MOC, MOL, OCC, C-MOC PQRS-MOC and the future Alphabet soup of physician regulatory capture

1457

1305

Paul M Kempen, MD, PhD Board certified 1989, 2005 And never again! Time to actively pursue legislation!

Regulatory Capture:
Regulatory capture occurs when special interests co-opt policymakers or political bodies regulatory agencies, in particular to further their own ends. ABMS and FSMB have declared themselves as Sole official agents of verification of physician abilities-yet provide NO educational materialsthis is left to the national specialty societies who are coerced for the $$$$$$$$$$

First certification with 2 year cycles of profit

Revisions @ 5-8 years/ renewal=2 NO license= useless document

Does a physician really need this?

The Certification industry Millions for nothing but a promise!

CME PRA R AMA recognition Award

Licensure and credentialing confer, in the eyes of the public a Good Housekeeping Seal of Approval (To Err is Human 1999 page 3)

License and certification: Limiting competition via Guilds (Restricting competition)

Milton Friedman, (1962)
the pressure on the legislature to license an occupation rarely comes from the members of the public . . . On the contrary, the pressure invariably comes from the occupation itself.

Harold Demsetz, (1968)

regulation has often been sought because of the inconvenience of competition.

The FSMB:MOL
National non-profit corporation claiming membership representation of the 70 State medical and osteopathic boards-but no income from membership on IRS 990 forms. Founded in 1912, specializes in promoting legislation to state medical boards to regulate the practice of medicine on a national level. Provides no physician continuing medical educational (CME) programs or patient care; Educates only lawyers and state regulators Specific corporate lobbying budget of $221,222 (2009- IRS 990). Annual gross receipts FSMB exceed $38 million in 2011
FSMB is a parent organization of the Accreditation Council for Continuing Medical Education (ACCME) and the Educational Commission for Foreign Medical Graduates (ECFMG).
FSMB memberships include the National Board of Medical Examiners (NBME), the Accreditation Counsel for Graduate Medical Education (ACGME), and the ABMS. FSMB was a founding member of what was to become ABMS and remains an

associate member of that body.

Sells tests, not education, as a corporate product: ECFMG, FLEX, SPEX, USMLE part I, II, III,.IV?..........

FSMB planning for MOL

FSMB is planed pilot projects with 11 states starting early 2012, including: ------ Calif.(D.O.), Colo., Del., Iowa, ------ Mass., Ohio. --------------Mississippi, Okla. (D.O.), Ore., Va., Wis. All States WILL follow! Politics are local and changes must be addressed primarily --at the state level!

New ABIM MOC and Recertification Requirements, Summary

Prior initial ABIM certification in Internal Medicine Posses unrestricted, valid U.S. or Canadian medical licensure Every 10 years Enroll in the MOC program by paying the yearly fee Pass exam Every 5 years Earn 100 MOC points At least 20 points in medical knowledge At least 20 points in practice assessment 60 points from either area Complete a patient survey Complete a patient safety module Every 2 years Complete an MOC activity Robert I. Goodman, M.D., F.A.C.P. 11 September 2013

These Weren't The Rules When I Certified. Why Do I Have To Do This Now?

Certification and MOC have been and continue to be evolutionary processes. In order to help you keep pace with the changes in the science of medicine and assessment, ABMS and ABIM believe that a more continuous MOC program is vital to fulfilling our mission of assuring patients that Board Certified physicians are committed and qualified to provide highquality care. http://moc2014.abim.org/q-and-a.aspx

I Hold Certification That Is Valid Indefinitely. Why Are You Reporting That I Am Not Meeting MOC Requirements When I Don't Have Any Requirements To Meet?

