It’s difficult to choose a new doctor
The government is considering a first-of-its-kind national directory of health care providers. Here are our ideas on how to make that directory work for us.
Today’s families often find themselves having to choose a new doctor or specialist because they have moved, or have enrolled in a new health plan. We want to pick well-trained, high quality doctors that respect and understand us. If we have insurance, we know we should pick a doctor in our plan’s network. That’s the best way to use our health insurance benefits and keep our out-of-pocket health costs down. But too often our health plan’s directory of in-network doctors are inaccurate. And usually the directory doesn’t include the information that we really care about – like after-work office hours, languages spoken, or their ratings for patient safety record and quality of care services.
This problem might be solved soon. The federal Centers for Medicaid & Medicare Services (CMS) is considering a first-of-its-kind national directory of health care providers. We submitted our ideas on how to make that directory work for consumers and patients:
How to improve health plan network directories
The directory, as proposed, would create a single database of all licensed physicians and other health care professionals. It would be called the National Directory of Healthcare Providers and Services (NDH). A tool this comprehensive doesn’t currently exist.
Existing directories are plan-specific and often don’t contain reliably accurate information about which plans each provider participates in or other useful information. If established, patients could go to one database to find information about doctors in their plan. And with one central directory, doctors themselves would spend less time updating their information in dozens of different directories in order to keep patients informed.
We fully support the creation of a robust national directory system that contains key information important to insured families, academic researchers and federal regulators. We believe the information in the directory should be accessible to everyone, especially the general public.
When we submitted our ideas for the creation of the national directory, we asked that it meet the following goals:
A tool for insured individuals to find cost-effective providers. Patients’ out-of-pocket costs are highly dependent on their ability to identify and use in-network providers. If they cannot find a provider in their network, they are obligated higher co-pays, co-insurance and in many situations are responsible for an out-of-network balance bill. Today’s health plans often fail to give insured patients accurate and easy-to-use provider directories. As a result, insured people have difficulty finding a needed provider covered under their insurance plan. We urged the Department to create an NDH that is accessible to patients to identify network providers.
A tool for insured patients and health plans to identify providers who meet the highest levels of quality care and professional standards. Patients want to find providers with an excellent record in providing high quality health services to improve their chances of getting effective and safe treatment. Although health providers report quality and safety information to federal and state regulators, this information is not always public and can be hard to find. We urged the Department to create an NDH that links to quality and patient safety data collected by states and the federal governments.
A tool for researchers and regulators to collect the numbers of licensed, active providers by specialty and by geographic area and to assess plans’ network size and breadth. Patients need robust networks that allow them to select high quality providers close to home. A single database of providers and their affiliated network would enable regulators to effectively evaluate the adequacy of health plan networks. We urged the Department to create an NDH that can serve as the source of the information needed to assess and enforce network adequacy.
A tool for the public, plans and providers to improve accuracy and allow for swift updates and corrections to network directories. Provider directory data has often been found to be inaccurate or out of date. We urged the Department to create an NDH that allows providers and plans to submit changes efficiently and for consumers to report errors and omissions they discover.
We also asked the government to include patients and consumers when designing this directory to ensure it works for all of us. We need a simple way to find in-network doctors that meet our priorities so we can get the best care possible.
Senior Director, Health Care Campaigns, PIRG
Patricia directs the health care campaign work for U.S. PIRG and provides support to our state offices for state-based health initiatives. Her prior roles include senior director of health policy with the National Consumers League, senior policy advisor at NJ Health Care Quality Institute, and advocate at AARP and NJPIRG. She serves on the Ground Ambulance and Patient Billing Advisory Committee at the Centers for Medicare and Medicaid Services. Patricia enjoys walks along the Potomac River and sharing her love of books with her friends and family around the world.