Provider directories for insurers are often filled with inaccurate information and can take months to be updated, making it difficult for patients to find in-network care. To address this, CMS has proposed a national provider directory to streamline the process—but both provider and insurer groups disapprove, Nona Tepper writes for Modern Healthcare.

MA provider directories are rife with inaccuracies

In 2018, almost half of Medicare Advantage (MA) plan directories contained inaccuracies, even though CMS requires MA plans to update their provider directories on a quarterly basis. These inaccuracies can make it difficult for patients to find care, especially if a provider they were seeing suddenly becomes out-of-network for a certain plan.

For example, Hannah Hale, a 35-year-old patient who suffers from multiple genetic and autoimmune disorders, was unable to continue seeing her usual gastroenterologist after her health insurer failed to reach an agreement with a newly merged GI group the provider was part of. However, her insurer did not update its provider directory, making it seem like her doctor was still in-network.

"Every patient in the Dallas area who sees a GI doctor who's on my plan lost access to GI care," Hale said. "Their directory is just full of errors."

In a statement, a spokesperson for Hale's insurer wrote that "[w]e regularly update our provider directories. … Occasionally, providers may be listed incorrectly, and we work to address these issues whenever they arise."

How CMS plans to improve provider directories

To address these ongoing problems with provider directories, CMS in October proposed the creation of a national provider directory.

"Instead of insurers loading providers' contact information, availability and more into disparate systems, providers would sign into a centralized data hub to input their information," Tepper writes. "… Public and private payers would then use those data to assemble their own directories."

According to CMS, a study from the Council of Affordable Quality Healthcare estimated that collecting directory data in a single platform could save physicians $1.1 billion in annual administrative costs.

"A [national provider directory] could both streamline existing data across CMS systems and public information in an easier-to-use format than what is available today," the agency wrote.

However, both provider and insurer groups have expressed their aversion to such a plan.

The American Hospital Association (AHA) last month wrote to CMS saying that not every health system has the technology necessary to support a move to a single provider directory. The organization was also skeptical that the move would reduce providers' administrative burden since it overlaps with current federal reporting requirements, "which have, admittedly, been plagued with inaccuracies."

"Adding an additional data source without sufficiently addressing how or why it differs from the myriad provider directories already in existence could further complicate patients' ability to access accurate information," AHA wrote. "Meanwhile, such a requirement would add [a] considerable, duplicative burden on providers." Currently, AHA has asked CMS to not move forward with the proposal.

Among insurers, many are concerned that they will be responsible for verifying that providers' information remains up-to-date and accurate at all times.

"It can't be the federal government saying, 'I'm going to push this responsibility down to health plans because I couldn't figure out how to make a national directory that works,'" said Michael Bagel, director of public policy at the Alliance for Community Health Plans. "That doesn't result in something that's meaningful." (Tepper, Modern Healthcare, 1/20)