Pennsylvania’s Physician Credentialing Process Is Keeping Doctors from Patients
September 18, 2015 | By: Michael Consuelos, MD, MBA
Physician credentialing. It sounds like one of those down-in-the-weeds but necessary details that patients, the general public, and their elected representatives have no need to concern themselves with. Right?
Wrong. Pennsylvania’s antiquated, cumbersome, paper-based system of making sure that doctors are approved, or credentialed, to care for patients is gumming up the works. Our credentialing system is slowing down access to health care.
Rural and urban areas with vulnerable communities, where physicians can be in short supply, often feel the impact most keenly. The credentialing process can mean the difference between getting a doctor’s appointment in a few weeks—or waiting for months.
Before “new” doctors (those who have just completed their training) or doctors who are relocating can start seeing patients, they must be credentialed. That can take up to six months and involve 25–50 pages of faxed-in forms.
To slow things down even more, doctors must be credentialed not once, but separately for every insurer accepted by their practice. A typical physician practice may accept health plans for six, seven, or even more insurers.
For doctors, that’s a lot of redundant paperwork and lost revenue. For patients, it’s a big delay before they can see that new physician just hired to reduce wait times for appointments.
Credentialing bottlenecks have affected me many times during my career. In July, my wife's practice hired a new pediatrician who is still waiting to be credentialed. This lag reduces patient access and creates unnecessary administrative burden on her office.
To understand just how frustrating this can be, let’s use an example of a “credentialed” activity we are all familiar with: driving.
As a driver, what if you had to stop and apply for a new license every time you crossed state lines? Or switched car insurance companies?
In essence, that’s what doctors have to do.
Several trends are escalating this situation from major inconvenience to important policy issue.
Over the last year, nearly 400,000 Pennsylvanians—many of them previously uninsured—got health coverage through Obamacare. That’s a lot of Pennsylvanians who need to start seeing doctors.
The demand for doctors is also increasing because our state is aging. Between 2010 and 2020 about 500,000 Pennsylvanians will turn 65. This growing population of seniors and elderly will need physicians’ help to maintain the best possible quality of life and independence.
Health care champions like State Rep. Matt Baker (R-Wellsboro) aim to address this problem. Rep. Baker is working on legislation that would simplify and streamline the credentialing process. A key goal is to create a common credentialing form that all insures could use—a “common app” for physicians.
Physicians want off the sidelines and into the game. We need them in the lineup to win the ultimate prize: good health for all Pennsylvanians.