Long-term patient care begins and ends with healthcare provider quality. At the same time, there is an increasing probability that long-term healthcare provider quality will decrease due to seismic social changes.

Faced with an increasingly aging baby boomer generation and reductions in state and federal financial support to Medicare and Medicaid programs, the demand for long-term care providers now exceeds the supply of qualified workers available, resulting in severe workforce shortages. These shortages make long-term care organizations and state medical boards desperate for long-term care staff, often resulting in a lack of credentials scrutiny at the time of licensing and hiring. This inattention to credentials verification opens the door for fraudulent, unqualified providers to enter the long-term care environment unnoticed.

Widespread in its impact, this correlation has been noted by the Centers for Medicare and Medicaid Services (CMS) which recently released a final rule (CMS-6028-FC) requiring provider screening (a.k.a. credentialing) performed on a tiered basis (low, moderate, and high) based on risk of fraud by provider/facility type. Unsurprisingly, long-term care providers and facilities such as newly enrolling home health agencies were assigned to the moderate or high risk categories, exemplifying CMS' comprehension of the correspondence between credentialing, proactive prevention of fraud and medical error, and quality of care.

In addition to preventing risk for the organization and providers, long-term care institutions are also faced with the added pressure of a dependent patient population. More than any other patient group, long-term care patients often have little to no capability to determine the qualifications of their healthcare providers and even less financial flexibility to choose alternate providers based on insurance requirements. They rely on the long-term care organization to guarantee qualified providers who will offer quality care, thereby increasing the liability of the responsible organization and resulting costs of medical errors and patient harm.

The Change Around The Corner: Electronic Credentialing and Licensing

The challenges to long-term care provider credentialing are myriad, so what's the solution? According to CMS and leading industry experts, the answer can be found in continuous electronic credentialing for affiliation with an organization and licensing by a state medical board. Through the automation and streamlined processes offered by patented credentials verification technology and shared online provider data management platforms, long-term care providers can securely submit a single online application to credentialing organizations/licensing boards which can then continuously verify credentials and monitor them in real time, allowing them to be notified of adverse actions, expirations, or other changes to provider information the moment they happen.

So what exactly is electronic credentialing? Electronic credentialing generally defeats the human error, inaccuracies, and typical inefficiency inherent to manual credentialing and instead involves one or more of the following attributes: (1) a provider portal allowing electronic submission of provider information, (2) a centralized provider data repository, (3) automated, continuous electronic verification of provider information, and (4) integration of provider information to upstream and downstream systems.

Now, more than ever, long-term care providers are expected to ensure greater patient safety, reduce medical errors, and lower costs. Providers should encourage their organizations and licensing boards to utilize real-time electronic credentialing and licensing as a significant factor in achieving these goals.

Matthew Haddad is the President and CEO of Medversant Technologies, which provides Web-based provider data management solutions.