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Response Guidelines DO
Provide substantive comments to the post below Do you agree with the way the
learner differentiates strategies for qualitative and quantitative research? Why or
why not? If anything is unclear, ask clarifying questions.
Your response must be a minimum of 200 words in length. Include at least two
APA-formatted citation (in-text, as well as the full reference). The citation may be
from course textbooks, assigned readings, or an outside source
Qualitative and Quantitative Data Analyses
Article 1 – Physician credentialing in a consumer-centric world
The article overviews the arduous administrative burden required of physicians related to
paperwork and documentation submitted for hospital credentialing and managed care (private
payer) contracting. The author discusses how similar the process and documents are between
both types of credentialing functions. Furthermore, the author calls into question the value of the
credentialing process in terms of the cost of applications along with the time it takes to complete
them. In fact, this author implies health plan credentialing should be abandoned (Derek, v. A.,
2002).
Research Methodology
The research methodology used in this article was a qualitative, grounded theory. The
qualitative approach analyzes experiences and feelings. Grounded theory utilizes simultaneous
collection of data and analysis. The author developed a theory that outlined opinions and theory
based on personal observation or reflection centered around his experience as a Chief Medical
Officer of a private health plan. Furthermore, the author made predictions on the administrative
burdens imposed on physicians related to credentialing as well as the lack of impact
credentialing has on patient care (Bettany-Saltikov, 2012).
Conceptual Framework
The conceptual framework of this article is formal hypothesis. This author utilized
historical information to assist in the formation of a hypothesis. The concepts in this article are
related to price increases, managed care and physician insurance (Derek, v. A., 2002).
Article 2 – Physician Licensing and Insurance Issues after Legal Issues
Although this article outlines the many hoops a physician must jump through after having
criminal charges imposed against them, these are the same elements required of any physician
who is credentialed to provide care in a hospital. However, the documents and information are
heavily scrutinized after criminal charges. This article outlines many of the steps that are
required for practitioners during the hospital credentialing process (Okray, 2013). Some of them
may overlap into the government payer and private payer credentialing process as well.
Research Methodology
The research methodology used in this article was a qualitative, grounded theory,
narrative. The author developed a theory that explained processes as well as made predictions on
the outcome imposed on physicians (Bettany-Saltikov, 2012). The article is based on the
experience of a medical staff attorney who has assisted physicians in providing the appropriate
documentation to multiple hospitals and clearinghouses to meet credentialing requirements.
Conceptual Framework
The conceptual framework of this article is linked to physicians, government agencies,
reporting requirements, hospitals and health care. The article ties together multiple elements
required for a physician to maintain a license and to continue to practice medicine. There are
only a few listed elements in this article since these are the most egregious for the physician.
There are many additional requirements that overlap into hospital, government payer and private
payer credentialing.
A qualitative, narrative approach will be used in the final research project. The narrative
approach will allow for interviewing industry peers regarding streamlining physician
credentialing as well as government payer enrollment. The advantages to the narrative approach
is the potential of garnering different opinions and perspective on the same topic based on that
individual’s experience. A weakness can be considered a perceived blurring of boundaries
between the researcher and participant (Gerrish & Lacey, 2013). A quantitative methods
analysis data used from several tools.
References:
Bettany-Saltikov, J. (2012). How to do a systematic literature review in nursing: A Step-By-Step
Guide. Maidenhead: McGraw-Hill Education.
Derek, v. A. (2002). Physician credentialing in a consumer-centric world. Health Affairs, 21(5),
152-6. Retrieved from http://library.capella.edu/login?url=https://search-proquestcom.library.capella.edu/docview/204639130?accountid=27965
Gerrish, K., & Lacey, A. (2013). The research process in nursing. Retrieved from
https://ebookcentral-proquest-com.library.capella.edu
Okray, J. (2013). Physician licensing and insurance credentialing legal pain management after
criminal charges. The Brief, 43(1), 54-61. Retrieved from https://search-proquestcom.library.capella.edu/docview/1465311184?accountid=27965
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