More than a year ago, during the first waves of COVID-19, credentialing presented a significant challenge to fast, expedient delivery of talent that was needed to meet the crisis surge. 

More than a year ago, during the first waves of COVID-19, credentialing
 presented a significant challenge to fast, expedient delivery of talent that
 was needed to meet the crisis surge.



 For facility staff pre-COVID, credentialing could take upwards of 20 hours per
 provider as they worked to check backgrounds, verify credentials, privileges,
 medical boards, education, and more. In addition, a slow credentialing process
 costs providers, facilities, and the industry at large. According to an
 Institute of Medicine study, providers lose income, facilities lose revenues,
 and the credentialing process contributes to half of the estimated $361
 billion a year wasted on healthcare administration.



 Threading the needle between &ldquo;just in time&rdquo; credentialing and
 licensure in order to quickly deploy desperately needed caregivers and
 ensuring that compliance and other safeguards are being met can be difficult
 &ndash; but as Cross Country Healthcare and other healthcare organizations
 have proved during the pandemic, it is not only attainable but a better,
 streamlined approach for the future.


<h2>A new normal for credentialing efforts.</h2>


 During times of crisis, the staff is the hospital resource most at risk for
 inadequate supply. The COVID-19 pandemic required many facilities to review
 their credentialing policies to see if there was an expedited path for
 credentialing medical staff or considering creating one.



 As Cross Country Healthcare worked alongside facilities to streamline and
 speed up the process, it uncovered powerful lessons learned to improve the
 &ldquo;door to floor&rdquo; process, including:


<ul>
 <li>
 Considering exceptions to some of the usual credentialing guidelines, such
 as replacing multiple committees with one to consider applications for
 privileges, limiting privileges given to a provider who went through
 expedited credentialing, or limiting the time in which those restricted
 privileges may be exercised.
 </li>
 <li>
 Identifying and establishing minimal credential requirements and deploying
 them rapidly nationwide, keeping in mind that each provision that is added
 can slow down the time to deliver healthcare talent to the bedside.
 </li>
 <li>
 Establishing rules for ongoing engagement and communication when revising
 and deploying new credential processes.
 <a
 href="https://www.crosscountryhealthcare.com/docs/northwell_case_study_fin1.pdf"
 target="_blank"
 style="font-weight: bold;color: #D7282F;"
 >View a case study with Northwell Health</a
 >.
 </li>
 <li>
 Implementing healthy reporting practices and tracking to safeguard against
 any impacts on patient care quality or compliance using an expedited
 process.
 </li>
</ul>


 In fact, Cross Country Healthcare has conducted extensive research and
 analysis of its proprietary crisis credentialing model to identify any impacts
 of the streamlined process on quality or compliance. The crisis credentialing
 model reflects changes to several aspects of the process, including the timing
 of drug screens, reference guidelines, and streamlining annual mandatory
 education testing. To date, the new, streamlined credentialing process has had
 no adverse effect on healthcare provider quality, performance, or compliance
 when compared to the pre-COVID credentialing process.


<h2>Reimbursement and regulatory changes.</h2>


 In response to COVID-19, many temporary changes were made regarding
 reimbursements to help manage the pandemic. Telehealth reimbursement has
 increased dramatically in Medicare, commercial plans and Medicaid, though in
 many cases, these reimbursement changes may be temporary.



 While traditionally, telehealth services have been reimbursed at a lower level
 than in-person visits, in March 2020, CMS allowed for more than 80 additional
 services to be furnished via telehealth and for providers to&nbsp;<a
 href="https://www.healthcarefinancenews.com/node/139941"
 target="_blank"
 >bill for telehealth visits</a
 >&nbsp;at the same rate as in-person visits. With the waivers in place, almost
 anybody with broadband internet can access telehealth and can do so from their
 homes. This has allowed healthcare organizations to continue offering certain
 basic services that otherwise would be lost to them.



 While CMS waivers will evaporate once the public emergency ends, elected
 officials will likely have reason to consider more permanent regulatory
 changes given telehealth&#39;s ongoing effectiveness in everything from
 primary care visits to behavioral health. Because so much of the industry is
 rapidly trending in this direction, it would be difficult to go back to
 pre-COVID telehealth reimbursement levels. Some service lines, such as
 telepsychiatry, would still be reimbursed at their current levels, but things
 like imaging and labs would see reimbursement cut by 60 percent to 70 percent.



 For a lasting change in areas such as
 <a
 href="https://www.healthcarefinancenews.com/directory/reimbursement"
 target="_blank"
 >reimbursement</a
 >
 and the ability to offer telehealth across state lines, an act of Congress
 will be required. On the surface, this seems like a tall order but there is
 more support than ever before for such a change.


