In a February 2023 conversation with Terry Chang, Vice President, Assistant General Counsel, and Director of Legal & Medical Affairs at AdvaMed, I asked him about his support for the trade association’s Health Care Industry Representative (HCIR) Credentialing Working Group, why the issue is important and what are the biggest opportunities for universal credentialing by accredited standards.
1. Tell me your story.
Currently I am the Vice President, Assistant General Counsel, and Director of Legal & Medical Affairs at AdvaMed in Washington, DC. AdvaMed is a trade association representing the world’s leading innovators and manufacturers of medical devices, diagnostic products, digital health technologies, and health information systems. I am now in my 16th year at AdvaMed and have worked on a number of initiatives to support a multi-disciplinary working group focused on credentialing. Like broader healthcare industry credentialing, the group comprises executives from various functions, including compliance, HR, and sales. Credentialing affects many parts of a supplier medtech company and hospital system.
2. What is your experience, history, and perspective on credentialing?
I support the AdvaMed Health Care Industry Representative (HCIR) Credentialing Working Group for almost 16 years. Early on, we focused on educating key stakeholders (e.g., AdvaMed Letter to The Joint Commission) on the role and responsibilities of HCIRs and on furthering greater uniformity and reasonable standards. We organized multi-stakeholder dialogues that produced a Joint Best Practices Recommendation of 12 associations. This evolved further as we worked with the Indiana Hospital Association (IHA) (IHA Matrix of Requirements; IHA Vendor Credentialing Resolution). That was carried into work with the Coalition, which was ultimately formalized into the Consortium. AdvaMed has also engaged other groups to further collaboration, advance standardization, and decrease the variation to improve efficiencies and patient access to medical technologies and the support provided by HCIRs.
Now, post Covid, there is a reemergence of interest and attention to the complexity of credentialing and the importance of finding better interoperable standards and ways to improve the current process. C4UHC’s accredited standards are the way to go and provide the solution.
3. Are there any other like processes to HCIR credentialing that have achieved interoperable efficiencies?
One of the reasons credentialing seems to have evolved this way is that initially, many programs appeared to have copied the processes from physician credentialing and privileging functions. Provider/physician credentialing understandably has numerous redundancies to prevent physician impostors and threats to patient safety. But since reps are not providing direct care and instead serve as an interactive technical resource, there isn’t a need for that level of redundancy. The reality is excess redundancy adds waste in terms of time and other resources and impedes effective support for patient care.
Some state legislators have pursued legislation to standardize the credentialing requirements within the state. Since a federal solution does not appear feasible in the foreseeable future, we are looking to support state legislative initiatives wherever possible. Legislation was introduced in Louisiana to establish credentialing uniformity and reciprocity. Ultimately, it was unable to advance. AdvaMed proposed model legislation referencing the first ANSI/NEMA Standard SC 1-2019 in states where related legislation was considered–e.g., Florida, Minnesota, New Jersey, and Rhode Island.
We will continue to look for opportunities to support state legislation that references the updated standard moving forward. There certainly is an interest in advancing healthcare ecosystem efficiencies. For instance, incentives could be put in place to overcome costs to move toward standardization.
4. Why is this issue important?
Timely patient access to care and escalating costs. Emergency care has been delayed because of credentialing inefficiency. For example, a patient presented to the ER with a pacemaker from a manufacturer that was not already credentialed by this hospital. The physician in charge utilized a workaround bringing the manufacturer rep in as a personal guest of the patient. The redundancy and associated billion-plus a year and growing costs consume limited health care resources without adding comparable value. If it can be done more efficiently and just as effectively, that would be best for patients and our health care system.
5. What do you see as the biggest opportunities for universal credentialing by accredited standards?
The biggest opportunities are furthering efficiencies, improving access to care, and driving costs down in the health care system.
6. What do you see as the biggest barrier to adoption?
There needs to be more awareness about this issue. The antidote is communication and collaboration – we can get there with education. Perhaps there could be incentives created for all stakeholders.
7. What would be your advice to different stakeholders in the process?
We focus on our members, advancing best practices and maximizing collaboration opportunities.
8. What is your vision for the future?
All the work C4UHC, advancing a pilot, promoting it to the larger health system, and advancing the business case for interoperable standards and a framework with reciprocity to move in that direction seems to be the immediate ideal. All of these factors will bridge the gap and bridge the incentive barrier.