Provider Profiles

Certifying Boards for MD's and DO's

• Massachusetts Board of Registration in Medicine – The Massachusetts Board of Registration in Medicine offers a comprehensive program to give patients access to information about the education, training, and experience of all licensed physicians.
• American Board of Medical Specialties (ABMS) – The American Board of Medical Specialties (ABMS), a not-for-profit organization comprising 24 medical specialty Member Boards, is the pre-eminent entity overseeing the certification of physician specialists in the United States.
• American Medical Association (AMA) – AMA / DoctorFinder provides you with basic professional information on virtually every licensed physician in the United States. This includes more than 690,000 doctors.
• American Osteopathic Association (AOA) – The AOA is a member association representing more than 61,000 osteopathic physicians (D.O.s). The AOA serves as the primary certifying body for D.O.s, and is the accrediting agency for all osteopathic medical colleges and health care facilities.

Podiatry Boards

• The American Board of Lower Extremity Surgery (ABLES) is a not-for-profit, multidisciplinary, autonomous certification board that has been recognized for its rigorous performance-based certification processes for more than 30 years. ABLES offers board certification for qualified DPMs, DOs, and MDs in the following disciplines:
  • Lower Extremity Medicine (non-surgical)
  • Lower Extremity Medicine and Surgery
  • Lower Extremity Medicine and Comprehensive Surgery, including Rearfoot and Reconstructive Surgery
• The American Board of Podiatric Surgery is recognized by the Joint Committee on the Recognition of Specialty Boards of the Council on Podiatric Medical Education under the authority of the American Podiatric Medical Association as the specialty board to conduct a certification process in podiatric surgery.
• The American Board of Multiple Specialties in Podiatry was organized in 1986 by podiatrists for the purpose of granting board certification to office-based or ambulatory surgeons. To verify, please call 888-852-1442.
• The American Board of Podiatric Orthopedics and Primary Podiatric Medicine (ABPOPPM) has been certifying podiatrists since 1978.

Oral Surgery Boards

• The American Board of Oral and Maxillofacial Surgery (ABOMS) is the certifying board for the specialty of oral and maxillofacial surgery in the United States and is recognized and approved by the Council on Dental Education of the American Dental Association.
• The Massachusetts Board of Registration in Dentistry registers and licenses formally trained dentists and dental hygienists who have passed the appropriate licensing exam.

How we pay our doctors

Harvard Pilgrim believes it is important for our members to understand all aspects of their health care and coverage. The following explains the principles and methods that determine how Harvard Pilgrim pays physicians. Since, in many cases, the way doctors are paid is determined by the groups with which they practice as well as other factors, you should feel free to have a conversation with your doctor if you still have questions about how he or she is paid.

Principles

Harvard Pilgrim has relationships with thousands of doctors who practice in a variety of settings. In some cases, we pay groups of doctors for taking care of our members, and in other cases, we pay individual doctors directly. Although the specifics may vary, Harvard Pilgrim abides by some fundamental principles. Our payment methods are designed to:

• Encourage necessary and appropriate care, including preventive care and the early treatment and active management of illness
• Encourage providers to work together to keep their patients healthy, and help them avoid more serious and costly illness wherever possible
• Improve clinical quality, access to services and patient communication, while also attempting to control the overall costs of care for consumers and other health care purchasers

Harvard Pilgrim does not create financial incentives that would directly benefit an individual doctor if a specific test is not ordered or a referral is not made for any individual patient. In addition, we encourage our affiliated doctors to discuss appropriate treatment options with their patients even in the rare instance in which a recommended treatment is not covered by their insurance.

Group payment

Harvard Pilgrim usually makes payments to groups of doctors for taking care of their Harvard Pilgrim patients. Group payment can be made in several ways. In one, Harvard Pilgrim pays the group a fixed amount for each of its Harvard Pilgrim patients and the group uses the total payment to cover the cost of certain services for those patients. In another, the groups are paid a fee for each of the services their doctors provide to Harvard Pilgrim members. At the end of the year, the groups have an opportunity to gain additional compensation if certain financial goals are achieved. Groups of doctors that participate in such arrangements have protections in their contracts with Harvard Pilgrim that limit their financial risk. This means that unusually high medical expenses that might be necessary in caring for an individual patient will not unduly affect a physician's compensation.

Fee-for-service payment

Harvard Pilgrim also pays many of its doctors a fee for each service that they provide, without any further adjustments.

Note: Each provider listing in this directory includes a code that indicates how Harvard Pilgrim pays the provider. ("G" for group payment and "F" for individual fee-for-service payment)