Provider directories and other associated public data sources – such as the open payments data – are critical for helping to more widely inform the public about providers. Without provider directories, consumers would have even more limited information about potential providers; moreover, inaccurate information could lead to costly decisions being made with improper information – e.g., selecting a health plan that actually does not have one’s desired providers or going to a provider, believing they are in-network, and then, subsequently, being presented with a bill that is much higher than one assumed. These directories – especially the public ones sponsored by CMS (Centers for Medicare and Medicaid Services) are also used by third parties to inform third-party resources that used by the public or other companies.

            For example, one large public directory of physician information is the portal Docspot. This portal collects data from more than six hundred public sources and amalgamates them together into one unified view that allows consumers and other parties to work with the data to make decisions about which physicians to see and trends such as regional costs. When one looks up a type of doctor – for example, internal medicine and then selects an area (Detroit, Michigan) – the results of the search are displayed. From there, one can see a list of internal medicine providers. Upon clicking on a provider, one can much of the publicly available information about the provider. For example, one can see their education, licensure information, contact information, professional fee information, and additional payments received. These data elements come from different data sets over varying periods of time. For example, the NPI directory may be referenced regularly to produce basic provider demographic data. In addition to the NPI directory, CMS’s Physician Compare and other provider-level data sources (such as provider-supplier data sets) are linked together to produce the profile. Importantly, to demonstrate data credibility, Docspot also shows what public sources were used to create the profile.

            Sites like Docspot are important to helping patients navigate a healthcare system that is both competitive – between providers and health plans – and complex – patients notoriously have difficulty navigating through the health system and any tool that can assist in reducing such complexity and stress ought to be welcomed. It is also a case study for why efforts need to be made to keep directories and public data sources up-to-date so that consumers can know, for example, if a provider is licensed in their state or still practicing in area or at a specific location.

            Publicly available data can give patients insights into how comfortable a provider may be with treating, managing, and coordinating the care for certain conditions. For example, if one has Type II Diabetes and Asthma, a public directory of provider data can let one know how many Medicare patients (right now, it is typically just Medicare) the provider has that have such chronic conditions. All things being equal, a provider both interested in and competent in the management of such conditions is likely to have a larger number of such providers compared to the mean for an area.             As with the plethora of data that is being produced in other fields, provider directory data along with other provider-based public data can be used to create new insights that assist the public and other researchers in providing tools that help consumers to better navigate through the complexities and anxieties of the healthcare system.

Categories: Healthcare

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