Tuesday, May 12, 2015

Today in JAMA: ABIM MOC Program's Evidence Base Gets Destroyed

Paul Tierstein, MD and Eric Topol, MD critically review the evidence base for the American Board of Internal Medicine's Maintenance of Certification program in the Journal of the American Medical Association (JAMA) and the results aren't pretty:
In this context, perhaps one of the most overreaching assertions by the American Board of Internal Medicine (ABIM) is that MOC is “evidence based,” even though recent reports provide no convincing evidence that MOC has improved quality of care. For instance, a recent literature review promoted as evidence supporting the value of physician certification and MOC concluded: “In general, physicians who are board certified provide better patient care, albeit the results have modest effect sizes and are not unequivocal.” However, that article was written by ABIM employees and published in a special journal supplement that was supported by the American Board of Medical Specialties (ABMS). In an observational study (supported by the ABIM and conducted by ABIM employees) of physicians who provided care for Medicare beneficiaries, imposition of the MOC requirement was not associated with a difference in the increase in ambulatory care–sensitive hospitalizations, but was associated with a small reduction in the increase in differences of cost of care, although the small difference in cost was only discernable after significant statistical adjustment (propensity matching followed by a multivariate analysis). In another observational study among internists who provided primary care at 4 Veterans Affairs medical centers in which an electronic health record was used with embedded reminders, there were no significant differences between physicians with time-limited ABIM certification (and required recertification) and those with time-unlimited ABIM certification on achieving 10 primary care performance measures.
Read the whole thing.

We should note that this entire new issue of JAMA is devoted to licensure, professionalism, and regulatory issues. Interestingly, no one wants to talk about the money. That would be too politically incorrect. (I guess that explains why I was not asked to be an author).

So let me refresh all of these authors' minds with a few of my former works:

The ABIM Foundation, Choosing Wisely, and the $2.3 Million Condominium

As ABIM Struggles to Find Itself, Doctors are Moving On

Why the ABIM Wants Us to Ignore 1997

ABIM Pleads for Mercy

Board Review: Sixteen Little Questions 

What Happens To Physicians Who Fail Their Maintenance of Certification Examination?

The MOC Money Flow 

I invite them to spend time reading these pieces, then ask yourself if we really need any form of "Maintenance of Certification" at all when Continuing Medical Education has been effective throughout the history of medicine. And I also want to know why the latest ABIM and ABIM Foundation Form 990s have not been released to the public by now.  Are they still cooking the books?

This whole lucrative regulatory capture of physicians needs legal review of these self-serving and unaccountable programs to the public at large, not a meaningless issue full of propaganda in JAMA.



NephTangles said...

JAMA has never never mentioned ABIM's financial issue. Guess it is not easy for them to see the elephant in the room.

x said...

dr wes, it will be interesting to know the actually conflict of interests of these authors on this jama edition, than just being reported on paper.

Anonymous said...

Dr. Wes,
As the dude, I forget his name, at Change Board Certification, attests, the ABIM is on the wrong side of this issue. That is, we all know board certification has no intrinsic value and does not result in better care. The fact that money is not mentioned is more a testament to how weak the whole concept of certification is.