Characterizing physician directory data quality: variation by specialty, state, and insurer

Area of Science:

• Health Services Research
• Medical Informatics
• Public Health Policy

Background:

• Addressing "ghost networks" and provider data quality is crucial for U.S. healthcare.
• Variation in provider directory data quality requires understanding root causes and solutions.

Purpose of the Study:

• To examine the consistency of address, phone number, and specialty information for physicians across national health plan directories.
• To analyze variations in data quality by insurer, physician specialty, and state.

Main Methods:

• Included physicians from Medicare Provider Enrollment, Chain, and Ownership System (PECOS) listed in at least two directories from five major U.S. health insurers.
• Assessed consistency of address, phone number, and specialty data.

Main Results:

• Address consistency ranged from 16.5-27.9%, phone number from 16.0-27.4%, and specialty from 64.2-68.0% across insurers.
• Patient-facing specialties like general practice and family medicine had higher address and phone number consistency.
• Anesthesiology, radiology, and emergency medicine had the lowest data consistency.

Conclusions:

• Minimal variation in directory consistency by insurer suggests a systemic problem.
• Significant variation by physician specialty indicates potential for improvement through incentives.
• Novel policy solutions and national/state standards are needed to centralize and improve provider directory data quality.