Five Lessons Learned from Successful CVOs

HealthStream regularly publishes guest blog posts like the one below from Vicki Searcy, Vice President of Consulting Services, VerityStream.

When I started consulting 25 years ago, an emerging area in credentialing was the development of Credentials Verification Organizations (CVOs). At that time, many of us thought that CVOs would be a component of a medical society or hospital association—and I worked with these types of organizations to establish CVOs across the country. Later, I started working with healthcare organizations to establish CVOs specifically for health systems and this ultimately became the type of CVOs I most often assisted. I surveyed CVOs for several years for NCQA and saw a wide variety of CVOs with different types of operations and scope of services.

An Explosion of CVOs

Over the past three to five years, there has been an explosion of the development of CVOs in health systems. This is largely due to the proliferation of health systems during the past few years. The VerityStream consulting group is either working in an environment where a new CVO is being established, we are in the process of operationally improving an existing CVO by implementation of various software solutions or we are in an onboarding environment where the “CVO” services are expanded to include involvement with recruiting, contracting, HR, credentialing, provider data management/interfaces, and payer enrollment.

Having been involved in the CVO industry for so many years, I’ve seen impressive successes—and, unfortunately, some spectacular failures. I’ve seen boxes of paper files returned to hospitals when a CVO connected with a hospital association failed. I’ve surveyed medical society CVOs where files were several inches thick and it was impossible to identify what data was provided to a specific hospital and when. I’ve been in CVOs so large and so busy that they had individuals who did nothing but verifications of licensure, or DEA registrations, etc. I’ve also worked with health systems where the CVO was functioning so effectively that no one in the hospitals could envision taking back credentialing and doing it facility by facility.

Five CVO Lessons Learned – Best Practices

1. Clearly define the scope of services provided by the CVO vs. the participating facilities. Make sure that there are quality processes in pace to assure files are complete (and adhere to agreed-upon standards) prior to releasing the files to the participating facilities.
2. Standardize the CVO work product—don’t customize. CVOs that are highly customized to the needs/wants of a particular customer/facility often fail—or the cost of doing business in this type of environment is so high that the operation becomes insupportable.
3. Limit access to a shared database for accountability and data integrity. The more individuals that you have entering and manipulating data in a shared database, the more likely it is that there will be inconsistent data. Most health systems want the practitioner data from the credentialing database to be the “source of truth” and to be interfaced to multiple business applications. Keep the data clean!
4. Don’t sell the idea of implementing a CVO by promising decreased staff in the medical staff offices. Focus on the staffing needed to provide the scope of services of the CVO. The facilities that participate in the CVO services can evaluate the staffing needed to provide their scope of services. Eventually, decreased staff in medical staff offices may be possible once credentialing is centralized. But in a CVO start-up, usually more staff is needed for a period of time while the CVO is implemented. There is often new software installed and implemented, policies and procedures to be developed, etc. Once the CVO has been in place and operations are stable, it is time to re-evaluate staffing requirements. One CVO that I worked with was able to reduce staff by half once they went entirely electronic—but it took a year to get to that place (and no jobs were lost—staff were deployed to facility medical staff offices or other positions within the health system).
5. Don’t change operating procedures every month. Most health systems that have a CVO have some type of an operations committee made up of representatives of the facilities that use the CVO services. Unless there is an immediate need to change an operating procedure (a new regulatory requirement, for instance)—policies and procedures should be evaluated annually and revised by the group as necessary/advisable. This helps avoid having operating procedures be a moving target—which can destabilize the CVO.

There will, I’m certain, be many changes in how health system CVOs operate in the future. We are already seeing interesting variations related to the scope of services in CVOs based upon technology which is available now or CVOs that focus on onboarding. There are numerous CVOs that provide credentialing and enrollment services. Some CVOs provide support for facility privileging (particularly when privileges are standardized across a health system). It will be interesting to continue to watch the development of CVOs in the coming years.

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