Board Certification Should Be Required in P4P

I applaud your efforts to develop pay-for-performance programs in pain medicine. I agree with the six metrics as elucidated in the December 2006 ASA NEWSLETTER article “Pay for Performance in Pain Medicine.” Certainly, all qualified pain specialists are currently applying these measures.

I have two points of contention: 1) The glaring deficiency of board certification as a reimbursement criteria and 2) misrepresentation of pay for performance (P4P) as an incentive or reward.

Let us come to grips with the first issue. It is a fact that the only accredited certification in pain management recognized by the Accreditation Council for Graduate Medical Education is a certificate of added qualifications in pain medicine through the American Board of Anesthesiology. When it comes to pain management, ASA affords “lip service” to board certification. P4P represents an opportunity to rectify this problem. Therefore, it is obvious that the most important metric is the measured qualifications of the physician practitioner. Linkage of payment to qualifications (board certification) is imperative to maintain quality.

My second thought pertained to P4P as a reward or incentive. The basic premise of pay for performance is punitive financial disincentives for those who choose to practice medicine outside the boundaries of self-appointed experts.

Therefore, I implore you to add board certification as a primary criteria in any P4P scheme in pain medicine. Also make it clear to leadership and membership that P4P is a punishment, not a reward.

Thomas A. Duc, Jr., M.D.
Charleston, South Carolina.

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