MOC, MOL, OCC and now C-MOC: the certification industrial complex

8/23/2019 MOC, MOL, OCC and now C-MOC: the certification industrial complex

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MOC, MOL, OCC and now C-MOC

Beyond mere Board Certification

Paul M Kempen, MD, PhD

Board certified 1989, 2005

And never again!

1457 1305


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First certification

with 2 year

cycles of profit

NO license=

useless document

Does an

anesthesiologist

really need

this?


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ACLS circular 2

min. cycle

Circulation 2010, 122:S729-S767

PEA, Ventricular tachycardia (VT) fibrillation (VF)


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Historical overview 100 years ago

No licenses or certifications

Lifelong learning and apprenticeships

1960s

Medicare/-caid government as new payer-need to document

AMA strong horse and CME-PRA as documentation (75%)

2000

Board certification switch to 10 year cycles prevalent

First steps to regulatory capture of physician CME as MOC

2010 MOL and significant resistance, MOC @ 50% participation

2014-MOC to become C-MOC, AMA declined to 15% membership

MOC points vs CME


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http://www.medibid.com/blog/2013/04/medicrats-increase-

healthcare-costs/

Physician vs Administrator growth in Healthcare

Parallels The increasing need to document in healthcare
http://www.medibid.com/blog/2013/04/medicrats-increase-healthcare-costs/http://www.medibid.com/blog/2013/04/medicrats-increase-healthcare-costs/http://www.medibid.com/blog/2013/04/medicrats-increase-healthcare-costs/http://www.medibid.com/blog/2013/04/medicrats-increase-healthcare-costs/http://www.medibid.com/blog/2013/04/medicrats-increase-healthcare-costs/http://www.medibid.com/blog/2013/04/medicrats-increase-healthcare-costs/http://www.medibid.com/blog/2013/04/medicrats-increase-healthcare-costs/http://www.medibid.com/blog/2013/04/medicrats-increase-healthcare-costs/http://www.medibid.com/blog/2013/04/medicrats-increase-healthcare-costs/


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The Certification industry

Millions for nothing but a promise!

CME PRA R

AMA recognition Award

Licensure and credentialing confer, inthe eyes of the public a GoodHousekeeping Seal of Approval

(To Err is Human 1999 page 3)


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Lifelong Education or testing?

Pursuit of Journals cutting edge IN YOUR

area of expertise!

Or Review regurgitation of textbook factoids

Does one size fit all and with 168 different

board certifications-how is that equal/fair?

Multiple certifications to become extinct?


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License and certification:

Limiting competition/Guilds

Milton Friedman, (1962)

the pressure on the legislature to license an

occupation rarely comes from the members of the

public . . . On the contrary, the pressure invariablycomes from the occupation itself.

Harold Demsetz, (1968)

regulation has often been sought because ofthe inconvenience of competition.


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ABIM, with the FSMB leads

the Certification industrial

complex

_______________________


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State Medical Boards have been doing this for

decades as well!


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MOC and MOL vs CPD

little difference

Goal is to provide documentation to unwitting

external agents and make money in the process

Like its predecessor, the CPD program has three

major (non-validated) components:

1) self-evaluation of the components of clinical

competence, (CME)

2) evaluation of essential knowledge and clinicaljudgment, (TESTS for $$$)

3) verification of credentials and attestation of

institutional and community good standing


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Voluntary recertification failed

progressively fewer diplomates opted to

participate in each recertification cycle:

3355 in 1974

2240 in 1977

1947 in 1980

1403 in 1986

Only 8945 diplomates, less than 10% of those

eligible, elected to undertake voluntary

recertification.


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Voluntary recertification failed

This decrease occurred despite strenuous

efforts to make the process more relevant and

attractive by:

linking it with the American College of Physicians

Medical Knowledge Self-Assessment Program,

offering modular formats and choice of content,

charging low fees.

SO the answer is to just FORCE

everyone into high cost compliance!


