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-proprietary 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 re-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 MOC options 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. Where are the good lawyers willing to take up our case? 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.
Lee O. Welter, MD says
Find support here — AAPSonline.org — The Association of American Physicians and Surgeons – AAPS – is a non-partisan professional association of physicians in all types of practices and specialties across the country.
Since 1943, AAPS has been dedicated to the highest ethical standards of the Oath of Hippocrates and to preserving the sanctity of the patient-physician relationship and the practice of private medicine.
Our motto, “omnia pro aegroto” means “all for the patient.”
james gaulte says
This is not just bad news for pediatricians but for internists and other PCPs as well. Without insurance companies’s acceptance of NBPAS,the success of that venture is not likely.
Chris Foley says
Stop your 3rd party dependency! Direct pay is the antidote here.
Dr. Gina Reghetti, D.O. says
Become completely Independent and break away from all third party payers and all the ACA Governmentally controlled non-sense! Rid Insurance Corporates and stop giving them the power over you! You’re worth so much!
Bow to no one or Corporation. Direct Fee for Service, no Insurance ever!
Patients will come and appreciate that they have privacy! Teach Patients to be responsible and pay for medical services. Teach them how to keep Healthcare cost down by not expecting others to pay for them!
If the hospitals won’t let you practice in their arena then stay Ambulatory Care only! Let the patients go to the ER!
When all Doctors Stop practicing in the Hospitals that mandate that we get certified by the organizations that restrict our trade, then we will get their attention; the nation’s attention! Until then doctors will continue to be used, abused, and dealt a great injustice!
Just DO it; you’ll be glad you did.
Doctors just need to pull out! Then everyone will realize how important we are for health and safety in this country! They’ll see how many people will drop to their death due to providers, not doctors rendering their care!
Doctors will then be able to spend time with their family and friends, and get to enjoy life because they will make more money and gain so much more free time. Go independent all the way! You don’t need that non-sense piece of board certification! It only means enslavement and continued expense.
Chris Foley says
STEWART CAMPBELL says
Greetings Dr. Reghetti,
I just stumbled across this site and totally agree with your astute observations.
More emphatically, I truly believe that “OBAMACARE” will destroy the U.S. Medical Profession
and “BANKRUPT” our country!!!
“OUR REPUBLIC IS DOOMED UNLESS A NEW NATIONAL INDEPENDENT
POLITICAL PARTY IS ESTABLISH ASAP!!!
I have developed a “NATIONAL POLITICAL BLUEPRINT” capable of
establishing a new independent party that will ultimately:
“SAVE OUR REPUBLIC”!!!
The National Medical Profession is the “KEYSTONE” to successfully
accomplishing this “AMBITIOUS GOAL”!!!
If you and/or anyone within the Medical Profession is truly interested in
saving the greatest Medical Institutions ever created and:
“SAVING OUR REPUBLIC”
please contact me at: firstname.lastname@example.org
William Kirmes DO says
Bravo..Went independent on 1/1/15..Tough financially but worth it. Other factors made it harder as well. We all need to do this regardless of the initial difficulties.
Chris Foley says
Bill — direct pay only since 2001 and have never looked back. Let me know if I can help in any way. I have been a speaker at AAPS in this regard (2013).
Carrie Webber says
Thank you for all your efforts
If they don’t recognize your board certification through the NBPAS, tell them not to let the door hit them on the way out. They should have the right to determine how they will pay and you should then have the right to tell them to f off.
If they lose enough pediatricians in their networks and their patients complain and how crappy their network coverage is, I think they’ll change their tune.
Steve Karp MD says
The future looks fairly dim for physicians. I joined NBPAS. I’m in PA. Physicians here are expected many thousands of dollars returned to them from malpractice overcharges that the courts have required be returned to us. I posted on the PA medical Society website that we Physicians should use this money to sue the ABMS due to their monopolistic behavior. No responses from other physicians. Without banding together we get picked off in no time flat. I’m not in a group of 10 physicians. I’m just one lonely pair of typing hands writing to himself (apparently) and wondering what happened to American know how and the can do spirit?
Chris Foley MD says
Good on ya, Steve. Mass disenrollment from MOC and the ABIM is the only way to go — and of course drop 3rd party participation of all types. Opt out. I am a cash based IM for 15 years here in St Paul with reasonable fees. I cannot take new patients right now. Go for it.
