Microhospital Credentialing: Scale Down Without Shirking Standards

Despite the burgeoning care model’s promise, its proliferation is outpacing the development of environment-specific requirements.

The following is an excerpt from an article that originally appeared on the Credentialing Resource Center, September 13, 2017.

Featuring a handful of inpatient beds and a narrow selection of community-tailored services, microhospitals are seeking to revolutionize care delivery in cities across the country.

These pint-sized purveyors of targeted interventions have a two-fold appeal: they present healthcare institutions with a low-risk vehicle for expanding or redefining their market presence and tout faster, more accessible care for patients in hubs where sluggish traffic, overcrowding, and limited building options can put traditional hospital services out of comfortable reach.

But despite the burgeoning care model’s promise, its proliferation is outpacing the development of environment-specific requirements. Because microhospitals are currently regarded by CMS, accreditors, and many states as acute care hospitals, medical staff professionals (MSP) and medical staff leaders must determine how best to rescale credentialing and privileging processes originally developed for tertiary facilities.

The good news for MSPs is, once an organization has overcome any legal hurdles and opened its microhospital doors, credentialing providers for practice at the new location will likely have a minimal impact on the existing workload, says Kathy Matzka, CPMSM, CPCS, FMSP, an independent medical staff consultant in Lebanon, Illinois. “I don’t see a big change as far as an MSP’s job.”

Of course, a microhospital’s specific approaches to vetting, assessing competence, and governing the medical staff may vary depending on a number of operational circumstances. But a department dedicated exclusively to microhospital credentialing would be an unlikely sighting.

“It wouldn’t be cost-effective,” says Matzka. “They really don’t have the volume to support a full-time or, in some cases, even a part-time credentialer.”

Instead, she envisions most microhospital operators would implement approaches commonly seen among similarly situated critical access hospitals (CAH). That is, freestanding entities would appoint an administrative staff member to take on credentialing as an additional responsibility or outsource the function to a commercial credentials verification organization (CVO), while system-based microhospitals would route the credentialing work to a larger member facility or a centralized department.

Organizations that opt to perform microhospital credentialing on-site should work smarter—not harder—to overcome resource limitations that might make compliance more arduous. “The trick is learning how to be efficient and expedient to meet those regulations,” says Lyndean Lenhoff Brick, JD, president and CEO of Murer Consultants, a healthcare management consulting firm in Mokena, Illinois, that has guided client health systems through microhospital builds.

Brick recommends cross-training staff on related functions. For example, credentialing may be performed by an HR director, accreditation specialist, or quality specialist. “They’re going to have to wear many hats to make this economically viable.” To improve the chances that cross-training will stick, be sure to hire competent staff with a high capacity for multi-tasking, Brick advises.

Microhospital-based credentialers can also look to their peers in the trenches for management tactics, such those in CAHs and other compact facilities that have decades of experience in running lean, efficient operations. “Cross-training is not really a new concept. It really is just an extension here in the microhospital of what’s taken hold already in the healthcare industry,” says Brick. “Rural hospitals have been doing this for generations.”