Keeping up with accurate provider directories detailing in-network providers comes with a big annual price tag––nearly $3 billion, according to a new report from CAQH.
CAQH, a non-profit focused on creating shared incentives in healthcare business, surveyed 1,240 physician practices about the burden of maintaining directors and found each practice spends $998.84 on average every month. That’s about the same cost as one staff day per week. And it comes out to $2.76 billion across all U.S. physician practices.
The findings come at a time when healthcare organizations have had to step up the maintenance of directories because unreliable information in directories can have big consequences. In addition, they are legally required to make these directories available to its members in order to find in-network providers. Unreliable directories are inconvenient to members but also have an effect on costs and access to care.
While there are laws governing how often directories need to be updated with information, which is typically provided by physicians directly, the frequency for updating plans varies. For example, Medicare Advantage plans have to contact providers quarterly to update directories, while some states require both commercial and government plans to reach out to providers at different times.
Part of the problem is that physicians are asked to update their information for upwards of 20 health plans, while larger practices may see requests from 30 plan contracts. That creates a larger burden for physicians and can impact accurate reporting.
"Our nation's fragmented approach to maintaining provider directories is not only a burden on physician practices, it may be undermining the accuracy of the data," April Todd, CAQH senior vice president for CORE and Explorations, said in a statement. "Health plans rely on the information providers give them. If we minimize the requests that drive provider burden, we can improve the accuracy of the data."
Physicians reporting to multiple health plan requests for directory information also have to do so in various formats. Practices that use one channel for all health plans can save 39.6% per month compared to those who use multiple approaches. A single channel could save the average practice $4,746 annually, while the total savings across physician practices would be at least $1.1 billion. CAQH pushed for a single platform approach in its report.
"This is going to take an industry-wide solution," Todd said. "If payers along all lines of business work together to reduce the burden on providers through a single streamlined approach, we can improve the accuracy of directories for all consumers."
Amy joined TriMed Media as a Senior Writer for HealthExec after covering home care for three years. When not writing about all things healthcare, she fulfills her lifelong dream of becoming a pirate by sailing in regattas and enjoying rum. Fun fact: she sailed 333 miles across Lake Michigan in the Chicago Yacht Club "Race to Mackinac."