Saturday, January 16, 2016

MEDICAL STAFF VOTES AGAINST MANDATORY MOC (MAINTENANCE OF CERTIFICATION REQUIREMENTS)



BOARD CERTIFICATION: SHOULD THE GENERAL PUBLIC HAVE AN INTEREST IN THIS ARCANE SUBJECT? IN THE OPINION OF THIS WRITER, THE ANSWER IS YES. The extravgant remuneration of American Board of Medical Specialty (ABMS) CEOs and presidents has been disclosed to be as high as $1.3 million at the American Board of Pediatrics (ABP), $681,000 at the American Board of Internal Medicine (ABIM), and over $800,000 at the American Board of Psychiatry and Neurology (ABPN). This level of remuneration requires high costs for Maintenance of Certification (MOC) and for study programs acceptable to each of the boards. These requirements in turn cut down on the amount of time practicing physicians can spend with patients and their own families. MOC requirements unnecessarily increase physicians' administrative costs, in turn helping to drive medical costs ever upwards. To date there is no evidence-based science showing that these requirements improve medical care. Here is how one medical staff recently dealt with this matter (the following is verbatim reproduction of the resolution passed by the hospital's medical  staff). 

ARGUMENTS AGAINST

THE BYLAW AMENDMENT REQUIRING BOARD CERTIFICATION 

Several concerns have been raised as to the way this amendment to the medical staff bylaws has been written

#1  Requirement for board certification is NOT the community standard.

#2  New physician members who subsequently allow their board certification to lapse or marginally fail to pass recertification will immediately lose their medical staff privileges.

#3  The logistics of maintaining continuous active certifications in multiple boards (as required by certain subspecialties) carries with it the very real risk of a possible time gap in active certification (with a resultant loss of privileges)

#4  Physicians at the mid-point of their careers, who are otherwise well qualified in their specialty and who have previously passed their boards (but did not recertify) would not be eligible to apply for medical staff privileges.

#5  Current physicians who fail to complete the re-application process or pay their medical staff dues in a timely fashion automatically lose their medical staff membership and are REQUIRED TO FILE A NEW APPLICATION.  These long-standing members may well be subject to the new requirements.

#6  It is not unthinkable that the new medical staff members (who are subject to these strict requirements) will quite reasonably feel that ALL medical staff members should be bound by the same mandate. These new members may ultimately be represented in such numbers that they tip the balance and there is a resulting Bylaw change to that effect. 

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Editor's comment:  Our recommendation is that physicians opposed to mandatory MOC adopt this amendment or one similar to it at their own hospitals. The physician who led this charge against mandatory MOC was James B. Weidner, MD, specialist in cardiovascular disease and internal medicine. The hospital is Regional Medical Center in San Jose, previously known as Alexian Brothers.

Meanwhile, at the Union of American Physicians and Dentists (UAPD) Triennial, the UAPD passed two resolves of interest concerning MOC. Resolution # 5 states that "Medical Staff Bylaws allow medical staff membership for physicians who meet the minimum state requirements for the position (board certificate or eligibility is not a hiring requirement)." Resolution # 10  states that "UAPD negotiate for reimbursement of the Maintenance of Certification/Fees Programs by the state in our contract." 
   

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References:

Change Board Recertification, http://www.changeboardrecert.com

Open Letter to the American Board of Pediatrics, http://rebel.md/open-letter-the-american-board-of-pediatrics/

"Maintenance of Certification (MOC) and the IRS: where money and power meet," 7/29/15

"Maintenance of Certification, a rising business opportunity," 5/15/2015

"When does a $681,000 salary require additional incentive compensation?,"  4/17/15

"Resolutions passed at the UAPD 2015 Triennial," December 8, 2015



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