Monday, April 06, 2015

The Clever Practice Improvement Module Roll-Over

On February 3, 2015, in response to overwhelming physician pushback regarding the Maintenance of Certification program sanctioned by the American Board of Medical Specialties (ABMS), the American Board of Internal Medicine suspended the Practice Improvement Modules contained in Part IV of their MOC program for two years.

What physicians failed to realize, however, is the minutes required to complete the busywork inherent to "Practice Improvement" exercises were being officially rolled over to the the new "Doc Fix legislation" before Congress (see page 28, line 24 and pages 32-39 of the bill) and robbed from direct patient care as a result.

It is difficult to ascertain if the ABIM leadership knew about the new 263-page doctor payment reform bill when they made their placating announcement, or if the inclusion of these wasteful and inherently meaningless practice improvement exercises is just more insurance industry hogwash permitted by the bill's clueless authors.  But the fact that the bill includes references to quality measures created by "consensus-based entities" like the troubled National Quality Forum and references to "maintenance of certification" should be very concerning to every working US physician. This "doc fix" bill will officially make MOC an expensive and mandatory pay-to-play scheme, formally sanctioned by our very own government.

Doctors need to voice opposition to the "Doc Fix" bill now by calling your Senators. 

Otherwise, the "fix" will be in for working doctors everywhere.

Congress, are you listening?



Anonymous said...

Of course they knew. Why fight the MOC battles on six fronts, when you can clear the playing field with one swipe of a lobbyist's ATM card?

In exchange for "overwhelming support" from every (MOC-selling) specialty society - the bill contains the language to make MOC mandatory and make the ABMS the only 'approved' source of that MOC.


Paul Kempen said...

But of course this statement is further suspicious "that the Sec-
6 retary determines, when effectively ex-
7 ecuted, is likely to result in improved
8 outcomes. "

No need for proof, all you need is a well lobbied and under the table payment to some secretary and these mere 263 pages of legislation become a blank check for anyone who can buy the secretary and have their program penned into law!!!!
Politics at their best. I am only glad that the uproar of physician disdain has currently let the secretary to eject MOC from the current 2015 law and hopefully the prospect will continue to prevail as long as we doctors keep the moementum up and QUIT paying the damn ABMS!

DrWes said...

Anony -

The ultimate "gotcha" might be when docs refuse to accept Medicare patients as a result of this provisional Catch-22.

Anonymous said...

I have been saying this all along. The ABIM can apologize all day long while they sneak behind everyone's back and pass a bill in congress which will codify their business plan and simultaneously nullify any and all competition. Duh!! This is how the game is played.

Our own 'professional societies' are in on it, too. The ACC has codified its registries galvanizing their grip on practicing cardiologists and gauranteeing a future cash flow independent of their dues. The AMA pursued this same strategy (renting CPT codes to the government); thereby, existing/representing a collection of bureaucrats with their own purposes.

Please see the recommendations from the Choose Wisely campaign. Each is about reducing or restricting services. Our professional societies have promised to pressure practitioners in a quid pro quo for more power/income. When 20% of the ACC/ABIM recommendations are proven WRONG after only two years, where is the accountability?! If Dr. Wes places an ICD before 3 months, he can expect a call from the DOJ. When the ABIM/ACC give out WRONG directives...cue the crickets.

Of course, this mistake can be overlooked since the limiting access to medical care justifies the end of lowering costs. Gotta crack a few eggs to make an omelette.

PS. The same morons who can't assemble five correct Choose Wisely recommendations are writing our board exams. Go figure.

gur said...

there is a interesting trick that abms is teaching physicain community. we will use the senate to put u in line. ABMS/ABIM are our own frankenstein and we physicians are the ones who have to fix it. can we doctors design our own bill get it signed by 200000+ doctors and send it to public referendum
lets let the nation that in order to fix we need to open free market in health care.
if heath care is socialised so will this nation be and so will be our liberty.
it is not a small game that we are being forced to.
it is the game of survival of our naiton.
abim/abms/fsmb are just the means of our enemy to achieve its ends.

Anonymous said...

Oh wonderful! The free market in healthcare. You docs do such a wonderful job of telling patients how much you will charge and how much a particular test, surgery, hospitalization will cost. And it's so easy to shop around in the midst of an emergency! But history tells us how you did such a great job of keeping costs from rising too fast.

Socialized medicine? Lord save us! Just look at the horrible system they have in western Europe - better outcomes at half the cost. Please do save us from that result.

Thanks, docs. Good to know you have our best interests in mind.

Anonymous said...

Legislation attempt still underway on how to insure ( demand-fines) docs cannot turn away medicare / Medicaid patients ! Stay tuned docs ! And, to Mr. Anonymous who thinks socialized healthcare is the greatest --- please go live there / talk to patients / check the technology committee guidelines on many diseases/ ask about how long it takes to see a specialist ?? Before you open that expert mouth ! Oh - btw ,check out the med school student debt levels -- incomes for PCP's , Yeah - they're really getting rich ( 4 years undergrad + 4 years med school + 3-7 years residency ) -- jeez -- what a scam those docs ( and ,Rn's & techs) have ! Get a grip !

Anonymous said...

dear anonymous, i know u are upset when i say that these small attempts are just a part of big plan. but i would suggest u to read this book. the road to serfdom. to understand why all these small legislations are part of one plan.
i know that u r upset that doctors did not go good job trying to fix heath care prices, just sit for a while with open mind and try to think when was the last time, doctors actually had capacity to act in open market. the health market has been unoffically notafree makrekt anymore once the hospitals started loobying around and created Certificates of need, insurance companies lobbied around to find ways around anti-trust rules, pharmaceutical compnies destroyed the existence of generics, and medical education education in this contry was systemically made a puppett of university system. doctors are the last remaining link who can save this countries health care system. the doctor physican relatiuonship is sacrosant and it is our only last chance to fight patriot act, hippa rules and many other draconian restrictive acts.
i will be back soon big a bigger and more explanatiory note. sorry for my limited reply.