There Is ‘Skepticism and Support’ for National Provider Directory, CMS Official Says

After the Centers for Medicare and Medicaid Services put out a request for information on a proposed CMS-led national directory of providers in October, one CMS official shared insight Wednesday on the feedback the agency has received.

“Overwhelmingly, we heard a lot of support and a lot of skepticism, and that’s what we expected. Then we heard some things we weren’t expecting, and so those are also things that we need to take into account,” said Alexandra Mugge, director and deputy chief health informatics officer of the Health Informatics and Interoperability Group at CMS. Mugge was speaking at the AHIP Medicare, Medicaid, Duals and Commercial Markets Forum held in Washington, D.C on Wednesday.

When CMS asked for public input on the national directory, it proposed a system in which it would collect information from providers and compile it into a single directory maintained by CMS. This directory would be shared with patients and allow them to find and compare providers based on preferences like language and location.

It would differ from the current system, in which each health plan has to get information from each provider. This is time consuming, costly and leads to inaccuracies. A 2019 survey found that maintaining directories cost physician practices $2.67 billion a year.

“There are thousands of directories in healthcare today,” Mugge said. “We spend billions of dollars every year trying to maintain accuracy. But even with those expenditures, we’re seeing accuracy rates at 50% and even lower in many cases.”

Due to the issues associated with provider directories, many stakeholders are — tentatively — in favor of having a national directory. 

“I would say that overwhelmingly stakeholders support this concept of the national directory — if it’s done correctly, if it’s done right,” Mugge stated. “That’s a really big if because no one here is delusional. … I’m very clear that this would be a very difficult endeavor. It’s going to be hard, very hard, but personally I believe that CMS is in the right place to do this.”

Danielle Lloyd, senior vice president of private market innovations and quality initiatives at AHIP, said the advocacy organization requested a public-private partnership when it comes to the national directory. Lloyd moderated the panel on Wednesday.

“Part of our commentary was that if Medicare collects for Medicare, that looks different, right?” Lloyd said. “Medicare is the whole country, Medicare is a national network, right? It’s different from how private insurance works. And we still don’t want to have this national directory sort of solving for a federal issue here and then all of our directories … are over here and then the providers are still getting pinged a bazillion times. How do we really make this a private-public partnership and make sure that this directory solves for a little more than Medicare?”

Lloyd previously told MedCity that private payers require more information in their directories than public payers do.

“When you think about original Medicare, for example, it doesn’t really have a network since almost every physician accepts it,” Lloyd said. “For a private payer, each plan product may have a different network. So, it’s not enough to know whether a provider takes Plan A, you have to know whether it takes Plan A’s HMO product, or PPO product, or both. And, you need to know if that differs by location if they practice part of the week in one place and part of the week in another.”

On the panel, Mugge responded that the national directory has to include more than just Medicare, and that a public-private partnership is something CMS wants to include. However, due to the large undertaking the directory would require, it will likely take several steps to complete.

“This has to be a phased-in, measured approach,” Mugge said. “We’re not going to be able to dive in and do all this at once. … I’m just throwing out examples here, but maybe it starts with the data that CMS currently has. Maybe it does start with Medicare, or it starts with our [National Provider Identifier] database. But it does need to be expanded over time to include all of those additional use cases to make it what it needs to be.”

Although a national directory will be difficult to make, the technology is available to do it, added Micky Tripathi, national coordinator for health information technology at HHS, who was a co-panelist.

“I am positive that 99% of you have in your minds the idea of a directory being like a single, static database. … I would encourage you to not think of that as what a directory should be,” Tripathi said. “Think about the way Expedia works today. When you get onto Expedia and you say, ‘I want to fly to Boston, and I’m going to fly tomorrow, and I’d like to fly via these three airlines.’ What does Expedia do? It’s got a set of API’s in the background that goes to all the databases the airlines maintain and gives that information back based on the queries. All of that gives you the experience of being kind of a single database, but it’s really a federated set of databases that connect with each other.” 

As for when a national provider directory could be completed, the panelists did not say. But Mugge and Tripathi did make one thing clear: the idea of a national directory is not a futuristic concept and is something that could be executed. That of course is assuming that all the stakeholders can coalesce around a single vision.

Photo: Tero Vesalainen, Getty Images