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Precision of Provider Licensure Data for Mapping Member Accessibility to Medicaid Managed Care Provider Networks

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Title: Precision of Provider Licensure Data for Mapping Member Accessibility to Medicaid Managed Care Provider Networks
Authors: Bell, Nathaniel, Lòpez-DeFede, Ana, Wilkerson, Rebecca, Mayfield-Smith, Kathy
Source: Faculty Publications
Publisher Information: Scholar Commons
Publication Year: 2018
Collection: University of South Carolina Libraries: Scholar Commons
Subject Terms: Geocoding, Licensure, Medicaid, Nurse practitioners, Patient-centered medical homes, Employment (statistics & numerical data), Humans, Medical (statistics & numerical data), Nursing (statistics & numerical data), Managed Care Programs (statistics & numerical data), Medicaid (statistics & numerical data), Nurse Practitioners (statistics & numerical data, supply & distribution), Patient-Centered Care (statistics & numerical data), Physicians (statistics & numerical data), Travel (statistics & numerical data), United States, Nursing
Description: 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.
Document Type: text
File Description: application/pdf
Language: English
Relation: https://scholarcommons.sc.edu/nurs_facpub/12; https://scholarcommons.sc.edu/context/nurs_facpub/article/1012/viewcontent/s12913_018_3776_4.pdf
DOI: 10.1186/s12913-018-3776-4;
Availability: https://scholarcommons.sc.edu/nurs_facpub/12
https://doi.org/10.1186/s12913-018-3776-4;
https://scholarcommons.sc.edu/context/nurs_facpub/article/1012/viewcontent/s12913_018_3776_4.pdf
Rights: © The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/ ), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Accession Number: edsbas.6CD5B85B
Database: BASE
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  Data: Precision of Provider Licensure Data for Mapping Member Accessibility to Medicaid Managed Care Provider Networks
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  Data: <searchLink fieldCode="DE" term="%22Geocoding%22">Geocoding</searchLink><br /><searchLink fieldCode="DE" term="%22Licensure%22">Licensure</searchLink><br /><searchLink fieldCode="DE" term="%22Medicaid%22">Medicaid</searchLink><br /><searchLink fieldCode="DE" term="%22Nurse+practitioners%22">Nurse practitioners</searchLink><br /><searchLink fieldCode="DE" term="%22Patient-centered+medical+homes%22">Patient-centered medical homes</searchLink><br /><searchLink fieldCode="DE" term="%22Employment+%28statistics+%26+numerical+data%29%22">Employment (statistics & numerical data)</searchLink><br /><searchLink fieldCode="DE" term="%22Humans%22">Humans</searchLink><br /><searchLink fieldCode="DE" term="%22Medical+%28statistics+%26+numerical+data%29%22">Medical (statistics & numerical data)</searchLink><br /><searchLink fieldCode="DE" term="%22Nursing+%28statistics+%26+numerical+data%29%22">Nursing (statistics & numerical data)</searchLink><br /><searchLink fieldCode="DE" term="%22Managed+Care+Programs+%28statistics+%26+numerical+data%29%22">Managed Care Programs (statistics & numerical data)</searchLink><br /><searchLink fieldCode="DE" term="%22Medicaid+%28statistics+%26+numerical+data%29%22">Medicaid (statistics & numerical data)</searchLink><br /><searchLink fieldCode="DE" term="%22Nurse+Practitioners+%28statistics+%26+numerical+data%22">Nurse Practitioners (statistics & numerical data</searchLink><br /><searchLink fieldCode="DE" term="%22supply+%26+distribution%29%22">supply & distribution)</searchLink><br /><searchLink fieldCode="DE" term="%22Patient-Centered+Care+%28statistics+%26+numerical+data%29%22">Patient-Centered Care (statistics & numerical data)</searchLink><br /><searchLink fieldCode="DE" term="%22Physicians+%28statistics+%26+numerical+data%29%22">Physicians (statistics & numerical data)</searchLink><br /><searchLink fieldCode="DE" term="%22Travel+%28statistics+%26+numerical+data%29%22">Travel (statistics & numerical data)</searchLink><br /><searchLink fieldCode="DE" term="%22United+States%22">United States</searchLink><br /><searchLink fieldCode="DE" term="%22Nursing%22">Nursing</searchLink>
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  Data: 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.
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  Data: © The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/ ), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
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