MOC as Physician Stick and Carrot

Remember when the American Board of Medical Specialties (ABMS) Maintenance of Certification (MOC®) was sold to physicians by our specialty societies and ABMS member boards as a "pathway to know that they are staying current in the medical knowledge they use to treat patients and make important care decisions daily?"

Congress was sold the same thing in 2013:

"ABMS MOC® is a system of specialty-specific assessment and professional development activities that require medical specialists to reflect on their practice performance, identify gaps, and adopt new practices to improve care."

It seems physicians and the public were purposefully mislead. MOC® was always a stick that is now being introduced as a carrot to direct physician behavior.

Yesterday, Blue Cross and Blue Shield of Michigan announced (via their friends at the Michigan State Medical Society), that lowly family practice physicians, internists, and pediatricians that are "designated" patient centered medical home physicians won't have to participate in MOC® after all:

"Effective Jan. 1, 2019, the board certification status of family medicine, internal medicine and pediatric practitioners will be reviewed annually. If their board certification status has lapsed and they are a designated patient centered medical home physician, Blue Cross will grant an exception and allow the practitioner to remain in their Blue Cross and BCN managed care networks. This exception does not apply to new practitioner enrollments. Blue Cross and BCN will continue to require all providers to have board certification upon initial enrollment for affiliation."

Meanwhile, the ABMS "Vision Commission" tap dances and distracts by seeking more public comment 2019 timeline magically appears, just as the transition to Medicare's next unproven "value-based" physician pay model is implemented.

Patient care value?

Now you see it, soon you won't.

-Wes

The Fallacy of dEthics

Meet dHealth (video).

dHealth is digital, algorithmic, group-based health care delivery using blockchain technology.

Who are the dHealth promotors and visionaries? The exact same ones who lead the ABIM and ABIM Foundation in 1999 when it set out to "define medical professionalism" for us. Their final product, the 2002 Physician Charter on Medical Professionalism still stands tall as the guiding light of dEthics for much of organized medicine.

dEthics demands that devotion to the best interests of each individual be replaced by an ethic of devotion to the best interests of the group for which the physician is personally responsible.

dEthics is now driving corporate medicine. Data control. Information control. Education control. More with less; profit before person.

No one saw this more clearly that Dr. Richard Fogoros on his now quiet Covert Rationing blog:

The intent of the 2002 Charter on medical professionalism was to repair the problem (i.e., to cure the “frustration”), not by confronting the forces of evil doing the coercion, but rather, by simply changing medical ethics to make bedside rationing OK. And that’s just what the document did, though only after careful re-editing to make this radical change to medical ethics sound as benign as possible.

dHealth is the next great hope. The vision for world health sees blockchain technology allowing nurses (video) to access to a "complete file" of a patient's health information and to "see into the future in health" to deliver scalable care worldwide remotely using corporate dEthics as their guide.

What could possibly go wrong?

-Wes

h/t: to james gaulte at the Retired Doc's Thoughts blog.

The MOC Fight

From Medical Economics:

“Physicians are pushing legislation on the state level because they don’t trust the ABMS [American Board of Medical Specialties] and its financial conflicts of interest,” says Paul Mathew, MD, a volunteer board member of the NBPAS in Cambridge, Mass. “Many feel the only way to declaw the tiger is legislative action due to insurance companies and academic institutions having no reason to change their pro-MOC policies.” The ABMS oversees MOC for its 24 boards.

-Wes

For Whom MOC Tolls

He saw me in the hall between cases and our eyes connected, however briefly. I probably looked a bit tired, hair askew, and rushed after a long ablation case as I scurried to grab a quick bite to eat before my next case started. He was one of our best fellows in cardiology - hard working, innovative, never one to skip a clinical detail or shirk a responsibility, who clearly wanted to chat. He approached respectfully, smiling timidly, and said quietly:

"Dr. Fisher, is it true that I have to pay ABIM $155 to maintain my certification even though I passed my boards? And do I have to do this for life? I went to the ABIM website and it really isn't clear what we have to do."

I explained the ABIM's current iteration of fees and testing as best I could in the brief time we crossed paths. The ever-shifting sands of the ABIM parsed fee and "point" structures, "discounts," programs, credits, and value of participating (or not) in Maintenance of Certification have lead, I believe intentionally, to the current chaotic state of US physician Board certification. I felt sorry for him but was not surprised he was confused, especially since explaining the board process was equally difficult. I sensed he knew that speaking candidly about his concerns with others in positions of leadership might compromise his reputation as a hard-working, reliable cardiology trainee and was grateful he felt he could approach me with his concerns.

This is what US physician board certification has become: little more than a shakedown of our best and brightest to fund a bloated bureaucratic credentialing system that adds little to no value to our trainees' learning experience. After our conversation, I grabbed a salad and returned to do my pre-operative checklist for my next patient. My phone received a text message:

""They also included a discount on multi-year payment."

"$155 is my annual savings during fellowship..."
-Wes