APA Study Reveals Network Inadequacy in DC Exchange Plans

The majority of network psychiatrists listed as practicing in the Washington, D.C., area by three major health plans in the District of Columbia health exchange are either not able to schedule an appointment or are not even reachable at the telephone numbers listed for enrollees to call.

That’s one of the findings by a team of researchers with the APA Foundation who telephoned a randomly selected sample of psychiatrists publicly listed as network psychiatrists for the three largest health insurance carriers on the DC Health Link Health Insurance Exchange. The study and its results were presented at APA's 2016 Annual Meeting last month in Atlanta during the session “Constrained Access to Psychiatrists in Washington, D.C. Among the Largest Health Insurance Exchange Carriers’ Networks.”

Among the presenters were past APA President Steven Sharfstein, M.D.; Steven Epstein, M.D., chair of the Department of Psychiatry at Georgetown University School of Medicine; James Griffith, M.D., chair of the Department of Psychiatry at George Washington University; Joyce West, Ph.D., M.P.P., policy research director of the APA Foundation; Irvin “Sam” Muszynski, J.D., director of the APA Office of Reimbursement Policy; and Maureen Bailey, associate director of APA’s Office of Parity Implementation and Enforcement Policy.

The analysis revealed that close to a quarter of the phone numbers for the listed psychiatrists were either non-responsive or were nonworking numbers. And only 14 percent of psychiatrists were able to schedule any appointment at all; in one plan, only 4 percent were able to schedule an outpatient appointment.

The findings highlight a problem with “network adequacy” that has hindered access to care and the implementation of parity nationwide: the use by health plans of “narrow” or “phantom networks” that seem to advertise to enrollees an ample selection of psychiatrists, but which in fact offer very few real options for timely care. In many cases, listed providers are not accepting new patients and others have moved out of the geographic area; in some reported cases, listed psychiatrists are retired from practice or deceased.

“The passage of parity legislation is not enough,” said Sharfstein in an interview with Psychiatric News. “Patients need real access. But in the real world, patients’ experience of trying to access mental health treatment belies what health plans are telling their enrollees. There is no access when there are no clinicians who can provide treatment, and there is no parity when there is no one in the network.”

“Our investigation revealed that 86 percent of the psychiatrists listed in the network directories were either unreachable or not actually taking new outpatients,” Colleen Coyle, M.D., APA’s general counsel, told Psychiatric News. “The callers had to call several times in many cases to get a response, and in the end only 14 percent of those listed as being available to patients were able to schedule new outpatient appointments, but with very long wait times in most cases.”

In the study, the research team compiled lists of all the psychiatrists who were publicly listed as being network psychiatrists in the online directories of the three largest health insurance carriers participating in the DC Health Link Health Insurance Exchange. Fifty psychiatrists were randomly selected from the psychiatrist network lists of each carrier.

Team members assessed whether the listed phone numbers were working, whether the psychiatrists practiced at the location, and whether someone at each of the offices could be contacted during a seven-day period from February 22 to March 21. At least three calls were placed to contact unreachable physicians’ offices.

These are the key findings:

“As the Affordable Care Act theoretically expands access to mental health and substance use disorder care, networks are shrinking both because psychiatrists are dropping out of the networks citing unreasonable administrative burden and low payment rates as reasons and because plans are narrowing their networks while providing robust directories of providers to attract purchasers to the plan,” Coyle said. “The net impact is that mental health patients are paying for care they cannot access, and those who are able to access care pay for that care out of pocket. Consumers are not getting the benefit of the mental health coverage they have paid for.” ■