The Unfinished Book

Niagara Falls summit a ‘decent first attempt’ to get buyers and sellers on the same page.

Vendor credentialing may have been eclipsed over the past 12 months by healthcare reform, concerns about the economy, and the midterm elections. But “out of sight, out of mind” definitely does NOT apply here. The topic appears to be very much on suppliers’ minds. Questions – and concerns – still outweigh the answers for distributors and manufacturers, who are asking:

  • Will hospitals ever agree on one set of requirements for clinical sales reps (that is, those who call on patient care areas), and one for non-clinical?
  • Will the number of vendor credentialing firms narrow, eliminating some of the duplication – and cost – that currently exists in the system today?
  • Will a so-called “universal passport” – which would give a sales rep access to any hospital in the country – ever exist?
  • Will vendor credentialing firms – who maintain that they are merely doing hospitals’ bidding – ever push back and encourage hospitals to cut back on the policy requirements?

Providers have their own questions. “You think we want to do this?” one materials executive reportedly said to suppliers at a recent vendor credentialing conference, referring to hospitals’ vendor credentialing efforts.

Get the discussion started
In October, VeriREP, a vendor credentialing program created by the Western New York Purchasing Alliance (now Altus Management), convened what it called a “vendor credentialing summit” in order to air some of these issues. Key stakeholders – including a few vendor credentialing companies, hospitals, manufacturers and trade associations – were on hand in Niagara Falls, N.Y., for the event.

The fact is, hospitals have to do some kind of credentialing, says Kevin Connor, president of VeriREP, which primarily serves hospitals and suppliers in the Northeast. “They need to have PPDs [TB skin tests] managed by their infection control or employee health departments. They need to know reps are insured.

They need to know [the reps calling on them] aren’t criminals.”

The question is, can a credentialing process be devised that will satisfy buyers and sellers?

“We hear constantly from reps and companies what a hassle this whole vendor credentialing process has become to them,” says Connor, explaining the rationale behind the summit. “We thought [the summit] would be a great opportunity for people to get together, put some issues on the table, record what those issues are, maybe resolve some, maybe not others, because they have no solutions. But at least get the discussion started. Did we accomplish that goal? Yeah. It was a decent first attempt.”

Unfortunately, just three vendor credentialing organizations – VeriREP, Status Blue and Vendor Credentialing Services – showed up, says Connor. “I think the big reason was that [the summit] was being hosted by a [vendor credentialing organization],” that is, VeriREP, he adds. Future summits may have to be hosted by a neutral third party, “somebody that everybody feels more comfortable with.”

Consensus reached
Those in attendance reached consensus on a number of issues, including the most basic, that is, the need for vendor credentialing – and even for third-party vendor credentialing companies.

Vendor credentialing firms fill a huge unmet need among hospitals, says Jo Ann Autenrieb of Intermountain Healthcare, Salt Lake City, who attended the summit. Intermountain is a case in point. In 2006, Autenrieb was named the IDN’s vendor access program manager, charged with developing a systemwide program for vendor credentialing.

“We had a program in place, but it wasn’t very good,” she says. Many of Intermountain’s 23 hospitals had their own versions of credentialing. Different hospital departments chased down immunization records from the sales reps. “I wouldn’t even begin to tell you how that information was stored,” she adds. Vendors were asked to come to Salt Lake City to listen to the IDN talk about its access requirements. “So you had the cost of everybody’s time and plane fare,” she points out. “We knew we had to centralize the process and make it more professional.”

Autenrieb spent the better part of a year investigating setting up an IDN-wide vendor credentialing department. But after researching the manpower and software that would be required to do so, she decided that Intermountain would be better served by employing one of the vendor credentialing companies, which were starting to break onto the scene. After some time, Intermountain chose to outsource credentialing to one of those firms, Marietta, Ga.-based Status Blue.

“The bottom line is, it has been more than what we expected,” she says. “It has been wildly successful.” The credentialing process has been standardized across all of Intermountain’s facilities.

A key to the success of the program has been the participation of Intermountain’s employees and staff, says Autenrieb. “We knew we needed the support of our employees. We needed them to be aware of what was going on, what the requirements [for vendors] were. We have many doors within our hospitals.”

Employees had to be trained on proper protocol. Now, staff members throughout Intermountain facilities feel comfortable challenging vendors who are walking the halls without a proper badge, she says.

On a continuing basis, Autenrieb monitors vendor logs to see who’s coming into the IDN’s facilities, who they’re calling on, and whether they are complying with Intermountain’s requirements. She also monitors the training not only of Intermountain employees, but vendors as well, helping them understand the IDN’s policies.

Buoyed by the success of the program, Autenrieb is examining how consultants, service technicians, contractors and others can be brought into the program. “Intermountain has been extremely pleased,” she says. “We feel we’re looking at the safety of our patients, employees and vendors. We want to make sure everyone is on the same page.”

Not all vendors are enthusiastic, she admits. “But this is our house; this is the way we do business.

Cost of doing business
“I want vendors to understand this is not a revenue-builder for the hospital,” she continues. “That’s something we’ve been accused of.”

Sensing the frustration of some vendors, Autenrieb has issued an open invitation to them to come to Intermountain and tour its facilities. “I want them to see the business end of our operation” and to learn what it’s like for hospital staff to work with the many vendors that call on them, she says. “We want our vendors to know why it’s important that we educate them on our policies and how we do business.

“The way we look at it is this: [Vendor credentialing] is part of the high cost of doing business,” says Autenrieb. Suppliers have relationships with Intermountain clinicians, and the deals they strike “affect our profit margin,” she says. Vendor credentialing is essential to help monitor those relationships.
Credentialing also helps Intermountain standardize products and eliminate redundant SKUs in its warehouse. “To our vendors we say, ‘If you want to introduce a new product, you need to go to the sourcing manager,’” says Autenrieb.

