Extra Credentialing Worries Experts.

The next time you're performing a laparoscopically assisted vaginal hysterectomy, think about this: The same insurance company may be paying another gynecologist almost a third more than you for performing the same procedure.

What's the key to commanding such increased reimbursement? The answer in some cases is having credentials from the Accreditation Council for Gynecologic Endoscopy (ACGE), the certifying arm of the American Association of Gynecologic Laparoscopists.

And while it's not yet a widespread phenomenon for health plans to base reimbursement decisions on medical association credentials, some experts worry that it could catch on among insurers as a cost-cutting measure, whereby some doctors are paid less or not at all if they don't have the right paperwork.

So far, only a handful of ob.gyn.-related special interest groups offer credentialing or competency exams, but it could become more pervasive, experts say, as societies seek to appeal to physicians' tendency to pursue marks of distinction. In addition, some societies may be under increasing pressure to attract members with more than the usual fare of continuing medical education courses.

Under an enhanced reimbursement program at Aetna U.S. Healthcare that has been in place since 1994, physicians who are accredited by the ACGE collect 30% more than physicians who perform the same procedures without those credentials.

ACGE-certified physicians are paid more only when they perform advanced laparoscopic procedures such as oophorectomies, laparoscopically assisted vaginal hysterectomies, bilateral salpingo-oophorectomies, and cystectomies through a laparoscope.

Reimbursement for less complicated procedures or diagnostic laparoscopy is the same for all providers.