Dermatology Physician Directories are Blemished with Inaccuracies

The results of an undercover dermatologist directory study showed that among 4,754 total physician listings, 45.5 percent were duplicates and only 48.9 percent of uniquely listed physicians were reachable. The sting was conducted by members of the University of California’s (UC) San Francisco Department of Dermatology who created a false scenario to arrange appointments in an effort to ascertain the accuracy and appointment availability of listed physicians in Medicare Advantage (MA) plan directories.

Background

Insurers have been narrowing the scope of contracted physicians offered in health plan networks, and MA plans are no exception. MA plans, such as Humana, are insurance alternatives offered by private insurance companies that contract with Medicare to insure beneficiaries. MA plans must meet network adequacy requirements. If directories are filled with physicians who are no longer accepting the plan or no longer at the listed address, MA participants experience difficulty in arranging care.

The Sting

The UC study sought to assess the largest MA plans in 12 U.S. metropolitan areas. The UC members devised scripted telephone calls in which they called for appointments on behalf of a fictitious father who had a severe itch for several months. The caller asked whether the dermatologist accepted the relevant plan listed and asked for the next available appointment date. Calls were made to every dermatologist listed in directories for the 12 areas.

Results

The callers found that many of the listed dermatologists had incorrect contact information; were deceased; retired; relocated; were not accepting new patients; did not accept the listed insurance plan; or were subspecialized. For the nearly 50 percent of successfully made contacts, the listed insurance plan was still acceptable, but average appointment wait times were 45.5 days. Both the accuracy of network directories and the appointment wait times varied substantially by the type of health plan and the metropolitan area. Further, the inaccuracies were found in areas with long appointment wait times and in areas where insurers were terminating selected physician contracts.

Conclusions

Narrowed physician networks and inaccurate listings leave little choice for Medicare beneficiaries. The UC members assert that accurate physician directories “are essential for proper oversight of network adequacy, and for patients who rely on these listings to evaluate health plan options during open enrollment.”