Department of Health Policy and Management, School of Public Health, Texas A&M University, 212 Adriance Lab Rd, 1266 TAMU, College Station, TX 77843-1266. Email:
Am J Manag Care. 2024 Nov;30(11):584-588. doi: 10.37765/ajmc.2024.89627.
Provider directory inaccuracies have important implications for care navigation and access as well as ongoing regulatory efforts. We assessed the extent to which identified provider directory inaccuracies persisted across 7 specialties (cardiology, dermatology, endocrinology, gastroenterology, neurology, obstetrics-gynecology, primary care) and 5 carriers in the Pennsylvania Affordable Care Act insurance marketplace.
A secret shopper survey recontacted inaccurately listed providers (N = 1802) between 403 and 574 days after they were identified in an earlier secret shopper survey.
Descriptive analyses, with tests of proportion and t tests to assess whether differences across carriers, specialties, and geographic locations were statistically significant.
Of 1802 inaccurate provider listings, 451 (25.0%) had been removed at follow-up, 966 providers (53.6%) were successfully contacted, and 385 providers (21.4%) could not be reached. Of the recontacted providers, 240 (13.3%) were listed accurately at follow-up and 726 (40.3%) were listed with various inaccuracies, including 31.0% (n = 558) with inaccurate contact information, 11.2% (n = 201) listed under the wrong specialty, and 1.9% (n = 34) erroneously listed as being in network despite being out of network. We found substantial differences across carriers and specialties but not by rurality. Inaccuracies also were less likely to persist in the state's 2 metropolitan areas. Among inaccurate provider listings, on average, 540 days (median, 544 days) had passed between the initial and subsequent contacts.
A large number of provider directory inaccuracies persist well beyond the 90-day expectation mandated by federal regulations, raising substantial concerns about compliance. These inaccuracies may impose substantial barriers to patient access and may render existing assessments of network adequacy ineffective.
供应商目录的不准确之处对医疗导航和可及性以及正在进行的监管工作有重要影响。我们评估了在宾夕法尼亚州平价医疗法案保险市场的 7 个专业领域（心脏病学、皮肤病学、内分泌学、胃肠病学、神经病学、妇产科、初级保健）和 5 家保险公司中，发现的供应商目录不准确之处在多大程度上持续存在。
秘密购物者调查在早些时候的秘密购物者调查中发现不准确的供应商（N=1802）后 403-574 天重新联系这些供应商。
描述性分析，使用比例检验和 t 检验来评估不同保险公司、专业和地理位置之间的差异是否具有统计学意义。
在 1802 个不准确的供应商列表中，有 451 个（25.0%）在随访时已被删除，966 个供应商（53.6%）成功联系上，385 个供应商（21.4%）无法联系上。在重新联系的供应商中，有 240 个（13.3%）在随访时准确列出，726 个（40.3%）列出了各种不准确之处，包括 31.0%（n=558）的联系信息不准确，11.2%（n=201）列出的专业错误，1.9%（n=34）错误地列为网络内供应商，尽管实际上是网络外供应商。我们发现不同保险公司和专业之间存在很大差异，但与农村地区无关。不准确之处在该州的两个大都市区也不太可能持续存在。在不准确的供应商列表中，从最初联系到后续联系之间平均经过了 540 天（中位数，544 天）。
大量的供应商目录不准确之处持续存在的时间远远超过联邦法规规定的 90 天预期，这引起了对合规性的严重关注。这些不准确之处可能对患者的可及性造成重大障碍，并可能使现有网络充足性评估无效。