(The PQRS-MOC TRAP from ABMS/CMS)

ABIM will honor all certifications already issued, and diplomates who received certifications that are valid indefinitely will remain certified (assuming you hold a current and valid license). However, for all ABIM Board Certified physicians, regardless of when they were initially certified, ABIM and ABMS will begin reporting whether or not they are "Meeting MOC Requirements." In addition to the "Meeting MOC Requirements" requirement,

diplomates with a certification that is valid indefinitely

area by 12/31/23 in order to be reported as "Meeting MOC Requirements." This is in addition to continuing to meet the point requirements of the MOC program. Grandfathers who do not meet the MOC program requirements will be reported as "Certified, Not Meeting MOC Requirements." They will NOT be reported as Not Certified for failing to meet MOC requirements.
http://moc2014.abim.org/q-and-a.aspx

will need to pass the MOC exam in their certification

The millions in 2011 (gross receipts)

American board of-2011 990s (Millions)
FAMILY MEDICINE INTERNAL MEDICINE EMERGENCY MEDICINE EMERGENCY MEDICINE PSYCHIATRY AND NEUROLOGY PEDIATRICS RADIOLOGY AMERICAN BOARD OF MEDICAL SPECIALTIES OBSTETRICS AND GYNECOLOGY ANESTHESIOLOGY SURGERY ORTHOPAEDIC SURGERY PATHOLOGY OPHTHALMOLOGY OTOLARYNGOLOGY PHYSICAL MEDICINE & REHABILITATION PLASTIC SURGERY NEUROLOGICAL SURGERY DERMATOLOGY UROLOGY THORACIC SURGERY ALLERGY AND IMMUNOLOGY PREVENTIVE MEDICINE NUCLEAR MEDICINE MEDICAL GENETICS gross reciepts profits/ revenue
55 49.3 39.1 39.1 33.2 27.1 19.2 14.8 14 13.6 12 12 10 7.6 5.9 4.3 3.2 2.8 2.7 2.6 2 1.7 1.3 1 0.564

Net assets
2.8 -1.7 4.3 4.3 6.3 3.7 -0.28 1.55 2 1.2 -1.7 1.3 0.86 0.659 1.4 0.91 -0.084 0.097 1.2 0.664 0.059 0.285 0.133 0.055 -0.127

Exec salary ($ thousands)

48.9 -45.4 22.9 22.9 50.4 46.1 30 11.9 31.8 17.6 12.1 25.2 9.3 5.1 7.1 9.9 3.12 2.6 6.2 5.7 10.1 3.6 2.7 2.2 1.6 not reported 728 787 532.2 532 827.3 933 660 562.5 566 272 670 493 406 366 494 437 315 173 140 135 277.3 103 193 110

Totals ABMS and affiliates

374.064

29.9

343.6 10,712.3

The income in thousands in 2011 CEO executive salaries

PEDIATRICS PSYCHIATRY AND NEUROLOGY INTERNAL MEDICINE FAMILY MEDICINE SURGERY RADIOLOGY OBSTETRICS AND GYNECOLOGY AMERICAN BOARD OF MEDICAL SPECIALTIES EMERGENCY MEDICINE EMERGENCY MEDICINE OTOLARYNGOLOGY ORTHOPAEDIC SURGERY PHYSICAL MEDICINE & REHABILITATION PATHOLOGY OPHTHALMOLOGY PLASTIC SURGERY THORACIC SURGERY ANESTHESIOLOGY PREVENTIVE MEDICINE NEUROLOGICAL SURGERY DERMATOLOGY 933 Stockman MD CEO 827.3 Faukner CEO 787 Cassel CEO 728 Puffer CEO 670 Lewis MD 660 G Becker MD Exec Dir 566 L Gilstrap MD Ex Dir 562.5 K Weiss MD CEO 532.2 E Reisdorf 532 Reisdorf MD 494 Miller MD 493 Hurwitz 437 A Tarvestad JD 406 B Bennet MD 366 Clarkson MD 315 Barett MD 277.3 Boumgartner MDCEO 272 exec dir non-MD 193 Merchant MD 173 Sanderson Exec Dir 140 Hood MD

29% of US Doctors never certified!

http://www.abms.org/MOC_Myths_And_Facts/download/ABMS.pdf

Only all US Doctors performing MOC!

Also: Hospital boards, other physicians, nurses, Better business bureau, etc

Do we need any more quality control in medicine???

