The Centers for Medicare & Medicaid Services and state regulators should guarantee that insurers don't choose which providers to include within their networks solely based on costs, the American College of Physicians (ACP) said Tuesday in its annual report on the state of healthcare.
Specifically, ACP wants to avoid overly restrictive provider networks where insurers only use cost to select providers. So it's calling on state and federal officials to update standards for revising network adequacy to include, for example, patient-to-physician ratios and the use of out-of-network providers as indicators of access.
The group, which represents internists nationwide, also wants network standards to require regulators to consider whether in-network doctors contract with out-of-network hospitals.
In a letter to the U.S. Department of Health and Human Services, which was released alongside the report, ACP outlined recommendations, including establishing contingency plans that prioritize continuity of care with patients' preferred providers.
Insurers often claim that by limiting their networks, they can offer health plans with more efficient providers, thereby cutting costs while also improving care, FierceHealthPayer previously reported. But ACP said in the report that networks don't have to be narrow, but rather "organized correctly" to improve care coordination while allowing patients to receive care from high-quality doctors.
ACP also added that insurers should to be required to explain why they drop doctors from their networks.
To learn more:
- here's the ACP report and letter (.pdfs)