Exploring a shared solutionAORN is working with industry, hospitals, medical associations and accrediting organizations to develop ways to improve the credentialing process for healthcare industry representatives
By Carina Stanton
Senior News Editor
Today hospitals and healthcare companies are at a tipping point. Each is working to manage the high costs, increasing time required and lack of standards available for credentialing the healthcare industry representatives (HCIRs) that enter hospitals across the country on a daily basis.
Whether these professionals are visiting a facility to drop off loaner instruments or work with OR staff to monitor or train on new technologies, many HCIRs must meet various credentialing requirements before entering a healthcare facility. However, with no national standard for credentialing criteria, increasingly, facilities are creating their own credentialing requirements that each vendor representative must meet.
Healthcare industry representatives visiting
a healthcare facility may need to prove
their credentials.
Photo courtesy of HealthStream.
Despite the different viewpoints that hospitals and vendors may have on the issue, most will agree that the ever increasing challenge of managing current vendor representative credentialing documentation for the high volume of HCIRs that enter the healthcare setting is stretching budgets, employee time and patience.
"Holding the HCIR accountable is important for the safety and privacy of the patient and staff," said Ruth Vaiden, RN, CNOR, CRNFA(E), vice president of clinical development and education for SurgiCount Medical in Temecula, Calif., and a former AORN president. "However, there has to be a consistent standard [for credentialing] that is less costly to the vendor."
Listening to member concerns, AORN is working in collaboration with other health care associations, such as Advanced Medical Technology Association (AdvaMed), industry representatives, and accrediting organizations like The Joint Commission. Our goal is to come up with a shared solution together, said Fred Perner, MBA, JD, AORN's vice president of business development.
Drilling down
Perner is leading AORN's efforts to collaborate with industry, hospitals, partner associations and accrediting organizations to address these challenges so all parties involved can ensure patient safety through vendor representative credentialing, but in a cost effective way that efficiently uses resources and protects patients.
"There are two sides of the equation here and you need to understand all of the perspectives," Perner said. "We know that industry representatives play a vital role in the healthcare setting. Having said that, we know there are problems associated with credentialing, including lack of standardization and a lack of shared data, resulting in repetitive transactions," he explained.
Perner said the key is getting everyone at the table to agree and work together. So far, he has found many willing participants on all sides of the issue who want to improve vendor representative credentialing.
"When we understand each other's positions, needs and capabilities, we can create the foundation for a vendor credentialing process that truly serves patient safety, which is everyone's end goal," he added.
Finding common language
One of Perner's first steps in addressing vendor credentialing concerns was to look at the different credentialing processes and third party credentialing firms in the marketplace. He also reached out to The Joint Commission.
In 2009, The Joint Commission plans to solicit comment from the field on draft requirements related to vendor representative credentialing. This feedback will help guide development of the standards requirements, according to Laura Smith, MA, associate project director in The Joint Commission's Division of Standards and Survey Methods. "The goal is to implement these standards requirements in 2010," she said.
In the meantime, groups like AdvaMed have been developing potential credentialing criteria for vendor representative credentialing and sharing this information with Smith and others at The Joint Commission, while educating stakeholders on the varied and multiple roles of the HCIR.
"AdvaMed has spent a lot of time thinking about the concerns different stakeholders are trying to protect, including patient safety, risk management, privacy protection and regulatory responsibilities," Perner noted.
One example of these concerns, is that some of the hospital HCIR requirements impose confidentiality agreements that are inconsistent with the FDA (Food and Drug Administration) adverse event reporting requirements, which are essential to the safety of a device, explained Terry Chang, MD, AdvaMed director of medical and legal affairs. AdvaMed is an association that represents medical device manufacturers, makers of medical equipment, medical software and medical technology.
Chang is the administrator of AdvaMed's interdisciplinary working group created in 2006 to explore solutions to some of the unintended consequences that have resulted from a surge in access and credentialing requirements for vendors.
Early on the group recognized that many of the concerns with vendor representative credentialing stem from a lack of standardization and a high degree of variability for credentialing requirements. To address this lack of standardization, AdvaMed's working group developed Recommended HCIR Credentialing Criteria based on field experience with credentialing policies nationwide. The vendor representative credentialing criteria include:
- health vaccinations
- product liability insurance
- background identification
- hospital unit orientation
- training documentation
"We hope these criteria and the other credentialing documents we created and shared with The Joint Commission will serve as a starting point to vet these concepts with other stakeholders," Chang said.
