Pay to Play

[Old_Mil]

I've noticed a few hospitals recently that have tried to enact a "credentialing fee". Basically, you take a job, they send you the paperwork, and they ask you to submit a $250 (in both instances) fee to get credentialed and go to work.

In both instances, I've told the facility to take their job and stick it where the sun doesn't shine.

I hope all of you will have the same reaction. This isn't a pay to play field and I find the entire concept obscene.

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[Doctor Bob]

The places I've worked that have had this, all applied the credentialling fee to the physician staff dues. So my first year dues were cheaper (a net 0 difference).
So it didn't bother me.

 

[msgsk]

Never heard of this! Also never heard of paying for physician staff dues. They better have some good turkey sandwiches in the doctor's lounge...

 

[Doctor Bob]

Also never heard of paying for physician staff dues. They better have some good turkey sandwiches in the doctor's lounge...

These were places with fancy doctor's lounges... free food and drinks 24/7

 

[Arcan57]

Our hospital does have a credential fee. It takes a ton of work to get someone credentialed and keep them credentialed by doing chart reviews, etc for compliance reasons. It's even more difficult to meet the standard when someone doesn't have enough volume at the hospital to be able to review them since it involves driving to their office to pull charts. You could argue they should cost shift it onto the patients but I'm not sure that's the right thing either.

 

[deleted480308]

Our hospital does have a credential fee. It takes a ton of work to get someone credentialed and keep them credentialed by doing chart reviews, etc for compliance reasons. It's even more difficult to meet the standard when someone doesn't have enough volume at the hospital to be able to review them since it involves driving to their office to pull charts. You could argue they should cost shift it onto the patients but I'm not sure that's the right thing either.

Why would it be wrong for patients to pay the cost of running the hospital?

 

[Old_Mil]

It takes a ton of work to get someone credentialed and keep them credentialed by doing chart reviews, etc for compliance reasons.

That may be, but shifting the administrative costs onto your employees is ridiculous.

 

[Janders]

we pay, as part of our staff dues.

the staff who handle credentials actually work for the medical staff, not the hospital. we pay their salary, though the hospital kicks in a little.

we use the money for some food, and to allow med exec funds to apportion for charity, projects, etc.

seems common here in NE

 

[Arcan57]

That may be, but shifting the administrative costs onto your employees is ridiculous.

We're not employees. It's probably more accurate to think of us as strippers.

 

[EM Junkie]

We have a credentialing fee, paid by our group (single site democratic). I think it's $250. No staff dues though, and we have free food and drink 24/7.

 

[GeneralVeers]

I've never had to pay it, and if there are fees, the group pays it. If any site where I'm doing locums demanded it, I would tell them where to shove it, and seek work elsewhere.

 

[em1234]

I've seen this credentials fee at both my SDG and CMG jobs. I've never paid it. It's always been covered by the group/CMG.

 

[Tiger26]

I work where demand > supply, thus have never had to pay for this

 

[RustedFox]

Two out of my three job sites asked for a credentialing fee; which the CMG paid for.
My other non-CMG job site did not (to my recollection) have such a fee, or it was paid for by the group.

 

[shookwell]

One place where I credentialed to work locums wanted a $500 fee. When I got to that paper in the pile, I stood up and told them I wouldn't credential if I had to pay $500 and the director just tore up that document and told me not to worry about it. Most places need you more than you need them.

 

[Apollyon]

Apparently, I still owe $150 (maybe $125) from last year for med staff dues. No free meals, no lounge, nothing else. Carpet upstairs in the C-suite, though! I am still credentialed there, but haven't worked there in over a year.

 

[Hamhock]

During training, I picked up shifts in a semi-rural hospital that I considered "locums" shifts, but they considered part-time employee.

After completing the credentialing packet and meeting for four hours of unpaid "orientation", HR asked me to sign a form allowing them to deduct $500 (about) from my first paycheck for credentialing. I was already scheduled for shifts.

I just didn't respond.

They emailed me about it for a few months. I told them it made no sense and that I had never heard of such a thing (and I hadn't; haven't heard of it again until this thread). They eventually stopped asking.

I would have quit if they tried to force me to pay. I won't take any jobs in the future that try to pull such a scam.

HH

 

[dchristismi]

Our group pays the credentialling fees for our docs.

 

[turkeyjerky]

One of the places I'm getting credentialed at required this. When I put up a stink about it, the woman at the CMG told me that the hospital actually required that the fee be paid directly by the doc, in order to discourage people from applying for privileges if they weren't going to actually work there. I paid it, but they're gonna reimburse me on my first check.