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Subspecialty or added qualification

Recertification in a subspecialty, such as

cardiology or gastroenterology, will not

require the maintenance of an active internal

medicine certificate;

Certificates of added qualifications, such as

geriatric medicine or clinical cardiac

electrophysiology, will continue to require anactive certificate in the underlying discipline.


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Year 2000

Active participation in CPD was made

mandatory for continuing ABIM directors

regardless of whether their certificates are

permanent or time-limited.

Directors will receive no special treatment,

financial or otherwise.

Really????


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Dr. Christine Karen Cassel

Certification AreaCertification

StatusCertification History Comments

Internal Medicine Certified

Certified09/12/1979,

Certificate valid

indefinitely

Certificates awarded in

Internal Medicine prior to1990 do not require

renewal. However, ABIM

encourages all diplomates

voluntarily to renew

certificates relevant to their

practice.

Geriatric Medicine Certified

Certified 01/01/1998,Certificate valid through

12/31/2004

Certified 02/17/2005,Certificate valid through

12/31/2015

Ex-President of the ABIM was a member of the same 2000 ABIM Task Force

on Recertification and originally certified in medicine in 1979,

(re-) certification in geriatrics occurred only in 1998 and 2005,

without the recommended primary recertification in internal medicine.

Requires basic IM

certification for validity


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Dr. Humayun Javaid Chaudhry

Certification Area Certification Status Certification History Comments

Internal Medicine

Not

Certified

Certified 08/21/1996,

Certificate valid through12/31/2006

Humayun J. Chaudhry, DO, MS,

MACP, FACOI

SecretaryFSMB President/CEO


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Specialty or

Subspecialty Certification History Status as of 1/13/2013Neurology

Certificate No.

29063

Certified on

01/30/1987certificate validindefinitely

Certification Status: Certified

MOC Status: Not Meeting MOC Requirements

and Is Not Required To Do SoClinical Status: Unknown

Lois Margaret Nora, MD, JD, MBA

President and Chief Executive Officer


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We identified officers in various internal

medicine organizations using official websites


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Meta-analytic statistics were not feasible due to

variability in outcome measures across studies.


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Board Certification and Clinical Outcomes:

The Missing Link

Purpose: no systematic review has examined

the link between certification and clinical

outcomes.

Method. Data sources consisted of studies

cited between 1966 and July 1999

identified 1,204 papers;

selected 237 based on subject relevance;

reduced to 56 based on study quality

identified only 13 that met inclusion criteria


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First comprehensive review

2000

Overwhelmingly retrospective data base

review as method

Little real data to be presented

Conclusions typically favorable in spite of

limited science

Overwhelming influence from ABMS

in sponsorship and authors noted!


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ABMS statement on certification

ABMS 2012: FACT: ABMS recognizes that

regardless of the profession - whether it ishealth care, law enforcement, education or

accounting - there is no certification that

guarantees performance or positive

outcomes

http://www.abms.org/Maintenance_of_Certification/pdfs/ABMS_MOCMythsFacts12_26_2012_final_revised01092013.pdf


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Awareness of Whether or Not Primary Doctor

is Board-Certified

DK=Dont know RF=Relative frequency??

From:2003 THE GALLUP

ORGANIZATION

for

The American

Board of Internal

Medicine


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Incidence of Having Researched A

Physicians Credentials

Q.13 Have you ever asked or checked with anyone, such

as a receptionist, nurse, doctor, friend, or coworker, if a

doctor was board-certified?

Q.14 Have you ever visited a web site or other source of

information to verify a doctors credentials?

Very low rate (33%) of

checking vs

knowledge (72%)of certification on last slide!

From:

2003 THE GALLUP ORGANIZATION

for The American Board of Internal Medicine


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Testing Frequency

From:

2003 THE GALLUP ORGANIZATION

for The American Board of Internal

Medicine

_____________________________________________


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Nurses

Colleagues

Patients & families

Private interest groups

Also: Hospital boards, other physicians, nurses, Better business bureau, etc


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Regulatory Capture:

Regulatory capture occurs when special

interests co-opt policymakers or political

bodies regulatory agencies, in particular

to further their own ends.

