I admire Paul Tierstein, MD’s honest attempt to create a greatly simplified alternative to the ABMS’s Maintenance of Certification (MOC) program called the National Board of Physicians and Surgeons (NBPAS). I hope he’s successful, but I sense there will be large headwinds for the effort ahead.
The Affordable Care Act (ACA) modified Sections 1848 (k) and 1848 (m) of the Social Security Act, which defines how CMS pays physicians for their services. Section (k) is the section that defines how a “Quality Reporting System” is to be set up (with subsection (4) requiring the “Use of Registry-based Reporting”) and Section (m) defining physician incentive payments physicians might receive if quality reporting occurs properly. (Sadly, those CMS incentive payments do not cover the cost of participating in MOC for most of us.)
Section (k) was modified by the ACA to include the ABMS MOC program as a “physician registry.” The registry was “defined” as requiring all four parts of the MOC program created by the ABMS, including the much-maligned “practice improvement modules” that have been described by the physician community as overly time-consuming, irrelevant and may even violate federal research statutes regarding the study of physicians, their practices, and patients.
Unfortunately the new NBPAS does not address these requirements of the our new health care law, leaving the creation of the NBPAS to look like a Rand Paul moment all over again with physicians signing up for something that, legislatively, means nothing.
Welcome to the concept of regulatory capture.
Physicians should realize that special interests and their lobbyists (including the hospital, pharmaceutical, survey companies, and insurance lobbying groups) were highly influential in the creation of our new health care law. They are also very good at politics. It is unlikely that these entities want to see MOC go away, irrespective of how corrupt the system has become. There’s just too much money involved. Even our own specialty societies use the MOC program’s educational requirements to coerce physicians to take their educational courses to “earn MOC points” to help pad their bottom lines as physician attendance (and corporate sponsorship) at scientific sessions has dwindled over the past years.
But what’s more important to our patients in the long run? Time for their needs or time for test-taking and survey collection? Is it more important to satisfy government requirements or address the real needs of our patients? Certainly continuing education of physicians is needed, but irrelevant work for an unaccountable third-party organization so they can measure us rather than help us is not.
Physicians need to take the stick, but we can’t do this alone since we care for patients. So we need to ask this question: Will our specialty societies commit to supporting practicing physicians or the new bureaucratic divide? (They can’t do both.) Will they truly step up to the plate and commit their considerable staff, dollars, pager-less hours, lobbying and legislative efforts to help remove the corrupt MOC program from the Affordable Care Act or allow practicing physicians — their members — to wallow in the corrupt status quo as they are coerced to participate in MOC?
I remain pessimistic that creating another board will fix the current deep-seated problems with the ABMS MOC construct with ABMS as the mothership directing a flotilla of 24 member boards. In my view the only way to truly change MOC is to have a coordinated effort from all specialty societies to insist our legislators remove the portion of our new health care law that requires we participate in a physician registry that robs not only practicing physicians, but patient care itself.
Wes Fisher is a cardiologist who blogs at Dr. Wes.