 

[deleted547339]

One of the places I'm getting credentialed at required this. When I put up a stink about it, the woman at the CMG told me that the hospital actually required that the fee be paid directly by the doc, in order to discourage people from applying for privileges if they weren't going to actually work there. I paid it, but they're gonna reimburse me on my first check.

Makes sense.

 

[emergentmd]

I've noticed a few hospitals recently that have tried to enact a "credentialing fee". Basically, you take a job, they send you the paperwork, and they ask you to submit a $250 (in both instances) fee to get credentialed and go to work.

In both instances, I've told the facility to take their job and stick it where the sun doesn't shine.

I hope all of you will have the same reaction. This isn't a pay to play field and I find the entire concept obscene.

I am sure this fee gives people the Black Helicopter feeling, but it has nothing with the hospital wanting to make money/recoup their costs. Yes it costs alot and very time consuming but hospitals would gladly pay this to get more ACTIVE staff on board.

I have been part of this discussion for years and the reason our hospital talked about (but never implemented) this fee was b/c many docs just apply so they can keep their options open/have it on their resume eventhough they never stepped foot in the hospital. I would say that 80% of the medical staff either never steps foot or comes to the hospital less than 5 times a year. The fee was to dissuade these docs from reapply. Some have been part of the medical staff for over 10 yrs and have never been to the hospital.

 

[always.chillin]

So I recently stopped working at a particular hospital. I still hold privileges there but have no interest in renewing them. I received a notice to pay staff dues. In the by laws it says not paying dues will result in loss of privileges. I don’t care to ever work there again. Will they send me to collections for not paying?

 

[southerndoc]

So I recently stopped working at a particular hospital. I still hold privileges there but have no interest in renewing them. I received a notice to pay staff dues. In the by laws it says not paying dues will result in loss of privileges. I don’t care to ever work there again. Will they send me to collections for not paying?

No, but they may revoke your credentials. This may get reported to the National Practitioner Data Bank, and if so, will negatively affect your credentialing for the rest of your career.

Best to pay the fee and resign after your sure everything is good.

 

[HemeOncHopeful19]

No, but they may revoke your credentials. This may get reported to the National Practitioner Data Bank, and if so, will negatively affect your credentialing for the rest of your career.

Best to pay the fee and resign after your sure everything is good.

I actually think administrative revocation of privileges (such as not paying a fee) is specifically NOT a reportable issue to NPDB. I may or may not have had to look into this when I rotated at a site for fellowship that we only use 1 month a year and had some verbal order I had never signed off on the last day of the previous rotation and a bunch of messages threatening to pull my privileges for it being delinquent (spoiler alert: nothing ever happened anyway)

NPDB Guidebook, Chapter E: Reports, Reporting Adverse Clinical Privileges Actions

Hospitals and other health care entities must report adverse clinical privileges actions to the NPDB that meet NPDB reporting criteria - that is, any professional review action that adversely affects the clinical privileges of a physician or dentist for a period of more than 30 days or the...

www.npdb.hrsa.gov

A physician's or dentist's clinical privileges are suspended for reasons not related to professional competence or professional conduct.

No

 

[southerndoc]

I actually think administrative revocation of privileges (such as not paying a fee) is specifically NOT a reportable issue to NPDB. I may or may not have had to look into this when I rotated at a site for fellowship that we only use 1 month a year and had some verbal order I had never signed off on the last day of the previous rotation and a bunch of messages threatening to pull my privileges for it being delinquent (spoiler alert: nothing ever happened anyway)

NPDB Guidebook, Chapter E: Reports, Reporting Adverse Clinical Privileges Actions

Hospitals and other health care entities must report adverse clinical privileges actions to the NPDB that meet NPDB reporting criteria - that is, any professional review action that adversely affects the clinical privileges of a physician or dentist for a period of more than 30 days or the...

www.npdb.hrsa.gov

A physician's or dentist's clinical privileges are suspended for reasons not related to professional competence or professional conduct.

No

You're completely right. It's not a reportable offense. However, do you trust someone to not report it? I wouldn't chance it. There have been a user or two on SDN who have posted being reported to the NPDB for severing relations with a telemedicine company.

 

[WhatJobDoIPick]

So I recently stopped working at a particular hospital. I still hold privileges there but have no interest in renewing them. I received a notice to pay staff dues. In the by laws it says not paying dues will result in loss of privileges. I don’t care to ever work there again. Will they send me to collections for not paying?

Wow, such extortion.

Reminds me of a job I had where they made us debit our CME accounts for medical staff fees, state license and DEA.

What a racket these clowns have going.

 

[BoardingDoc]

Reminds me of a job I had where they made us debit our CME accounts for medical staff fees, state license and DEA.

