January 19th, 2021 | Ryan Garman, Director, Sterling Healthcare & Life Sciences

License Monitoring for Healthcare Employers

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It may seem counterintuitive given how much healthcare employers are dealing with right now, but license monitoring has never been more important for healthcare employers. As hospitals are overflowing, post-acute facilities are managing more complexity than ever, and as finances are stretched, organizations need to maximize efficiency and minimize risk. Given the severe talent shortages, employers should also be helping their providers keep their licenses in good standing, and they need tools that make it easy to hire/re-deploy talent across state lines.

In speaking with clients over the years, I have heard again and again what a pain point monitoring is, so I understand if—given the current climate—revisiting those processes sounds miserable. However, there is good news. Monitoring has come a long way. Advancements in data and technology have enabled solutions that make daily, continuous monitoring easier and more robust—not to mention generally less expensive—than the gap-filled, old approaches.

The Risks and Frustrations of Traditional Approaches

First, let’s take a look at those clunky old approaches that have been the bane of existence for so many credentialing teams. Teams would track expiration dates and check for issues at some regular cadence that almost certainly was not daily. The problem with that is that a license check is a moment in time, while licenses are dynamic. If you check licenses annually, there are 364 days in between checks when a change could have occurred that you would not know about. Generally, the longer the license issue has gone undetected, the larger the financial penalties. There are companies that have had to pay settlements as high as several million dollars; just a quick look at the OIG Civil Monetary Penalties site highlights numerous settlements of tens and hundreds of thousands of dollars, for organizations ranging from skilled nursing facilities to dental practices. This risk is financial—reputational risk, and risk to your patients, are even more concerning.

In our recent webinar on this topic (available on-demand here), which I presented with Amy Andersen, Vice President of Operations at Verisys, we polled the audience and learned that 63% of attendees only check current licenses. It can be risky, though, not to have a historical view of all licenses the provider has held, and in all states. Amy shared an extreme example of a practitioner who had lost his license 17 times in different states… “and because states don’t talk to each other, this doesn’t get caught.”

However, the crushing administrative burden of old processes made it too overwhelming to do better. Managing and storing the license information, tracking the expiration dates and sending reminders, verifying renewals, and documenting primary source verification are all tasks that have made for complex and burdensome work, even to do the bare minimum. You may have hundreds or thousands of different licenses in your organization, and it is almost impossible to manually check each one regularly at the primary source to ensure they are in good standing.

However, license issues are not an edge case, nor are they limited to bad actors. Of the millions of licensed practitioners that Verisys screens daily, they see that at least 7% do not have a current, active license. 7%! Licenses may be impaired, suspended, revoked, or expired. A provider might have committed a terrible crime, but they might have forgotten to renew their license in time or to pay their student loans. This happens all too frequently.

Better Solutions

Given that license status can change on a daily or even hourly basis, the best way to manage licenses is to continuously monitor them. And fortunately, the data is now robust and accessible. Sources are improving their technology and processes and making more data readily available. There are states and boards that now publish multiple times a day. Sterling monitors licenses against primary-source data from thousands of data sources—over 800 taxonomy types, all provider types and license restrictions, across all 50 U.S. states and territories. Through our partnership with Verisys, we have well-established relationships with state and territory boards and access to more data than is published publicly, including historical data. The result is a fuller and more in-depth view of the provider.

Fortunately to use this powerful data you no longer have to go and check with an army of people—you can leverage technology to do this for you. At Sterling we have a new medical license monitoring solution that harnesses the data and delivers it via intuitive, easy-to-use technology. My colleague Nathan Anderson, Vice President of Product at Sterling, provides a glimpse of the streamlined interface and step-by-step workflow in a video here, but in a nutshell, here’s how it works. You share your full population to be enrolled in monitoring and their corresponding licenses (no matter how many licenses they have or have had). We verify the license at the primary source and capture a screenshot. We then enroll the license in ongoing monitoring. If a change in license status occurs, an alert is triggered and sent immediately to the contacts you have designated. We also track the expiration date and can send reminder notifications as the expiration approaches at the cadence you select. When a license is renewed, we automatically identify the renewal and run a new primary source verification.

The net result is much more comprehensive monitoring, with less work. The data and technology are working for you 24/7. You close your exposure period. If an issue arises with a license, you can take action right away, not in weeks or months. Perhaps most surprisingly, this is generally less expensive than the old approach (even before you count potential fines). It’s something you can put in place and immediately reduce risk to your patients, reduce the compliance risk, and reduce the risk of penalties.

Unexpected Benefits for Your Organization and Providers

Hopefully I have made my point that the ongoing monitoring solution is definitely the way to go when it comes to reducing risk and administrative burden. However, there are some unexpected benefits as well that are especially important right now, amidst a pandemic, talent shortage, and significant increase in travel nursing.

First, as I mentioned at the beginning, you want to do everything you can to support your providers during this time—and frankly, you need to, as you are going to have a hard time replacing them if you lose them. New license monitoring solutions like ours help providers with licenses in good standing get credentialed and move through administrative processes more quickly. These solutions make it easy to track expiration dates or other issues that could impact providers’ ability to practice. As Amy Andersen said in our webinar, “Providers are overworked, they are understaffed in many cases, and there’s just a shortage of providers—and especially during the pandemic that’s the case. This is not something that they want to spend their time doing. Anything that you can do as an organization to assist them helps tremendously.”

Being able to see all of a provider’s licenses also allows you to more easily move them from one location to another, even across state lines, when needed. We can monitor compact licenses, which allow providers to practice in multiple states, and are becoming increasingly common. This is helpful whether you are in Healthcare Staffing and deploying travel nurses, running a multistate health system and reassigning doctors and nurses temporarily to your highest-need locations, or employing telehealth providers.

Looking Ahead

As we turn the corner on Covid-19 in the months ahead, we are all aware that healthcare as we have known it will have fundamentally changed. Many of the challenges we faced pre-pandemic, such as talent shortages, are likely to be worse, as are financial strains. Consider how new license monitoring solutions can help lighten the lift for your organization, reduce exposure, and support your valued providers. Please reach out directly if we can answer questions.

This publication is for informational purposes only and nothing contained in it should be construed as legal advice. We expressly disclaim any warranty or responsibility for damages arising out this information. We encourage you to consult with legal counsel regarding your specific needs. We do not undertake any duty to update previously posted materials.