Summit Medical Group Saves Money & Improves Efficiency with Credentialing Software

Summit Medical Group, located in East Tennessee, is a private practice group founded in 1995. The group has grown from 37 physicians to almost 150 in seven years. Summit is dedicated to providing quality care, improving access, controlling costs and being responsive to business needs in its medical care delivery. At Summit there is a constant eye on the bottom line to ensure a maximum return on investment. With 150 physicians, 32 office locations, four ancillary centers, two urgent care clinics, a centralized laboratory and approximately 40 managed care contracts; efficiency is a high priority at Summit.

In 2000, Summit’s management team identified the credentialing process as a possible area in which to improve efficiency and save money. By doing this, the tedious process of maintaining provider information could be addressed, while assuring that providers are properly credentialed with the appropriate payers and facilities.

During the first few years of its formation, credentialing was perceived as “working” within Summit and therefore no action seemed necessary. However due to the growth of the medical group, it became apparent that an automated credentialing system would be beneficial in a number of ways, including:

• Automation
• Organization of data
• Improved job satisfaction
• Reduced full time equivalent (FTE) support staff requirements within credentialing department
• Improved methodology of cross-training
• Faster turnaround on credentialing
• Reduction in “non par” denials

Problem

Like many practices, Summit needed a long-term, cost-effective solution to the inefficiency and delays associated with the credentialing/provider data management process. The standard operating procedure was to manually complete individual applications. This could require 1-2 hours per application, depending on the length and complexity of the form.

The provider data resided in various spreadsheets, word documents and databases throughout the organization. Completing credentialing paperwork in a manual environment for 150 providers at an estimated two hours per initial application and approximately 30-45 minutes for re-credentialing applications meant a tremendous time commitment.

Inherent in the manual process was the likelihood of mistakes and incomplete applications, which could potentially further delay a provider’s ability to see patients within a managed care organization (MCO). Summit had come to an intersection that required a decisive step toward adding another FTE credentialing person versus implementing an automated system. The automated system was deemed to be the more cost-effective decision of the two options.

Solution

Having made the decision to move forward, Summit began the search for a software solution that would give them the functionality and flexibility they needed. Ultimately they signed a license agreement with Sy.Med Development, Inc. in the fall of 2000 to license the company’s OneApp PRO software.

This software allows users to enter all the information necessary for credentialing into a simple, user-friendly Windows database, then “link” the data onto any application or form. Forms are scanned into the system using a standard TWAIN compatible scanner. The users then “map” the data onto the forms. Once a form is mapped, it can be linked to each provider’s data as often as necessary. This eliminates dependence on a third party vendor for mapping forms and maintaining data.

Among the reasons for choosing OneApp, Summit cites the following:

• Physician office perspective vs. that of a medical staff office or Credentials Verification Organization
• Flexibility
• Strong commitment to customer support
• Rapid return on investment
• Quick deployment and ease of use
• Strong commitment to continued product improvement
• Minimal hardware investment or IT support required

Results

The software was installed at Summit within 10 days of license agreement execution. Sy.Med provided on-site training for two days in addition to the installation. The Summit credentialing department staff was able to complete applications automatically at the end of the first training day.

Since installing the OneApp software, Summit has recognized tremendous improvements in the efficiency of completing applications and maintaining demographic information for their providers. In fact, prior to licensing OneApp, Summit was considering hiring another one or two FTEs to help with credentialing. Instead, they have been able to improve job satisfaction with the existing staff and avoid the additional human resources expense.

Additionally, other uses for the OneApp database have been identified, including:

• The software alerts users daily of any licenses or certifications within Summit’s parameters for expiration.
• All provider data is maintained in the OneApp database, eliminating the need to maintain records in separate spreadsheets and databases. This database has become the key point of entry for any changes in provider information.
• Users can share database information with other departments, including human resources, billing and information technology.
• Provider Curriculum Vitae’s are updated automatically as data is changed or added in the database.
• OneApp data can provide web site content for provider profiles.
• Sharing provider information electronically with other departments, both within and outside the organization.

These advantages aside, the number one result has been the ability to re-allocate the efforts of the credentialing staff to more productive and professionally challenging tasks and to assure efficiency and accuracy in the provider data management area.

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