AMA President Jack Resneck Jr., MD testified this month before the Senate Finance Committee on the problem of so-called ghost networks of physicians and other health professionals and also explored potential solutions to improve the accuracy of provider directories—especially as it relates to mental health care.
LACMA executive committee member Dr. Robert Bitonte has been a champion for directory accuracy: “I agree with Dr. Resneck that we need to standardize the process of data submission so that each practice is not dealing with 20 different submission processes for 20 different plans, especially as independent physicians, on top of many other problems, face administrative burdens like the never-ending prior authorization debacle.”
In recent years, dozens of studies have shown issues with the directories, as did a study released on the morning of the hearing by the committee’s chair, Sen. Ron Wyden, D-Ore. In phone calls to a sample of 120 provider listings across 12 different health plans, 33% were inaccurate, had nonworking numbers, or had unreturned calls. Wyden’s study found that appointments were available only 18% of the time, according to the AMA.
Why it’s important: “When directory information is incorrect, the results can be complicated, expensive and potentially devasting, especially to patients,” Dr. Resneck told the Senate Finance Committee.
“Inaccurate directories shift the responsibility onto patients to locate a plan’s network or pay for out-of-network care,” added Dr. Resneck, who chairs the University of California, San Francisco dermatology department. “Patients are financially impacted and may be prevented from receiving timely care."
"Moreover, in the long run, continuing to allow inaccuracies makes it easier for plans to fail to build networks that are adequate and responsive to enrollees’ needs. Accurate directories are a basic function and responsibility of health plans offering network products.”
In the Wyden study, “more than 80% of the listed, in-network, mental health providers staff attempted to contact were ‘ghosts,’ as they were either unreachable, not accepting new patients, or not in -network.”
Dr. Resneck and other panelists at the hearing generally agreed that physician practices have an important role to play in directory accuracy but ultimately the responsibility lies with the health plans.
They also agreed on the need to standardize the process of data submission so that each practice is not dealing with 20 different submission processes for 20 different plans, especially as they deal with other administrative burdens such as prior authorization.
Dr. Resneck also stressed the need to require and enforce adherence to quantitative network adequacy standards, including wait-time requirements.