Four Models for Managing Vendor Credentialing

In our work with healthcare vendors and suppliers across the U.S., we see four models that are used to manage vendor credentialing. The approach chosen depends on the size of the company and number of reps, whether or not credentialing is viewed as a corporate function, resources and management style.

  • Rep managed:  Reps are left to figure out and handle credentialing requirements  on their own.  The employer tells the reps that meeting these requirements is their responsibility.  This is common in small organizations, but some of the largest healthcare vendors follow this practice as well. This can be a challenge for many reps because reps are typically results, not process, oriented.  Even so, we estimate 60% of vendor companies take this approach.
  • Hybrid: In this case, there’s some level of corporate support to help the reps, but the reps are still on their own for meeting some requirements.  Typically the corporate support is for company documents and payment. The reps are held accountable for managing any training or immunization requirements.  Many companies use this model so they are sure that their brand and overall customer relationship is managed without the complexity of addressing each individual reps status.  Some 25% of the vendor companies go this route.
  • Fully managed:  A specific corporate staff member has oversight and day-to-day responsibility for ensuring reps meet any credentialing requirements appropriately.  Reps tap this resource for official company documents, for company guidelines about which policies are appropriate and which are not, and for assistance in finding approved resources for training, etc.  This results in higher numbers of reps fully compliant with their customers’ requirements, and the company able to centrally manage moves, adds, changes, and deletes to their rep staff and territories.  Current estimates are that 1 in 10 companies adopt the fully managed model, but the number is growing.
  • Outsourced:  A third party, like Vendormate, is contracted to ensure participation and compliance. The supplier may outsource all of credentialing or parts of it.  Companies adopt this to ensure high levels of compliance without the expense and complexity of building credentialing expertise in house.  As a relatively new option, just 5% of the vendors have outsourced their rep credentialing managing.

In our experience, the suppliers who have some element of a managed function – that is some oversight of the reps’ participation and compliance status – are the suppliers who have the least trouble with credentialing.  They’re ahead of the game – with a great percentage of reps fully compliant and fewer customer concerns.

Guest post by Jean Hodges, Vendormate

April 19, 2012 at 2:49 pm 6 comments

New Hire On-boarding: Get Reps Credentialed from Day One

A new hire = paperwork.  I-9s. Insurance forms.  Confidentiality agreements.

But while you’re plowing through the new hire paper, don’t overlook what your new account reps need for vendor credentialing. Getting the newly hired sales or service reps credentialed right away means they can get into the field faster and with fewer hurdles.

Some of our customers even start the credentialing process before day one.  For example, giving the candidate a list of immunizations that need to be documented.  Or making sure any background check documentation is available for the credentialing program.

Whether you do it on day one or before, create your on-boarding credentialing checklist and make sure HR, hiring managers, or anyone else involved in on-boarding, know what you need.

Here’s a list of things to include:

  • Contact information for your company’s credentialing lead.  Who should the rep contact now and in the future with any questions?  Include name, email, phone numbers, hours of availability, response times, and a backup contact in an emergency situation
  • Reference guide to any document repositories or credentialing tools your company uses
  • Checklist of common credentialing requirements.  Which ones can a rep sign and which ones need to be reviewed by someone else?  Who handles the review?
  • What to do about one-off or unusual credentialing requests
  • Training resources.  Does your company provide this, or does the rep need to handle this on their own?  What’s your reimbursement policy?
  • Immunization or other medical resources.  Again, does your company use specific providers?  What’s your reimbursement policy?
  • Quick reference guide to credentialing organizations.  Does your company have a corporate agreement with a VCO that will benefit the rep?

March 27, 2012 at 3:05 pm Leave a comment

Joint Commission Adds Usability Test to Vendor Credentialing

We’ve heard more and more reports from hospitals that Joint Commission auditors are looking for a vendor compliance program even though there is no official vendor credentialing statement from The Joint Commission.  It’s no longer uncommon for Joint Commission auditors to ask whether or not a hospital has a vendor credentialing program and to ask the hospital staff to pull the records for any vendor representative currently on site.

But when Robert Wood Johnson University Hospital Hamilton (NJ) went through a recent Joint Commission audit, they got an extra request.  The auditor asked the director of materials management to print out 20 rep profiles.  The profile records needed to list the required documents as well as the compliance status.  The logic?  The auditor wanted a demonstration not only that the program was active, but also that the hospital staff knew how to use Vendormate VISION to access the information.  Fortunately, that was no problem for this hospital.