Gathering feedback
After reviewing these documents, particularly the Recommended HCIR Credentialing Criteria, Perner and other members and staff leaders at AORN determined these criteria do serve as a good starting point to share with others.
So, Perner recently shared AdvaMed's criteria document with members of the Industry Partners for Patient Safety group (IPPS), which was established in 2007 by AORN members who are industry leaders interested in supporting and promoting the awareness of surgical patient safety.
Other AORN members, including members of the Business, Industry and Consulting Specialty Assembly are also providing feedback on the criteria.
In addition to reviewing the credentialing criteria, IPPS also recently conducted an online survey with AORN managers to determine how facilities are credentialing vendors.
"IPPS fully endorses and supports vendor credentialing for patient safety and we believe it is relevant that AORN is on the forefront of establishing criteria for vendor representative credentials, because the operating room is the intersection where patients, perioperative staff and industry representatives most often meet," said Jack Serino, chair of IPPS.
AORN is also reaching out to these involved parties to better understand possible concerns with the current vendor credentialing situation and to determine best practices for the future.
A big concern from industry is cost.
"Some of my reps may be in two to four different hospitals on a given day and each hospital may have a different process for credentialing," said Vaiden of SurgiCount and an IPPS member. "On average, it costs us $150 to credential one of our representatives at one facility."
Healthcare industry representatives often work in
operative or invasive procedure settings and may
need to prove their training for this work as part
of their credentialing process.
Photo courtesy of HealthStream.
Her facility has also hired a dedicated staff person to manage HCIR credentialing.
AORN has also been talking to hospital representatives to understand their current processes for vendor credentialing and why these processes were developed.
"Some HCIRs had no idea how to move about the perioperative environment without compromising the sterility of items, thereby putting the patients at risk," explained Claire Everson, RN, LMT, CNOR, clinical educator at Banner Health in the Phoenix metropolitan area and a member of AORN's board of directors.
"Some HCIRs were bringing in supplies that hadn't gone through committee for patient use and then we had no way to get reimbursed," she added.
At St. Francis Hospital in Tulsa, Okla., AORN President Susan K. Banschbach, RN, MSN, CNOR, noted that her facility began requiring special identification and verification of HCIRs visiting her facility in 1980. But, she added, "over the past several years this verification has progressed to a more comprehensive system following an adverse outcome on a patient at a facility on the East Coast when a vendor adjusted a fluid flow piece of equipment."
Both Everson and Banschbach's facilities use an internal system for vendor credentialing, which includes a packet of information HCIRs must fill out that is kept on file at the hospital. Those HCIRs with frequent contact to patients require enhanced credentialing documentation and identification to show proof that they are qualified to enter patient areas.
Banschbach likes her facility's internal approach to vendor credentialing because it allows her direct involvement in the process. However, she recognizes that due to the sheer volume of work required to manage HCIR credentialing documents, some facilities are using outside vendor credentialing firms, such as RepTrax, Status Blue, and VendorMate, Inc.
Getting buy-in
AORN also is gathering feedback on vendor credentialing from partner associations, such as the Association of Critical Care Nurses, the Association for Healthcare Resource and Materials Management, and the American College of Surgeons and Innovative Healthcare Access Coalition. Perner and Chang hope to have all feedback gathered to develop a standardized HCIR credentialing criteria by the end of the year.
With this understanding for what hospitals and vendors are facing to credential vendors, and feedback on how the process could be improved, AORN, AdvaMed and others are sharing this information with Smith and others at The Joint Commission.
"The Joint Commission is concerned with patient safety and quality of care as it relates to credentialing of vendor representatives. As a result, our focus is on the vendor representatives in operating rooms and procedure rooms who provide training or guidance in the direct presence of patient care," Smith said.
Perner stressed, "Our hope is to provide The Joint Commission with a collaborative message and agreed-upon recommendations for improving vendor credentialing. The more feedback we can gather from all parties involved to share with them, the better."
Additional Resources
The Role of the Health Care Industry Representative in the Perioperative/Invasive Procedure Setting
How are you dealing with vendor credentialing in your facility or company? |
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