A few months ago, I was honored to host a #kareochat (thanks, @gokareo!) about filling the appointment schedule. The discussion hit on one of my favorite topics: payer directories. Repeat visitors to this space and/or readers of my ebook probably already know that I consider payer directory listings to be the top reputation management priority for most practices (at least if you’re aiming to serve insured patients). Even though these directories aren’t always near the top of a physician or specialty search in Google or Bing, most patients will know the name of their insurance plan, and will go to the plan’s site to be sure any physician they consider seeing will take their plan. (This goes double for any patient who has been burned by accidentally seeing a doctor out-of-network, resulting in an unexpected bill.) Patients will find their plan directories, and use them to screen out doctors who don’t take their insurance.

Of course, the other reason I put payer directory listings at the top of the monitoring priorities is that they are so often wrong! It’s logical to assume that the directories would be updated automatically or that the payers should take care of this without assistance from providers. But even though payers are nominally responsible, providers have to be vigilant, because the stakes for themselves and their patients are too high, and payers just aren’t getting the job done.

@drtom_kareo (Dr. Tom Giannulli, medical director at Kareo) pointed out that legislation is coming (SB 137) in California to mandate payers correct their directories. Plus, the CMS has already announced that it will fine Medicare Advantage plans for errors in their physician listings. In theory, this will push the payers to get their directory houses in order — right?

While the legislation is going to bring more attention to the problem, which is great, I don’t think solving it will be so easy.  Here are a few reasons why I think it’s not that simple.

Are payers deliberately ignoring their directories?  I don’t think so. The idea that legislation is the push that insurance companies need to finally wake up and do something about their messed up directories assumes that they haven’t been trying. But they have an interest in the directories being accurately, too.  After all, they also get burned when patients are angry about out-of-network charges.

Maintaining a directory is much harder than you would think. I know this because I used to be a directory publisher. I was lucky in a way, since this was back in the glory days of print, and so we had only one shot per year to get everything right. Although that huge deadline added stress for us, it also motivated all of the companies listed in our book to get in touch with us and make sure we got things right before we went to press.Today’s directories are almost exclusively electronic, and that means they can — and do — change all the time. That decreases the urgency on the part of practices to monitor them, and also makes it harder for payers to set up a system to keep everything perfect.

Setting a rule and threatening punishment doesn’t make errors easier to catch. Just announcing that payers “must” fix errors (or be punished) may provide motivation, but it doesn’t solve the underlying systems issues and challenges that make keeping the directories current such a challenge. The payers may actually have no idea why they can’t stay on top of directory data, or how to do it well — threatening punishment doesn’t change that.

One reason my directory company had a near-perfect accuracy rate was the fact that directory publishing was our core business. It’s hard enough to do a directory well as a core business, but as a sideline or marketing tool, well, that’s got to be very tough.  (Let’s not forget how common mistakes are in physician reviews and ratings sites like Healthgrades, Vitals, even Google and Bing. And this is their main business!)

The new rules aren’t going to fix the directories or shut down insurers who have inaccuracies. Payers who have inaccuracies instead risk being fined, and likely being forced to absorb the costs of errors that are currently passed on to patients, and sometimes providers.

Companies have ways of dealing with laws like this, where they will be fined for not doing something that government thinks they should. They will evaluate the costs of new systems to deal with the problem, and the costs of the fines for failure, and decide how much failure is acceptable.They will also look to push responsibilities to others — as they did with SB 137 in California, which includes requirements for physicians to notify payers when directory changes are needed and to respond to payer queries. The legislation allows for physicians to be dropped from plans or have payments delayed if they fail to assist in keeping directories accurate.

The bottom line is, maintaining payer directory accuracy is really a shared responsibility — whether legislated as such or not. Payers can’t keep their directories accurate without your help (even if, arguably, they should be doing a much better job than they do).  Practices have way too much to lose if their information is incorrect in a key payer directory to hope that tougher talk or even new laws will absolve them of the need to keep track of what’s published in them.  (Remember that if you’re not listed properly in the directory of a health plan you accept, you could be passively turning away patients who used the directory to find an in-network doctor. And if you’re listed in a plan you’ve dropped, you could wind up seeing a patient out-of-network, potentially causing an unpleasant surprise bill for the patient, and lower reimbursement for your practice.)

In California, at least, health plans have succeeded in codifying that shared responsibility — and pushing some of the risk of punishment onto practices.  I have a hunch the same thing will start to happen in other states, too, as insurance regulators try to address the hassles and expenses that inaccurate directories are causing patients. But even if it doesn’t, practices still have way too much to lose to leave payer directory accuracy up to the payers alone.

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