??? Because you'd rather pay these fees out of your own post-tax dollars? I use CME money every year for this as it's clearly the most economically efficient way to pay for these things.

 

[NYEMMED]

I actually think administrative revocation of privileges (such as not paying a fee) is specifically NOT a reportable issue to NPDB. I may or may not have had to look into this when I rotated at a site for fellowship that we only use 1 month a year and had some verbal order I had never signed off on the last day of the previous rotation and a bunch of messages threatening to pull my privileges for it being delinquent (spoiler alert: nothing ever happened anyway)

NPDB Guidebook, Chapter E: Reports, Reporting Adverse Clinical Privileges Actions

Hospitals and other health care entities must report adverse clinical privileges actions to the NPDB that meet NPDB reporting criteria - that is, any professional review action that adversely affects the clinical privileges of a physician or dentist for a period of more than 30 days or the...

www.npdb.hrsa.gov

A physician's or dentist's clinical privileges are suspended for reasons not related to professional competence or professional conduct.

No

You're completely right. It's not a reportable offense. However, do you trust someone to not report it? I wouldn't chance it. There have been a user or two on SDN who have posted being reported to the NPDB for severing relations with a telemedicine company.

Yes not reportable to the NPDB

However, when you credential the facility sends a verification to every previous facility you have worked at. If they report you lost privileges, it could make things much harder than it needs to be.

Just send them a resignation

 

[Janders]

Since this zombie has been revived.

It is absolutely customary and usual that hospital medical staffs have credentialing fees, and annual membership dues.

I am currently the President of our medical staff. Our dues are $500/yr (MD/PA/NP). Telemedicine has a separate deal. This is actually very competitive vis-a-vis other local hospitals (we've checked). We are trying diligently to decrease them, and may if our switch to a new system-wide credentialing software saves money as expected. It is important to remember the medical staff is separate from the hospital proper, and there must be a firewall.

What do these fees cover?
(1) There is a person, or more likely a large company, that goes through your credentialling packet, ensures it is true, collects it, runs background checks, etc etc. While annoying, this is important to avoid as many Doctor Deaths as possible. This costs money.
(2) There is likely a medical staff office (ours has two people working in it). They are the boots-on-the-ground to handle credentialing. They also handle 100 other little things like meetings, minutes, chief-of-service searches, figuring out so-and-so's address to send flowers when their spouse dies, etc. Often the medical staff pays for all or part of their salary, and the hospital supports the rest. They can be your best friends.
(3) There are medical staff meetings (annual, quarterly, med exec monthly). Some of these may have some food / drink. Perhaps even a social or two.
(4) Most medical staffs make some charitable contributions, both to hospital and other community-related fundraisers. Again, this money comes from somewhere.
(5) Medical staff officer positions should be compensated. Not millions, but if you take 4-6hr a month to review applicants and interview them and vote for them to join the staff, sure has hell you deserve money for that. Again, said money comes from somewhere.

Now, if you are doing locums, or part of a large corporate group working at many sites, I COMPLETELY agree said corporation should pay the fee. But realize it is coming out of the overhead they are charging you. In our group, the "group" pays, which means it is paid with pre-tax dollars, but it is OUR money which is being used. No free lunches.

 

[HemeOncHopeful19]

Since this zombie has been revived.

It is absolutely customary and usual that hospital medical staffs have credentialing fees, and annual membership dues.

I am currently the President of our medical staff. Our dues are $500/yr (MD/PA/NP). Telemedicine has a separate deal. This is actually very competitive vis-a-vis other local hospitals (we've checked). We are trying diligently to decrease them, and may if our switch to a new system-wide credentialing software saves money as expected. It is important to remember the medical staff is separate from the hospital proper, and there must be a firewall.

What do these fees cover?
(1) There is a person, or more likely a large company, that goes through your credentialling packet, ensures it is true, collects it, runs background checks, etc etc. While annoying, this is important to avoid as many Doctor Deaths as possible. This costs money.
(2) There is likely a medical staff office (ours has two people working in it). They are the boots-on-the-ground to handle credentialing. They also handle 100 other little things like meetings, minutes, chief-of-service searches, figuring out so-and-so's address to send flowers when their spouse dies, etc. Often the medical staff pays for all or part of their salary, and the hospital supports the rest. They can be your best friends.
(3) There are medical staff meetings (annual, quarterly, med exec monthly). Some of these may have some food / drink. Perhaps even a social or two.
(4) Most medical staffs make some charitable contributions, both to hospital and other community-related fundraisers. Again, this money comes from somewhere.
(5) Medical staff officer positions should be compensated. Not millions, but if you take 4-6hr a month to review applicants and interview them and vote for them to join the staff, sure has hell you deserve money for that. Again, said money comes from somewhere.

