Tran Amity, Mettias Hannah, Nakamine Lauren, Ng Tiffany, Prabhudesai Devashri, Chen John J, Buenconsejo-Lum Lee E
John A. Burns School of Medicine, University of Hawai'i at Mānoa, Honolulu, HI (AT, HM, LEB).
College of Natural Sciences, University of Hawai'i at Mānoa, Honolulu, HI (LN, TN).
Hawaii J Health Soc Welf. 2024 Dec;83(12):316-321. doi: 10.62547/UVII6313.
Since 2017, Hawai'i has had a statute requiring health plans to update their provider directories at least monthly. However, the results of this study suggest that despite this regulation, errors in physician directories may be an ongoing problem. Using publicly available online Medicaid physician directories from Med-QUEST, Hawaii Medical Service Association (HMSA), AlohaCare, 'Ohana Health Plan, and United Healthcare, 473 unique listings for dermatologists were reviewed and 411 (86.9%) of these listings contained at least 1 inaccuracy. Using the deficiency scoring methodology designed by the Centers for Medicare & Medicaid Services (CMS), it was found that the proportions of deficient listings were significantly different among the directories (<.001). Med-QUEST had the highest weighted final deficiency score of 92.9% and HMSA had the lowest weighted final score of 49.2%. In between were United Healthcare (71.0%), 'Ohana Health Plan (69.7%), and AlohaCare (65.7%). It is unknown whether these results are an improvement from the implementation of the statute. Nevertheless, this issue can cause additional barriers for Medicaid patients who already experience narrower networks and longer wait times for dermatologists. Furthermore, it would also be worth investigating if this issue is also prevalent in listings for other specialties.
自2017年以来，夏威夷有一项法规要求健康计划至少每月更新其提供者名录。然而，这项研究的结果表明，尽管有这项规定，医生名录中的错误可能仍是一个持续存在的问题。利用从医疗探索（Med-QUEST）、夏威夷医疗服务协会（HMSA）、阿罗哈关怀（AlohaCare）、欧哈纳健康计划（'Ohana Health Plan）和联合健康保险公司（United Healthcare）公开获取的在线医疗补助医生名录，对473个皮肤科医生的独特列表进行了审查，其中411个（86.9%）列表至少包含1处不准确信息。使用医疗保险和医疗补助服务中心（CMS）设计的缺陷评分方法，发现名录之间缺陷列表的比例存在显著差异（<.001）。医疗探索的最终加权缺陷得分最高，为92.9%，而夏威夷医疗服务协会的最终加权得分最低，为49.2%。介于两者之间的是联合健康保险公司（71.0%）、欧哈纳健康计划（69.7%）和阿罗哈关怀（65.7%）。目前尚不清楚这些结果是否比该法规实施前有所改善。尽管如此，这个问题可能会给那些已经面临更窄的医生网络和更长的皮肤科医生等待时间的医疗补助患者带来更多障碍。此外，研究这个问题在其他专科的列表中是否也普遍存在也将是值得的。
