‘Ghost’ providers poison mental health repositories, impacting access

As Americans seek to reduce health care costs, patients have often been encouraged to use online tools find providers in their network from whom they can obtain care at a lower cost. But one new study suggests that the entire system of health care directories may be faulty. According to Oregon Health and Science Universityresearch shows that up to 58% of all providers listed in Oregon’s Medicaid system in 2018 were “phantom providers” who are unavailable to see patients.

The numbers were particularly stark for mental health specialists; while about 54% of all primary care providers were “ghosts,” more than two-thirds of mental health prescribers fell into this same category.

According to Jane M. Zhu, lead author of the new study, “Phantom Networks: Discrepancies Between Reported and Realized Mental Health Care Access in Oregon Medicaid,” the results are concerning, especially if they also reflect other provider systems. . “If the majority of providers aren’t actually accessible, it leads to delays and disruptions to the care and treatment that people need,” she said.

The findings come at a time when mental health care is particularly hard to come by. Some 37% of the US population lacks adequate access to mental health professionals, according to a 2021 study by the nonprofit organization USA Facts, with some states, including Wyoming, Utah and Mississippi, experiencing particularly high shortages of qualified mental health care providers. This study estimated that more than 6,000 additional mental health professionals would be needed to eliminate care shortages.

“We just need more mental health professionals to meet the demand,” Zhu said.

The study authors suggest that discrepancies in Oregon’s Medicaid directory may be due to administrative tracking issues. Whatever the cause, inaccuracies are not just a problem for patients. As the study notes, “significant discrepancies between providers listed in directories and those that registrants can access suggest that provider network monitoring and enforcement may fail if based on directory information. “. In other words, health insurance companies may mistakenly believe that their enrollees have access to more doctors than they do – and law enforcement agencies may also believe that more options are offered to patients than is correct.

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