licensure — has long riled the nation’s physicians over what doctors say are costly, burdensome, and frivolous programs to prove their medical skills are up to date. Many physicians also question the financial motives of the certifying boards, and debate the impact of MOC on patient outcomes. The outcry has gotten lawmakers’ attention: In April, Oklahoma, with support from the Oklahoma State Medi- cal Association (OSMA), became the first state to enact a law banning the use of MOC “as a condition of licensure, reimbursement, employment, or admitting privileges at a hospital.” News of the legislation quickly prompted TMA’s 2016
House of Delegates to follow suit in adopting a resolution that calls on the association to “pursue legislation that eliminates discrimination by the State of Texas, employers, hospitals, and payers based on American Board of Medi- cal Specialties’ [ABMS’] proprietary MOC program as a re- quirement for licensure, employment, hospital staff mem- bership, and payments for medical care in Texas.” ABMS, the umbrella organization for 24 medical spe-
cialty boards, stands firmly by MOC as a public account- ability measure and by entities’ ability to use it as a creden- tialing standard. “The purpose of continuing certification is really to en-
hance patient care, which is crucially important all the time, but especially in the transformative times we have in health care right now. Hospitals, health care systems, and others have a responsibility to identify quality credentials they wish to use, and this legislation handicaps them from using it,” ABMS President and Chief Executive Officer Lois Nora, MD, said. At the same time, she says specialty boards are tuning
into physicians’ protests with considerable changes. Dr. Nora points to “lots of innovations happening across the 24 boards. ABMS and member boards have made dramatic transitions in MOC, maintaining it as the public trust in a quality credential, while also making it more physician sensitive.”
SHOW ME THE EVIDENCE Once a lifelong credential, ABMS member boards shifted to requiring physicians to continuously re-up their board cer- tification. But over the past decade or so, Dr. Monday says the process went from a one-time test and keeping up on specialty-specific CME of doctors’ own choosing, to jump- ing through a series of mandated hoops, tests, and fees. In addition to testing, for instance, physicians must
regularly earn credits every few years by demonstrating competency and completing ongoing MOC activities in four categories:
• Professionalism and professional standing, shown by holding an unrestricted medical license;
• Lifelong learning and assessment, shown by participat- September 2016 TEXAS MEDICINE 29
MOC COSTS FOR INTERNISTS
The American Board of Internal Medicine’s (ABIM’s) 2014 increase in fees and required mod- ules for its maintenance of certification (MOC) program has had an impact on physicians. A 2015 study published in Annals of Internal Medi- cine sought to compare the total cost of the 2015 version of the MOC program with the 2013 version.
The study found internists will incur an aver-
age of $23,607 in MOC costs over the course of 10 years for the 2015 version of the ABIM test. The fees range from $16,725 for general inter- nists to $40,495 for hematologist-oncologists. When factoring in the much greater cost of physician time spent on MOC, researchers calculated time costs account for 90 percent of MOC costs. Cumulatively, the study states, 2015 MOC will cost $5.7 billion over 10 years, which is $1.2 billion more than the 2013 MOC program. The estimate includes $5.1 billion in time costs (32.7 million physician-hours spent on MOC) and $561 million in testing costs. The study’s authors call for a rigorous evalu- ation of the ABIM MOC program on clinical and economic outcomes in an effort “to balance po- tential gains in health care quality and eficiency against the high costs identified in this study.”
Source: “A Cost Analysis of the American Board of Internal Medicine’s Maintenance-of-Certification Program,” Annals of Internal Medicine, Sept. 15, 2015
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