The Accuracy of Dermatology Network Physician Directories Posted by Medicare Advantage Health Plans in an Era of Narrow Networks

By Jack S. Resneck Jr, MD; Aaron Quiggle, BA, MS; Michael Liu, BS; David W. Brewster, BA
JAMA Dermatology, October 29, 2014

In the evolving health insurance marketplace, many health plans have increasingly deployed “narrow networks,” reducing the number of contracted physicians or hospitals in a given metropolitan area. Whereas the use of these narrow networks in exchange plans offered under the Affordable Care Act (ACA) might have been expected given pressures to control costs and limit premiums, insurers have taken similar actions in several states to reduce the number of participating physicians in private plans offered as alternatives to Medicare patients known as Medicare Advantage (MA) plans.

Whereas some inaccuracies in ACA exchange plan directories may be expected given the novelty of those products in 2014 and the last-minute contracting that occurred, the MA marketplace is more mature and should have more stable physician listings. Accurate physician lists are particularly important at a time when MA plans are increasingly deploying narrow networks, making determinations of network adequacy critical for both primary care and many difficult-to-access specialties.

Methods 

Using MA enrollment data from July 2014, we determined the 3 largest insurers in each of the 12 MSAs by enrollment.

A scripted telephone call was placed by one of us (A.Q. or M.L.) to each unique physician listing. All calls were placed during varied times of the day and days of the week for each MSA and occurred between August 5 and September 4, 2014.

He asked whether the listed physician accepts the relevant MA plan(s) and sees patients with itchy rashes and, if so, when the next available new-patient appointment was.

Results

For the largest MA plans in the 12 MSAs… there were 4754 physician listings (4408 MDs, 346 DOs) meeting inclusion criteria.

Within health plans, a large number of these listings represented duplicates (2164 [45.5%]).

Among the 2590 remaining unique listings, there were many that our callers were unable to contact (464 [17.9% of unique listings]). Some of these were nonworking or wrong telephone numbers, and others were offices that reported that they had never heard of the listed physician. Several more (221 [8.5% of unique listings]) reported that the listed physician had died, retired, or moved out of the geographic area.

Many of the listed physicians whose offices we reached were not accepting new patients (221 [8.5% of unique listings]). There were also several who were subspecialized and were not willing to make an appointment for a patient with an itchy rash.

Fewer than half of listed physicians for each plan (1266 [48.9% of unique listings]) were reached, accepted the listed plan, and offered an appointment for a patient with an itchy rash. Because of the large number of duplicate listings, this translates to only 26.6% of individual directory listings being unique, taking the listed plan, and offering a medical dermatology appointment.

Wait times for the appointments offered by those listed physicians were relatively long (median, 30 days; mean, 45.5 days).

Discussion

Our findings of inaccurate physician directories and long dermatology appointment wait times in many areas come at a time when many health plans are narrowing their MA networks by reducing the number of in-network physicians. There has been concern voiced about the proprietary methods that health plans are using to select physicians for termination and whether those methods themselves may limit access for patients with more costly health conditions. Our study cannot address those specific concerns, but our data do support the hypothesis that the large physician directories posted by many health plans exaggerate perceived access to dermatologists for MA patients. Furthermore, the long in-network appointment wait times observed for many of these plans suggest a lack of capacity that can only be exacerbated by further network narrowing.

http://archderm.jamanetwork.com/article.aspx?articleid=1919439

One of the more alarming trends in health insurance innovation is the increasing use of narrower provider networks. Patients are losing their choice of their health care professionals and hospitals. Not only can this result in impaired access and longer wait times, it also can unfairly benefit the insurers by discouraging sicker patients from enrolling because of concerns about being unable to access the care that they need – especially specialized services.

This study looked at provider lists of dermatologists offered by a representative group of major private Medicare Advantage plans. Although the plans offered in the new insurance exchanges under the Affordable Care Act can plead being victims of transitional logistical complexities causing errors in their network lists, the private Medicare Advantage plans have been around for many years in an expansionary market and thus should represent the best of network administration. So how are they doing?

This study was completed less than two months ago and thus represents the current state of the art. When contacted, only one-fourth (26.6%) of the total number of dermatologists listed in the Medicare Advantage provider networks offered new appointments, and the mean wait time was 45 days. Only one-fourth! And with a 45 day wait!

This narrow network thing has really caught on. Some of these same Medicare Advantage plans are now cutting more providers from their networks, including dermatologists. And the newer ACA exchange plans are starting out with even narrower networks.

How can this benefit patients? Take away choice? Hiding true providers in otherwise worthless lists? Moving patients further back in the queues? And they want to give us more of this?

Traditional Medicare doesn’t have any networks. They are a creation of the private insurance industry, designed to serve their own nefarious interests. Enough! Time to get rid of them and enact an improved Medicare that takes care of all of us.