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CMS eyes a nationwide provider directory

A single, nationwide healthcare services and provider directory may come with a number of technical and administrative challenges
By admin
Oct 14, 2022, 12:26 PM

CMS is continuing down the path of data transparency and patient-centered services by requesting industry input on the creation of a new nationwide directory of healthcare providers and services.

A unified, standardized provider directory could make it easier for consumers to identify in-network clinicians who are accepting new patients and find providers who meet their specific preferences and health needs.

“Currently, the health care directory landscape is fragmented, resulting in patients sometimes struggling to find up-to-date information about providers in their network and providers facing redundant and burdensome reporting requirements to multiple databases,” CMS said in a press release announcing a request for information from industry stakeholders.

“Because of that burden, directories often contain inaccurate information, rarely support interoperable data exchange or public health reporting, and are costly to the health care industry.”

The problem is more widespread than many realize. For example, the agency has found that 47 percent of Medicare Advantage (MA) health plan directories contain at least one inaccuracy, while the majority of MA organizations had between 30 percent and 60 percent inaccurate provider practice locations.

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Inaccurate directories contribute to a wide range of issues, from potential delays in care to surprise bills from providers who are no longer in-network for a specific insurance plan.

In 2018, 52 percent of physicians responding to an American Medical Association (AMA) survey said they routinely encountered patients with insurance coverage issues due to inaccurate information in provider directories. Most providers participating in that poll said that continually updating their information for multiple plans was burdensome to staff, and they were unaware that health plans are held accountable to mandates requiring regular updates.

CMS is theorizing that a national approach to directory listings could relieve these concerns.

“A robust health care directory built on modern interoperable technology could greatly improve the availability of provider data and spur electronic health data exchange,” CMS asserted.  Such a directory “could serve as a ‘centralized data hub’ for all health care directory and digital contact information with accurate, up-to-date and validated data in a publicly accessible index developed through streamlined information submission from providers.”

The agency hopes to tap the power of modern approaches, such as application programming interfaces (APIs), to make it simpler and easier for providers to stay on top of their own information so consumers can make informed choices about their care.

The centralized, interoperable database would complement other national data exchange efforts, including public health reporting in the wake of the COVID-19 pandemic and the ongoing effort to implement the Trusted Exchange Framework and Common Agreement (TEFCA), CMS said.

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While APIs and other standardized interoperability tactics have certainly helped improve data exchange in the past few years, building and disseminating the infrastructure required to support a large-scale project of this kind will no doubt be a significant challenge.

Providers are still widely struggling to access other types of health data, including data with a more immediate impact on patient outcomes.  Such an ambitious undertaking, which would ideally seek out participation from every single provider in the country, would likely take several long years of hard work and financial investment before it bore fruit.

Without a clear and attractive financial incentive—or a regulatory mandate of some kind—for participating in such work, CMS may have a hard time recruiting altruistic volunteers for altering the current provider directory landscape.

Nevertheless, success would be a major improvement over the status quo, and may support consumers as they shop for affordable, accessible services in the midst of an ongoing provider shortage.

CMS is encouraging all stakeholders to share their opinions on the potential project before December 6, 2022.  Interested parties can respond to the Request for Information in the Federal Register by clicking here.

Jennifer Bresnick is a journalist and freelance content creator with a decade of experience in the health IT industry. Her work has focused on leveraging innovative technology tools to create value, improve health equity, and achieve the promises of the learning health system.

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