Maintenance of Certification must go: One physician's viewpoint
The Maintenance of Certification (MOC) program’s expense and time commitments continue to grow, producing greater complexity and more headaches for the nation’s physicians.
The American Board of Medical Specialties (ABMS) lobbied Congress to pass legislation linking Board Certification to Medicare and Medicaid reimbursement payment. The Physician Quality Reporting System (PQRS) led the American Board of Anesthesiology (ABA) to become a “provider” in 2013, even though in 2011 the ABA publicly stated that “The ABA does not believe that the additional requirements for the MOC bonus will have a sufficient impact on patient care, nor will the reimbursement bonus justify the additional time and resource burden on its diplomates. Accordingly, the ABA does not intend to submit an application for CMS [Centers for Medicare and Medicaid Services] approval of an ABA MOC-PQRS program in 2011.”
Just weeks ago the ABA gave notice that it will become a new PQRS-MOC provider, under multiple pressures including the impending requirement for providers to register by the end of 2013 so that diplomates can avoid the 1.5% and 2% penalties looming in 2014 and 2015, respectively.
As a concerned physician, I have followed the multiple requirements for this MOC program and clearly noted that leaders of the ABMS certification industrial complex themselves have been reluctant to subscribe to the corporate policy of certification they propose, except under duress.
Simulation training has been dictated as a core and primary MOC requirement in my specialty. All anesthesiology certifications have become “limited” to 10-year intervals since 2000, mandating absolution of simulation for the 1,500 anesthesiology resident graduates each year since 2010.
The leadership in anesthesiology recently disclosed in the ASA newsletter that although these 4,500 “new millennium” graduates are all due to recertify and must have completed simulation by 2010, in the first two years of the MOC-Anesthesiology (MOCA) simulation requirement, only 583 ABA diplomates completed courses at 27 ASA centers. By the end of 2013, only 1,600 had done so.
With over 50,000 ASA members, and 35,000 practicing anesthesiologist in the United States, the fact that only 583 physicians submitted to MOCA simulation in the first two “mandatory years”, reaching only 1,600 after the years (0.1% participation,) is hardly a resounding vote of approval for MOCA.
Recently, four of my colleagues underwent this simulation training. None indicated there was reasonable value regarding the six CME credits at a discounted cost of $1,200 (the typical cost is $2,000) to our department’s membership. They were required to respond in the exit survey indicating three things they had learned, and would only receive these MOCA® credits after an interval to affirm that the chosen “practice improvements” had been instituted.
The “survey process” itself appears geared to reaffirm the “value” of this simulation as just one more coercive technique.