March 6, 2012 at 2:37 pm 9 comments

What Suppliers Don’t Know About Vendor Credentialing

Vendor and rep credentialing in healthcare is now a standard practice.  And what was once left for the sales and service representatives to manage on their own is quickly taking root as a corporate function.

Suppliers in healthcare are recognizing the potential impact of an “every rep for him/herself” approach on a company’s business.  Inconsistent and inadequate credentialing can affect every area of a company’s operations—from financial to legal. Even corporate reputation.

As we talk with healthcare vendors across the U.S. about their efforts to manage credentialing, we see some common pitfalls when credentialing hasn’t been adopted as a corporate function.

  • A lack of standard company responses to credentialing and of a way to streamline these processes creates confusion for reps and staff, causing lost time and productivity.
  • Without oversight, sales reps can inadvertently sign inappropriate documents (such as business associate agreements) which could lead to unforeseen legal concerns.
  • If credentialing documents aren’t in place, sales reps’ access to hospitals and healthcare providers can be jeopardized, creating a delay or loss in sales and services.
  • Without centralization, credentialing is parceled out to various departments and staff resulting in gaps in credential coverage.
  • Eventually, healthcare providers may begin to question a vendor’s ability to safely deliver services to their patients if a vendor establishes a pattern of non-compliance.

According to Sonya Harrison, with Ethicon Endo Surgery, “Vendor credentialing is a corporate function with Ethicon Endo Surgery and I’m quite sure it is at other large companies as well. We have our own compliance programs and adherence to those programs gives us the opportunity to ensure our associates are in compliance internally.  If they are in compliance internally, it’s relatively easy to be in compliance externally.  If companies don’t have an internal compliance program, formalized training or some sort of credentialing process, there may be doubt externally about a company’s ability to conform to healthcare compliance programs.”

More and more suppliers are responding to this exposure by making rep credentialing a corporate responsibility.  Then, vendor credentialing becomes centralized.  It has a designated “home” and isn’t left to drift from department to department or to reps.   Vendor credentialing gets the resources it needs to be done effectively. And the supplier can carefully manage one of its greatest assets — its reputation.

Guest post by Jean Hodges, Vendormate

February 22, 2012 at 4:11 pm 1 comment

What Are You in For?

The question seems innocuous enough.  But it becomes loaded with concerns about patient privacy when a hospital contractor not on the medical staff asks it.

Hospitals and ASCs that concentrate their rep and vendor credentialing programs on device reps in clinical areas overlook the large number of vendors and reps in their halls that aren’t providing clinical products and services, but still present HIPAA, liability, and other risks to their patients and daily operations.

Facilities contractors in particular move virtually unnoticed through the hospital yet have extensive access.  Facilities vendors range from general contractors to plumbers to painters, to name a few.  Because of the services they provide, their relationship is quite different compared to that of a medical device rep.  So, thinking about facilities vendors and credentialing, a few areas you may want to consider:

  • Immunizations:  Although they’re not working directly with your patients, they may be working  in patient care areas.  Ensure they are not unnecessarily exposing themselves—or others—to certain diseases that could easily be prevented by an immunization.
  • Training and Licensing:  Considering the impact a facilities vendor mishap could have on your hospital, you should ensure that the individuals working in your hospital are qualified to do the job, have any necessary licenses, and do not have a criminal history.
  • HIPAA Awareness:  Many of our hospital and ASC customers are very sensitive to potential patient privacy breaches.  You will want to know these reps are aware of HIPAA regulations…and won’t be inclined to ask one of your patients “what are you in for?”
  • Insurance:  Adequate insurance coverage is an absolute must.  A New York hospital recently had to pay over a million dollars to a contracted facilities worker who fell off the roof while doing maintenance.  His employer didn’t have proper workers comp insurance coverage, which prompted the individual to sue the hospital.   This could have been prevented had the hospital captured and verified necessary insurance through its credentialing process.

Although facilities vendors may not be as keenly aware of the countless rules and regulations in the healthcare world as your clinical vendors, they should provide you with documents and information you need to mitigate the risks they do pose.  If you have a process in place today that allows you to rest easy at night in regards to facilities vendors, that’s great.  But, if you don’t, you should consider adding these service providers to your vendor credentialing program.

Guest post by Colby Leggett, Vendormate, Provider Account Management Team Manager

November 17, 2011 at 7:43 pm 6 comments

Drug Shortages, the Gray Market, and Vendor Credentialing

Discussion of drug shortages and the gray market is certainly rising.   And while the media frenzy may seem hyped, the storm has been brewing through most of this year.

