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.

MOC participation statistics

In December 2012 I requested from CMS, via the Freedom of Information Act, a summary of all payments for the PQRS-MOC program (see table on page 55.) It was revealing to see that in 2011, only 1,683 physicians signed up for the program, and that only 964 were actually paid a cumulative $959,042.94 in a total of 458 payments. This amounts to an average payment per physician of $994.86, with multiple physicians paid together under some corporate collaboration. 

Given that there are more than 850,000 physicians in the country, state data obtained from the Ohio Medical Association (see graphs on page 50)  shows that  roughly one-fourth of all  physicians have never become board certified, and PQRS-MOC participation is almost non-existent. The federal government is looking forward to a significant windfall reduction in payments to physicians under these conditions, once the penalty phase begins in 2015. The reduction in physician payments at 1.5% and 2% “penalties” for non-participation may total between $2.5 billion and $3.3 billion in 2015 and 2016, ­respectively.

‘Regulatory Capture’

The PQRS-MOC  program was conceived by the ABMS to secure enrollment of all physicians in the ABMS’ MOC programs via “regulatory capture,” which occurs when special interests co-opt policymakers or political bodies-regulatory agencies, in particular-to further their own ends.

Due to the increasing employment of physicians by hospitals, this regulatory capture may undermine the already tenuous fiscal stability of community hospitals, in particular.

The increased costs to physicians’ practices will be carried by employer hospitals, facilitating the “dumbing down” of medical care via replacement of physicians with less expensive and less-educated midlevel providers, who for now are not required to undergo MOC, but are reimbursed by CMS.

Does the American public really want to see physicians priced out of the market due to  arbitrary constraints by corporations offering nothing of real value or improvement in care, thus further facilitating healthcare provided by the least educated midlevel providers to contain costs?

The board certification process has never been validated as improving healthcare by outcome-based studies, serving instead more as an exclusive guild, yielding benefits to only those already enrolled. The ABMS recertification program is a multimillion dollar yearly expenditure of questionable value.

The fallacy of certification was openly admitted recently by the ABMS on its website: “FACT: ABMS recognizes that regardless of the profession-whether it is healthcare, law enforcement, education or accounting-there is no certification that guarantees performance or positive outcomes.”

It is time to stop the multiple ABMS  “legacy organizations” from repackaging their products into an unproven, wasteful, unnecessary, and expensive yearly subscription payment requirement of all physicians.  Taxpayers, as patients, will ultimately pay for this increased cost of doing business for physicians or simply suffer quality decline by receiving care from “cheaper” midlevel providers.

Do you oppose MOC? Do you support the program? Medical Economics wants to hear from physicians about this controversial issue. Share your thoughts by e-mailing them to: Medec@advanstar.com.