Vendor Credentialing: Are we all on the same page yet?

Suppliers, hospitals and vendor credentialing companies appear to be moving in step with each other…with a few exceptions

“Pragmatic and optimistic” is how Bruce Mairose describes the recent Vendor Credentialing Summit in Alexandria, Va. “I believe each of the constituencies have a desire to do the right thing for the patients,” says Mairose, vice chair, supply chain operations, Mayo Clinic. “There is consensus on the need for national standards as well. I believe there is a recognition of what expectations should be guided by national standards.
“The challenge for everyone is coalescing not only peer groups, but internal stakeholders within their respective organizations, around common interpretation of the requirements and guidelines that are driving [healthcare industry representative] credentialing.”

Since vendor credentialing first reared its ugly (or beneficent, depending on one’s point of view) head six or seven years ago, supply chain executives and their vendors have hardly seen eye to eye on the issue. But recent work by the hospital associations of Indiana and Minnesota, and Mayo Clinic, as well as the recent Summit, point to what looks like a new day. (See related article.) This new attitude may become formalized with the anticipated launch of an industrywide group focused on vendor credentialing – the Coalition for Best Practices in HCIR Requirements (where “HCIR” stands for “healthcare industry representative”).

“People feel there’s hope,” says Rhett Suhre, chair of the Advanced Medical Technology (AdvaMed) working group on HCIR credentialing and director, HCIR credentialing, Abbott. “At the first Summit, there was confusion, misunderstanding and frustration. At the second Summit, the attendees discussed what requirements were the most appropriate. At this year’s Summit, we discussed the work that had been done to arrive at a draft best practices document, and spent the majority of the meeting sharing best practices and working toward how to best meet the requirements.

“Everybody understands why this is needed in the industry,” says Suhre. “It’s all about improving patient care. If we can all understand that, we can work together on how we can best do it.”

A change in mood
“The tenor and tone of Summit has changed,” says Doug Cones, director, sales operations, Cardinal Health, who has attended all three Summits held since 2010. At the most recent event, there was less finger-pointing, and more working together to try to figure out the best way to meet everyone’s needs. “People are listening to all sides to make sure this process is efficient for everyone. We want to make sure there is awareness across the three constituencies – hospitals, vendors and the vendor credentialing companies – that the primary focus is patient safety, privacy, and making sure reps are adequately trained. These are things everybody gets and can agree on.

“The big change is, our reps get it and know it’s part of the process,” he continues.

“Overall, there’s an acceptance that credentialing is here to stay,” says Shawn Walker, CEO, Bay State Anesthesia, North Andover, Mass., and past president of IMDA, the specialty distributor association. This is especially true among the largest suppliers, who have devoted the resources necessary to comply with providers’ requests, she points out. But the smaller and more independent the supplier, the more it tends to resist credentialing, says Walker. This is due in part to the fact that credentialing directly impacts these organizations’ pocketbooks.

One also has to consider the “genetics” of many small companies, she says. “[Credentialing] chafes against the personalities of the types of organizations they are. They’re independent, in many cases, because they don’t want to be told what to do. And they don’t like paperwork. So I would say it continues to be a struggle, especially at the independent rep level.”

Disparate requirements
Sponsored by a number of manufacturers, distributors and supply-chain-related organizations, including the Health Industry Distributors Association, the Summit was the third annual such event.

“People realize credentialing is going to be there,” says Kevin Connor, president and CEO, VeriREP and a key figure in organizing the first Summit, held two years ago in Niagara Falls. “The question is, ‘How can we make it as seamless and inexpensive and efficient as possible?”

Vendors still experience angst due to the fact that hospitals in the same metropolitan area might be contracted with different vendor credentialing companies, requiring reps to jump through multiple hoops, he says. “The expense of credentialing wasn’t the concern [of suppliers at the Summit] as much as the disparate requirements. We heard more complaints about, ‘This company makes me do this, this one makes me do that.’ I said that the fabric needs to remain the same throughout the industry, but everyone can embroider their competitive advantage on it.”

Connor likens the early days of credentialing to the dot-com boom of the early and mid-1990s. Back then, a growing number of start-up companies were all but forcing vendors to use their pipeline to allow hospitals to send supply orders. Connor recalls the upheaval caused by the crazy things the dot-coms were trying to force vendors to do.

Similarly, five or six years ago, multiple credentialing companies arose, so that in a busy metro area, a rep could have four or five different subscriptions. “It was an expensive proposition,” he says. “Hospitals would tell the vendor credentialing company what they wanted, and the vendor credentialing company would do it.” Things got a little crazy, he says.

