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    MOC changes aim to lessen burden on physicians, but debate continues

    Despite new standards designed to address time and cost pressures associated with participation in maintenance of certification (MOC), some physicians believe the program represents one more expensive and redundant obstacle as they attempt to climb a mountain of other bureaucratic and compliance mandates associated with the Affordable Care Act, International Classification of Diseases—10th revision (ICD-10), the Health Insurance Portability and Accountability Act (HIPAA) compliance, use of electronic health records, billing and reimbursement challenges, and much more. 

    In February the American Board of Medical Specialties (ABMS) announced new standards for maintenance of certification (MOC) programs that were designed to address objections about the time and cost required by the process.

    The updated guidelines, which were developed over two years, are a framework for ABMS’ 24 member boards to use when implementing their MOC program. Set to take effect in 2015, they are designed to reduce redundancy between physicians’ MOC work and improvement projects in their practices.

    The new standards also allow more innovation, have a more patient-centered perspective, and emphasize professionalism, patient safety, and performance improvement, says Mira Irons, MD, senior vice president of academic affairs at ABMS.

    Maintenance of Certification

    Next: Pressure grows for MOC participation


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      Quite frankly, this should not be a surprise. ABIM, a member board under ABMS, doubled the frequency and the workload of MOC expectations. Even worse, many of us have done a tremendous amount of work (for me already in excess of the 100 points they required) prior to 2014 toward our next MOC cycle, and yet ABIM announced that they were going to wipe the slate clean beginning in January of 2014, meaning that none of the work we've done will count. Also, lifetime certified physicians will no longer be able to “hide” as ABIM will add the tagline to their time-unlimited certification status as to whether or not these physicians are meeting “maintenance of certification requirements.” ABIM has acted in bad faith by not disclosing the changes to the system before any of us started doing work before January 2014; also while not probably a violation of the contractual relationship of being “lifetime certified,” their actions are disingenuous, if not underhanded. ABIM can't produce any data that doubling the work of MOC will improve patient care. The new requirements increase physician burden without any provable benefit. Physicians are angry – me included. These are the type of unnecessary burdens that we used to expect organized medicine to be on guard and defend against. This is why I am so vocal and skeptical about MOL. At the whim of the politically-driven legislature and their desire for re-election, MOL could be the next staging ground for a bait and switch on physicians. We must proceed very carefully on MOL in Colorado, if we are going to be serving the dues paying members of our medical societies. Eisenhower warned against a military-industrial complex. This is a board-certification industrial complex. I am convinced beyond any doubt, this is about the fleecing of physicians and the making of money, not about patient safety. Hypothetically, if safety is the goal--and let's argue just for a minute that MOL will ACTUALLY improve outcomes and safety--where are the MOL efforts for all the other non-physician health care professions (whom provide anesthesia, prescribe narcotics, and order expensive and potentially dangerous tests, etc.)? You can't have true patient safety by treating physicians as if they function in a silo. And please don't trot out the excuse that physicians have to lead the way. For once, I'd like to hear about how the organizations I support financially want to make my day to day life as a physician better, or at least more bearable. The realities of real-life practice and the external burdens that cost a lot of money, time, and exert so much stress, are truly crushing, and organized medicine is not addressing them adequately. How does all this excess and unnecessary stress on practicing physicians affect patient safety? I wonder if Coptic has thought about it in terms of liability/exposure? Recent polling of physicians has more of them than ever before wishing they could retire or switch professions and discouraging medical school to their children and loved ones. To end where I started, the fact that ABMS is being sued should be of no surprise.
    • Dr. Jonathan Weiss
      The ABIM has been ducking open debate on this issue for years. Why? What are they afraid of? That their pot of gold is in danger? Well it is in danger. More and more doctors are realizing the truth, that is is a scam that does nothing to make docs any better, but undoubtedly adds still more burden to medical professionals already drowning in out of control overhead, excessive bureaucracy and overregulation. Enough! Step out into the light Dr. Baron. Meet MOC opponents in an open forum and let's see what transpires. In the meantime, all physicians need to speak out and take a stand against MOC the way Drs. Benbassat, Kempen and other have done.
