'Phantom' providers plague mental health directories, impacting access

As Americans seek lower health care costs, patients have often been encouraged to use online tools to find providers in their network from whom they can obtain lower-priced care. But a new study suggests that the entire system of health care directories may be flawed. According to the Oregon Health & Science University, research shows as many as 58% of all listed providers in the Oregon Medicaid system in 2018 were so-called “phantom providers” who aren’t available to see patients. 

The numbers were especially stark for mental health specialists; while around 54% of all primary care providers were “phantoms”, more than two-thirds of mental health prescribers fell into that same category.

According to Jane M. Zhu, the lead author of the new study, “Phantom Networks: Discrepancies Between Reported and Realized Mental Health Care Access in Oregon Medicaid,” the findings are worrisome, especially if they reflect other provider systems as well. “If the majority of providers are not actually accessible, it leads to delays and interruptions in care and treatment that people need,” she said.

The findings come at a time when mental health care is particularly hard to find. Some 37% of the American population does not have adequate access to mental health professionals, according to a 2021 study by the nonprofit organization USA Facts, with some states, including Wyoming, Utah, and Mississippi seeing particularly high shortages of qualified mental health providers. That study estimated more than 6,000 additional mental health professionals would be necessary to eliminate care shortages.

“We simply need more mental health professionals to meet the demand,” Zhu said.

The study’s authors suggest that the discrepancies in Oregon’s Medicaid directory might be due to administrative tracking issues. Whatever the cause, the inaccuracies are a problem for more than just patients. As the study notes, “Significant discrepancies between the providers listed in directories and those whom enrollees can access suggest that provider network monitoring and enforcement may fall short if based on directory information.” In other words, health insurance companies may wrongfully believe their enrollees have access to more physicians than they do – and enforcement agencies might similarly believe a higher number of options are being offered to patients than is accurate.