Now, if you are doing locums, or part of a large corporate group working at many sites, I COMPLETELY agree said corporation should pay the fee. But realize it is coming out of the overhead they are charging you. In our group, the "group" pays, which means it is paid with pre-tax dollars, but it is OUR money which is being used. No free lunches.

This post almost reads like a satire but I do believe it is actually serious

 

[anonperson]

This post almost reads like a satire but I do believe it is actually serious

What's the satirical part?

This has been 100% my experience at the community hospital I have privileges at and is a common situation at most non academic places.

 

[Janders]

Yeah I’m a pretty sarcastic and cynical person, but what I wrote was not satire.

 

[HemeOncHopeful19]

Yeah I’m a pretty sarcastic and cynical person, but what I wrote was not satire.

The idea that people that work at a hospital should have to pitch in money to pay for you to get free snacks at your meetings is just really out of touch in 2024 IMO

Will people pay it since it is required for their livelihood? Sure.

Should they have to help pay the costs to run a hospital in an era where hospital facility fees dwarf physician reimbursement to comical proportions? I don’t think so, even if it is “tradition”

 

[anonperson]

The idea that people that work at a hospital should have to pitch in money to pay for you to get free snacks at your meetings is just really out of touch in 2024 IMO

Will people pay it since it is required for their livelihood? Sure.

Should they have to help pay the costs to run a hospital in an era where hospital facility fees dwarf physician reimbursement to comical proportions? I don’t think so, even if it is “tradition”

That was just one part of the costs and probably fairly small. Honestly, I don't think it was even mentioned in the budget overview so may not have actually been accounted.

The various department chairs should be compensated for their time. The hospital pays half of the stipend while the rest comes from these dues.

Even with the stipend, some departments have a difficult time getting people to be chair for the year because it's a thankless job.

Our main costs were related to the chair stipend, chief of staff stipend, donations to medical org, yearly Christmas party, bonus to the admin staff who do the thankless application process etc. Nothing egregious to be honest

 

[WhatJobDoIPick]

??? Because you'd rather pay these fees out of your own post-tax dollars? I use CME money every year for this as it's clearly the most economically efficient way to pay for these things.

No? Because it should be covered by the hospital outside of CME. CME is CME.

 

[Janders]

Our main costs were related to the chair stipend chief of staff stipend, donations to medical org, yearly Christmas party, bonus to the admin staff who do the thankless application process etc. Nothing egregious to be honest

Precisely. Hospital covers half or more of stipends and typically all the monthly meeting stuff but we do hold our own annual staff meeting and a summer social (on a boat) which we invite the hospital (especially the nurses and other staff) to attend. We also end up donating probably 50-100k/year to various charitable endeavors. It’s not a very big budget, and probably half the money pays goes directly to third party privilege clearinghouse ****e. It’s also entirely controlled BY the medical staff and their elected reps on med exec, so if people want to cut costs and drop things they can…

I think some people don’t understand that “the hospital” and “the medical staff” are two separate entities which are independant though clearly interdependent.

 

[NYEMMED]

The idea that people that work at a hospital should have to pitch in money to pay for you to get free snacks at your meetings is just really out of touch in 2024 IMO

Will people pay it since it is required for their livelihood? Sure.

Should they have to help pay the costs to run a hospital in an era where hospital facility fees dwarf physician reimbursement to comical proportions? I don’t think so, even if it is “tradition”

Medical staff do not work for the hospital, they work at the hospital.

 

[BoardingDoc]

No? Because it should be covered by the hospital outside of CME. CME is CME.

If your hospital routinely pays for your medical licence and DEA renewals, more power to you. This is not something I have ever seen at any of the 9 hospitals I've worked at or groups that I've done telemedicine for. Given that reality, CME as a way to pay for required costs is clearly advantageous.

 

[WuMedic]

I think some people don’t understand that “the hospital” and “the medical staff” are two separate entities which are independant though clearly interdependent.

An independent medical staff, if truly independent, is invaluable in this day and age.

Story time:
Plenty of hospitals, especially as part of bigger hospital "networks" now allow midlevels to see patients somewhat independently (full independent practice is still not allowed in my state, but for example, requiring attestations only on the initial Consult or H&P, not not requiring the attending to round daily on patients in med-surg). Obviously this saves them money.

