PDF(Pubmed)
Abstract：
BACKGROUND: As U.S. legislators are urged to combat ghost networks in behavioral health and address the provider data quality issue, it becomes important to better characterize the variation in data quality of provider directories to understand root causes and devise solutions. Therefore, this manuscript examines consistency of address, phone number, and specialty information for physician entries from 5 national health plan provider directories by insurer, physician specialty, and state.
METHODS: We included all physicians in the Medicare Provider Enrollment, Chain, and Ownership System (PECOS) found in ≥ 2 health insurer physician directories across 5 large national U.S. health insurers. We examined variation in consistency of address, phone number, and specialty information among physicians by insurer, physician specialty, and state.
RESULTS: Of 634,914 unique physicians in the PECOS database, 449,282 were found in ≥ 2 directories and included in our sample. Across insurers, consistency of address information varied from 16.5 to 27.9%, consistency of phone number information varied from 16.0 to 27.4%, and consistency of specialty information varied from 64.2 to 68.0%. General practice, family medicine, plastic surgery, and dermatology physicians had the highest consistency of addresses (37-42%) and phone numbers (37-43%), whereas anesthesiology, nuclear medicine, radiology, and emergency medicine had the lowest consistency of addresses (11-21%) and phone numbers (9-14%) across health insurer directories. There was marked variation in consistency of address, phone number, and specialty information by state.
CONCLUSIONS: In evaluating a large national sample of U.S. physicians, we found minimal variation in provider directory consistency by insurer, suggesting that this is a systemic problem that insurers have not solved, and considerable variation by physician specialty with higher quality data among more patient-facing specialties, suggesting that physicians may respond to incentives to improve data quality. These data highlight the importance of novel policy solutions that leverage technology targeting data quality to centralize provider directories so as not to not reinforce existing data quality issues or policy solutions to create national and state-level standards that target both insurers and physician groups to maximize quality of provider information.
METHODS: We included all physicians in the Medicare Provider Enrollment, Chain, and Ownership System (PECOS) found in ≥ 2 health insurer physician directories across 5 large national U.S. health insurers. We examined variation in consistency of address, phone number, and specialty information among physicians by insurer, physician specialty, and state.
RESULTS: Of 634,914 unique physicians in the PECOS database, 449,282 were found in ≥ 2 directories and included in our sample. Across insurers, consistency of address information varied from 16.5 to 27.9%, consistency of phone number information varied from 16.0 to 27.4%, and consistency of specialty information varied from 64.2 to 68.0%. General practice, family medicine, plastic surgery, and dermatology physicians had the highest consistency of addresses (37-42%) and phone numbers (37-43%), whereas anesthesiology, nuclear medicine, radiology, and emergency medicine had the lowest consistency of addresses (11-21%) and phone numbers (9-14%) across health insurer directories. There was marked variation in consistency of address, phone number, and specialty information by state.
CONCLUSIONS: In evaluating a large national sample of U.S. physicians, we found minimal variation in provider directory consistency by insurer, suggesting that this is a systemic problem that insurers have not solved, and considerable variation by physician specialty with higher quality data among more patient-facing specialties, suggesting that physicians may respond to incentives to improve data quality. These data highlight the importance of novel policy solutions that leverage technology targeting data quality to centralize provider directories so as not to not reinforce existing data quality issues or policy solutions to create national and state-level standards that target both insurers and physician groups to maximize quality of provider information.
摘要：
背景：由于敦促美国立法者在行为健康方面与幽灵网络作斗争，并解决提供商数据质量问题，更好地描述提供者目录的数据质量变化以了解根本原因并设计解决方案变得很重要。因此,这份手稿检查了地址的一致性，电话号码,以及保险公司从5个国家健康计划提供者目录中获取的医师条目的专业信息，专科医师,和国家。
方法：我们将所有医生纳入了Medicare提供者注册，链条,和所有权系统(PECOS)在美国5家大型全国性健康保险公司的≥2家健康保险公司医生目录中找到。我们检查了地址一致性的变化，电话号码,以及保险公司在医生之间的专业信息，专科医师,和国家。
结果：在PECOS数据库中，有634,914名独特的医生，449,282在≥2个目录中找到，并包括在我们的样本中。在保险公司中，地址信息的一致性从16.5%到27.9%不等，电话号码信息的一致性从16.0%到27.4%不等，专业信息的一致性从64.2%到68.0%不等。一般实践,家庭医学,整形手术,皮肤科医生的地址（37-42％）和电话号码（37-43％）的一致性最高，而麻醉学，核医学,放射学,急诊医学在健康保险公司目录中的地址(11-21%)和电话号码(9-14%)一致性最低.地址的一致性有明显的差异，电话号码,和国家的专业信息。
结论：在评估美国医生的大量国家样本时，我们发现保险公司在提供者目录一致性方面的差异最小，这表明这是一个保险公司尚未解决的系统性问题，在更多面向患者的专业中，具有更高质量数据的医师专业差异很大，这表明医生可能会对提高数据质量的动机做出反应。这些数据突出了新的政策解决方案的重要性，这些解决方案利用以数据质量为目标的技术来集中提供商目录，以免不加强现有的数据质量问题或政策解决方案，以创建针对保险公司和医生团体的国家和州级标准，以最大限度地提高提供商信息的质量。
方法：我们将所有医生纳入了Medicare提供者注册，链条,和所有权系统(PECOS)在美国5家大型全国性健康保险公司的≥2家健康保险公司医生目录中找到。我们检查了地址一致性的变化，电话号码,以及保险公司在医生之间的专业信息，专科医师,和国家。
结果：在PECOS数据库中，有634,914名独特的医生，449,282在≥2个目录中找到，并包括在我们的样本中。在保险公司中，地址信息的一致性从16.5%到27.9%不等，电话号码信息的一致性从16.0%到27.4%不等，专业信息的一致性从64.2%到68.0%不等。一般实践,家庭医学,整形手术,皮肤科医生的地址（37-42％）和电话号码（37-43％）的一致性最高，而麻醉学，核医学,放射学,急诊医学在健康保险公司目录中的地址(11-21%)和电话号码(9-14%)一致性最低.地址的一致性有明显的差异，电话号码,和国家的专业信息。
结论：在评估美国医生的大量国家样本时，我们发现保险公司在提供者目录一致性方面的差异最小，这表明这是一个保险公司尚未解决的系统性问题，在更多面向患者的专业中，具有更高质量数据的医师专业差异很大，这表明医生可能会对提高数据质量的动机做出反应。这些数据突出了新的政策解决方案的重要性，这些解决方案利用以数据质量为目标的技术来集中提供商目录，以免不加强现有的数据质量问题或政策解决方案，以创建针对保险公司和医生团体的国家和州级标准，以最大限度地提高提供商信息的质量。
