The Growing Role of Medical Service Professionals in Provider Data Management

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When you walk into an appointment with a new doctor, many steps have already been taken to ensure that you’re in good hands. While many people may think of provider credentialing as a modern concept, traces of what medical service professionals (MSPs) do date back as early as 1000 BC, when the Persian cult of Zoroaster had a physician “licensure” process. Today, while their work occurs behind the scenes and unbeknownst to most patients, MSPs are the gatekeepers of nearly all provider lifecycle data in health systems and health plans, and are responsible for medical credentialing, including licensure verification and other complex provider data management-related tasks. 

Roles of the medical services professional (MSP)              

As the healthcare industry has evolved, the role of MSPs has become vastly different than it was in the past. Previously, the role of MSP was a primarily clerical position. Today, being an MSP requires significant leadership, decision-making, organizational, and communication skills. Specialized knowledge of legal matters, an understanding of healthcare financing, payer relationships, and health networks, and command of the intricate details of credentialing, privileging, and payer enrollment are all necessary skills for MSPs. MSPs are part of the critical ongoing effort to keep patients safe by ensuring that only qualified, licensed medical professionals are allowed to care for patients, and their role is expanding as healthcare becomes increasingly digitized and centralized.

In response to the expanding scope of the MSP role, healthcare organizations are implementing software solutions to streamline provider data management and optimize workflows for MSPs by eliminating manual and repetitive tasks, enabling them to operate at the top of their profession. For MSPs, operating at the top of the profession means working with conjunction with leaders and using their unique knowledge and skills to:

  • Make high-level recommendations to committees and medical staff leaders 
  • Recommend criteria for clinical privileges for specialties and subspecialities 
  • Review credentials and recommend action on providers’ initial appointments and reappointments
  • Collect data for provider peer review and performance improvement
  • Assess the hospital’s universe of potential payers, form delegated relationships with payers, and negotiate terms with payers 

The Evolution of Provider Data Management

In recent years, six big changes to provider data management have led to the expansion and evolution of the role of MSPs: 

1. Healthcare organizations have become more complex

In the past, most physicians worked in private practice and affiliated with a local hospital by joining the hospital’s medical staff or applying for privileges there. It was less common for physicians to be employed directly by hospitals. Today, there is much more variety in where physicians work, from hospitals, outpatient centers, and urgent care facilities to retail clinics and via telemedicine. Manually credentialling, privileging, and enrolling each of these providers is too time-consuming and leaves room for error. Automated tools make this process much more efficient. For example, MSPs use tools that interact with the Council for Affordable Quality Healthcare (CAQH) for fast provider profile updates and use web crawlers to automatically obtain practitioner data.

2. There are more providers to credential

Today, MSPs are managing many more physicians than before, at many more facilities. Furthermore, as multidisciplinary care teams become more commonplace, increasing numbers of non-physician providers require credentialing and privileging, including advanced practice registered nurses, certified registered nurse assistants, physician assistants, speech-language pathologists, dietitians, and social works. This influx of providers to credential makes relying on paper-based methods inefficient and risky. As an alternative, most MSPs today use databases to gather and store practitioner data in a single location and eliminate duplicate tasks. Secure, cloud-based tools make handling provider data simpler by performing primary source verification, maintaining records, distributing information throughout the organization, and more. 

3. Reimbursement time matters more

Historically, processing manually completed provider applications would take weeks or months, and the reappointment process was similarly manual and slow. Today, however, taking too long for these processes presents costly risks to organizations. Leading digital end-to-end provider data management solutions use alerts, reminders, automated workflows, and self-serve data and document uploads to accelerate the credentialing application process. 

Streamlining the payer enrollment process also makes step-by-step tracking of practitioner applications easy for MSPs, and helps organizations receive reimbursements faster. The best provider data management tools allow tasks to be done in bulk, such as sending applications in batches and verifying multiple facilities, providers, and verification types, thus saving time and maximizing efficiency.

4. MSPs are more responsible than ever for patient safety

Only a generation ago, physicians were protected from negligence or malpractice claims if something went wrong while they were caring for a patient. While things are very different today, there still isn’t any federal standard for credentialing and privileging. Healthcare organizations must take great care to ensure that their providers are qualified and competent in order to foster patient safety and protect the hospital or health system’s accreditation status and bottom line. 

Without the help of automation, these tasks can be a big burden for medical staff services. The right provider data management tools make performing tasks such as primary source verification for provider credentialing much more efficient. Additional tools are available for gathering, analyzing, and reporting data for peer review, including Ongoing Professional Practice Evaluation (OPPE) and Focused Professional Practice Evaluation (FPPE), to automate processes, provide insights for improvement, and enable organizations to track the quality of provider care. 

5. Data security is more complicated

MSPs manage and control access to countless sensitive data files. Paper-based systems make it much more difficult to ensure that data is secure, putting an additional burden on MSPs. Cloud-based software has extensive privacy and security features that remove this burden by addressing concerns like activity tracking, auditing, and encryption; applying administrative permissions; and adding security features to meet specific federal, state, and board regulations.

6. Professional and educational opportunities for MSPs have increased

Opportunities for additional education, training, and professional development have grown along with the MSP role. Today, the National Association of Medical Staff Services (NAMSS) membership includes more 6,000 medical staff and credentialing services professionals and provides education and advocacy for MSPs in a wide range of healthcare settings, including traditional hospitals, payer organizations, rehab centers, telehealth companies, locum tenens firms, law offices, and more. They recently celebrated MSP Week in November to raise awareness about this critically important role in provider organizations.

Many patients are unaware of the critical roles that MSPs play in ensuring their safety. While it may happen behind the scenes, the MSP role will continue to evolve as healthcare and provider data management become more and more complex. Healthcare organizations must keep up with the changing needs of the industry by adapting their technology and implementing automated, end-to-end provider data management solutions. By doing so, health systems ensure that MSPs have the tools they need to operate at the top of their profession, support providers, and ultimately help keep patients safe. 

Jennifer Cloud CPMSM, CPCS IS the Senior Director of CVO Svcs at symplr.