Taming the beast of multistate provider licensure for telemedicine
Photo: Eric Demers
The HHS Assistant Secretary for Planning and Evaluation’s Office of Health Policy found telehealth use during the initial COVID-19 peak increased from less than 1% of visits to 80%.
But even if some important questions about virtual care’s staying power have been answered recently, health systems and telehealth startups continue to face major challenges navigating licensing requirements to operate across state lines.
Whether it’s confusing, divergent policies, state by state, staffing shortages causing massive delays, or higher-than-ever demand for virtual care, health systems and startups need to find ways to lower administrative costs and shorten timelines.
Healthcare IT News sat down with Eric Demers, CEO of Madaket, vendor of a provider data management platform, to discuss his point of view on how to streamline telehealth licensing and ensure top-level, on-demand care for the patients who need it most.
Q. Generally speaking, what are the multistate caregiver licensing challenges health systems and telemedicine companies face?
A. Licensing is a complex, tangled web of varying requirements, timelines and red tape, regardless of the state. Complicating matters even more, each state has its own rules about which documents are needed for verification, different speeds at which the documents are processed, unique platforms for submission and, most important, different eligibility lengths before licenses require renewal.
Managing these license updates for a network of providers, whether a single practice or a health system, is more than just a full-time job – it’s a full-time department. Yet nonclinical staff have been in short supply for years now, with 61% of providers experiencing a shortage of qualified applicants.
This leaves many doctors, nurses and other health professionals in charge of their own licensing verification and updates, a task for which they are not formally trained, nor do they have the time. Not only does this process create inefficiencies and confusion, but mistakes can be very costly.
Once information is submitted to the state, it enters a black hole of communication, with processing time ranging from a couple months to the better part of a year. That delay can already put providers at risk of falling out of compliance, but it multiplies if there are mistakes in the submission, causing the process to reset and the clock to start back at zero.
Telemedicine companies encounter these challenges more frequently than traditional providers. With a business model built on flexible, remote care, it’s in the interest of telemedicine providers to expand across as many states as they can, increasing their network of care.
Of course, with that rapid growth comes more bureaucracy, a challenge that weighs heavily on these smaller providers.
Q. How can health systems and telemedicine companies lower administrative costs and shorten the timeline of multistate licensing?
A. Licensing is a burdensome task that requires attention to detail, long-term monitoring and a great deal of patience. Expanding that across multiple states requires an understanding of niche differences that can affect whether the verification is successful. The process has a narrow margin for error, and mistakes can be extremely costly.
Automation is a valuable tool for any provider looking to decrease that risk and can be a major time and cost saver. Provider data management platforms act as central sources of truth, tracking deadlines and status for all medical staff on payroll and storing their information.
These hubs of information save onerous manual processes of entering and re-entering licensing information for multiple states or providers in the same hospital network, instead automatically filling that information using its existing knowledge bank.
Provider data management platforms also track deadlines for all relevant states, ensuring that providers are notified of renewals with ample notice and are not caught scrambling to ensure they are in compliance.
Much like other automation software designed to streamline government forms – TurboTax, for example – provider data management platforms clearly spell out the specific requirements for each needed state in a digestible manner, simplifying the process and lowering the risk of submitting incorrect information.
As I outlined, there are real economic consequences to delays in the licensing process. Individual providers will not be allowed to practice until their license is approved, which can extend for several months if the information supplied is not accurate and complete.
All these factors contribute to the massive administrative waste in the healthcare industry. 15-30% of medical expenditure goes toward administrative spending, half of which is wasted on unnecessary tasks and logjams caused by bureaucratic red tape.
And with staffing shortages in all phases of care, there are fewer trained professionals to manage increasingly complicated processes. Many sites are so strapped for administrative personnel that the burden falls directly on the care providers to manage licensing requirements, along with enrollment, credentialing and other general admin tasks.
Automating eases the burden on staff, allowing more resources (staff and money) to be directed instead to patient visits. Doctors are able to see more patients per day, receive payment faster and dedicate more of their limited time to practicing, rather than on administrative tasks.
Q. You have said that your company has helped clients like MindStrong navigate millions of provider transactions in 2022 alone, helping to deliver needed care to patients in many states. How did you do it?
A. Automation is not just a solution for licensing. There are several other administrative burdens that eat into providers’ time and profit. Each payer system has its own unique process for enrollment, and, like with licensing, delays can have dire consequences.
When a provider is not correctly enrolled in a payer’s system, the payer will not be able to reimburse the provider for care billed to that plan. This puts providers in the unenviable position of having to either carry the cost of care for months, waiting for the issue to be resolved, or turn away patients on these plans until things are sorted out.
And similar to licensing obstacles, providers must keep their credentials in order with their medical groups, proving their eligibility to deliver care before they’re able to practice.
Licensing, credentialing and enrollment all require much of the same information. Madaket’s platform spans the provider data management ecosystem to automate all these tasks and many others. Instead of entering the same information into several different automation solutions, providers are able to enter it once into a platform that acts as a single source of truth for all their administrative renewals.
The breadth of the platform and its secondary function as a transaction company also helps to validate a directory of information that eases tasks for third parties, such as payers, individual providers and others. While licensing may require renewal every few years, active users of the platform update their information monthly, resulting in a data pool more accurate than others publicly available.
Payers, for example, can find up-to-date information on a provider that was entered during a recent credentialing, and use that information to keep their own databases accurate and streamlined. Those database elements affect compliance with federal regulations that require payers and providers to support price transparency and limit surprise billings to consumers.
All these elements combine to offer full control of healthcare administrative ops.
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Healthcare IT News is a HIMSS Media publication.
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