The average physician practice updates information for 20 health plan contracts, and large practices may work with more than 30 health plans. (Image: Shutterstock)
Managing staff directories costs physician practices in the U.S. $2.76 billion each year, a new survey finds. The time and money spent on the task comes to an average of $999 per practice per month—the equivalent of one full-time staff day per week.
The survey of 1,240 physician practices was conducted by CAQH, a nonprofit stakeholders group that promotes streamlining of health care business processes. The group recommends a single platform for updating and managing provider directories, saying that physician practices would save more than $1 billion a year if a uniform system was put in place.
"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," said April Todd, senior vice president with CAQH. "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."
|An administrative jungle
The survey outlined a system that has a great deal of variation in how information is submitted and processed. The survey found that the average physician practice updates information for 20 health plan contracts, and large practices may work with more than 30 health plans. The study noted that some health plans have worked to reduce this administrative burden, but practices are still dealing with multiple requests, formats, and schedules for the various plans with which they contract.
For example, a 2018 America Medical Association survey found that providers used a variety of means to provide directory information, including by fax (38 percent); credentialing software (13 percent); email (13 percent); provider management and enrollment software (5 percent); and phone, mail and other methods (14 percent).
Adding to the problem are regulatory requirements that vary between government programs. "CMS requires Medicare Advantage plans to contact providers quarterly. States require commercial and government-funded plans to conduct outreach on a variety of schedules, including some that exceed the federal requirements," the report said. "According to Berkeley Research Group, 19 states require provider directory updates at least on a monthly basis; 12 require updates between quarterly and annually; and seven require directories to be 'up to date' or updated in a timely manner."
|Missing the mark on accuracy
Keeping information accurate and up to date is a major challenge, the study said. CMS research conducted by the Centers for Medicare and Medicaid Services (CMS) found that as much as half of the information contained in provider directories may be inaccurate. "Because members rely on directories to identify and contact providers in their plan, inaccurate directories can present a barrier to care and result in higher out of pocket costs," CAQH said in its release.
CAQH, which markets its own streamlined platform for updating provider information, said its research indicates that practices using one channel for maintaining provider directories spend nearly 40 percent less per month than those that use multiple channels. The group estimates that if all practices used a similar approach, the average physician practice could save $4,746 annually.
"This is going to take an industry-wide solution," said Todd. "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."
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