<h2>Modernizing licensure requirements and processes.</h2>


 The COVID-19 pandemic has forced federal and state policymakers, Republicans,
 and Democrats to acknowledge that clinician‐​licensing laws block access to
 care. In a&nbsp;March 24, 2020, letter to governors, Secretary of Health and
 Human Services Alex Azar urged states, &ldquo;To extend the capacity of the
 healthcare workforce to address the pandemic.&rdquo; The recommendations
 included removing barriers to right‐​skilling: &ldquo;Relax scope of practice
 requirements for healthcare professionals, including allowing professionals to
 practice in all settings of care &hellip; [and] any requirements for written
 supervision or collaboration agreements&rdquo;; &ldquo;Allow physicians to
 supervise a&nbsp;greater number of healthcare professionals;&rdquo; and
 &ldquo;modify laws or regulations to allow medical students to conduct triage,
 diagnose, and treat patients under the supervision of licensed medical
 staff.&rdquo;



 By suspending such rules to improve access to care for COVID-19 patients,
 states have acknowledged that licensing prevents clinicians from providing
 services they are competent to provide. The patchwork of state licensing
 regimes has been one of the most challenging barriers to overcome. Some states
 have made temporary concessions concerning their control over licensure to
 support patients during the COVID-19 pandemic. However, while these measures
 have helped, a uniform national mechanism for licensure for telehealth across
 state borders would be much more effective.



 Initiatives such as the&nbsp;<a href="https://imlcc.org/" target="_blank"
 >Interstate Medical Licensure Compact</a
 >
 (IMLC) make it easier for providers to become licensed in multiple states.
 Still, the IMLC has not been adopted in every state, and the process for
 providers to take advantage of this reciprocity is not automatic.



 Many state responses to the COVID-19 crisis have included the availability of
 temporary, emergency, or fast-tracked licensure or the temporary waiver of
 certain licensure requirements. Although individual state-based measures can
 help increase physicians&#39; availability, a unified response would allow the
 healthcare community to be more responsive to future healthcare crises.



 One potential avenue for this is the Emergency Management Assistance Compact
 (EMAC). EMAC has been ratified by Congress and every U.S. state and territory.
 It provides state emergency management agencies with broad powers to
 cooperatively respond to emergencies, including liability waivers, license
 reciprocity, and reimbursement for costs.



 The National Emergency Management Association&nbsp;<a
 href="http://connectwithcare.org/wp-content/uploads/2020/04/EMAC-FOR-TELEHEALTH-1.pdf"
 target="_blank"
 >supports the use of EMAC</a
 >
 to implement uniform waivers to state licensure requirements for the provision
 of services via telehealth and has released a
 <a
 href="http://connectwithcare.org/wp-content/uploads/2020/04/Template-EMAC-Telehealth-Executive-Order-04.2020.docx"
 target="_blank"
 >form executive order</a
 >
 that Governors can use to achieve this result efficiently. If adopted, this
 order includes a broad waiver of in-state licensure requirements for
 physicians licensed in another jurisdiction and allows them to provide any
 services they could provide in their home jurisdiction via any remote
 telecommunications technologies. Universal adoption of such an order would let
 physicians treat patients anywhere in the country via telehealth and
 facilitate the efficient implementation of nationwide telehealth networks.



 The latest movement in reducing complexity and ensuring compliance with
 licensure is also underway. Under current law, healthcare professionals must
 maintain licenses in each state they provide services. The bipartisan TREAT
 Act, introduced on August 4, 2020, would allow healthcare professionals
 licensed in good standing to provide in-person care or telehealth visits from
 any state in future national emergencies without jeopardizing their state
 licensure.


<h2>Shaping the Future.</h2>


 Cross Country Healthcare has been at the forefront of leading change in the
 areas of credentialing and licensure. Several of its leading executives are
 engaged in spearheading efforts to evolve these practices both within client
 facilities and in the industry as a whole.



 To learn more about the optimizing credentialing and licensure processes and
 other post-pandemic recovery efforts,
 <a
 href="https://www.crosscountryhealthcare.com/six-crucial-trends"
 target="_blank"
 >download</a
 >
 Cross Country Healthcare&rsquo;s extensive, evidence-based guide &ndash;
 Forever Altered: Adapting to a Post-Pandemic Healthcare Landscape.

Cross Country Healthcare

Licensure & Credentialing: Turning Temporary Fixes into Permanent Fixtures

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