Wednesday, July 16, 2014

Two new websites oppose MOC!

Opened on July 08, 2014

  1. The American Board of Internal Medicine’s (ABIM) Maintenance of Certification (MOC) program is onerous and provides little value

  2. There is no data that MOC improves patient outcomes

  3. The MOC modules are irrelevant busywork that reduce physician time for patient care.

  4. MOC is costly for physicians and has become a money-making enterprise for ABIM

  5. There is no public demand for MOC

  6. The existing Continuing Medical Education requirements are a preferred approach to life-long learning.

  7. To date, despite numerous calls for change, ABIM has not made meaningful changes to the MOC program

Therefore, I pledge not to participate in MOC unless significant changes are made to the program. If I have previously enrolled in MOC, I will boycott future enrollment unless significant changes are made to the program.

 If you support this pledge, please send it to your colleagues and your hospital medical staff office for distribution.

 Supported by Physicians for Certification Change

The Physicians for Certification Change (PCC) are board certified or board eligible physicians from all specialties who are concerned about the recent changes to Maintenance of Certification (MOC) requirements. Our goal is to influence certification organizations like the American Board of Internal Medicine (ABIM) to change their policy regarding MOC.  We believe recent requirements are onerous, expensive and lack value.  While we do not have complete agreement on every recommendation, most members of PCC believe MOC should be changed in the following manner:
  •  Allow CME to satisfy all MOC biannual activities. Eliminate, or make optional, the medical knowledge, practice improvement and patient safety computer modules that have little practical value.
  • Charge a nominal fee (eg $100 per year) to track annual CME attendance as a substitute for MOC
  • Cut ABIM’s costs and correspondingly reduce initial certification and recertification fees by at least 20% over the next two years
  • Vastly simplify the ABIM website and MOC administrative tasks so physicians do not waste time on administrative activities
  • Members are divided on the issue of requiring recertification exams. Many believe the exam questions are not a reliable gauge of physician’s knowledge. Others favor requiring a recertification exam every 10 years, but the exam should be fair and easily passed by a physician in practice who keeps up with the literature and engages in adequate CME.

Founding members of the Physicians for Certification Change include:
Paul Teirstein, M.D.; Gregg Stone, M.D.; David R. Holmes, M.D.; Martin B. Leon, M.D.; Mladen I. Vidovich, M.D.; Kirk N. Garratt, M.D.; David Cox, M.D.; Andrew D. Michaels, M.D.; Peter B. Berger, M.D.; Chris White, M.D.; Bonnie H. Weiner, M.D.; Jeffrey W. Moses, M.D.; Michael Lim, M.D.; Augusto Pichard, M.D.; Dean Keriakes, M.D.; Samuel M. Butman, M.D.; Andrew Doorey, M.D.; Lloyd W. Klein, M.D.; Allen Jeremias, M.D.; Carl Tommaso, M.D.; Peter Pelikan, M.D.; Ramon Quesada, M.D.; Emmanouil Brilakis, M.D.; James Goldstein, M.D.; Bob Applegate, M.D.; Ted Feldman, M.D.; Morton Kern, M.D.; Charlie Chambers, M.D.; John Hodgson, M.D.; Aaron V. Kaplan, M.D.; Arnold Seto, M.D.; Craig Thompson, M.D.; David Rizik, M.D.; John Hirshfeld, M.D.; Karen Smith, M.D.; Peter Ver Lee, M.D.; Nauman Siddiqi, M.D.; Zoltan G. Turi, M.D.; Amir Lerman, M.D.; Roxana Mehran, M.D.; Igor Palacios, M.D.; Mitchell W. Krucoff, M.D.; Joseph D. Babb, M.D.; Westby G. Fisher, M.D.; E. Magnus Ohman, M.D.; Carlos E. Ruiz, M.D.; Steve Ramee, M.D.; Ajay Kirtane, M.D. & Kimberly A. Skelding, M.D.


Tuesday, July 15, 2014

Academic Medicine will not publish ANTI MOC letter-or even respond to the allegations-making ethical guidelines a joke!

I submitted this and it was rejected-the Academics/MOC carpetbaggers have the journals to themselves...and they like it that way. For instance (an you be the judge):
ABMS Commentary, free advertisement or “publishing-ethical violation”?

