Vendor Compliance

Healthcare Reform and Vendor Credentialing

March 29, 2010

One of the questions buzzing among our customers is “What’s the expected impact of healthcare reform on vendor credentialing?” The answer is likely to be less than you think.  The desire to credential vendors comes from a variety of sources that existed well before healthcare reform movement.  While government mandates certainly drive some aspects of vendor credentialing in healthcare, much of it is from influences outside the government.

True, one of most significant drivers of the vendor credentialing movement is the government’s aggressive efforts to control fraud and waste perpetrated by the private sector providing services that are funded by Medicare/Medicaid.   These are the requirements to prevent providers from paying reps, principals, and entities that have previously defrauded the government and by proxy the American people.    But concerns about appropriate use of government funds already exist and have already led to the practice of checking state and federal level sanction lists.   So even if healthcare reform increases the number of patients whose medical care is paid for with government funds, the fraud control practice is already in place.

The other drivers for vendor credentialing come from the healthcare organizations that set medical practice standards. The focus of AORN, ACS, AHA, and the Joint Commission  on the procedures and behaviors in the healthcare process at least equal, if not outweigh, the government policy drivers. Because of these organizations’ concerns about patient safety, they have created best practices and other recommendations that translate into the immunization guidelines, the training requirements, and the sign in/out policies.

So the two great drivers of vendor credentialing — fraud prevention and patient safety — are already in play, regardless of the state of healthcare reform.   And any healthcare expansion, in terms of either the government’s role in funding or the number of people with access to healthcare, will not have a significant impact.

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