The Accuracy of Dermatology Network Physician Directories Posted by Medicare Advantage Health Plans in an Era of Narrow Networks | Dermatology | JAMA Dermatology | JAMA Network
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    1 Comment for this article
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    High-Rated Medicare Plans Without Adequate Dermatologist Access
    Scott A. Davis, Steven R. Feldman | Department of Dermatology, Wake Forest School of Medicine
    The timely article by Resneck and colleagues(1) should be a wake-up call for Medicare to ensure that access to needed services is a top priority. The plan rating system, now given real effect on plans’ bottom lines under the Affordable Care Act, promises to reward 3-star-and-higher plans financially for supposedly providing better care. Better care is defined through a list of 37 quality measures for Medicare Part C and 18 for Part D, few of which directly address access to specialists.(2) Although Resneck did not assess the relationship between a plan’s rating and wait time to see a dermatologist, it is doubtful that there would have been a significant relationship. For example, Today’s Options, the plan that did not allow the callers a single dermatologist appointment in Syracuse in Resneck’s study, is rated a 4-star plan overall,(3) achieving 4 stars in the domain “Member Experience with Health Plan”, 5 stars in the domain “Member Complaints and Changes in the Health Plan’s Performance”, and 4 stars in the domain “Health Plan Customer Service”.(4) On specific measures, the plan gets 4 stars on “Getting Needed Care” and 4 stars on “Getting Appointments and Care Quickly”. Based on the high ratings for this plan, it would be tempting to conclude that dermatologist care is not being counted as “needed care.” Sadly, plans apparently do not expect to be penalized for posting inaccurate listings of their physician networks. To have a real impact on plans’ ratings, perhaps large numbers of patients will have to file complaints about their plans to show how much they value dermatologist access. With the immense financial importance now attached to ratings, it is essential that patient advocates ensure the ratings are measuring the right criteria. If excellent dermatologic care is not properly factored into the ratings, both dermatologists and patients will suffer. References (1) Resneck JS, Jr., Quiggle A, Liu M, Brewster DW. The Accuracy of Dermatology Network Physician Directories Posted by Medicare Advantage Health Plans in an Era of Narrow Networks. JAMA Dermatol 2014;10. (2) Centers for Medicare and Medicaid Services. Medicare Health & Drug Plan Quality and Performance Ratings 2013 Part C & Part D Technical Notes. http://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovGenIn/Downloads/Technical-Notes-2013-.pdf 2012 August 9. Accessed October 31, 2014. (3) Universal American. 2015 Medicare Advantage Plans. http://www.universal-american-medicare.com/todaysoptions# 2014. Accessed October 31, 2014. (4) Centers for Medicare and Medicaid Services. Part C and D Performance Data. http://www.cms. gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovGenIn/PerformanceData.html 2014. Accessed October 31, 2014.

    CONFLICT OF INTEREST: Dr. Feldman is a consultant and speaker for Galderma, Stiefel/GlaxoSmithKline, Abbott Labs, Warner Chilcott, Janssen, Amgen, Photomedex, Genentech, BiogenIdec, and Bristol Myers Squibb. Dr. Feldman has received grants from Galderma, Astellas, Abbott Labs, Warner Chilcott, Janssen, Amgen, Photomedex, Genentech, BiogenIdec, Coria/Valeant, Pharmaderm, Ortho Pharmaceuticals, Aventis Pharmaceuticals, Roche Dermatology, 3M, Bristol Myers Squibb, Stiefel/GlaxoSmithKline, Novartis, Medicis, Leo, HanAll Pharmaceuticals, Celgene, Basilea, and Anacor. Dr. Fleischer has received support for research, speaking, or consulting from Astellas, Centocor, Amgen, Abbott, Galderma, Stiefel, Medicis, and Intendis. Dr. Feldman is the founder and holds stock in Causa Research, and has received stock options from Photomedex.
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    Original Investigation
    December 2014

    The Accuracy of Dermatology Network Physician Directories Posted by Medicare Advantage Health Plans in an Era of Narrow Networks

    Author Affiliations
    • 1Department of Dermatology, University of California, San Francisco, School of Medicine
    • 2Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, School of Medicine
    • 3medical student at University of California, San Francisco, School of Medicine
    • 4American Academy of Dermatology Association, Washington, DC
    JAMA Dermatol. 2014;150(12):1290-1297. doi:10.1001/jamadermatol.2014.3902
    Abstract

    Importance  Insurers are increasingly deploying “narrow networks” with fewer contracted physicians both in health plans offered in new state exchanges under the Affordable Care Act and in Medicare Advantage (MA) plans, which are commercial alternatives offered to Medicare beneficiaries. Patients choosing health plans rely on the accuracy of network directories posted by insurers. The MA plans must meet network adequacy requirements, and inaccurate directories of participating physicians might prejudice those determinations.

    Objective  To determine the accuracy of MA plan directories of participating dermatologists, and the appointment availability of listed physicians.

    Design, Setting, and Participants  Scripted telephone calls were placed to every dermatologist listed in directories for the largest MA plans in 12 US metropolitan areas. The caller sought an appointment on behalf of his fictitious father who had severe itch for several months, asked whether the dermatologist accepted the relevant plan, and asked for the next available appointment date.

    Main Outcomes and Measures  Appointment availability and wait time.

    Results  Among 4754 total physician listings, 45.5% represented duplicates in the same plan directory. Among the remaining unique listings, 48.9% of physicians were reachable, accepted the listed plan, and offered an appointment for our fictitious patient. Many of the dermatologists listed had incorrect contact information, were deceased, retired, or had moved, were not accepting new patients, did not accept the insurance plan, or were subspecialized. The mean (range) wait time for appointments among the remaining listings was 45.5 (1-414) days. Both the accuracy of network directories and the appointment wait times varied substantially by health plan and metropolitan area. For 1 plan, our caller was unable to obtain an appointment with any listed dermatologist.

    Conclusions and Relevance  Medicare Advantage physician directories for dermatology in many areas substantially overestimate the number of in-network physicians available to treat patients with medical skin conditions. These inaccuracies occurred in areas with long appointment wait times and where plans are terminating selected physician contracts. This suggests a lack of capacity that would be exacerbated by further network narrowing. 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.

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