      I continue to be astounded that the ABIM refuses to openly debate the topic in an open forum. The Benjamin Rush Society invited the ABIM and ABMS to debate MOC in their home town of Philadelphia last April-they failed to come (http://www.youtube.com/watch?v=AetMD0OYVkY). The ABIM does NOT want to debate the issues openly in a neutral forum because the whole extortion process is unwanted by physicians in General, and it provides no index of quality. The ABIM and ABMS are trying to introduce these changes under the radar through the gradual program of lobby congress and hide from Open discussion. MOC is simply a money making extortion program self-serving to the certification industry. The ABIM itself concluded as early as 1986 and themselves published in 2000 the fact that voluntary MOC would not be possible (ANN INT MED 2000; 133:202-08 . THAT is why they imposed it with artificially restricting the certification to 10 then 8 and now to Continuous subscriptions to MOC to maintain a certificate that they themselves deem to be "VOLUNTARY". I hereby OPENLY invite the ABIM to debate ME and my colleagues in any open format before practicing physicians any time and any place. I would invite Medical Economics to sponsor such a debate and poll the general physician population in attendance to finally clarify openly the disgraceful and unethical extortion of physicians for corporate executive's gains. The fact that Dr Baron and the ABIM actively excluded comments to their website that they do NOT want to hear is testimonial to these facts stated clearly above-they only hear what they want to hear and I quote: "Baron readily acknowledges that some dissenters’ comments were not allowed on the ABIM forum. “It’s not an open forum. It’s a moderated forum, and it is moderated according to principles that are posted on the site,” he says. “We welcome input on the program, but if people are going to take a subject area and post comments that say there shouldn’t be any program, people will not bother to read the comments or engage in the conversation.” “When people say all we care about is money and that the program should be done away with, we simply don’t regard that as a comment that is engaged with how to make MOC better. We know there are people think there should not be MOC and they have lots of places on the Internet where they make that point. We are trying to manage a civil discourse on a subject on which there is a range of opinion,” he says. He points out that many comments critical of MOC were allowed past the moderator. “It is one thing to offer specific criticisms of the program, but another to say there shouldn’t be a program and we don’t see the role of this conversation to be to give a platform to that,” Baron says."
    • Dr. Jon Schneider
      I do not mind having my name used. I very much appreciated this article in that the MOC needs significant changes. I think the idea of alternatives to going to a testing center are essential to this process. I feel strongly, too, that the MOC has to be more flexible about refunding the high cost of testing when people such as myself are dying of cancer and are no longer able to sit through a five hour test. I reluctantly signed up for the MOC in 2011 and clearly informed them of my concerns about my cancer progressing. This year my concerns became a reality. I suggested alternative testing or a refund several times with the repeated response that it is a "firm policy to NOT refund fees." It became apparent that the Board was more concerned with the money than my well being. I would appreciate any advice in regard to this issue.
    • Dr. S
      Doctor Schneider, while you are to be commended for trying to keep your MOC up during cancer treatment, this is also a sign of how the board certification miasma has screwed up out priorities. As physicians, we are put under tremendous stress to the point where we barely notice it, but it does take a toll. We need to take better care of ourselves so we can better care for our patients. Physicians who are unhappy with their work or are sick since they're not taking the care of themselves they need are not going to provide good care to their patients. Requiring more busywork like MOC to our lives just increases the burden that ends up lowering care. So, Dr. Schneider, your first priority at this point is to take the tare of yourself that you need. Do not worry about MOC. Your patients and associates will understand that you have better things to do than trivial MOC exercises. Just as no one's headstone says "I wish I had worked more", no physician's headstone will say "I wish I had kept up with my MOC".
    • Dr. Jon Schneider
      I very much appreciate your response and I can assure you that I have not compromised my health by keeping up with the MOC. I retired in 2007 to serve as a full time volunteer medical director for an adolescent mobile health outreach program. Gradually, since my diagnosis in 2009, I have drawn back to one day/week. I view that one day as therapeutic as anything else I am doing. I absolutely love what I am doing those days I can see patients and I know I am giving them a high quality of care they would not otherwise have. The MOC WAS a matter of pride and it no longer is. The present issue, I think, is the Board's self-serving decision to neither refund my fee nor allow me an alternative method of testing. You really have to ask yourself, "Why are these people unable to think outside of the box?... or to ask themselves how would they like to be treated under the my circumstances?"

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