The Centers for Medicare and Medicaid Services (CMS) is proposing to create a national health care provider directory, reports Allison Bell for Think Advisor. The goal is to ensure that health care provider directories, which are notoriously inaccurate, are kept up to date and reliable. No one should have to spend precious time going through hoops to find a physician their health plan covers.
As proposed, the new National Directory of Healthcare Providers & Services, or NDH would collect accurate information from doctors and other health care providers. In turn, patients would be able to use the database to find in-network providers willing to see them. It would save people a lot of time and energy. It could also help minimize their need to use out-of-network providers at their own expense.
Today, each health insurer keeps its own provider directory. But, health insurers usually have limited provider networks and do a poor job of ensuring the reliability of these directories. Even in Medicare Advantage, health insurers are not penalized in a meaningful way for gross inaccuracies in their directories. However, their enrollees who rely on these directories often find that they have been misled as to the in-network physicians they can see.
Why don’t we already have a centralized provider directory? (For that matter, why do we allow Medicare Advantage plans to have provider networks rather than requiring that they cover care for all providers who accept Medicare?) A centralized government database would hurt the companies that currently are paid to create directories for insurers. But, over the last decade, these companies have shown their inability to keep these directories accurate and up to date. Allowing them to continue is a disservice to the public.
In an audit of health insurer provider directories, CMS found that, in the four years from 2017 to 2021, less than half of the provider entries in these directories were complete and accurate. The directories failed to disclose accurate contact information, health plan relationships, and information on whether the provider was taking new patients.
A centralized provider database would be a good step towards leveling the playing field for consumers, both when choosing a health plan and when trying to identify network providers. It should help ensure people have the information they need.
In the same vein, CMS should create a centralized claims database. Today, information about the services health plans cover (patient encounter data) tends to be incomplete and inaccurate, making it impossible for the government to assess quality, according to the Medicare Payment Advisory Commission. A national database of claims information would not only help ensure collection of accurate claims information, but it would promote public health. The government would be able to see in real time, what services people were receiving, when and where they were receiving them, and at what frequency.
Our federal government has allowed health insurers to set a lot of their own rules for far too long, at far too great a cost to taxpayers and the people who need health care. It’s time to reset the table.
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