But over time, as vendor credentialing companies became more embedded in the supply chain, they began approaching hospitals with suggestions on what they considered to be important information to capture in the credentialing process, and what they considered to be irrelevant. Naturally, hospitals could – and often did – decline to take their advice.

“We have to be competitive and support our customers’ requirements,” says Connor, whose company chose to focus on regional markets. “But if we can help them manage expectations, that’s great.

“The question was brought up at the Summit: Are the hospitals driving the requirements, or are the vendor credentialing companies offering solutions to problems they don’t have?” says Connor. “As time goes on, the core elements of what needs to be done will surface, and I think they’re already starting to.”

Alignment is needed
“From the vendor/supplier side, we have to figure out the best, most efficient way, to ensure that our representatives are able to meet the requirements of our customers,” says Suhre, who is on the steering committee of the Coalition. “From the provider side, I think they understand they need to align their requirements on the things that are the most important. There are certain documents reps aren’t authorized to sign, so it’s better if they are able to get those documents to the authorized person in the company. Credentialing provides that mechanism.

“There were misperceptions about what hospitals were required to do, whether they were referring to The Joint Commission, OSHA or CDC,” he says. “And that was another thing we did at the Summit – provide clarity on what is and what is not required.” In fact, the Joint Commission’s “Frequently Asked Question,” published in April 2012, was a topic of discussion. The FAQ answered the question, “What are The Joint Commission’s expectations regarding non-licensed, non-employee individuals in health care organizations, including health care industry representatives?” (See related article.)

Best practices
Vendor credentialing companies are committed to bringing order to the credentialing process, according to those who attended the Summit.

In a panel discussion, representatives from VeriREP, IntelliCentrics, Vendormate and Vendor Credentialing Service stated that aligning on a set of requirements or best practices made sense, says Suhre. “They stated that they have, in fact, been moving toward that for the last year or so. Time will tell if they’re promoting alignment to best practices in their discussions with their customers.”

One idea floated at the Summit was that, once the industry agrees on vendor credentialing “best practices” criteria, vendor credentialing companies offer their customers a “best practices option,” says Suhre. The system would be good for vendors, as it would move the industry toward standard requirements. But it would also help hospitals that are new to credentialing, and who have yet to put a process in place, he suggests. “They could see that the industry is coalescing around this set of requirements, and if they opt for this package, they will get up to speed rapidly.”

In fact, organizers of the Coalition for Best Practices in HCIR Requirements have circulated a draft of recommended best practices for vendor credentialing. “It’s an iterative process that began at last year’s Summit,” says Suhre. Borrowing from concepts proposed by the Indiana Hospital Association as well as Mairose, the committee put together the document and sent it to various organizations for vetting, including the American Hospital Association, American College of Surgeons, Association of periOperative Registered Nurses and the American College of Cardiology, among others.

“Our goal is to have a final document that we will ask people to endorse,” says Suhre. But the recommended best practices will be a “living document,” that is, subject to modification as circumstances dictate, he emphasizes. For example, if a disease becomes more prevalent, such that the CDC recommends that healthcare workers be vaccinated against it, the Coalition would review that and perhaps incorporate new recommendations into the best practices document. Discussions on such changes would be held throughout the year, with a final vote at the annual Summit.

There would be certain expectations of those who endorsed the final document, says Suhre. “If you were a supplier, you would do everything you need to do to ensure your representatives meet the recommendations. As a provider, you would be asked to align yourself with the best practices. And if you were a professional organization, such as the American College of Surgeons, you would advocate among your peer group that they follow the best practices recommendations.”

Ultimately, the Coalition hopes to have its own website, or central repository, to house information on ongoing developments related to vendor credentialing. In the meantime, it will rely on the websites of other organizations, such as AdvaMed and the Healthcare Industry Supply Chain Institute, to store and disseminate pertinent information.

“The Coalition is committed to open and ongoing dialogue between industry and healthcare providers to facilitate safe and confidential patient care by ensuring continuing access to advances in medical technology,” said Ashley Palmer, director government affairs, HIDA, in presenting the Coalition concept at the Summit. Its mission is to:

• Streamline the healthcare industry representative credentialing process for all stakeholders…
• while meeting the common goals of patient safety and confidentiality…
• through the development of industry recommendations and best practices.

It will produce educational materials and industry recommendations, said Palmer.
“The idea [behind the Coalition] is to streamline the credentialing process, reinforcing that we believe in patient safety and confidentiality and that we are committed to continue building a bridge between vendors and the supply chain through dialogue and collaboration, and ensure continuing access to medical technology,” says Walker, who has been part of the discussions in forming the Coalition. “We want to give people a place where they can participate, spread the word that the industry now has an umbrella we can all sit under.” What’s more, the Coalition would give those involved in vendor credentialing broad recognition, “so, hopefully, we can more efficiently bring about change and standardization.”

