What you need to know before you talk to a CVO
Make sure the CVO can work with your needs
Traditionally, credentialing verification organizations (CVOs) have been the almost exclusive province of managed care organizations and large hospital systems. But an increasing number of mid-sized hospitals are now taking advantages of the services provided by CVOs to reduce the cost and slow turnaround time often associated with performing primary source verification in-house.
According to Kristen Scholl, CVO operations manager at Novalis Credentialing Verification Organization in Albany, NY, some large hospitals and hospital systems have already moved to create their own CVOs. "Maybe one of the larger hospitals in the entity will perform all of the credentialing functions on behalf of the others," she says. Meanwhile, smaller hospitals with less of a credentialing burden are usually more inclined to keep the credentialing process in-house. "It’s probably more the mid-sized hospitals that are willing to outsource," she says.
Their reasons for doing so usually include reducing the burden placed on the hospital’s medical staff office, which typically has a number of responsibilities in addition to credentialing, Scholl says. For those hospitals, "CVOs would typically do the primary source verification piece, but the hospital still has quite a bit of responsibility as far as determining which areas of the hospital physicians work in and which kinds of surgeries and procedures they can perform. This is just one administrative task that can be done somewhere else. Sometimes hospitals like to take advantage of that."
Despite the obvious benefits of outsourcing, however, it’s important for facilities to do their homework before making the decision to use a CVO and identify exactly what their needs are for credentialing services.
Physicians Hospital and Physicians Healthcare Network is a physician-hospital organization (PHO) in Columbus, OH, co-owned by the hospital and 400 physician partners. For some time, the PHO had delegated its credentialing function to the hospital. While the hospital did a good job meeting the credentialing standards set by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) in Oakbrook Terrace, IL, it did not meet the standards of the National Committee for Quality Assurance (NCQA) in Washington, DC. In addition, there were some issues regarding confidentiality and sharing of information, says John Hamilton, manager of operations at the PHO. "There have been some legislative changes recently that make it more difficult for [the hospital] to share information with an outside entity," he says. "Even though they’re a partner in our organization, legally we’re separate. So, legitimately, there were some concerns there."
At that time, however, there wasn’t enough revenue coming in to pay for a full-fledged internal credentialing program at the PHO. "So we started to review all of our options," Hamilton says. Ultimately, the PHO evaluated 11 CVOs, using cost, turnaround time, and NCQA accreditation as their primary criteria. "We wanted to know that they had the staff on board to meet our needs and that there was a contract to hold them to that," Hamilton says.
Another important consideration was the fact that the system housing the PHO’s credentialing information was a homegrown access database, says Lori Anthony, administrative coordinator. "It’s pretty much maxed out, and we were looking for someone who could provide us with a system to use. There was only one company I found at the time that had the ability for us to use its systems."
The PHO finally contracted with a CVO that provides an on-line, Internet-based credentialing system that allows them to track and monitor the credentialing process. "We became very enamored with that particular program," Hamilton says. "We’ve been working with them almost six months, and we’ve credentialed all of our physicians under the new program in that period of time."
In the past, when credentialing was still performed by the hospital, turnaround time could take anywhere from 30 days to six months. "It depended on when the committees met," Hamilton says. "[The committees] had to not only obtain the information, but [the data] had to go through all the hospital committees before we could put them through ours." With the CVO, the average turnaround time has been 28 days.
One function the PHO decided not to outsource was site visits. "We have nurse site reviewers who are contingent staff for the PHO who have gone out and performed our initial site visits, which is something that the hospital traditionally never did for us," Hamilton says. "We just didn’t have that function delegated to us by the contracted health plan. We’ve kept that in-house, and coupled with the program we have through our current CVO contract, it has been very good for us. I think it would be hard for us to go back to using the hospital again."
In fact, Hamilton and Anthony have begun working with the hospital medical staff regarding the possibility of outsourcing their primary source verification to the same CVO. "That would allow us to have one application that would meet the needs of the PHO as well as the hospital credentialing function," Hamilton says. "By having the CVO perform all of the primary source verification by using one application, we would avoid a lot of duplication for the physicians."
Before you select a CVO, be aware that they can differ widely in the options they offer and in the quality of service they provide. Anthony recommends checking references carefully. "I did a pretty thorough check and learned a lot in talking to the references," she says. "There were a couple that didn’t come back as positive as I had anticipated. Also, when talking to references, ask them if they’ve heard of other CVOs that you might not be aware of."
Hamilton recommends taking careful stock of the services your organization requires before approaching a CVO. "Understanding exactly what you need and what you’re looking for from a CVO up front and asking them to respond to each of those items will save you a lot of heart ache in the long run," he says.
Be aware that asking a CVO to customize its services to fit your needs can increase costs. "We were fortunate that we didn’t have a lot of history, so there weren’t a lot of customized things that the PHO needed from the CVO," Hamilton says.
Look for hidden costs as well, such as mailing costs, Hamilton advises. Also, ask specific questions, such as: "When do you get the file? What does the file look like?’ Be very thorough in your evaluation," he says. "A lot of these companies have turnkey programs that are very easy for them to administer. But when you talk about being flexible and being able to customize the program to your organization, that’s where it can be costly."