Recently, the outspoken resistance of practicing physicians to the American Board of Medical Specialty’s (ABMS)
Maintenance of Certification programs has exploded. The number of commentary articles published by the ABMS
in medical journals, espousing the importance of their own proprietary products and value to society, has also
exploded. These articles are typically written by highly paid executives of the industry,read as unpaid
advertisements of the “home office” and typically fail to present clear disclosure of the inherent corporate ethical conflicts explaining the clear supportive message for MOC. Indeed, to imagine that CEOs and senior vice presidents could be expected to not be protagonists of that corporate proprietary mission, is inconceivable to me. Yet these articles presenting very opinionated “commentary”, continue to find free publication reflecting validation in medical journals. Disclaimers declaring “advertisement” would be more warranted. Furthermore, these following statements:
Funding/Support: No external sources of funding.
Other disclosures: None reported.
Ethical approval: Reported as not applicable.
Contradict rational facts and serve only to obfuscate the inherent corporate advertising clearly identified. The message acclaims MOC, Certification and all aspects of the ABMS well beyond anything demonstrated in outcome based studies from independent researchers.(1) One author, the current President and Chief Executive Officer of the ABFP and the EXECUTIVE EDITOR of JABFM, who earned over $600,000 per
IRS documentation, while stating: “Conflict of interest: none declared” in that journal.
This text is speculative of many possible opportunities, should these ABMS be supported. The fact is, that ABMS
certification has never been documented to matter, in spite of over 5 decades of corporate attempts. Increasingly, the
physician population is exposing the corporate tactics of regulatory capture and distancing themselves from ABMS
“products”. It is time for the editorial boards of all journals to stop providing free advertisements to ABMS
  corporations to sell themselves to the public and physicians. They have corporate journals for such free access. How do editorial boards allow free advertisements without providing “equal time” for opposing viewpoints? Should these ads even be published, including disclosure that indicates “Paid authorship by the ABMS corporate executives”?
Where are the ethics of journal editors and why is the one sided free advertisement of this select corporate entity
Anyone wishing a copy of these articles should contact me off list.

Peterson LE, Carek P, Holmboe ES, Puffer JC, Warm EJ and Phillips RL: Medical Specialty Boards Can Help
Measure Graduate Medical Education Outcomes. Acad Med. 2014;89:840–842.

Thursday, July 10, 2014

ABIM MOC Failure Rates

Dr Wes' post is important but based only on first time takers of the test.

In case you haven't seen his latest:
Also see this graph from Sermo and the implications for those Recertifying:
Sermo | Sign in
If you are a physician licensed to practice in the United States (MD or DO), you are invited to connect with your colleagues on Sermo, the professional network started by physicians, for physicians.
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I would suggest the text there indicates that the FIRST time testers are used as the index for pass/failing. This means it is prejudiced against the OLDER group of test takers (now would this be illegal due to the age discrimination?). If you have been continually exposed to the "latest statistics, etc" you will be better able to regurgitate that which is DESIRED (but also not necessarily true as it will fall in 2-5 years when the "new truth" is told).
It looks even worse on closer exam:

3413 total test takers with 65% pass means 1194 total failed of whole group
1867 of these were first time recerts and pass rate of 80% means 373 failed
This leaves 1546 "repeat or non-first time recertification testers" of which 821 failed!
This is a 53% failure rate among that group of second time recertification testers!
This means with every cycle of recertification you stand to get failed increasingly.
Seems like this is intended to weed out old guys/gals and make room for the young ones- AND YET THERE IS SUPPOSED TO BE A SHORTAGE OF PRIMARY CARE!
So it would seem with every "cycle" of 10 years, you are increasingly failing OLDER people, with indexing on the youngest only!

What are your thoughts to this?
I also actually requested CMS DATA on payments for PQRS-MOC in 2011 (the only year available and the results were published in Med economics which you may find useful as factual data:
Maintenance of Certification must go: One physician's vi...
  The Maintenance of Certification (MOC) program’s expense and time commitments continue to grow, producing greater complexity and more headaches f...
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MOC physician incentives
It is clear not all registered got their money and with 850,000 US docs, with a 2% cut in payments this will be a huge perhaps $2.5 billion cut in CMS payments equal to the "sequester" cuts which cause people to raise hell. This is why I think 2005-6 will be hallmark years for wake-up calls to physicians regarding the MOC extortion and government collusion and I hope results in large numbers dropping medicare and caid as providers-shifting care to Fauxicians.

