U-M studies find 78 percent of U.S. hospitals don't require board certification for initial privileging; only 41 percent of health plans use it for credentialing of physicians
Most parents assume that their child's pediatrician is board certified, giving them the peace of mind that the physician has the knowledge, skill and experience to offer the highest quality of care in the field.
But many of those pediatricians practicing at hospitals or associated with health plans may, in fact, not be certified or may not have taken the proper steps for recertification, according to researchers at the University of Michigan Health System.
Results from two studies appearing in the Feb. 22 issue of the Journal of the American Medical Association (JAMA) show that 78 percent of U.S. hospitals don't require board certification to grant pediatricians initial privileging, or permission to practice in the hospital, and only 41 percent of health plans require general pediatricians to be board certified at any time during their association with the plan.
"In a time when patient safety and physician competency is of great concern to the public, we were surprised to find that more hospitals and health plans were not requiring current board certification of their physicians," says lead author for the two studies Gary L. Freed, M.D., MPH, chief of the Division of General Pediatrics and director of the Child Health Evaluation and Research (CHEAR) Unit at the U-M Health System. "Many hospitals report they require physicians to be board certified, but our study found approximately half of the hospitals in America and nearly half of the health plans do not have a specific time frame in which their physicians must achieve recertification."
Previously, once physicians received board certification, it remained valid for their entire medical career. But in 1987, the American Board of Pediatrics (ABP) began issuing time-limited certificates to ensure pediatricians remained competent and knowledgeable in their fields. This process requires recertification every seven years for a physician to maintain his certification status.
With limited information available about hospitals' and health plans' requirements for certification and recertification of their physicians, Freed and his colleagues set out to conduct two separate studies to determine hospitals' use of board certification for privileging, and the credentialing policies of health plans related to certification. Both studies used telephone surveys to gather information.
Study: Hospital privileging and board certification/recertification
Of the 159 nationally representative hospitals that participated in the study, 78 percent said that they did not require board certification at the time of initial privileging for their general pediatricians.
While 70 percent did require certification to be completed at some point by their pediatricians, about half of the hospitals did not have a specific time frame in which certification or recertification must be completed. And only 43 percent required their pediatric subspecialists to achieve subspecialty certification within a designated time frame.
With only 45 percent of hospitals requiring general pediatricians with time-limited certificates to recertify, Freed says hospitals are missing an opportunity to provide a measure of quality assurance to patients and their families.
"Certification and recertification provide hospitals with a wonderful opportunity to increase the public's trust in the care provided in their institutions," notes Freed, the Percy and Mary Murphy Professor of Pediatrics and Child Health Delivery at the U-M Medical School. "However, many institutions may view recertification as a burden to their physicians, when instead it should serve as a valuable quality assessment tool in their privileging process."
Study: Credentialing policies of health plans and use of board certification
The most significant finding of this study is that only 41 percent of health plans require their credentialed general pediatricians to be board certified, says Freed.
The remaining 59 percent never require certification of their general pediatricians. Health plan credentialing of physicians is designed to be a systematic approach to collection, review and verification of a physician's professional qualifications.
However, of the 174 plans examined in the study, 90 percent do not require general pediatricians to be board certified at the time of initial credentialing, Only 40 percent require subspecialists to become board certified in their subspecialty at some point during their association with the plan.
Of likely surprise to both patients and insurers is that 77 percent of plans say they still allow their pediatric subspecialists to bill as a subspecialist, even if their certification has expired. While 42 percent of the plans reported requiring recertification for general pediatricians, less than half have a specific time frame in which recertification must occur.
"The credentialing process is designed to aid health plans in choosing competent physicians for the care of their members, and the lack of use of board certification is a significant issue for the plans and the public,"says Freed. "No one would want to fly in airplane with a pilot who hasn't gone through regular training and assessment, and the public should expect no less from their health care providers. Parents have the right to have high expectations for the physicians they have entrusted with their child's care."