ABMS and FSMB have declared themselves as

Sole official agents of verification of physician

abilities-yet provide NO educational materials-this is left to the national specialty societies

who are coerced for the $$$$$$$$$$


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FSMB planning for MOL

FSMB is planning pilot projects with 11 states

starting early 2012, including:

Ohio. Calif.(D.O.), Colo., Del., Iowa, Mass.,

Mississippi, Okla. (D.O.), Ore., Va., Wis.

All Politics are local and

changes must beaddressed primarily ---

at the state level!

---------------------

------


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States with anti MOC/MOL resolutions

Fighting as professionals

Ohio

Michigan

New York

Texas

North Carolina

Iowa


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Medical Society of the State of New

York: resolutions 2013 RESOLVED, That the Medical Society of the State of New York

acknowledges that the certification requirements within theMaintenance of Certification process are costly, time intensive and resultin significant disruptions to the availability of physicians for patient care;and be it further

RESOLVED, That MSSNY acknowledges and affirms the professionalism of

individual physicians to self-determine the best means and methods formaintenance of their knowledge and skills; and be it further

RESOLVED, That MSSNY communicate to the American MedicalAssociation (AMA) and American Board of Medical Specialties (ABMS)examples of disproportional fees, onerous time requirements andunnecessary fragmentation of commonly recognized specialties; and be

it further RESOLVED, That MSSNY oppose mandating Maintenance of

Certification until such time as evidence-based researchdemonstrates MOC is linked to improved patient outcomes;and be it further

RESOLVED, That a copy of this resolution be transmitted to the AMA

House of Delegates for its consideration.


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How to organize

States have rights to legislate licenses-the battle willbe drawn here

Organization of State opposition among physicians-DATABASES/EMAIL!

Proactive measures to meet real needs

Define the truth-expose the lieswith States owndata!

Require only Certification and NOT recertification for: Hospital privileges

Group membership

Insurance payment and participation


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Testimonial to cost

National specialty societies/academics are becomingthe MOC Franchise supporters of the ABMS Testing

industry:

"On Sunday I spent 5 hours on the computer

completing a course to be accepted as my Part IVmodule for maintaining my board certification in

Family Medicine. The course was free. Today I found

out that in order for the course to be credited to my

MOC I have to pay the American Board of

Family Medicine $625 !! How do they justify this?"

Dr. M


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American Society of Anesthesiologists
http://www.asahq.org/http://www.asahq.org/


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STATEMENT

________________________________________________________________________________

2010

With CMS: any "carrot" will quickly become a "stick" of penalty

_____________________________________________________


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2013 0.5% if no MOC, 1% if MOC(performance year for 2015penalty)

2014 0.5%2015 -1.5%2016 -2%

Medicare Physician Quality Reporting System

PQRS-MOC Incentives and Penalties

https://www.ama-assn.org/ama/pub/physician-resources/clinical-practice-

improvement/clinical-quality/physician-quality-reporting-system.page

The 9 ABMS (all subspecialties) qualified for the 2012 Physician


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The 9 ABMS (all subspecialties) qualified for the 2012 Physician

Quality Reporting System Maintenance of Certification Program

Incentive.Allergy and Immunology

DermatologyEmergency Medicine

Internal Medicine

Neurological Surgery

Nuclear Medicine

Obstetrics and GynecologyOphthalmology

Radiology

American Osteopathic Association-

The following boards are qualified:

Internal Medicine

Obstetrics and Gynecology

Pediatrics

Radiology

https://www.ama-assn.org/ama/pub/physician-resources/clinical-practice-improvement/clinical-quality/physician-quality-reporting-system.page
http://moc2014.abim.org/


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Coming January 2014:

A more continuous ABIM MOC program

( Cert i f icat ion w il l become only an entrypoint for subscr ip t ions to MOC):

"Certified, Not Meeting MOC Requirements."

Questions and Answers

http://moc2014.abim.org/q-and-a.aspx

These Weren't The Rules When I Certified Why
http://moc2014.abim.org/


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Certification and MOC have been and continue

to be evolutionary processes. In order to help

you keep pace with the changes in the scienceof medicine and assessment,ABMS and ABIM

believe that a more continuous MOC program

is vital tofulfilling our mission ofassuringpatients that Board Certified physicians are

committed and qualified to provide high-

quality care.

