Precision of provider licensure data for mapping member accessibility to Medicaid managed care provider networks

Abstract Background In July 2018, the Centers for Medicare and Medicaid Services (CMS) updated its Medicaid Managed Care (MMC) regulations that govern network and access standards for enrollees. There have been few published studies of whether there is accurate geographic information on primary care...

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Main Authors:	Nathaniel Bell, Ana Lòpez-DeFede, Rebecca C. Wilkerson, Kathy Mayfield-Smith
Format:	Article
Language:	English
Published:	BMC 2018-12-01
Series:	BMC Health Services Research
Subjects:	Medicaid Nurse practitioners Geocoding Licensure Patient-centered medical homes
Online Access:	http://link.springer.com/article/10.1186/s12913-018-3776-4

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spelling	doaj-212abc428e3141fcb39370f0ac8c27e62020-11-25T02:09:57ZengBMCBMC Health Services Research1472-69632018-12-0118111010.1186/s12913-018-3776-4Precision of provider licensure data for mapping member accessibility to Medicaid managed care provider networksNathaniel Bell0Ana Lòpez-DeFede1Rebecca C. Wilkerson2Kathy Mayfield-Smith3College of Nursing, University of South CarolinaDivision of Integrated Health and Policy Research, Institute for Families in Society, University of South CarolinaDivision of Integrated Health and Policy Research, Institute for Families in Society, University of South CarolinaDivision of Integrated Health and Policy Research, Institute for Families in Society, University of South CarolinaAbstract Background In July 2018, the Centers for Medicare and Medicaid Services (CMS) updated its Medicaid Managed Care (MMC) regulations that govern network and access standards for enrollees. There have been few published studies of whether there is accurate geographic information on primary care providers to monitor network adequacy. Methods We analyzed a sample of nurse practitioner (NP) and physician address data registered in the state labor, licensing, and regulation (LLR) boards and the National Provider Index (NPI) using employment location data contained in the patient-centered medical home (PCMH) data file. Our main outcome measures were address discordance (%) at the clinic-level, city, ZIP code, and county spatial extent and the distance, in miles, between employment location and the LLR/NPI address on file. Results Based on LLR records, address information provided by NPs corresponded to their place of employment in 5% of all cases. NP address information registered in the NPI corresponded to their place of employment in 64% of all cases. Among physicians, the address information provided in the LLR and NPI corresponded to the place of employment in 64 and 72% of all instances. For NPs, the average distance between the PCMH and the LLR address was 21.5 miles. Using the NPI, the distance decreased to 7.4 miles. For physicians, the average distance between the PCMH and the LLR and NPI addresses was 7.2 and 4.3 miles. Conclusions Publicly available data to forecast state-wide distributions of the NP workforce for MMC members may not be reliable if done using state licensure board data. Meaningful improvements to correspond with MMC policy changes require collecting and releasing information on place of employment.http://link.springer.com/article/10.1186/s12913-018-3776-4MedicaidNurse practitionersGeocodingLicensurePatient-centered medical homes
collection	DOAJ
language	English
format	Article
sources	DOAJ
author	Nathaniel Bell Ana Lòpez-DeFede Rebecca C. Wilkerson Kathy Mayfield-Smith
spellingShingle	Nathaniel Bell Ana Lòpez-DeFede Rebecca C. Wilkerson Kathy Mayfield-Smith Precision of provider licensure data for mapping member accessibility to Medicaid managed care provider networks BMC Health Services Research Medicaid Nurse practitioners Geocoding Licensure Patient-centered medical homes
author_facet	Nathaniel Bell Ana Lòpez-DeFede Rebecca C. Wilkerson Kathy Mayfield-Smith
author_sort	Nathaniel Bell
title	Precision of provider licensure data for mapping member accessibility to Medicaid managed care provider networks
title_short	Precision of provider licensure data for mapping member accessibility to Medicaid managed care provider networks
title_full	Precision of provider licensure data for mapping member accessibility to Medicaid managed care provider networks
title_fullStr	Precision of provider licensure data for mapping member accessibility to Medicaid managed care provider networks
title_full_unstemmed	Precision of provider licensure data for mapping member accessibility to Medicaid managed care provider networks
title_sort	precision of provider licensure data for mapping member accessibility to medicaid managed care provider networks
publisher	BMC
series	BMC Health Services Research
issn	1472-6963
publishDate	2018-12-01
description	Abstract Background In July 2018, the Centers for Medicare and Medicaid Services (CMS) updated its Medicaid Managed Care (MMC) regulations that govern network and access standards for enrollees. There have been few published studies of whether there is accurate geographic information on primary care providers to monitor network adequacy. Methods We analyzed a sample of nurse practitioner (NP) and physician address data registered in the state labor, licensing, and regulation (LLR) boards and the National Provider Index (NPI) using employment location data contained in the patient-centered medical home (PCMH) data file. Our main outcome measures were address discordance (%) at the clinic-level, city, ZIP code, and county spatial extent and the distance, in miles, between employment location and the LLR/NPI address on file. Results Based on LLR records, address information provided by NPs corresponded to their place of employment in 5% of all cases. NP address information registered in the NPI corresponded to their place of employment in 64% of all cases. Among physicians, the address information provided in the LLR and NPI corresponded to the place of employment in 64 and 72% of all instances. For NPs, the average distance between the PCMH and the LLR address was 21.5 miles. Using the NPI, the distance decreased to 7.4 miles. For physicians, the average distance between the PCMH and the LLR and NPI addresses was 7.2 and 4.3 miles. Conclusions Publicly available data to forecast state-wide distributions of the NP workforce for MMC members may not be reliable if done using state licensure board data. Meaningful improvements to correspond with MMC policy changes require collecting and releasing information on place of employment.
topic	Medicaid Nurse practitioners Geocoding Licensure Patient-centered medical homes
url	http://link.springer.com/article/10.1186/s12913-018-3776-4
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Precision of provider licensure data for mapping member accessibility to Medicaid managed care provider networks

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