The Impact of Credentialing on Safety and Financial Outcomes: What We Can Learn from Recent Cases

March 24, 2021 RLDatix Marketing

The healthcare industry is continuously striving for Zero Harm by leveraging initiatives, tools and resources that support the safety of patients, families and staff. RLDatix’s Applied Safety Intelligence™ (ASI) framework includes compliance and provider management as central components that help link patient safety and risk management, focusing on moving the industry from a reactive, retrospective review of adverse events toward proactive prevention.  

In recent years, examples of ineffective credentialing processes have hit national headlines, signaling a clear call to action for organizations to rethink and restructure their processes to support patient safety. Two separate cases in Texas and North Carolina demonstrate the critical role effective credentialing plays in keeping patients safe and protecting organizations’ financial outcomes.  

Cracks in the Healthcare System: The Christopher Duntsch, ‘Dr. Death’, Case  

In 2017, neurosurgeon, Christopher Duntsch, infamously known as “Dr. Death” practiced in at least four Texas hospitals over a three-year period which resulted in numerous botched surgeries and two patient deaths, before he was sentenced to life in prison for one count of intentionally injuring an elderly patient. The victim, Mary Efurd, lost the use of one leg and also reported that medical equipment had been left in her body during the surgery. Throughout the trial, numerous patients came forward to share their stories of the pain and suffering they had suffered at the hands of Duntsch. He has now been accused of injuring more than 30 patients.  

The prosecutors in the Duntsch case maintain that he was able to practice for so long by exploiting cracks in the healthcare system that were created with the hopes of ensuring doctors such as Duntsch cannot continue to practice. Although Duntsch had violated standards of care in Dallas and his license was suspendedhis status as an independent contractor combined with his resignation shortly thereafter meant that the hospital was not required to report this data to the National Practitioner Data Bank. In another case involving Duntsch, after being granted temporary privileges, Duntsch was responsible for two adverse surgeriesIf Duntsch was an employee who had been fired for his actions, the hospital would have been responsible for reporting the incidents but reporting requirements for the data bank are only applied to staff and not independent contractors 

The Financial Impact of Provider Management: North Carolina Medicaid Case  

A recent North Carolina case highlights the financial loss that can result from a lack of robust credentialing and provider data management processes. A report from State Auditor Beth Wood’s office indicated that The Division of Health Benefits, responsible for screening and enrolling providers, had failed to identify and remove physicians whose professional licenses had been suspended or terminated. The impact of this oversight resulted in more than $1.6 million in Medicaid paymentto 21 unlicensed providers.  

Not only does this case shed light on the financial implications of a fractured credentialing process, it also reveals an even more serious problem connected to the safety and well-being of patients, as physicians’ licenses can be removed for actions such as malpractice, Medicaid fraud and sexual misconduct.  

Leveraging a Robust Credentialing Solution to Keep Patients Safe 

Both the Texas and North Carolina cases reveal that healthcare organizations must implement rigorous internal processes that support effective provider management. An in-depth credentialing tool such as RLDatix’s Provider Management solution helps organizations revamp their credentialing processes to streamline onboarding, improve provider satisfaction and, most importantly, drive safer care.  

RLDatix centrally maintains provider records including primary source verifications, enabling organizations to lessen risk and improve patient safety by ensuring that providers are equipped with necessary credentials to properly care for patients. We are committed to equipping you with an integrated approach to credentialing that supports your HRO initiatives by streamlining workflows, enabling data connectivity and breaking down silos across your organization.  

To learn more about how RLDatix’s Provider Management solution can support your credentialing and privileging efforts, click here. 

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