In 2022, the Centers for Medicare & Medicaid Services (CMS) proposed the creation of a centralized physician directory. The proposal sought to address three pressing challenges facing both healthcare providers and patients within the United States healthcare system:
- Fix the pervasive issue of inaccuracies and inconsistencies in provider directories. Studies have consistently revealed high error rates in directory listings, with inaccuracies ranging from incorrect contact information to outdated network affiliations.
- Promote transparency and empower healthcare consumers. A centralized physician directory would offer patients a comprehensive and standardized source of information, enabling them to make informed decisions about their healthcare providers.
- Combat physician burnout by fixing administrative inefficiencies faced by healthcare providers.
Any such centralized database is likely years away from becoming a reality, leaving healthcare providers stuck maintaining their own directories. It may seem straightforward, but the unfortunate reality of provider data management necessitates immediate action.
Directory Challenges and Why They Matter
Manually sending directory updates to insurers is a burdensome task that costs practices nearly $3 billion each year. It requires physicians to spend hours updating data rather than delivering direct patient care, and it still doesn’t ensure accuracy. Recent research found that physician information held within directories of five major national health insurers was inconsistent in four out of five entries.
This isn’t a shot at providers; far from it. Managing directory data such as location, specialties, contact information, and network affiliations is hard, mainly because it’s constantly changing. Who can blame medical practices for struggling to keep up when a third of directory information changes every year? What’s more, there is no standardization for sharing updates; quite the opposite. Data exchanges between payers and providers occur through disparate methods, such as faxing, sharing spreadsheets over email, data scraping, and cold-calling, rather than on a shared platform. For providers coordinating with numerous health plans, each with its own method of sharing provider information, the complexity of directory management escalates exponentially.
The regulatory landscape only strengthens CMS’ case for a centralized physician directory. The implementation of the NSA intensified the need for providers to submit data more frequently to avoid non-compliance. Still, directories too often lack the capability to identify non-compliant entries, hampering regulatory adherence and data accuracy. When a single incorrect entry can levy heft fines on providers and payers alike – and lead to patients facing delays in care access – the stakes of inaccurate provider data are laid bare.
The Role of Automation in Driving Provider Value
The infrastructure to create a transition to a centralized directory is woefully lacking. And while the merits of such an initiative are debated, the challenges healthcare providers face in maintaining and updating provider information continue to mount. The fragmented directory landscape contributes to data inaccuracies and places significant burdens on providers that waste revenue and delay patient care.
Although health systems and payers require more robust technological frameworks to support the transition to a unified provider directory, there is reason to be optimistic that industry improvements are on the horizon. Yes, the challenges healthcare providers face in maintaining and updating provider information are undeniable, but agnostic, technology-enabled solutions that facilitate seamless data exchange and synchronization processes are helping.
Last year’s CAQH Index tracked $89 billion spent conducting administrative transactions and found the industry can save $18.3 billion by transitioning to fully electronic transactions. By embracing data management platforms that centralize data exchange, healthcare systems and payers can alleviate provider burdens, improve patient experiences, and ultimately ensure better outcomes for all. Of course, these solutions must address key challenges such as data fluctuations, standardization issues, and regulatory compliance.
The traditional approach, reliant on manual processes, is no longer sufficient, necessitating the adoption of neutral solutions for accurate data exchange. Automation has emerged as a critical solution to overcome these hurdles, offering the ability to update and synchronize provider information in real-time, continuously. By automating tasks such as data entry, validation, and updating, healthcare providers can reduce administrative overhead and devote more resources toward delivering high-quality patient care.
About Eric Demers, CEO Madaket Health
Eric Demers is the CEO of Madaket Health. He believes we can transform healthcare delivery through the power of data and interoperability. With more than 25 years of global healthcare experience, Eric has built and scaled leading technology and service companies, from early stage to Fortune 100. He is highly sought-after for speaking and consulting on international health, having advised global entities and governments on critical issues facing healthcare. A growth-minded leader, Eric has founded three companies and exited two. Eric previously served in strategy-focused executive roles at IBM, Accreon, MEDecision and Orion Health. He is a graduate of Brandeis University and The George Washington University School of Medicine and Health Sciences.
