OK, you need to find an HIV specialist—but there’s no section in your HMO book listing them just like internists, OB-GYNs or other specialists. Hmmm...
That’s because there’s no board for accrediting HIV doctors, most of whom are either infectious-disease specialists or internists who ended up with lots of HIV positive patients. But genuine accreditation of HIV care would vastly benefit both HIVers and their doctors because it would help separate the wheat from the chaff—and make health plans take HIV-related reimbursements more seriously.
The movement to make it happen is already underway. In California, a new law requires HMOs to refer HIVers to HIV specialists, who must earn that title by meeting such criteria as passing a bi-yearly exam developed by the American Academy of HIV Medicine (www.aahivm.org). The AAHIVM has also created an HIV care curriculum and its own credentialing exam for providers nationwide.
“It’s a major breakthrough,” says Scott Hitt, MD, the group’s interim executive director, of the California law. “There was enormous resistance from insurers [because] they lose big money on HIV patients.” That’s not stopping the AAHIVM from trying to create what Hitt calls “a level playing field” for HIV care. “Last year we credentialed 1,300 people,” he says—a number the group hopes to double this year.
But not everyone’s rooting for them. “We don’t think it’s appropriate that an advocacy group credential its own members,” says Christine Lubinsky, executive director of the HIV Medicine Association (www.hivma.org), AAHIVM’s rival of sorts, which represents 2,500 HIV providers. Instead, the HIVMA is working with The American Board of Internal Medicine and the American Board of Family Practice to develop an HIV-care curriculum that’ll pass muster with the American College of Graduate Medical Education, a major accrediting body.
One thing both groups agree on: research finding that the more HIVers a doctor sees, the better those patients do. Hitt hopes other states soon follow California. But first things first: “Now we have to get the HMOs to actually list the HIV specialists in their books under their own heading.” Nobody said it would be easy.