On May 3, the Senate Finance Committee held a hearing, “Barriers to Mental Health Care: Improving Provider Directory Accuracy to Reduce the Prevalence of Ghost Networks.” The hearing featured testimony from several mental health experts, including Robert Trestman, MD, PhD, professor and chair of psychiatry and behavioral medicine at the Virginia Tech Carilion School of Medicine and Jack Resneck, MD, president of the American Medical Association. Witnesses and members discussed the problem of “ghost networks,” or provider directories that contain inaccurate or outdated information.
Improving access to behavioral health care is an area of focus for the Senate Finance Committee. During the 117th Congress, the committee issued a bipartisan request for information (RFI) seeking input from invested parties on strategies to strengthen the behavioral health workforce, integrate physical and behavioral health care, advance access to tele-behavioral health services, ensure mental health parity, and improve access to care for children and young people [refer to Washington Highlights, Sept. 24, 2021]. The RFI yielded responses from the AAMC and over 300 additional partners, which were synthesized in a report documenting deficits in the mental health care system [refer to Washington Highlights, April 1, 2022]. Chair Ron Wyden (D-Ore.) and Ranking Member Mike Crapo (R-Idaho) subsequently convened five bipartisan working groups, each dedicated to drafting legislation addressing a specific area of mental health care access.
In his testimony, Trestman summarized the literature regarding ghost networks, citing multiple studies that found inaccuracies in provider directories across commercial, Medicare Advantage, and Medicaid plans. He catalogued the most common types of errors in these directories, including the inaccurate listing of providers as accepting new patients or a particular type of coverage, as well as outdated contact and location information. Trestman described the impact of ghost networks on patients, observing, “For people who are experiencing significant mental illness of substance use disorders, the process of going through an inaccurate provider directory … is at best demoralizing and at worst set up to precipitate clinical deterioration.” He described the administrative burden that insurers impose on physicians, asserting that insurers “intentionally make it difficult” for providers to participate in their networks. As an example, Trestman cited his own clinic at the VTC School of Medicine, which requires three full-time equivalent employees to maintain their credentialing with payers.
In a key exchange, Sen. Robert Menendez (D-N.J.) underscored the nation’s inadequate physician workforce, noting, “The reality is that there just aren’t enough providers.” He highlighted bipartisan efforts by the committee to strengthen the behavioral health workforce, which eventually resulted in the inclusion of 200 additional Medicare-supported graduate medical education (GME) slots in the Consolidated Appropriations Act, 2023, with 100 specifically apportioned to psychiatry and psychiatry subspecialties [refer to Washington Highlights, Jan. 4]. Menendez also referenced his leadership of the AAMC-endorsed Resident Physician Shortage Reduction Act (S.1302 / H.R. 2389), which would provide 14,000 additional Medicare-supported GME positions over seven years.