Well, it’s official. After months of speculation about insurer acceptance of anything other than ABMS certification, Blue Cross Blue Shield of Michigan is on record refusing certification through the National Board of Physicians and Surgeons. To my knowledge, they are the first to do so.
This is actually a big deal for pediatricians in Michigan. For our internist friends, the ABIM has slowed down implementation of MOC. But the American Board of Pediatrics refuses to listen to pediatricians, and instead instructs insurers to “check” our certificates yearly.
Blue Cross Blue Shield requires “board certification” to participate, and they enforce this ruthlessly. Last year, one of my colleagues was threatened with loss of his BCBS patients for being two weeks late on a hand washing lesson for the American Board of Pediatrics. He passed his examination, completed his ABP-propriatary CME, paid his fees, but didn’t turn in his hand washing data to the boards. For that, Blue Cross Blue Shield threatened to ruin his practice. Read the full story here.
So imagine our thrill when Dr. Paul Teirstein created the National Board of Physicians and Surgeons with pediatrician Dr. David John Driscoll of Mayo on the board to certify pediatricians. Not only is the cost reasonable, the requirements are egalitarian. Unlike the ABP which has more onerous and expensive requirements that disproportionately target young and female pediatricians, NBPAS has the same requirements for everyone: pass the board examination once, and complete 50 hours of CME of your choosing.
With this viable alternative at hand, our group of 10 pediatricians sat down with BCBS of Michigan to discuss our concerns. In reading our contract with BCBS, it states:
“To participate as a PCP, a practitioner must be board certified or board eligible in one of the following specialties: internal medicine, pediatrics, general practice, family practice, geriatrics, or internal medicine/peds. A practitioner can be a physician or a nurse practitioner. “
That’s it. No mention of ABMS. No mention of MOC. Actually, we were naive enough to believe that maybe BCBS didn’t know the definition of “board certified” had changed from a past-tense one-time deal when the bylaws were written, to the ongoing never-ending nightmare it is now. Our physicians are routinely ranked as the highest quality doctors in their network, surely they’d listen to us!
So we sat down for an hour with their medical director, and politely explained the situation. We asked that board certification either be clarified as “initial board certification” or allow certification through NBPAS. Blue Cross Blue Shield rejected both requests and instead sided with the ABMS monopoly and the American Board of Pediatrics MOC scheme.
As it stands, I don’t know what our next step is. There is no large physician organization to fight for us, we are truly on our own. Small groups of physicians are easily bullied by these well-funded corporations. This is incredibly disheartening. The collusion runs deep, and it will take more than one small group of pediatricians in Grand Rapids to fight this battle with us.
Meg Edison MD is a pediatrician in private practice. You can follow Dr. Edison on Twitter @megedison