Another summit attendee – Cynthia Medina – offers a vendor’s perspective.

“The way we see it is, when our reps go into a hospital, it’s the same relationship as when you go into a friend’s home,” says Medina, who manages vendor credentialing for Maquet, the Wayne, N.J.-based OR product company. “If there’s a sign at the door that asks you to remove your shoes…you do so as a courtesy.” So it is with vendor credentialing. That said, Medina isn’t averse to exerting a little pushback to the process.

With more than 200 reps in the field, managing Maquet’s vendor credentialing program is a big task. “The company recognized [credentialing] had become a part-time job for our sales reps,” says Medina. Reps were getting so many e-mails from vendor credentialing firms that they tended to ignore them, and then they would find themselves denied access to hospitals for failure to respond to requests for information. So Maquet hired Medina to field those e-mails and help reps comply with the many requests being made of them. “Instead of our reps managing the credentialing process, it made sense for us to do it, so they could be productive in the field.”

Most Maquet reps deal with multiple vendor credentialing firms, each of which asks for different things, she says. For example, some hospitals call for a 10-screen drug panel instead of the more traditional five-screen, or they may dictate five drugs that differ from those covered in the traditional five-drug screen.

Many hospitals instruct their vendor credentialing firms to demand from vendors the same information the hospital collects from their employees. “But we are not their employees,” she says. “Some of this [information] has absolutely nothing to do with sales reps being in their locations.”

What’s more, some hospitals have taken to include multiple policies – some as many as 25 – in their vendor credentialing processes. “I understand there are certain things hospitals want reps to know,” says Medina. “But some are redundant. Don’t ask me for proof of knowledge of OR protocol and aseptic technique, then put 15 different handwashing policies in there.”

Medina believes hospitals can be more selective in the policies they include, and she believes vendor credentialing firms should step up and provide hospitals some guidance on the matter.

Due diligence
Despite the problems, Medina understands why hospitals insist on credentialing, and believes that vendor credentialing companies probably do a better job of it than hospitals themselves. One Maquet rep was denied access to a hospital because the hospital lacked the time to review her credentials, she recalls. That probably wouldn’t have occurred had a vendor credentialing company been involved.

That said, the process would work much better if everyone – hospitals and suppliers – did their due diligence, she believes.

“We do our due diligence by hiring good candidates and then making sure they are well-trained,” says Medina. New employees are immediately sent for titers, vaccinations, TB tests and drug screens. “When we send a marketing team member into an OR, we make sure they are credentialed. When we send an engineer out to explain our technology, they are credentialed. Before any of our employees enter an OR, we make sure they are credentialed.”
Maquet reps are trained on an ongoing basis, she adds. “I want to make sure our reps are not pulling information out of their head, but that it’s coming from their training.”

For their part, hospitals need to “vet” the sales reps who call on them, says Medina. If a rep fails to meet the same high standards that companies such as Maquet expect of them, the hospital should deny them access to the facility.

Vendor credentialing companies need to do some due diligence as well, she adds. Instead of merely passing along hospitals’ informational requests, they need to push back and make sure that those requests yield meaningful information.

As 2010 draws to a close, vendors seem to have accepted their customers’ need to impose controls on the reps who call on them. But, as the vendor credentialing summit showed, the devil remains in the details.

A real controversy exists around background checks, says Connor. When the topic was brought up at the summit, “the manufacturers jumped all over it,” he says. “It’s dicey. We agreed that background checks should be conducted, but we didn’t agree on the parameters on which those background checks should be evaluated.”

For example, is a Class A misdemeanor enough to keep a rep out? And what is the definition of “misdemeanor” anyway? It varies from state to state.
“Everyone agrees that a felon should not be in the hospital,” continues Connor. But should a person convicted of a DUI be denied access? And how long ago? A year ago? Five years ago? “These are decisions hospitals have to make – and today, they are making them on an inconsistent basis,” he says. “If there’s one area that should be explored and standardized and really discussed from a legal, compliance perspective, it needs to be the background check.”

Not surprisingly, the cost of vendor credentialing was another topic of discussion at the summit, particularly among small suppliers. Some of the hospital supply chain executives dismissed their concerns, pointing out that many suppliers used to spend more on coffee and bagels for their customers than they do on vendor credentialing today, says Connor. “Is it a trade-off?” he asks. “Not really. But it is a way it’s being justified.”

What’s next
Attendees at the summit agreed that a committee with representatives from key industry organizations should continue the discussion and develop some kind of structure for vendor credentialing. “Almost everyone seemed to conform to the idea that stakeholders should continue to meet as the industry matures,” says Melissa Jeckovich, credentialing specialist for VeriRep.

“Coming away, there needs to be some standardization,” says Autenrieb. Yes, hospitals will always have unique requirements. But perhaps as much as 80 percent of the credentialing process – items such as immunization requirements, etc. – could be standardized industrywide, she believes.

“I think we’re a lot more standardized than we think we are,” says Connor. “Certain criteria are ‘must-haves,’ like a rep’s name, rank and serial number,” he says. Indeed, virtually everyone at the summit agreed on some basics, such as a rep’s contact information, insurance documentation and proof of training.

“And everyone agreed that [vendor credentialing companies] should exist as a third party to capture this information. Hospitals don’t have the resources to do it; it’s an administrative nightmare for them, and they don’t trust manufacturers providing it to them,” he adds.

“The conference enhanced relationships, standardization and a knowledge-based way of doing business,” says Autenrieb. “Some people were frustrated and angry. That was an eye-opener. But it was beneficial.”