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 -  


Monday, June 16, 2014

Hypocrisy in organized medicine- an OBGYN states MOC facts

While many physicians donate their services seeing patients, volunteering at Free and community clinics, freely working on hospital and other not-for-profit committees, there is a tendency for retired academic physicians who have always had a hard time relating to those of us in the trenches to get big salaries from the American Boards and other organized medical societies.  Are you interested in how to find out what your specialty pays its leaders?
Do we really believe that the executive running the American Board of Obstetrics and Gynecology,a former University department chair currently works 70 hours per week? Or is that number used in the 2012 federal tax return to justify a salary of $582,136 plus $ 566,799 in "deferred compensation". Does his "Director of Evaluation", another former department chair really work 70 hours per week? Many OBs do actually work that number of hours, but are there 2 AM emergency "evaluations"? How many practicing OBs would love a job that paid $524,198 plus $519,183 in deferred compensation making sure that evaluating other doctors was valid? I give these guys credit, 70 years old and still working 70 hours per week? Do they actually go into the office those 70 hours? Or do they count the numerous dinner meetings, flying to Academic meetings, going to Washington to lobby on their organizations behalf and reading scholarly journals in order to keep up as work hours?  Obstetricians and Gynecologists do all those things and don't get paid for their time. In fact, those of us with private offices have to pay high overheads in order to do all those things; that's why many of us really work 70 hours per week. MOC makes us pay for their life style and costs us real money plus 30-50 hours each year that goes un reimbursed. Shouldn't we in the words of Mahatma Gandhi demand satyagraha (insistence on truth)? Veritas vos liberabit, Howard C. Mandel M.D., FACOG 

MOC – a Solution in Search of a Problem


Doctors who completed their training in the early 1990′s, came into practice being told that their Board Certifications would be valid for just 10 years, with the need for re-testing every 10 years. The premise behind this concept was that physicians who participated in MOC found great value in it and that patients demanded that their doctors participate in MOC.
Having re-certified in 2005, and finding no real benefit to my practice, and feeling rather humiliated by the methods utilized by the Board to ensure a “secure” exam, I decided to query my colleagues and patients about their feelings towards MOC.

Friday, June 13, 2014

Anti-MOC makes the cover of the June 2014 GI & Hepatology News


Tuesday, June 10, 2014

MOC on Trial-a Medscape article worth reading!

Do Recertification Demands Waste Doctors' Time and Money?

Batya Swift Yasgur, MA, LMSW

June 04, 2014

MOC on Trial

In 2013, the Association of American Physicians and Surgeons (AAPS) filed an antitrust suit in New Jersey federal court, claiming that MOC is a "moneymaking, self-enrichment scheme" that "restrains trade and causes a reduction in access by patients to their physicians."[4] The lawsuit focused on a New Jersey-based physician who was denied hospital privileges because he had not recertified. According to AAPS, "there is no justification for requiring the purchase of [ABMS's] product as a condition of practicing medicine or being on hospital medical staffs."