These Weren t The Rules When I Certified. Why

Do I Have To Do This Now?



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For all ABIM Board Certified physicians, ABIM andABMS will begin reporting whether or not you are"Meeting MOC Requirements" (i.e., completing anMOC activity every two years, earning 100 points

every five years, etc.). In order to be reported as "Meeting MOC

Requirements", you will be required to complete anMOC activity to earn ABIM MOC points every twoyears and earn 100 ABIM MOC points in the correct

distribution every five years. The points earned everytwo years will count toward your five-yearrequirement.

The exam requirement has not changed. You need topass the exam in each certification area you want tomaintain every 10 years

What Are The Changes To ABIM's MOC

Program In 2014?http://moc2014.abim.org/q-and-a.aspx


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To maintain more than one certification, thecost will be the fee of the most expensivecertification plus half for each of the others.

For no additional cost, you may be eligible for

CME credit for the completion of ABIM MOCproducts. MOC, in one of the internalmedicine specialties, ranges from $206- $257

per year.

Keep in mind that,for most ABIMCertifications, you do not need to maintaininternal medicine certification to remaincertified in the subspecialty.

How Much Does It Cost?



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The secure exam, taken once every 10years, can earn 20 MOC points.

(VS CME???) You will now have the option of paying

for the program on an annual basis orfor the full 10 years in advance at adiscount.

Your MOC fee includes unlimited accessto all of ABIM's self-evaluationproducts, many of which earn CMEcredit.

Will Any Of These Changes

BenefitMe?



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ABIM will honor all certifications already issued, and diplomateswho received certifications that are valid indefinitely will remaincertified (assuming you hold a current and valid license).

However, for all ABIM Board Certified physicians, regardless ofwhen they were initially certified, ABIM and ABMS will beginreporting whether or not they are "Meeting MOC Requirements."

In addition to the "Meeting MOC Requirements" requirement,diplomates with a certification that is valid indefinitelywill need to pass the MOC examin their certificationarea by 12/31/23 in order to be reported as "Meeting MOC

Requirements." This is in addition to continuing to meet the pointrequirements of the MOC program.

Grandfathers who do not meet the MOC program requirements willbe reported as "Certified, Not Meeting MOCRequirements."They will NOT be reported as Not Certified forfailing to meet MOC requirements.

I Hold Certification That Is Valid Indefinitely. Why Are You

Reporting That I Am Not Meeting MOC Requirements

When I Don't Have Any Requirements To Meet?



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What Is The Evidence That Supports The Need To Meet MOC

Requirements On A More Continuous Basis? How Do You Know

The Public Wants This?

The Institute of Medicine (IOM) has argued that in a profession

with a "continually expanding knowledge base" a mechanism is

needed to ensure that practitioners remain up-to-date with

current best practices.

The growing knowledge base requires that training and ongoing

licensure and certification (????) reflect the need for lifelong

learning and evaluation of competencies.

Research has shown that the public expects that physicians

undergo a rigorous, periodic examination of knowledge.


I ABIM Th O l ABMS B d Wi h A


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No, ABMS is requiring that all of its 24

member Boards implement a more

continuous MOC program. The AmericanBoards of Colon and Rectal Surgery,

Dermatology, Family Medicine,

Ophthalmology, Pediatrics, and Physical

Medicine and Rehabilitation are just a few ofthe Boards which currently provide or are

working to provide continuous programs.

Is ABIM The Only ABMS Board With A

Continuous Program?

Five Things Physicians and


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g y

Patients Should Question

Participating Internists

American Academy of Allergy, Asthma & Immunology

American Academy of Family Physicians

American College of Cardiology

American College of Physicians

American College of Radiology American Gastroenterological Association

American Society of Clinical Oncology

American Society of Nephrology

American Society of Nuclear Cardiology

Other specialties sure to follow!just say no? To what? Patient satisfaction? Lawsuits?


