7 reasons why provider data is often inaccurate

Published
  • June 05 2018, 4:00am EDT

7 reasons why provider data is often inaccurate

Healthcare industry stakeholders annually spend more than $2 billion capturing provider information, but too often the data is inaccurate, according to CAQH, a stakeholder coalition that works to improve business processes.

More than 20 participants formed the Provider Data Action Alliance to develop a roadmap for tackling provider integrity issues during a nine-month period. This group included public and private payers, hospitals, provider groups, regulators, accreditors and health information exchanges. Other stakeholders from more than 100 organizations reviewed the recommendations.

“We live in a world where patients are unable to locate a provider because of inaccurate directories, health plans cannot quickly identify sanctioned providers, providers have difficulty finding in-network specialists for patient referrals, and patient claims payments are incorrectly denied or delayed,” according to the group.

Lack of standard definitions

Further, there are no standard definitions for data elements and a lack of accountability between data producers and users to keep the data current. “The problem spans providers, payers and government agencies, all of whom touch provider data in some way,” says Atul Pathiyal, senior vice president of products and strategy at CAQH. Here’s a look at the problems.

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Data inaccuracies

The research found several common factors that cause data inaccuracies. They include no authorative sources of information being available, so providers use various sources that are out of sync with each other; government agencies’ data needs are different; data changes frequently; and until recently, many providers have been unaware of the role they play in keeping data accurate.

Lack of efficiency in data collection

In developing the roadmap to better data management, stakeholders determined that the time and attention of providers must not be wasted when collecting and maintaining accurate data. “A provider should have to report changes to their data as few times as possible,” report authors asserted. “In turn, the system should be able to disseminate these changes to interested stakeholders.”

Incongruity with business demands

As providers participate in accountable care organizations and value-based care initiatives, it is becoming paramount for organizations to make sure their data is right to meet business demands. “With the emergence of patient information, it increasingly is important to know where a provider or payer is,” Pathiyal says.

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Multiple data sources

Developers of the roadmap identified four primary issues that comprise the root of provider data challenges—few authoritative provider data sources exist; provider data standards and requirements vary widely; provider data changes frequently, and multiple entities must be notified; and providers are not sufficiently engaged in the provider data dialog.

Seeking consensus on resolving the problem

Developers of the roadmap for better data management offer five challenges to guide a coordinated industry response. They include:

* Require stakeholders to publicly commit to taking joint action to catalyze momentum and achieve industry alignment.

* Require a multi-stakeholder governance structure capable of defining and shaping solution details.

* Define an initial data set and establish standards, including a standard to measure data quality.

* Educate regulators and accreditors on the industry commitment so that, over time, any regulations or standards can be aligned with the industry solution.

* Establish measures for value, cost and overall data accuracy so results of the industry effort can be assessed.

Seeking agreement on success targets

Report authors set a bar for three core goals that would demonstrate that the solutions agreed to actually make a difference and improve data management. These goals describe a system of investments in standards, governance and infrastructure that cuts costs and administrative burdens enough to justify the investments; providers are able to see some meaningful progress immediately, even as producers and users of provider data cannot wait for a perfect system to be developed; and the program is good enough to start, as striving for quick perfection is impractical and unnecessary.

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More Information




The complete report, “An Industry Roadmap for Provider Data,” is available here.