Regarding the story “Providers, advocates seek tougher rules on network adequacy”, as a consultant helping hospitals shore up their cardiovascular service line organizations, I too often find the providers' logistics grossly fragmented and outdated. If the providers' directories are outdated, or lacking in specific sub-specialists and/or primary-care physician coverage, or lacking formal patient transfer systems from hospital to hospital as in the case of networks involving inner-city institutions integrated with rural area hospitals, then the likelihood of the health plan being up to speed is nil. Health plans cannot “manage” care delivery. So it's up to the hospitals and physicians to first demonstrate their willingness and ability to better manage these logistics and then educate their network plans to follow suit.
Conrad Vernon
Heart & Vascular ConsultantsBurnet, Texas