The American Hospital Association released a survey in July of this year noting that a staggering 99.5% of all hospitals have experienced drug shortages in previous 6 months and 82% of them had to delay patient treatment due to these shortages.

On the heels of that, the Institute for Safe Medication Practices released a survey indicating that gray market vendors are soliciting 92% of hospitals.

In a gray market, vendors distribute through channels that while legal are unofficial, unauthorized, or unintended by the original manufacturer.  Typical prices of drugs in a gray market can exceed ten times the standard contract price.

The survey also noted that half of all hospitals had actually purchased from these gray market sources and 12% of respondents indicated some type of adverse reaction from using these products.

The combination of drug shortages, gray market vendors and reps working outside the system makes credentialing the pharmaceutical vendor company, distributors, and associated representatives critical.

An effective vendor credentialing program can help providers deal with some aspects of this situation.

  1. Know your suppliers:  Use the company level information in your vendor credentialing program to highlight manufacturers and authorized distributors.  Identify Verified-Accredited Wholesale Distributor (VAWD).  Make this one of the credentials you track.  Try to restrict your purchasing to these sources.  Start reaching out to your distributor and manufacturer base now – before a shortage – to establish relationships that will help keep you from being surprise by shortages later.
  2. Identify and track gray market rep activities:  Having reps register and sign in before visiting your clinicians or your buyers may be enough to put the brakes on aggressive sales actions.  At the very least, you’ll have more insight into the sources of gray market sales activities.
  3. Run any gray market suppliers you do use through your vendor credentialing program before buying anything.  Credentialing at the corporate and rep level ensures the vendor is eligible to participate in federal reimbursement programs, is not on the FDA debarment list, the company is in good financial and legal health and that expectations for doing business with the health system have been properly set through policy presentment.
  4. Reach out to your distributor and manufacturer base now – before a shortage – to establish relationships that will help keep you from being surprise by shortages later.  Stockpiling isn’t the answer.  Creating strong relationships with distributors and manufacturers during the good times will pay off during a crisis.
These recommendations should be part of your larger strategic supply chain efforts for dealing with drug shortages.  If you’re looking for a place to start, take a look at this set of recommendations from Premier.

November 4, 2011 at 3:58 pm 1 comment

When to Credential Healthcare Contractors

A fundamental definition of “vendor” is anyone who is paid for a product or service. In healthcare, vendor credentialing needs to be done for both the vendor company and for any individual with a direct relationship to the provider.

This seems straightforward enough, but the reality in healthcare is actually complex. And credentialing contract staff members is the epitome of this complexity.

Contracted staff members are essential in healthcare delivery today. And hospitals and ASCs have a number of options in managing the contractor relationship.  In some cases the contractor is paid directly by the healthcare provider. In others, an agency is responsible for recruiting, supplying, and managing qualified contractors.

Who then should the hospital credential?  The individual?  The agency?  Both?

Contracted staffing agencies fall into two categories:

  • CVO (Credentials Verification Organizations): certified by an accreditation agency (e.g. Joint Commission) to conduct their own credential verification and report the credentialing information to their clients (health systems/providers)
  • Non-CVO: not accredited to conduct internal credentialing for their employees

Although CVOs take on the responsibility of credentialing their employees, the hospital still needs to know that the contracted employees are current in any licenses or other requirements and that the CVO itself is currently accredited.  In this case, the healthcare provider should make these requirements clear as part of the contract process.  As far as credentialing goes, the healthcare provider should credentialing the CVO agency as a company, but would not need to credential the individual contractors.

For non-CVOs, the healthcare providers themselves would need to handle any individual level credential verification directly.  This means completing credential verification on contracted employees that may include license to serve patients, background check attestation from the agency, hospital policy acknowledgments and immunizations.

Still trying to figure it out?  Try this decision tree:

Contractor Credentialing Decision Tree

The provider needs to be sure that the credentialing is being done by an accredited organization.  So only when the provider is hiring the contracted staff through a CVO is the provider off the hook for credentialing the individual.  Even then, the provider should credential the agency itself — searching for any sanctions as well as financial due diligence.

October 19, 2011 at 12:53 pm Leave a comment

Older Posts Newer Posts

Upcoming Events

Sign up for Vendormate News

2013 Vendor Credentialing Summit
August 14 - 15, 2013

July 28-31, 2013
San Diego, CA
Booth 1121

Recent Posts

Archived Posts