Nurses Colleagues Patients & families Private interest groups

Physician vs Administrator growth in Healthcare

Parallels The increasing need to document in healthcare

ACA in PRINT

http://www.medibid.com/blog/2013/04/medi crats-increase-healthcare-costs/

States with active anti MOC/MOL resolutions: Fighting as professionals Ohio Michigan New York Texas North Carolina Iowa

Medical Society of the State of New York: resolutions 2013

RESOLVED, That the Medical Society of the State of New York acknowledges that the certification requirements within the Maintenance of Certification process are costly, time intensive and result in significant disruptions to the availability of physicians for patient care; and be it further RESOLVED, That MSSNY acknowledges and affirms the professionalism of individual physicians to self-determine the best means and methods for maintenance of their knowledge and skills; and be it further RESOLVED, That MSSNY communicate to the American Medical Association (AMA) and American Board of Medical Specialties (ABMS) examples of disproportional fees, onerous time requirements and unnecessary fragmentation of commonly recognized specialties; and be it further RESOLVED, That MSSNY oppose mandating Maintenance of and be it further RESOLVED, That a copy of this resolution be transmitted to the AMA House of Delegates for its consideration.

Certification until such time as evidence-based research demonstrates MOC is linked to improved patient outcomes;

The anti-MOC/MOL resolutions adopted by the AMA House of Delegates (2013 in Chicago) included: Opposition to mandatory specialty board recertification programs and discrimination by hospitals and other entities against physicians who don't recertify Support of lifelong continuing medical education and lifelong specialty board certification A call for increased transparency by the ABMS and its component specialty boards through published reports on revenue, expenses, and compensation of board members and senior staff A request that the AMA work with ABMS and component boards to integrate existing data-reporting programs with certain recertification programs

How to organize
States have rights to legislate licenses-the battle will be drawn here-PASS LEGISLATION & RESOLUTIONS! Organization of State opposition among physiciansDATABASES/EMAIL! Proactive measures to meet real needs Define the truth-expose the lies with States own data! MONITOR YOUR MEDICAL BOARDs work! Require only Certification and NOT recertification for:
Hospital privileges Group membership Insurance payment and participation

Time to actively pursue legislation!

American Board of OB/GYN

Sent as Email: Thu, Sep 12, 2013 7:23 pm
ABOG-Certified Diplomates are expected to practice consistent with this more expanded definition. Failure to do so may result in loss of certification. Physicians who do not limit a minimum of 75% of their practice to the areas of medicine listed in the above-named Bulletins shall not be eligible to become certified in or to maintain their certification by ABOG. Specifically, a physician who does not limit at least 75% of their practice to the areas of medicine included in the Bulletins listed above: shall not be eligible to sit for the Basic Oral Examination and not be eligible to become ABOG certified; if the physician is ABOG certified, that physician will not be eligible to participate in the ABOG MOC process; and if the physician is ABOG certified, such certification may be revoked

American Board of OB/GYN

Sent as Email: Thu, Sep 12, 2013 7:23 pm
In addition, to remain certified by ABOG the care of male patients is prohibited except in the following circumstances:
Active government service, Evaluation of fertility, Genetic counseling and testing of a couple, Expedited partner treatment of sexually transmitted diseases, Administration of immunizations, Management of transgender conditions, Emergency care when the Diplomate is required by their hospital to participate in general emergency care, and Family planning services, not to include vasectomy.

Certificate of achievement or license?

Change or degradation of certification?

Gone from 1989: attainment of consultant status

Gone to 2005: awarded MOC

CMS Redesigns Physician Compare Website Listings include:

Specialties offered by physicians and group practices Board certification If the physician is using electronic health records Physician affiliation with hospitals and other healthcare professionals

Medicare Physician Quality Reporting System PQRS-MOC Incentives and Penalties

2013

0.5% if no MOC, 1% if MOC (performance year for 2015 penalty)

0.5% -1.5% -2%
https://www.ama-assn.org/ama/pub/physician-resources/clinical-practiceimprovement/clinical-quality/physician-quality-reporting-system.page

2014 2015 2016

STATEMENT
STATEMENT 2010

2010

_____________ ________________________________________ _______________________________________________________________________ ____________________________ _________

'I'll make him an offer he can't refuse'

Certification improves nothing:
Physicians are and remain competent for many reasons-NOT because of MOC By creating legally mandated MOL, MOC becomes an offer you cannot refuse

Protection racketeering:
You dont really need the protection Until after the need is created by the offering entity!

Historical overview
100 years ago
No licenses or certifications Lifelong learning and apprenticeships

1960s
Medicare/-caid government as new payer-need to document AMA strong horse and CME-PRA as documentation (75%)

2000
Board certification switch to 10 year cycles prevalent First steps to regulatory capture of physician CME as MOC 2010 MOL and significant resistance, MOC @ 50% participation 2014-MOC to become C-MOC, AMA declined to 15% membership

MOC points vs CME

Lifelong Education or testing?

