Health Plan Use of Board Certification and Recertification of Surgeons and Nonsurgical Subspecialists in Contracting Policies

OBJECTIVES: To characterize the role of board certification in general surgeon, surgical specialist, and nonsurgical subspecialist credentialing and contracting policies and to examine possible variation among different types of health plans. DESIGN: Telephone survey conducted from October 27, 2006, through March 30, 2007. SETTING: Health plans across the United States. PARTICIPANTS: Health plan credentialing personnel from a random sample of 223 health plans stratified by enrollment size, plan type, Medicaid enrollment, and tax status. MAIN OUTCOME MEASURES: Proportion of health plans that require specialty board certification at initial contract or at some point during association with the plan and health plan requirements for recertification. RESULTS: Of 223 health plans, 9 were ineligible, and credentialing personnel completed the telephone survey in 176, which resulted in an overall response rate of 82%. More than 60% of the health plans in this study did not require surgical specialists, general surgeons, or nonsurgical subspecialists ever to be board certified to contract with the plan. Approximately two-thirds of respondents reported that they did not require surgeons (65%) or nonsurgical subspecialists (63%) with time-limited board certification to recertify in their specialty. More than half of the health plans reported that they made exceptions to their board certification policies based on geographic or network need. CONCLUSIONS: Most health plans did not use specialty board certification to assess surgeon and nonsurgical subspecialist competence.