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• Maintenance of Certification (MOC) for physicians is expensive, onerous, time consuming, brings enormous revenue to ABMS member boards and the AOA yet has no proven or even perceived patient benefit.
• American Board of Medical Specialties (ABMS)/American Osteopathic Association (AOA) mandated MOC is an example of an anti-competitive, regulatory monopoly, that discriminates against younger physicians, women and minorities, while exempting older physicians, who are mostly Caucasian.
In 2014 ABMS member boards moved to Maintenance of Certification (“MOC”) requiring exams, computer modules and various practice improvement activities every 1-2 years. These MOC activities require approximately 20 hours of work per year, are time consuming, expensive ($200-300/year), and there is no evidence MOC activities improve patient care. Much of the testing is irrelevant to an individual physician’s practice. For example, an orthopedic surgeon who only treats adult patients must spend time learning pediatric orthopedics just so they can pass the tests.
Attending continuing medical education lectures and conferences (like continuing legal education activities) has become the de facto measure of “keeping up” similar to CLEs in the legal profession.
COST OF MOC: The ABMS member boards charge physicians approximately $200-300 per year per board certification maintained, i.e. since many physicians have more than one board certification they often pay over $400 per year. On top of this is time away from practice for review courses and travel. Over the course of a career, a recent Annals of Internal Medicine* publication estimated a physician will typically pay $23,000 over a 10 year cycle (ie nearly $100,000 over the course of a 40 year career) to complete MOC activities.
FINANCIAL CONFLICT OF INTEREST: The ABMS member boards obtain considerable revenue from MOC. The American Board of Internal Medicine (ABIM) is by far the largest ABMS member board with 200,000 diplomates, and has annual revenue (derived from its 2014 tax Form 990) of $57M, with $27M deriving from MOC activities. Senior administrators of ABIM receive $400-850K in compensation.
MONOPOLY of ABMS and PAYORS: One of the “quality metrics” used by the NCQA to evaluate insurance companies is physician certification by the ABMS. • The originator and CEO of the NCQA (who is paid >$750K per year) is also on the board of the ABMS, illustrating how these private boards work together to maintain exclusivity in the “quality assessment” business.
REGULATORY MONOPOLY/RESTRAINT OF TRADE: ABMS has restrained trade by inducing health insurance companies and health plans to exclude physicians who do not purchase and comply with the ABMS MOC program.
SOLUTIONS: 1. AN ALTERNATIVE to ABMS member board and AOA required MOC is another, 501(c)3 not for profit organization, the National Board of Physicians and Surgeons (see NBPAS.org). • NBPAS was initiated by concerned, academic and private practicing physicians, many of whom are thought leaders in their various medical specialties. • NBPAS is a volunteer organization. The physician board members and President of NBPAS are unpaid. • Certification by NBPAS requires initial ABMS (or AOA) member board certification, but ongoing certification is primarily based on the physician completing 50 hours of ACCME accredited CME every two years and good citizenship (ie unrestricted medical license and no involuntary denial of hospital privileges) • NBPAS certification is inexpensive ($75/year) and does not require the irrelevant, expensive, and onerous requirement of MOC. • NBPAS has been providing board re-certification for over 2 years and is growing rapidly, having certified over 6000 diplomates to date and is accepted for admitting privileges by approximately 60 hospitals.
2. LEGISLATION: Numerous anti-MOC bills have recently been introduced in many states. 8 states have passed anti-MOC bills.
Anti-MOC Legislation is complex. • Strong bill = AMA proposed “model legislation”. Key excerpts:
• A facility licensed under this chapter shall not denyphysician hospital
staff or admitting privilegesor employment based solely on the absence of
maintenance of certification. • A health insurance entity, as defined in [state law], shall not deny
reimbursement to, or discriminate with respect to reimbursement levels,
or prevent a physician from participating in any of the entity's provider
networks, based solely on a physician's decision not to participate inmaintenance of certification.
Above information comes from www.nbpas.org
Click here for "Direct Adverse Effects of MOC® on Patients": http://drwes.blogspot.com/2017/08/direct-adverse-effects-of-moc-on.html?utm_source=feedburner&utm_medium=twitter&utm_campaign=Feed%3A+DrWes+%28Dr.+Wes%29
We - patients, loved ones of patients and physicians alike respectfully request our elected representatives to preserve healthcare, minimize the physician shortage, support patients with continued access to their doctors, end the discriminatory healthcare in existence and request your support of strong anti-MOC legislation that prohibits the use of maintenance of certification as a condition of licensure, reimbursement, employment or admitting privileges at hospitals.
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