Time to Modernize and Reform Physician MOC
Thursday, July 27, 2017 | Larry Sobal
One thing that I appreciate about the health industry is the amount of clinical innovation it produces. There is always a new medicine, procedure, diagnostic capability or treatment being announced; it is estimated that global medical scientific output doubles every nine years. But in an industry rooted in medical breakthroughs, there can also be maddeningly archaic, dysfunctional and opaque ways of doing things.
A good example is the physician Maintenance of Certification (MOC). And unlike Washington politics, a need to modernize and reform MOC appears to have generated a strong consensus among physicians. In case you are not fully familiar with the MOC issue, let me explain it.
The American Board of Medical Specialties (ABMS) chose the term “Maintenance of Certification” (aka “Continuous Certification”) to reflect their focus on a continuous process of professional development that spans the entire designated certification period for each physician specialty. Traditional recertification requires a diplomate (a physician who has received initial board certification) to apply for recertification near the end of the specified certification period and pass a secure recertification examination. MOC goes beyond this requirement to include continuing education and assessment activities throughout the recertification cycle.
On the surface, MOC sounds like a valid concept. Under the MOC program, required courses and modules need to be completed in order for a physician to remain “board-certified” by their specialty board. And hospitals and insurance companies who require MOC in their chosen specialty, whether it’s cardiology, obstetrics or neurosurgery, argue that this is a critical step (among many) to ensure physicians are up-to-date in their knowledge and allow them to maintain a certain caliber of their physician workforce so as not to put patient care at risk.
Supporters of physician MOC argue that there are many professions that require some form of licensure and continuing demonstration of knowledge ranging from accountants and lawyers to real estate agents, teachers and cosmetologists. Doesn’t it make sense that physicians be required to do the same?
According to a 2016 survey of 4,600 physicians, 81% report that MOC activities are a burden.
However, the point at which many physicians differ is how maintenance and validation of knowledge is carried out. And like many good ideas, there are some unintended consequences, potential flaws and possibly even some good old-fashioned greed associated with the MOC process. Let’s examine what those are.
For starters, opposition to MOC is not a small issue in the physician community. According to a 2016 survey of 4,600 physicians, 81% report that MOC activities are a burden, regardless of specialty, practice size, geographic area, years in practice and level of burnout.
The most common complaints against the current MOC system are:
- The cost associated with fulfilling all the MOC requirements, which can be significant for physicians, such as some cardiologists who have multiple board certifications. This cost is in addition to required continuing educational credits. MOC fees can approach $10,000 or more including costs for travel to testing centers, review courses, and time spent away from the practice.
- The time associated with the MOC process, which can be an additional 20-40 hours each year beyond required continuing education credits necessary to maintain licensure.
- The questionable intentions of the ABMS, which has grown into a large business enterprise. Many physicians feel exploited by ABMS to pay for unnecessary costs and spending by the ABMS, which gathers most of its revenues from MOC fees.
- The lack of evidence that MOC requirements can be validated with better patient care or objectively measure true physician competence.
To try and change the MOC barriers, physicians are doing a number of things. In 2015 physicians created the National Board of Physicians and Surgeons (NBPAS). NBPAS bills itself as a lower-cost, lower-hassle version of the ABMS and its boards, with requirements that hew more closely to what doctors actually face in their day-to-day practices.
Another option is to attack this at a state level, and now at least 21 states have passed or are considering bills to protect physicians who choose not to fulfill American Board of Medical Specialties (ABMS) requirements for MOC from losing their hospital privileges, insurance eligibility and/or state licensure.
Not surprisingly, the ABMS is seeking to block any state anti-MOC legislation. These pro-MOC forces have mounted their own lobbying campaigns to convince state legislators that hospitals requiring MOC for physician credentialing and insurers requiring MOC for physician reimbursement and network participation should be permitted to continue in the interest of quality of care and patient safety.
The American Medical Association (AMA) has weighed in and has passed a resolution calling for the “immediate end of any mandatory, recertifying examination by the American Board of Medical Specialties or other certifying organizations as part of the recertification process.” Further, AMA policy states: “Any changes to the MOC process should not result in significantly increased cost or burden to physician participants (such as systems that mandate continuous documentation or require annual milestones). The MOC program should not be a mandated requirement for state licensure, credentialing, reimbursement, insurance panel participation, medical staff membership, or employment.”
In summary, physicians in the anti-MOC movement charge that whereas initial board certification is a legitimate requirement, MOC has evolved into a money-making scheme that forces them to pay recertification testing fees that are too costly and are required too often when they are already required to complete considerable continuing education requirements.
Life-long learning is very important and I doubt any physician would argue with that. Medicine constantly evolves and new technologies and innovations roll out at amazing speeds. Physicians are the first to admit that it is hard to keep up with these rapid-fire medical changes and need to be constantly studying. From what I can see, the MOC process is not well designed to correlate learning to ability, and the whole MOC concept, like many other aspects of health care, should be modernized and reformed.
Illustration: Lee Sauer
Larry Sobal is Executive Vice President and a Senior Consultant at MedAxiom. He has a 35-year background as a senior executive in medical group leadership, hospital leadership and health insurance. Larry consults, writes and presents on topics relevant to transforming physician practices and health systems. His weekly blog post comes out on Thursdays and can be accessed at www.medaxiom.com.
About the Author
Larry Sobal, MBA, MHA, is CEO of a yet-to-be-named cardiology practice which is transitioning from employment to an independent physician group effective January 1, 2019. He has a 37-year background as a senior executive in physician practices, consulting, medical group leadership, hospital leadership and health insurance.
To contact, email: firstname.lastname@example.org