Tuesday, July 8, 2014

ABIM newest 65% pass rate among all takers, means 53% FAILURE rate among those recertifying, not for the first time!

There are posted the results from the most recent ABIM testing fiasco
It looks even worse: 
3413 total test takers with 65% pass means 1194 total failed of whole group 
1867 of these were first time recerts and pass rate of 80% means 373 failed 
This leaves 1546 "repeat or non-first time recertification testers" of which 821 failed!
 This is a 53% failure rate among that group!
Great Scott,  And based on what???

Thursday, June 26, 2014

Maintenance of Licensure threatening in Washington State-it must be fought NOW!

 The FSMB is a corporation with monetary interests in passing this legislation to initiate regulatory capture of physicians and physicians ONLY:

"William Gotthold, MD
Congressional District 8
In 2010, the Federation of State Medical Boards (FSMB) adopted a framework for Maintenance of Licensure (MOL) that called for license renewal to be contingent on evidence of participation in a program of life-long learning and continuous professional development.
This was to be more focused than the current requirements in most states for some hours of CME. In the past two years an FSMB task force, including many different stakeholders, has developed a set of recommendations that states can consider when they create their MOL requirements.
There are two parts to the model. One is to stay up to date in your area of practice, which is CME in its various forms.The other is to measure your performance in your actual practice to look for possible areas of improvement, obtain education or guidance on how to improve, apply that knowledge, and then measure again to verify improvement. Staying up to date with CME is not a new idea. The new concept is to measure actual practice performance, focus the CME where needed, apply this new knowledge to the practice, and then re-measure.
For many practitioners the measurement component is already part of various mandated reporting on quality parameters. Physician groups, hospitals, insurers and Medicare all do some form of quality measurement.
Most of these are aimed at process (did you measure the A1c), but more recently some are attempting to measure actual outcomes (what percent of your patients have an A1c at an acceptable level). Active participation in these types of programs should satisfy the measurement requirement. For other practitioners not involved in these formal programs, there are many CME programs that that have initial measurement and subsequent re-measurement as part of the CME process. More of these will surely be developed as more states move to the MOL model for license renewal.
For physicians certified by a member board of the American Board of Medical Specialties, active participation in the Maintenance of Certification program of their board will suffice for the requirements of MOL.
More information about the history of the MOL concept, and resources for CME programs, can be found on the FSMB website at"

This constitutes legislated medical care by a non-profit Corporation eager to sell you testing and products, just like the ABMS except this is mandated for you to re-license! The boards are "voluntary" at this point but the FSMB is out to make you dance! Information on how to fight this is available at:
Kempen PMSuccessful Opposition to Maintenance of Licensure: The Ohio Experience as an Educational Template.  Journal of American Physicians and Surgeons 2012 17:103-6 and 

Kempen PM. Maintenance of certification and licensure: regulatory capture of medicine.  Anesth Analg. 2014 Jun;118(6):1378-86. 

Fighting the Psych/neurology boards also makes them back off-for now

The boards are only backing off FOR NOW!

2. The ABPN has reduced the amount of MOC activity needed to meet the requirements for the 2015 through 2021 MOC examinations.Quarterly Update
Based on the recent feedback from the field and availability of ABPN-approved MOC products, the ABPN has reduced the number of requirements for those testing in 2015-2021.
For those who need to recertify in 2015, but are not in the C-MOC program, the requirements to apply are: 
270 Category 1 CME, of which at least 24 should include a minimum of two SA activities, and one PIP unit. Previously there were 40 self-assessment CME required.
For those who need to recertify 2016-2021, but are not in the C-MOC program, the requirements to apply are: 300 Category 1 CME, of which at least 24 should include a minimum of two SA activities, and one PIP unit. Previously there were 80 self-assessment CME and three PIP units required.
If you have satisfied additional self assessment and/or PIP unit requirements due to these reductions, you may apply the additional credit towards your first C-MOC cycle after passing the recertification examination.
Click here to download the 10-year MOC chart in PDF format pdf icon.

