Standardized Chaos

New Credentialing Form Prompts Physician Complaints  

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Medical Economics Feature - September 2006  

By  Ken Ortolon
Senior Editor

When the Texas Medical Association won passage of legislation creating a standardized form for physicians wanting to be credentialed by managed care plans and hospitals, the idea was to reduce hassles and paperwork.

Dallas radiologist Richard A. Suss, MD, says the form, which the Texas Department of Insurance (TDI) finalized after the law was passed in 2001, did just that. While it was long and time-consuming to complete initially, Dr. Suss says the form could be downloaded to a computer, filled out, saved, and then e-mailed or mailed to health plans, hospitals, and other credentialing entities with little modification.

"What could be easier?" Dr. Suss asked.

But in June, TDI unveiled a revised credentialing form without warning to physicians and others involved in physician credentialing. Reaction to the new form was immediate and negative. Doctors felt the form was not user-friendly, and they questioned some of the new data being requested.

At TMA's urging, TDI delayed implementation of the new form from July 1 to at least Sept. 1, while it gives stakeholders a chance to weigh in on the changes.

In the meantime, TDI officials say physicians can use either the old or new form, although the old form will not be reposted on the agency's Web site (www.tdi.state.tx.us). 

Setting the Standard

Physicians sought a standardized credentialing form because of the multitude of health plans, hospital medical staffs, and medical groups that routinely verified their credentials for contracting purposes or for granting staff privileges. TMA officials say they all had their own forms, which varied greatly, but also contained many of the same data elements. A standardized form, TMA argued, would cut down on paperwork hassles for physicians.

Sen. Kyle Janek, MD, (R-Houston), then a member of the Texas House, cosponsored legislation mandating the standardized form with Sen. John Carona (R-Dallas) in 2001. When their bill stalled, they added their standardized credentialing language to another bill.

After a lengthy process in which TDI received input from the various stakeholders, the new form was implemented in 2003. But TMA officials say immediate problems with the form needed to be fixed. Barbara James, BSN, RN, director of the TMA Science and Quality Department, says the form was well designed for use by health plans but "minimally helpful" for hospitals and medical groups. Also, some of the questions were awkwardly worded, she says.

In 2004, TDI sought opinions from interested stakeholders on revising the form, but nothing happened until June, when TDI posted the new version without granting physicians and other stakeholders an opportunity to review it.

TMA quickly heard from doctors who had multiple complaints about the new form. First, the already lengthy form had increased from 20 to 22 pages. Physicians also questioned the rationale behind one question that asked if the physician was "currently limited by any physical, mental, or chemical dependency problem" that could impair his or her ability to "perform the essential functions of your health profession in your specialty now or within the next three years."

The new form also seemingly asked physicians to give their medical liability claim history for their entire professional career, as opposed to a five-year period as specified in the original form.

"What made me mad was I don't want to keep talking about the same old lawsuits," said a physician who did not want to be named. "They're suits I've been dismissed from."

"It makes those of us who have been in frivolous lawsuits and got dropped even before you go to deposition kind of uncomfortable," said another physician who also asked not to be identified. The physician spent three hours completing the new form. "It's a terrible inconvenience because I'm new in practice and I desperately need to finish all these credential things."

Additionally, physicians calling TDI with questions about the new form reportedly got conflicting answers from agency staff. And some physicians who had already submitted the old form to health plans or hospitals were being asked to complete the new form even before the effective date. 

Starting Over

But perhaps worst of all was the fact there was no way for a physician to electronically transfer all of his or her data from the old form to the new one. That meant having to reenter all of their data from scratch.

Physicians weren't the only ones to complain about the new form. At least two health plans also expressed concerns, and the Coalition for Quality Healthcare (CAQH), a national credential verification organization, told TMA officials it would take six months to fully convert their database to the new form. CAQH verifies credentials for numerous health plans and has some 16,000 Texas doctors in its database.

On June 30, TMA met with TDI officials to discuss concerns over the new form. Those officials readily agreed to delay implementation of the form and convene a new stakeholders' meeting to iron out problems.

TDI officials also said the issue over liability claims was a misunderstanding created by conflicting language in the actual question and the instructions for completing the form. While the question clearly asks physicians to report any claim they've "ever" had, the instructions clearly ask only for claims within the last three years. The physician who was angered by that question says he was placated when he reread the instructions but called the apparent contradiction "bad policy."

As of the end of July, TDI had not scheduled the stakeholders meeting. A spokesperson for Senator Janek says he plans to monitor the process and will "engage" on the issue if the concerns are not resolved.

Meanwhile, TMA was attempting to find software that might electronically convert data from the old form to the new form. Bexar County Medical Society, which runs its own credential verification service, has developed a fix for its credentialing software that will transport much of the data to the new form. But that fix works only with its software and is available only to its clients.

Ken Ortoloncan be reached by telephone at (800) 880-1300, ext. 1392, or (512) 370-1392; by fax at (512) 370-1629; or by email at Ken Ortolon.  

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