Or does it?

Should national, if not industry, standards be established for vendor credentialing companies on the type of data collected about the thousands of sales representatives visiting healthcare facilities?

Not surprisingly, two of the leading vendor credentialing companies offer a resounding yes, but with some qualifications.

John Harper, director of marketing, Vendormate Inc., Atlanta, divvied the debate along two key lines: Participating in patient care and managing the supply chain. The former appears to be farther along than the latter, Harper suggested.

"Most healthcare systems have different requirements for vendors that access, record, transmit patient data and those that do not. Between vendor reps in procedural, or sterile areas, and those that aren’t. There are generally differences between vendors that visit the healthcare facilities and those that do not," he said. "It seems unlikely that these will become standards with the weight of law. Rather, these are likely to become standardized along the same lines that standards from AORN, ACS, and others emerge. There will be generally accepted best practices."

Yet processes are a bit more complicated when it comes to managing the supply chain, according to Harper, who estimated that healthcare organizations on average deal with more than 3,000 vendors to run their hospitals.

"There are thousands of vendors that are not medical device, pharmaceutical or medical distributors, such as food service providers," he continued. "The credentials of all of these vendors – in terms of financial due diligence, legal standards, insurance requirements – are functions of risk management. What is the risk to the ability to continue to deliver service? Standards are not likely to emerge here any more than all the businesses operating in any other industry use the same standards in qualifying their vendors."

John Wills, founder and president, Status Blue LLC, Marietta, GA, also remains somewhat skeptical but ultimately hopeful.

Wills cited the ongoing presence of exceptions or additions to standards as a complicating factor. "For example, there are some medical staffing committees that require certain credentials before extending privileges to a physician," he noted. "These credentials are not standardized and differ from one hospital’s medical staffing committee to another’s. Hospitals appreciate guidance and best practices, but they also place a tremendous amount of value on autonomy.

For Wills, cautious optimism may be the prevailing attitude.

"Vendor credentialing standards would be fantastic, but to assume that every hospital, compliance officer, risk manager, infection control officer, director of surgical services and supply chain manager would accept these standards and not deviate from them would be unrealistic," he said. "Each hospital deserves autonomy on how they decide to manage and credential their vendors."

In a sputtering economy that stresses standardization and fiscal transparency as potential antidotes, along with increasingly popular open source computing options, vendor credentialing companies have to reinforce their message that they generate process efficiency.

Despite competition from other companies as well as home-grown provider programs and a familiar argument afflicting the standards-focused supply chain software companies – products don’t communicate universally with one another – vendor credentialing companies find the debate healthy at least.

Vendor credentialing firms reflect the desires and policies of the healthcare systems they serve, Harper insisted. Meanwhile, healthcare systems have to balance carefully government mandates, industry trade group best practices, and their own insight to their operations, such as formulary boards, purchase review boards, board of directors, he continued.

"As far as transparency, there is no desire to deceive the supplier community," Harper said. "Vendor credentialing programs have already increased the consistency and transparency of the buyer’s requirements. Simply by publishing the requirements online, vendors have a better sense of the metrics of the buyer. 

"Until all of these align, standards, and resulting efficiency, are unlikely," Harper concluded. "The key will be determining who has the authority to set these desired national standards. Many expected The Joint Commission, as the leading accrediting body, to take up this charge, at least in respect to the clinical [vendor sales reps]. The alternative is the federal government. Unless we are willing to accept nationalized healthcare, and even more extensive government involvement in healthcare operations, that seems unlikely as well as a misguided approach. Rather, it makes the most sense to keep the operating requirements closest to the patient and caregiver – determined by the local healthcare providing organization."   

While a centralized way of credentialing vendors is possible, the current marketplace’s intrinsic nature makes it improbable, according to Wills.

"[This] suggests that the only task of vendor credentialing is that of a data repository," Wills said. "Collecting vendor representative credentials is a significant part of the service, but it is not the only service of value when working with a vendor credentialing partner. Hospitals who have performed proper due diligence and partnered with a vendor credentialing company have done so because of the additional attributes – vendor visitation logs, vendor scoring, reporting capabilities, etc. – and benefits provided when working with that partner. At this point in time there is no impetus for vendor credentialing companies to begin to write programs that would push, pull, and share data with each other."

But Wills admitted that a vendor paying an annual fee, submitting documentation once and gaining compliance with more than 300 hospitals is very efficient. "Could it be more efficient if we all shared information and revenues?" he asked. "Perhaps it could be. However, the quality of the credentialing service and the individualized attributes of each vendor credentialing company that a hospital chooses to utilize would be compromised or lost altogether."

Embracing an EHR philosophy for the vendor credentialing process seems like a no-brainer where administrators, clinicians, payers and patients ideally enter information once into a system, regardless of brand, company or service.

But in reality, such a concept may be unrealistic for vendor credentialing purposes.

"It would be ideal for hundreds of processes to be universal and paperless and have the task of data entry be undertaken once and thus completed permanently," Wills said. "However, the privacy of the vendor would be a concern with this universal philosophy. In the current environment within Status Blue, vendors are only sharing their information with hospitals that are contracted with Status Blue."

Wills further emphasized the need for priorities.

"It does not seem realistic for vendor credentialing records to be universally managed before the adoption of electronic patient records," he continued. "Discussing the future of such implementation makes sense. However, I would question the industry’s commitment to electronic medical records if vendor credentialing jumped ahead of the execution of the long overdue EMR initiative." 

What’s preventing standardization from happening in vendor credentialing circles is precisely the issue delaying EHR acceptance, according to Harper.

"EHR has faced a significant battle in coming true exactly because of this philosophy of providing data and letting it be shared with anyone who has an interest in it," he said. "That issue of privacy and control has yet to be solved."

But Harper indicated that the more accurate standardization parallel is with credit reporting rather than with EHR.  

"Vendor credentialing is about assessing the viability of a supplier – the company and the individual – to deliver the goods and services within acceptable risk boundaries," he said. "If all the buyers of vendor services were willing to aggregate the collection and management of vendor data the way the retail credit industry has done, creation of a unified data file as the starting point for risk assessment might be feasible. Each vendor company and rep could be given a risk score, and the buying healthcare system could assess the acceptability of that risk."  

But when it comes to process standardization, how far can and does the industry go? Wills questioned.

"Why not standardize all group purchasing and have there be one GPO for the entire industry? Why shouldn’t the industry try to create other monopolistic organizations in the name of standardization and efficiency?" he asked rhetorically. "The answers to these questions are as obvious as to why there will not be one universal vendor credentialing exchange or service. A free and open market allows for mergers, acquisitions and strategic alliances – all of which I suspect will happen in the future of vendor credentialing."