The Coalition will put more definition around, and focus on, credentialing, adds Cones, who is on its steering committee. “It will allow us to continue with the common discussion, bring more hospitals to the table, help [providers] understand our perspective, and help [vendors] understand theirs.”

“My hope is that this Coalition will be seen as a multi-disciplinary group that has maintained a focus on the needs and challenges of their respective constituencies, while…assuring a safe and healthy work environment within the patient care setting,” says Mairose. “Also, that the group has developed standards that are consistent with the intent and spirit of collaboration and patient safety, which brings the conversation out of the extremes to the middle ground.”

Shared benefits
The Coalition can lead to tangible benefits for all supply chain players, large and small, adds Suhre. One example is the development and dissemination of training modules on, for example, fire safety. “One of our goals is to take a training module that we all agree is appropriate, and make it available to everyone in the industry,” he says. “We keep costs down and we’re consistent, so that every rep calling on hospitals is receiving the same training.

“I want to make sure people understand, we’re past the ‘talking about it’ stage as an industry and are actively working on mutually agreeable solutions,” says Suhre. As new requirements crop up, or if compliance to a particular set of requirements is low, the industry now has a forum – with the Summits and, soon, the Coalition – to get together and figure out how to proceed in an efficient and appropriate manner.

“We’re really trying to work collaboratively to solve this,” he says. “We want to figure out what makes sense. If people understand that, we can begin to have that discussion.”

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Sidebar:
Attention turns back to credentialing

Recent work on vendor credentialing by the Indiana Hospital Association, The Joint Commission and Mayo Clinic indicate that the issue is on the radar of suppliers and providers, and that both are willing to get their hands dirty and address it.

“The amount of time, effort and cost that is being dedicated toward [healthcare industry representative] credentialing is significantly more than what people were experiencing in 2009,” notes Terry Chang, M.D., director, legal and medical affairs, Advanced Medical Technology Association, or AdvaMed. “That has resulted in a renewed focus on reaching a mutually agreeable solution,” that is, one that works for providers and vendors.

Recently, AdvaMed put together some numbers on what vendor credentialing costs the industry. Based on the number of hospitals in the country (approximately 5,754, per the American Hospital Association), the number of credentialed sales reps (an estimated 350,000), and the estimated time that suppliers and providers spend on credentialing (an estimated 240 hours per hospital per campus per year, and 40 hours per year by or on behalf of the average sales rep), the cost to the industry probably exceeds $800 million, says Chang, who has worked on behalf of AdvaMed on the vendor credentialing issue for a number of years. And that cost is being borne by both the buy and sell side of the supply chain.

More than cost
But cost isn’t the only issue, says Chang. The manner in which vendor credentialing is currently being carried out presents other risks. Given the absence of definitive guidance from oversight or regulatory bodies, providers may have naturally tacked on additional requirements in an effort to cover their bases, he says. “But diverse and often duplicative, and sometimes inappropriate, requirements can create risks for patient safety instead of improving it. And some of these required elements for [healthcare industry representatives] present a confusing message.” For example, is it necessary – or desirable – to insist that sales reps be trained on emergency evacuations of the hospital? “This is something you probably wouldn’t want the [healthcare industry rep] to be directly involved in,” says Chang. Rather, reps should perhaps play a supporting role at the direction of the institution.

Chang is encouraged by recent developments surrounding vendor credentialing, including The Joint Commission’s recent clarification of the issue, and he applauds the work of the Indiana Hospital Association, which drew up recommended standards for credentialing late last year. “The IHA standards are a great example of collaboration,” he says. “Through a series of meetings, all requirements were discussed and categorized as applicable or not applicable to each ‘level’ of [healthcare industry rep]. Enough detail was discussed so that the vendors know how to meet these requirements.

“One of the biggest advances is that it was recognized that if this requirement was met once, it should be sufficient for all healthcare organizations. Vendors also appreciated that the extensive work that they already do to ensure that their representatives are meeting these requirements is being recognized and accepted in an attestation letter.

“We’re excited about continued dialogue and collaboration with all stakeholders, to work toward a joint solution,” says Chang. In Indiana, hospital CEOs recognized that “in addition to the toll [vendor credentialing] takes on their own organizations, it involves a pool of resources that isn’t infinite. Eventually, it will affect overall cost of care.”