Maintaining provider directories is an expensive, time-consuming task that takes up the equivalent of one staff day per week for physician practices, a new Council for Affordable Quality Healthcare survey finds.
CAQH, a not-for-profit health plan alliance who members include top health insurers like Cigna, Aetna and Humana, conducted the survey on 1,240 physician practices in September. It found directory maintenance costs practices nationwide $2.76 billion annually, or $999 per practice per month.
"Providers are really getting these requests coming at them from all angles," said April Todd, CAQH's senior vice president for CORE and explorations. "So it really is a multi-factored administrative burden that the providers are seeing."
The cost to practices rises in accordance with the number of providers and plan contracts, the survey found. Practices with more than 25 providers spent an average of about $2,500 per month maintaining provider directories, while those with fewer than five providers spent $319 per month on average.
Providers with more than 31 plan contracts spent an average of $1,606 per month, while those with fewer than 10 contracts spent $428 per month.
CAQH also identified regional variations in directory maintenance costs, from an average of $808 per practice per month in the western U.S. to $1,246 in the eastern U.S.
Ultimately, CAQH's report touts a seemingly simple solution: health plans adopting a single, streamlined platform where practices can enter, update and review their practice information and share it with multiple plans at once.
As part of its analysis, CAQH found that practices that use one channel for all plans spend 40% less per month than those who use multiple approaches. Assuming similar efficiencies, the report determined that using a single channel to update directory information could save the average practice $4,746 annually. Nationally, streamlining directory maintenance through a single platform could say practices at least $1.1 billion annually.
But getting all payers to agree to go to one platform is easier said than done. A few of CAQH's members have shown interest, but there are lots of public and private payers out there, Todd said. Getting Medicare buy-in would be especially helpful.
"The challenge is getting everyone to get on the same page," Todd said.
Right now, though, CAQH is mainly trying to help stakeholders understand the level of burden and how it could be reduced, Todd said.
The average physician practice updates directory information for 20 health plan contracts, the survey found. Large practices might have up to 30 contracts. Practices must respond to multiple requests and submit information in different formats and schedules for each plan, according to CAQH.
It's not just resource intensive, it might also contribute to errors. The CMS has examined online directories for Medicare Advantage plans since 2016 and has consistently found up to half of the information is inaccurate, according to CAQH.
More than half of 700 physicians said their patients run into coverage issues at least once a month because of inaccurate directories, a 2018 American Medical Association survey found.
That's where health plans have an incentive to ensure their directories are up-to-date, Todd said.
"Everyone wants them to be accurate to make sure the plans serve their customers and for consumers to be able to get to the right place and keep their out-of-pocket costs as low as possible," she said. "It's really in everyone's best interest to improve the accuracy."
