Credit: Thongden_studio/Adobe Stock
The percentage of "ghost providers" in U.S. health plans' behavioral health provider directory sections varies widely from plan to plan but is often high.
Officials at the U.S. Health and Human Services Office of the Inspector General have published data supporting that conclusion in a report on the results of a review of 52 plans' provider directories.
The percentage of inactive providers listed ranged from just 8.8% to 99.2%: At one plan HHS OIG investigators reviewed, just three of the 356 providers listed in the plan's behavioral health provider sections were accepting new patients from that plan.
The percentage of providers who were inactive was over 33% at 33 of the plans included.
All of the plans reviewed were Medicare Advantage plans or Medicaid plans, but employers and employer plan participants have been talking about concerns about provider directory accuracy for years.
HHS OIG officials suggested that the Centers for Medicare and Medicaid Services should consider moving ahead with a proposal to develop a National Directory of Healthcare Providers and Services.
"Such a directory would include contact information and the plans each provider accepts," according to the report. "A nationwide directory could make it easier for enrollees to find accurate, up-to-date information when seeking care."
What it means: If CMS developed a frequently updated national provider directory, employers, employers' health insurers and network administration firms might be able to use the government directory to keep their own directories up to date.
The backdrop: Providers and patient groups say many health insurers and network administrators contribute to provider shortages by paying behavioral care providers too little and subjecting them to too many administrative obstacles.
Behavioral care network managers have argued that shortages of providers willing to work for a reasonable reimbursement rate make recruiting and keeping behavioral health providers difficult, and that the providers do a poor job of helping to keep their provider network directory entries up to date.
Some health care provider groups have objected to the idea of the government trying to help by creating a national provider directory. The American Hospital Association, for example, has warned that a poorly designed program could simply add to the administrative burden for health care providers rather than simplifying the task of keeping provider directory entries up-to-date.
© Arc, All Rights Reserved. Request academic re-use from www.copyright.com. All other uses, submit a request to TMSalesOperations@arc-network.com. For more information visit Asset & Logo Licensing.