Friday, January 09, 2015

Slow Down on Creating Alternate MOC Pathways

Yesterday was a remarkable day for practicing US physicians.  It was the day two articles appeared side by side in the New England Journal of Medicine: one promoting the American Board of Medical Specialties' Maintenance of Certification® (MOC) program, and another that thoroughly debunked it.  The comments placed to the stories told a story of solidarity, pent up rage, of corruption within our profession, and a commitment to change the status quo.  Doctors were relieved to learn that an alternate pathway to MOC, the National Board of Physicians and Surgeons, might offer a slightly less expensive pathway to acquire MOC points.

But I worry physicians might be reacting, rather than carefully considering, the implications of the alternate proposal.

I should say that I applaud Dr. Paul Tierstein's phenomenal piece published yesterday in the New England Journal of Medicine.  He cogently articulated the many problems with the ABMS MOC program but stopped short of dismantling the ABMS (and ABIM's) board re-certification process entirely as he promoted his new "National Board of Physicians and Surgeons instead:"
There will be three or four requirements, and you have to be certified by an ABMS board initially. We're not taking that on. I think the fellowship process is great, it's like a final exam for residency and fellowship. I think most people agree that it's okay (not perfect, but okay). You'll also have to have a valid medical license and not to have been denied privileges recently in your specialty. Then the key requirement is 50 hours of continuing medical education, provided by an ACCME-accredited provider over 2 years. And the cost will be far lower. The cost will be as little as possible.
While this may be an acceptable solution to the current MOC conundrum created by the inclusion of ABMS and the MOC program in our new health care law, I believe we should first investigate how the ABMS and MOC program became part of the Affordable Care Act in the first place.

Troubling concerns of collusion of ABIM board members with the Center for Medicare and Medicaid Services (CMS) and the National Quality Forum (which receives the bulk of its revenues from grants supplied by CMS) exist. Christine Cassels, MD, who is the current President and CEO of the National Quality Forum, was President and CEO of the ABIM from 2003 to 2013 and ultimately responsible for the $2.3 million dollar luxury condominium purchase by the ABIM Foundation in December, 2007. Richard Baron, MD served as treasurer of the ABIM and later an unpaid Director of ABIM in 2007-2008. Dr. Baron also served as Group Director of Seamless Care Models at the CMS Innovation Center which claims it "Identifies, validates and disseminates information about new care models and payment approaches to serve Medicare and Medicaid beneficiaries seeking to enhance the quality of health and health care and reducing cost through improvement." Dr. Baron then became a full-time employee of CMS in 2011-2012 before returning to ABIM in 2013.

Which leads to the question: how much influence did the ABIM leadership have in establishing a continuous money stream for itself and its Foundation during the writing and mark-up of the Affordable Care Act? (see pages 247 and 844-845 of this large pdf). Clearly, there should be public record available to this effect and physicians should inspect this record before creating an alternate MOC pathway.

Because if the ABIM influenced the writing of the Affordable Care Act for its own enrichment, rather than for "public good," this represents further corruption of an already broken MOC model, in my view.  There have been many experienced physicians adversely affected by the current MOC program.

So these are the questions practicing physicians should ask before enrolling in the current, or any other, MOC pathway:

(1) Do we need MOC at all? and
(2) Don't we need a full public disclosure of the audited financials of the ABIM and the ABIM Foundation and their financial dealings first? and  
(3) Shouldn't we insist on removal of the corrupt MOC program entirely from the changes made to Social Security Law by the Affordable Care Act before creating another unaccountable organization to practicing physicians?



rcentor said...

I missed the part of MOC being part of the ACA. I do not believe that is true. Educate me.

DrWes said...

rcentor -

I have updated his post with a hyperlink to the pdf of the Affordable Care Act and referenced some of the pages where the ABMS and Maintenance of Certification program are mentioned. Please note that all aspects of the ABMS program are mentioned (including the use of practice improvement modules, etc) as well as the requirement for assessment of "professionalism" that was "defined" by the ABIM Foundation as part of their charter.

The ABIM Foundation a shadow organization of the ABIM that shares many of the same ABIM officers that bought a $2.3 million luxury condominium after receiving a $6 million grant from the ABIM in 2007.

James O'Brien, M.D. said...

I agree with this. If there's no evidence, there's no evidence to do this by other means, no matter how well intended.

Lord John Russell said...

Dr. Wes, thank you for doing the gumshoe detective work to bring these troubling issues to light. A full accounting of the monies paid to the ABIM becomes imperative in light of these revelations.

Michael said...

Dr. Wes,

Well stated, as always. No matter how well intentioned it is in the beginning, an alternative board with its own MOC would most likely become just as oppressive and onerous at some point.

We are so anxious to model ourselves after Europe in so many ways that are non-productive, why can't we follow their example with respect to MOC. They have never had it, and hopefully never will. They don't even have anything similar to ABMS.

Paul Kempen gave a great talk at AAPS. It is linked here for anyone interested:

James O'Brien, M.D. said...

Maybe MOC and MOL ought only be for doctors who don't see patients. I don't see why an administrator who hasn't seen patients in years, like many who work for ABMS should be allowed to continue to practice medicine if they aren't getting their reps in the clinic.

I say it's time we go on offense.

Dr John said...

Love that idea!

Anonymous said...

Patient perspective...
OK. No re-certifications necessary. Does that also apply to PAs and other medical professionals? How about hospitals? Any need for them to be inspected or accredited? I assume nuclear and other medical technologies are inspected from time to time. Are those necessary? How about plants for manufacturing drugs? Should they be inspected?

Anonymous said...

"Patient perspective" is probably one of the so-called medical 'leaders' practicing his subversive rhetorical lessons in reductio ad absurdum. Clearly, this is an obvious attempt to skew the argument. "Patient perspective" should spend more time practicing medicine and less time telling tall tales on blogs.

Every physician is required to have a certain amount of CME (continuing medical education) to obtain a medical license in the state where they practice.

Anonymous said...

I assure you Anonymous @8:29, I am only a patient and have no affiliation with any segment of the medical profession. The only thing 'obvious' is your mistaken and defensive assessment of who I am. Now if you would care to answer my questions about what comes next and how does it impact the rest of the medical profession and your patients, we could advance the conversation.

James O'Brien, M.D. said...

ABMS does not like competition: