Thursday, March 13, 2014

A Quiz: Is Maintenance of Certification Worth It?

Recently, I noted that the Center for Medicare and Medicaid Services (CMS) Physician Quality Reporting System (PQRS) was going to offer an incentive payment of 0.5% beginning 1 January 2014 to doctors who participate in the American Board of Medical Specialties' proprietary Maintenance of Certification® (MOC) process and are in good standing.

I wondered: how much more money does that extra payment from CMS represent for the average physician?

So I decided to do some back-of-the-envelope calculations to see what the investment of hours of studying the ABMS's proprietary materials, test-taking, board review courses, patient survey-taking, and practice improvement studies could garner for the average physician. Is there some real dollar-and-cents value to participating in this process?

To estimate this value, I made some assumptions to simplify the math:
  • First, I assumed the Mediscape 2013 average male physician salary in America was reasonably accurate ($259,000/yr) and will not change this year.
  • Doctor salary is taxed at a 24% rate after withholdings are considered.
  • No time during regular work hours is devoted to performing any MOC requirement.
  • The average US male physician works and average of 45 weeks per year, 5 days per week for their total salary.
  • The doctors only see Medicare patients.
  • Every patient office visit is billed as a 99213 (established patient visit - 15 min). (I know, not realistic, but simple to estimate)
  • Doctors work 8AM-12 noon and 1pm-5pm daily, seeing 32 patients per day, every day they work.
  • Income medicare pays the physician for each 99213 established patient visit is $69.66 and there is a 100% collection rate
There are three questions you must answer for this quiz:

(1) Given the above assumptions, how much more income will the average US male physician earn as a result of their total PQRS payment from CMS each year?
(2) How much does this additional PQRS income represent per patient visit?
(3) In your estimate, is this additional income worth the time spent away from your patients or your family events because of study requirements?

Please show your work (and/or your thoughts) in the comments.

Rest assured you will not be timed on this test nor will you receive any renumeration, CME credit, or MOC credit for your participation in this fun. Rather, it is hoped it helps educate physicians on what they'll be getting for their "required" $194 to $256 fee paid annually to the ABIM.

The first one to answer this quiz correctly will be officially crowned with the invaluable and highly-esteemed Dr. Wes Adminstrative Oversight Award®. (I added the trademark symbol to this fictitious award because I'm sure this exercise will be of great value one day.)

Good luck!


PS: In the interest of saving time for my busy colleagues who'd rather cut to the chase, here's a link to my back-of-the-envelope calculations. (Feel free to point out errors in the comments)


Anonymous said...

Reality of course is 50% Medicare is a fairly high percentage so it is actually approx.$856 netted. In exchange for at least an entire day away from work and evenings studying. A day away from work costs far more than the $856 gained, or even the $1711.

DocInKY said...

Also need to price in the costs to comply with MOC. Board review courses, study materials, time for document preparatation. In my specialty, the self assessment CMEs seemingly are 'best' obtained by sanctioned/sponsored sources that cost money on a regular basis.

DocInKY said...

Need to also consider the costs of the entire MOC Process

Cost of mandated self assessment CMEs
Cost of test review courses (and possible travel to do so)
Cost of time for document prep and submission
Cost of "quality assessment" participation

The list goes on...

Selena Horner said...

I was thinking same thing as DocInKY... the time preparing - and that cost is more than just monetary - it is also time away from family and away from hobbies, the cost of materials.

What if you calculated those figures into whether MOC is worth it? I have a feeling the final result is a monetary loss.