Credentialing & Privileging

Real Metrics, Real Impact: How Credentialing Drives Patient Safety and Quality

By Acorn Healthcare Credentialing Solutions

Safeguarding patient safety is the top priority for healthcare providers. Credentialing-related issues are commonly cited problems in healthcare compliance and can have a direct impact on patient safety. In this context, it’s important to understand the difference between safety and quality. Through the patient lens, safety means avoiding bad events in a medical setting. Quality, on the other hand, is a purposeful, efficient model of care that reduces mistakes and increases the overall satisfaction in the experience for the patient.

Critical gaps in credentialing are often due to decentralized systems, outdated platforms, or lack of proper monitoring, which can lead to incomplete or missing data in provider applications. These issues expose organizations to fraud, delays, and potential malpractice risks​. With an average reporting of 250,000 deaths annually attributed to medical practice errors according to Johns Hopkins, the stakes have never been higher. The industry has seen a significant portion of these errors being traced back to insufficient or faulty medical credentialing processes. As healthcare systems evolve, so too must the ways in which they verify, credential, and enroll their medical professionals to maintain patient safety and quality.

Quantifying the Importance of Rigorous Credentialing Processes

Medical credentialing is the rigorous process of verifying healthcare providers' qualifications, experience, and licensure that protects both the provider and the patient from undue risk. However, when credentialing is done manually or inefficiently, the consequences can be dire. According to the NPDB, each year approximately 9,000 “never events” are reported due to systemic errors, with that figure including errors in medication, systems and processes, and communication. When reviewing the overall NPDB data, Public Citizen found that 1 in every 20 healthcare providers will have negative data in their records, which can include disbarment, suspensions, and exclusions. Without proper credentialing controls, those under-credentialed or fraudulently credentialed providers could potentially make their way in front of patients.

An NIH study found that approximately 90% of medical errors that occur in hospitals and health systems are related to system errors, and rigorous credentialing alone reduces adverse patient safety events by up to 25%. Compliance with credentialing standards is required by accrediting bodies like The Joint Commission and the NCQA (National Committee for Quality Assurance). According to The Joint Commission, facilities accredited by organizations like theirs, as well as the NCQA, tend to exhibit higher patient safety scores and report 50% fewer sentinel events

The Role of Automation in Reducing Risk

While traditional credentialing methods help mitigate risk, they are not infallible. Manual processes are susceptible to human error, fraud, and outdated information, all of which can put patients in danger. Automated credentialing systems streamline the verification and enrollment processes by using artificial intelligence (AI) and machine learning (ML) to ensure accuracy, consistency, and compliance. Automated credentialing and recredentialing cycles can reduce safety and quality risks by an additional 25–30%, according to credentialing provider reports.

As the complexity of credentialing grows, manually managing the credentials of hundreds or even thousands of medical providers is not only inefficient but also unsustainable. Automation reduces the administrative burden by allowing healthcare organizations to process credentials in a fraction of the time it would take using manual methods. Additionally, automation can keep up with real-time changes in provider credentials, ensuring continuous compliance with regulatory bodies, reducing the chance of non-compliance and the penalties that can follow.

A Clear Path to a Safer Future

As healthcare continues to evolve, the need for accurate and efficient credentialing and enrollment solutions will only increase. With Acorn Credentialing Solutions’ automated platform, healthcare providers can safeguard patient outcomes, reduce legal risks, and improve operational efficiency — all while maintaining the highest standards of care.

In a world where patient safety is paramount and the healthcare landscape is rapidly changing, automation is not just the future of credentialing — it is an absolute necessity. Reducing the number of malpractice claims, improving patient safety scores, and preventing sentinel events all hinge on how quickly the industry can embrace automated credentialing and enrollment technology. The healthcare industry must act now to incorporate automated solutions into their credentialing processes, ensuring that both providers and patients can thrive in an increasingly complex and regulated environment.

This article is sponsored by Acorn Healthcare Credentialing Solutions.