially shortening the amount of time it takes to credential some applicants, this process also helps to focus on the applications that require the most time and attention of the department chair and the credentials committee. 

Medical staff professionals can assist in this process by categorizing completed files into two piles, and this categorization is confirmed by the department chair, and potentially the designee of the credentials committee (assuming that the organization has a credentials committee).

Many hospitals use the last credentials committee meeting of the year to "regroup" and determine what issues to work on in the new year.  Perhaps it is time for your organization to take a look at how long the credentialing process takes and if there would be value in creating or revising the types of policies/procedures discussed in this column.