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Needless testing and Choosing Wisely

Stop wasting money on testing in patients

Yet

Test physicians yearly to screen out the veryfew marginal ones

Would the ABMS or MOC have mattered

in Kermit Gosnells case???
http://www.google.com/url?q=http://www.click2houston.com/news/reports-abortion-doctor-guilty-of-firstdegree-murder/-/1735978/20122278/-/2m5dyf/-/index.html&sa=U&ei=uzySUajEMYHu9ASfgIHoDA&ved=0CCwQpwIwAA&usg=AFQjCNHzz0KMNwMTb7_o1-I7FJHkVh8H3Q


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Standard

Contract

AmericanBoard of

Pathology

All rights to

board-none

to you!


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P4: YOUR obligations!

I understand and agree that, if I meet all of thequalifications for certification, my certificate

will be valid for 10 years contingent upon

my timely satisfaction of all requirements ofthe American Board of Pathology

Maintenance of Certification program.

I agree to be legally bound by the foregoing. Signature


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'I'll make him an offer he can't refuse'

Certification improves nothing: Physicians are and remain competent for many

reasons-NOT because of MOC

By creating legally mandated MOL, MOC becomesan offer you cannot refuse

Protection racketeering:

You dont really need the protection

Until after the need is created

by the offering entity!

Solicitation from 5/16/2013


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Solicitation from 5/16/2013

The American Board of

Anesthesiology4208 Six Forks Road, Suite 1500

Raleigh, NC 27609-5765

Phone: (866) 999-7501 | Fax: (866) 999-7503 | Email:[email protected] | Website: www.theABA.org

RE: Register for MOCA Cognitive Examination

We greatly appreciate your voluntary participation in the ABAs Maintenance of Certification in Anesthesiology Program (MOCA)!As a reminder,you are eligible to register for the July 2013 MOCA Cognitive Examination.

If you wish to register for the July 2013 MOCA Exam, the deadline isMay 21, 2013.

Please log into your ABA portal account at www.theABA.org toregister.

The 4-hour, computer-delivered examination will be administered to candidates at test centers in more than 300 cities located throughout the

United States, Canada and the U.S. Territories.

Registration Deadline and Fees:

To register for the MOCA Cognitive Examination, please log in to your portal account via the ABA website,www.theABA.org, and click the linklabeled Register for a MOCA Cognitive Exam.

Exam Dates (Select One): July 13-27, 2013Registration Deadline: May 21, 2013

Fee: $2,100Re-Examination Fee: $800

NOTICE: This message contains information from the American Board of

Anesthesiology that may be confidential and legally privileged. If you are not

an intended recipient, please notify the sender immediately, then destroy this

email and refrain from any disclosure, copying, distribution or use of thisinformation. Thank you.

ASA 1990 1999
mailto:[email protected]://www.theaba.org/https://portal.theaba.org/https://portal.theaba.org/https://portal.theaba.org/https://portal.theaba.org/http://www.theaba.org/mailto:[email protected]


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ASA 1990-1999

Closed Claims Project analysis

Analyzed claims from the 1990-1999, before 10 year cycleswere imposed

Board certification status was unknown in 51% of claims.

There were board certified 1330 claims (39%) vs 361 (11%) noboard certification identified

Currently 76% BC vs 24% NBC rates compare to 78% and 22%of claims analyzed in the 50% where known.

There was no statistically significant difference betweengroups: In both groups death occurred in 27% of claims;

permanent injury (6-8) in 22%,

and temporary or non-disabling injury 51% of claims in each group.

1990 Cl Cl i


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1990s Close Claims:

board certified (BC) vs. not certified (NBC)

Information regarding whether a claim was paid ornot includes payments by any defendant, not just theanesthesiologist

Payment reported reflects only payments made onbehalf of the anesthesiologist

Anesthesiologist median payment:

BC: $187,000 (range $3,000 - $2.7 Million) NBC: $150,000 (range $1,000 - $6 Million)

Claims resulted:

BC: 47%

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MOC, MOL, OCC and now C-MOC: the certification industrial complex

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