BC/BS employs non-credentialable person to do their credentials

I couldn't invent a better story.

BC/BS of Mass,( and many other health plans across the country) use a credentialing service for radiologists called: Radiology Management Sciences, LLC. Finding them is difficult as they operate in stealth mode, but the are apparently located in Menlo Park, Calif.

They are ? owned by, and certainly run by, one Stephen Bloch, MD.

Bloch has his bio on the net on the website of his venture capital firm, www.canaan.com/team_bloch.html . Bloch is listed as someone who "was a practicing radiologist".

Going to the website of the Mass Medical Board, one finds from his profile that Dr. Bloch is NOT board certified in radiology. It is odd that someone would complete the Mass General program in radiology and not get boarded, isn't it? Maybe he didn't finish? I don't know.

I phoned Dr. Bloch, after he signed a letter of denial for credentials for radiology for my office (we employ boarded radiologists to read our films, but BC/BS wants me to apply for credentials, which they won't grant since I'm an internist). I caught him in his Connecticut VC office, busily doing VC work. Guess what, Bloch never read my letter of appeal from their rigid rules. We have quality films, done in a state-licensed facility, done by licensed techs, and read by boarded radiologists. The issue was how to bill for this service without making the patients jump through hoops. Bloch didn't even see my letter, yet he sent a letter to me denying my appeal.

Another gem I gleaned from Bloch's bio is that the he founded TeleRad, a teleradiology services company.

I guess that means he might compete with those he credentials (or doesn't).

I suppose one might conclude that he might have a bit of a conflict of interest.

Bloch and Co. wrote a paper in Radiology in 1999 where they indicated that they save 2% of total radiology costs by denying credentials to some people. They claim this is all for quality, but don't show how quality was affected by their denial. Thus, the health plans must like Dr. Bloch, and Dr. Bloch noted in his paper that the cost of his program is only 20% or so of the savings. Thus, the health plans save 1.8% on radiology costs by employing him. Measured across all the radiology expenses this is a large number.

I'm all for quality measures and ensuring quality. But should it be on the backs of doctors like me who are trying to do the right thing, but just don't fit the box BC/BS wants to keep us in.

Last time I checked we still had free speech in this country. If anything I've written is not factual I will be happy to correct it upon presentation of evidence that I am incorrect.

These are the opinions of:

Robert S. Baratz, MD, PhD, DDS