Tuesday, June 17, 2014

Why Do Hospitals Side With Maintenance of Certification?

Tuesday, June 03, 2014

Why Do Hospitals Side With Maintenance of Certification?

With the recent 22% percent failure rate of the most recent Maintenance of Certification (MOC) testing offered by the American Board of Medical Specialties/American Board of Internal Medicine, I was puzzled as to why any hospital systems would want to support the proposed Maintenance of Certification changes imposed 1 January 2014.  After all, wouldn't hospitals risk of looking like they have substandard physicians on on their staff if they failed to pass their MOC exam? Do hospitals really really side with the ABIM's leadership that MOC testing is for public good?  Or might there another motive why hospitals support the MOC process?

To reach an understanding of this issue, I asked a senior member of our staff who has served many policy roles within the leadership of the American College of Physicians, the Illinois Chapter of the American College of Cardiology, and served as a founding fellow of the Society of Cardiovascular Angiography and Interventions (SCAI), Joseph V. Messer, MD, MACC.  Joe is widely respected in the cardiovascular policy circles and has worked extensively on such things as "Appropriateness Use Criteria" and performance measures for cardiology. He carries a unique understanding of the challenges inherent to bureaucratic methods to measure quality care and (importantly) the limitations of creating such systems.  Joe is a luminary in many respects and thought hard about the question I posed him.  His response was both eloquent and insightful.  With his permission, I am publishing his response to me so others might enjoy Joe's perspective on why hospital systems want to "align" with the MOC process. Here is what he wrote:
Wes, your question yesterday at our Cath Conference started me thinking. Since I have decided not to go the MOC route, haven't given it much thought. Here are my ideas: 

Both the Feds and the Hospital Systems prefer a single payer system. Several years ago at an ACC conference, the CMS representative told me their goal was to pour all the money into a single funnel and let healthcare systems worry about the distribution, providing a significant source of "handling" fees for the systems. 

CMS and hospital systems seek alignment. The "funnel" analogy is one example. Further, CMS has very limited authority to define and require demonstration of quality from providers. They will encourage the hospital systems to handle this role, and willprovide the $$ for same - thus more revenue for hospital systems, not unlike current support for residence and fellow training programs.

As we move toward a single payer system, hospital systems will continue their effort to control physicians - the most important of the distribution recipients in healthcare other than the systems themselves. By ultimate controlling MD's they can take a larger piece of the pie for themselves. Increasingly impotent physicians will have little recourse, since the public consumer now values convenience and low cost over quality.

Supporting MOC assists the hospital systems in controlling MD's. Systems will use public opinion, in part, as a tool in this effort. Hospital systems will vigorously claim that MOC assures higher quality. By requiring and advertising that all system employed MD's are MOC certified the systems will have another weapon against the "private practice" MD, many of whom will not pursue the MOC course, many of whom will be "concierge MD's" and the most vocal opponents of hospital systems. 

Ultimately, I believe the hospital systems want to control the certification process. By supporting the MOC initiative they will likely destroy the ABIM as it loses its physician support because of MOC. The specialty societies are lukewarm at best about MOC's and I hear increasing criticism of ABIM for its ulterior financial motivations. Some specialty societies are receiving similar criticism for the fees they charge for educational materials crafted to meet MOC requirements. Thus, ACC and others may well suffer with the ABIM for not vigorously opposed MOC in its current form.

Marginalizing the special societies has already begun. It is very clear that employed cardiologists find less interest in the ACC. The largest grant the ACC has ever received just went to two Chapters - Wisconsin and Florida - to test local, grassroot proposals for health care financing. ($15.8 million over 3 years). National ACC supported this project for a while, but then fell away when the leadership lost interest. My concern here is that the ACC/AHA/STS/HRS/SCAI remain key supporters of quality, appropriate use and performance measurement. If they are significantly weakened by all of these issues - MOC, physician employment, decreased specialty influence in CMS and Congress, the hospital systems will surely move into the vacuum to control education and quality definition to their advantage. 

But, when all is said and done, I doubt that the incoming crop of physicians care. In a recent survey (2-3 years ago) the primary motivation of medical school applicants was "job security".
Ugh.  Depressing.  Sadly, I think he's correct.

Thanks for your insights, Joe -