Profession

Internists earn extra credit for certification data

A partnership of health plans and a medical specialty board is designed to improve quality of care.

By Damon Adams — Posted Sept. 11, 2006

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The American Board of Internal Medicine is partnering with health plans so that physicians can use maintenance of certification to get credit in health plan performance and quality programs.

Under the program, internists complete a practice improvement module as part of the recertification process, then participating health plans accept those data for use in quality recognition programs. ABIM and health plan officials say the initiative reduces redundancy for physicians and promotes quality improvement.

The effort will allow more than 100,000 internists and subspecialists to qualify more easily for recognition and pay-for-performance rewards, the ABIM said.

"Our reason for doing this is to make the doctor's life easier," said Christine K. Cassel, MD, ABIM president and CEO.

Physicians must be enrolled in the ABIM's maintenance-of-certification program and finish a PIM, an Internet-based, self-evaluation tool that doctors complete to maintain certification. When a doctor completes a PIM, he or she may opt to authorize the ABIM to send information from the completed PIM to health plans, the ABIM said.

In March 2006, Blue Cross and Blue Shield of Nebraska became the first health plan to partner with the ABIM on the initiative. Other participating health plans include UnitedHealthcare, Aetna and Horizon Blue Cross Blue Shield of New Jersey.

Improving quality of care

Starting this fall, Aetna's Mid-Atlantic Region will accept completion of the ABIM's diabetes PIM in place of the diabetes chart review now required for primary care internists in Aetna's Delaware Valley pay-for-performance program, Aetna officials said. That area covers 2,000 internists in Delaware, southeastern Pennsylvania and southern New Jersey.

Aetna said the program is part of its goal to improve the quality of care, and it is considering the program for other parts of the country. The company also has talked to other specialty boards about linking maintenance of certification and pay-for-performance programs.

"We're going to see how this works," said Don Liss, MD, Aetna's regional medical director for the Mid-Atlantic Region. "Our hope is that we will find collaborative opportunities with other boards."

UnitedHealthcare said doctors who complete a PIM will earn credit under its UnitedHealth Premium designation program, a national assessment program that evaluates care delivery by physicians in 19 specialties. After finishing the PIM, doctors submit the information to UnitedHealthcare.

Working with the ABIM makes sense, health plan officials said.

"The [specialty] boards have always exerted a leadership role in assessing physicians and using that assessment process to lead to improved quality of care. You can expect this to be a model that will be duplicated by others," said Reed Tuckson, MD, senior vice president of consumer health and medical care advancement for UnitedHealth Group, parent company of UnitedHealthcare.

Other medical specialty boards are considering partnering with health plans to link board certification data and performance programs. The American Board of Family Medicine, for example, has talked with health plans about the idea and may have a program within a year. "We all want to use the same quality indicators," said James Puffer, MD, ABFM president and CEO. "We think this is the next really important evolution of maintenance of certification."

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External links

American Board of Internal Medicine on health plans recognizing maintenance of certification (link)

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