Steve Karp MD says
Unfortunately I’m Rad Onc and if insurers drop me when I don’t recertify with the ABR (2017) then I guess I’ll be in a tough situation, but it won’t be the first time. I’m an independent contractor and have had many go rounds with the PA AG’s office and FTC’s Bureau of Competition, all unsuccessful, and ultimately leading me to close my practice. I’m still paying on a mortgage for my office building which sits empty. Luckily (and that describes every step of my way since 1988), a call came out of the blue and I was able to get a job without having to move (if one considers a 1 and 1/2 hour drive each way good luck).
I’ve been through quite a bit these nearly 20 years in practice and could be one of the poster children for what’s wrong with our profession when it comes to the non patient related issues. Unfortunately anything smelling like unionization will be outlawed so we either end up in court or try some type of civil disobedience. Why march on DC If instead we’d all just not show up for work (except for ER, emergency surgery, unit care etc.). Maybe that’s a start. A rally in DC will probably receive a news blackout. Closing down the offices will be noticed by millions of people. And you can tell them when you return “Tell your representatives to get off our back.” And then do this as many times as it takes until DC gets the picture. Think of how the Chinese government got spooked some years back during spontaneous demonstrations. Will the reaction from DC be the same? Perhaps this will give the American people some clarity as to the intentions of their government.
STEWART CAMPBELL says
Greetings Dr. Karp,
I just noticed your posting.
Please note my response to Dr. Reghetti at 2:52 today.
Rest assured, I have a “VIABLE, EFFECTIVE, SOLUTION TO OUR POLITICAL NIGHTMARE” that will preserve the finest Medical Profession ever created and “SAVE OUR REPUBLIC”!!!
If you are interested, please contact me:
Fort Lauderdale, Fl.
Insurance companies are well known for ignoring physicians (especially primary care physicians). BCBS has a very long felonious history of doing this. This is nothing new.
Filing complaint with FTC Dr. Edison is great but filing complaints with State Insurance Commissioners and HHS works even better.
By the way, Chris Foley is 100% correct. Direct pay is the best and only cure for dealing with individuals who only want to steal your hard earned income (aka insurance companies).
Paul Kempen says
Dr Karp’s message is clear but we need to attack this via the state organizations and all of them. The feds never care about individual rights until a group hits critical mass. The MSMS has already adopted position against his sort of extortion and it is time to group together and make history!
Steve Karp MD says
So how do we group together? NBPAS of which I joined wants us to go begging to medical staff committees and insurers. And when they say no to all except ABMS then what. IMO it’s coming time to stop treating for a day at a time and let patient’s deal with it by telling them why we’re doing what we’re doing and what they need to do to fix it.
Mike Ciampi, M.D. says
AAPS is suing ABMS. I am not sure of the exact nature of the case, other than that it is on the grounds that AMBS is functioning as a monopoly and coercing and extorting members.
From their website: AAPS seeks declaratory and injunctive relief to enjoin ABMS’s continuing violations of antitrust law and misrepresentations about the medical skills of physicians who decline to purchase and spend time on its program. AAPS also seeks a refund of fees paid by its members to ABMS and its 24 other corporations as a result of ABMS’s conduct.
We need to support this effort. Find out more at http://www.aapsonline.org.
steve karp says
I’ll look into this. Thanks.
Connie Braun MD says
I agree with all above . Doctors cant make it anymore. Wonder is someone in BCBS is being paid off
for that attitude?? h,mm. Another organization that doctors should boycott is Healthtgrades. They put
information that is outright false about you . You are on there even if you did NOT sign up. In addition,
they let negative comments flow like candy without contacting you. They have a board certification
section and I quote: ” Doctors who are board certified are more likely to be more well informed
on current practices in their speciality>” that is just part of it. they also say they determine this thru
ABMS or ABIM. Dont they know how ludicrist this is. Dont they realize that there is more then ONE
certifying board. Dont they know that the ABIM hires writers and physicians to make up false
articles that being “board certified” has better outcomes etc., Says who?? there is not one double blind
study that states this. Now there is the Spex exam for those of us well lets say that have been
out for over 10 years $1300. Guess who runs that FSMB. If you refuse to get certified from
ABIM or FSMB then if you want to go to another state then you will have to take the SPEX exam!!!
Even if you have 200 or 300 CME credits. I agree go for money up front. Give them the receipt and
let them try to get it thru their insurance.