The Critical Link Between Provider Directories and Delivering Quality Care

By Eric Demers, CEO, Madaket Health
LinkedIn: Eric Demers
LinkedIn: Madaket Health

Is a centralized physician directory viable? Maybe not today. But the concept could be hugely valuable to patients and providers alike. In 2022, the Centers for Medicare & Medicaid Services (CMS) took the first steps toward making this a reality. The effort was driven by three significant challenges confronting healthcare providers and patients in the United States.

The first is access to care. When CMS first announced this concept, administrator Chiquita Brooks-LaSure had this to say: “Easy access to accurate and useful provider directory information is critical for patients trying to find healthcare that best meets their individualized needs and preferences.” In theory, a centralized directory would foster transparency and empower healthcare consumers. Through a centralized physician directory, patients would gain access to a comprehensive and standardized source of information, facilitating informed decisions regarding their healthcare providers.

Secondly, such a directory would rectify the prevalent issue of inaccuracies and disparities in provider directories. Various studies consistently unveiled high error rates in directory listings, encompassing incorrect contact details to outdated network associations. Given the recent changes to the regulatory landscape, there is a tremendous financial incentive to get physician directories in order. More importantly, patients rely on online sources to find doctors, which means the need for accurate online resources has never been higher. It’s simply unacceptable in the digital age for directories to be consistently riddled with errors.

The third challenge that CMS’ proposal aimed to help was physician burnout by addressing administrative inefficiencies encountered by healthcare providers. Unfortunately, the volume of administrative work is only growing for most physicians as new regulations require physicians to share more data with payer groups more often. It’s more difficult and expensive to retain staff in the current environment, but how does a single directory alleviate these issues?

The Problem with Directories

All this is to say that the current state of directories is dysfunctional, and it has a tangible impact on patients and providers. Providers are already so overworked that a 2022 study  from The Journal of General Internal Medicine revealed primary care providers (PCPs) require an average of 26.7 hours to effectively carry out administrative tasks and provide care to their patients on a given day.

Manually submitting directory updates to insurers is a burdensome endeavor, costing practices nearly $3 billion annually. Compound this with staffing shortages, and the reality is that many physicians simply do not have the time to give patients guideline-recommended preventative, chronic disease, and acute care. Directory updates alone require physicians to invest significant hours in updating data, diverting attention from direct patient care.

This process takes away from the most essential duty in healthcare – treating patients – and yet it still fails to ensure directory accuracy. Recent research looked at physician information across directories of five major national health insurers only to find that 81% of entries were inaccurate.

But we can’t blame physicians for this woefully inadequate system. Managing directory data is exceptionally challenging. These entries include everything from location details and specialties to contact information and network affiliations; data that changes all the time. A third of directory information changes annually, and with providers already struggling to stay afloat amid rampant burnout, there needs to be some standardization to reduce the complexity. Too often, data exchanges occur through disparate methods such as faxing, email spreadsheets, data scraping, and cold-calling.

How Automation Can Enhance Value

When CMS proposed the centralized directory, the American Hospital Association expressed concerns that the providers’ reporting burden would increase. That may be, but only if the industry doesn’t take lessons from the currently fragmented directory landscape. Healthcare providers are left grappling with the challenging nature of provider data management no matter what, and it demands immediate attention.

Centralized or not, provider directories need a more robust, standardized infrastructure. Agnostic, technology-driven solutions facilitating seamless data exchange and synchronization processes offer promising avenues for improvement. The CAQH Index from last year highlighted fully electronic transactions could streamline administrative processes and save the industry billions. Embracing data management platforms that facilitate centralized data exchange, healthcare systems and payers can alleviate provider burdens, enhance patient experiences, and ensure better outcomes overall. However, these solutions must address challenges such as data fluctuations, standardization issues, and regulatory compliance.

Manual processes are no longer adequate, and unless providers adopt neutral solutions for accurate data exchange, provider directory management will continue to be costly and detract from patient outcomes. Automation is a critical tool to overcome these challenges, enabling real-time updating and synchronization of provider information. By automating tasks such as data entry, validation, and updating, healthcare providers can reduce administrative overhead and redirect resources toward delivering high-quality patient care.