A smaller county hospital that I occasionally work at was bought up by a larger group. The larger network of hospitals does not require attendings to see midlevel patients if they meet certain criteria (I don't know what those are since I'm only in the ED which does not allow any midlevels outside of a mass casualty situation). The hospital wanted to bring NPs over to help cover some consults, and also cover the unassigned medicine service. The then-current policies did not allow for any midlevels to practice at the hospital so significant changes were needed to be made in the medical staff bylaws and for credentialing. I have never seen so many doctors at a medical staff meeting before, and never again since then. The overwhelming sentiment was that we were not going to go the way of the rural hospitals who only hire midlevels and have no physician supervision. There were a TON of PCP's whose names I see on charts there that I have never met before who showed up to vote against it, swearing that if it passed, we wouldn't ever see their patients again. Guys who had badges that didn't work because they were old magnetic swipes and not RFID and even one guy whose badge had the name of the hospital two iterations ago on it. I never realized we had that many doctors on medical staff at this tiny hospital.

Point is, a strong independent medical staff can still have its benefits, even if it costs a few hundred per renewal cycle. (Full disclosure, I don't pay my own credentialing fees as the group I work for pays them for us.)

 

[WhatJobDoIPick]

If your hospital routinely pays for your medical licence and DEA renewals, more power to you. This is not something I have ever seen at any of the 9 hospitals I've worked at or groups that I've done telemedicine for. Given that reality, CME as a way to pay for required costs is clearly advantageous.

Interesting. In my experience, even Team Health paid for this outside of CME.

 

[Janders]

Interesting. In my experience, even Team Health paid for this outside of CME.

Right but team health isn’t the hospital, it’s the “Ed group”. They are paying it out of your professional billings, however they label it.

 

[WhatJobDoIPick]

Right but team health isn’t the hospital, it’s the “Ed group”. They are paying it out of your professional billings, however they label it.

If you work for a hospital as a W2 employee, they are the "ED group" and should be paying for the things required to make money for them.

 

[Janders]

If you work for a hospital as a W2 employee, they are the "ED group" and should be paying for the things required to make money for them.

I do agree if you work directly for the hospital as an employee they should cover it.
And a large corporate group should cover it (but know where they are getting the money from)
And a SDG should cover it (but know…)

 

[betamale]

I've noticed a few hospitals recently that have tried to enact a "credentialing fee". Basically, you take a job, they send you the paperwork, and they ask you to submit a $250 (in both instances) fee to get credentialed and go to work.

In both instances, I've told the facility to take their job and stick it where the sun doesn't shine.

I hope all of you will have the same reaction. This isn't a pay to play field and I find the entire concept obscene.

i worked at a place like that and decided not to renew. I think it was $300 to be credentialed and that was 5 years ago in NJ.

 

[DocEspana]

I work for TH at a site and my hospital just hit me up for this. I just straight of forwarded the email to TeamHealth because I am not playing that game.

 

[goodoldalky]

How reasonable or asinine this is depends somewhat on your situation.
Are you a hospital employee? Asinine.
Are you part of a PE-backed contract management group who is contracted out to provide service X at hospital? Asinine.

Are you an independent physician who has selected that hospital as a place to practice, and want to hang your shingle as part of their medical staff? Well, then, there are costs associated with supporting the infrastructure of the group of physicians known as a medical staff.

It used to be that most people were in this latter bucket, and it made more sense. This group of people was actually critical in terms of running the hospital and determining how care was provided, etc., and some of that required a little bit of money.

The issue is that nowadays, physicians are more less interchangeable cogs brought in by some corporate entity, who already takes a huge chunk of overhead out of their pockets. In such an instance, asking an individual physician to pay the fee doesn't make a lot of sense, but I am seeing lots of CMGs starting to do it.... since it's probably a good idea.... in the name of profit!

 

[MechEDoc]

You could argue they should cost shift it onto the patients but I'm not sure that's the right thing either.

That cost is shifted onto the patients. Where do physician salaries come from?

 

[dozitgetchahi]

I've noticed a few hospitals recently that have tried to enact a "credentialing fee". Basically, you take a job, they send you the paperwork, and they ask you to submit a $250 (in both instances) fee to get credentialed and go to work.

In both instances, I've told the facility to take their job and stick it where the sun doesn't shine.

I hope all of you will have the same reaction. This isn't a pay to play field and I find the entire concept obscene.

I agree with you. Credentialing should be part of their investment in you during the hiring process. This isn’t medical school or something; I’m not paying *them* to work there.

Same with “staff dues” and all this other garbage. F paying them for things they should be providing as part of the job. If I was asked to pay up for the ****ty food they serve in most doctors lounges, I’d tell them to shove it. I’ll pay for my own food thanks.

 

[Arcan57]

That cost is shifted onto the patients. Where do physician salaries come from?

For most docs? Large 3rd parties - Medicare, Medicaid, private insurance.