Pursuit of Journals cutting edge IN YOUR area of expertise!

Or
Review regurgitation of textbook factoids
Does one size fit all and with 168 different board certifications-how is that equal/fair? Multiple certifications to become extinct?

 We identified officers in various internal medicine organizations using official websites

Editorial board certification status July 2013- 35 physician members Two individuals recertified as of Jan 1, 2014
in advance of date

Only ONE primary (1st) certification after 2000 making for older lifelong certified leaders Zero life-long Grandpa recertified in 2000,
2 never recertified to date

Eleven NEVER certified:

Two US based and 9 from abroad NO foreign leaders are ABA certified

Only Eight actively enrolled in MOC

Ex-President of the ABIM was a member of the same 2000 ABIM Task Force on Recertification and originally certified in medicine in 1979, (re-) certification in geriatrics occurred only in 1998 and 2005, without the recommended primary recertification in internal medicine.

Dr. Christine Karen Cassel

Certification Area Certification Status Certification History Comments

Internal Medicine

Certified

Certified 09/12/1979, Certificate valid indefinitely

Certificates awarded in Internal Medicine prior to 1990 do not require renewal. However, ABIM encourages all diplomates voluntarily to renew certificates relevant to their practice.

Geriatric Medicine

Certified

Requires basic IM certification for validity

Certified 01/01/1998, Certificate valid through 12/31/2004 Certified 02/17/2005, Certificate valid through 12/31/2015

Humayun J. Chaudhry, DO, MS, MACP, FACOI Secretary FSMB President/CEO

Dr. Humayun Javaid Chaudhry Certification Area Certification Status Certification History Comments

Internal Medicine

Not Certified

Certified 08/21/1996,
Certificate valid through 12/31/2006

D.O . Osteopathic Continuing Certification (OCC) only created in 2013

From:
To: Posted: Subject:

Lance Allen Talmage, MD

Ohio Medical Open Forum August 23, 2013 11:23 AM Recert of Dr. Chaudhry

Dr. Chaudhry is in fact recertified by the American Board of Osteopathic Internal Medicine from 2006 to 2016. The FSMB has developed a policy for nonclinically active Physicians to allow them to document appropriate Continuing Professional Development as an alternative. ------------------------------------------Lance Talmage ProMedica Physicians Group

Lois Margaret Nora, MD, JD, MBA President and Chief Executive Officer

Specialty or Subspecialty Neurology Certificate No. 29063

Certification History Certified on

01/30/1987
certificate valid indefinitely

Status as of 1/13/2013 Certification Status: Certified MOC Status: Not Meeting MOC Requirements and Is Not Required To Do So Clinical Status: Unknown

Finally recertified in April 2013

ASA 1990-1999 Closed Claims Project analysis

Analyzed claims from the 1990-1999, before 10 year cycles were imposed Board certification status was unknown in 51% of claims. There were board certified 1330 claims (39%) vs 361 (11%) no board certification identified Currently 76% BC vs 24% NBC rates compare to 78% and 22% of claims analyzed in the 50% where known. There was no statistically significant difference between groups: In both groups
death occurred in 27% of claims; permanent injury (6-8) in 22%, and temporary or non-disabling injury 51% of claims in each group.

1990s Close Claims:

board certified (BC) vs. not certified (NBC)
Information regarding whether a claim was paid or not includes payments by any defendant, not just the anesthesiologist Payment reported reflects only payments made on behalf of the anesthesiologist Anesthesiologist median payment:
BC: $187,000 (range $3,000 - $2.7 Million) NBC: $150,000 (range $1,000 - $6 Million)

Claims resulted:
BC: NBC: 47% 58%

Dermatol Surg 2012;38:171177

in-office adverse event data

CONCLUSIONS: Continued analysis reveals that medically necessary office surgery does not represent an emergent hazard to patients. The data obtained from 10 and 6 years of adverse event reporting in Florida and Alabama, respectively, are comparable and consistent. Medically necessary surgical procedures performed in the office setting by dermatologists have an exceedingly low complication rate, and complications that arose were largely unexpected, isolated, and possibly unpreventable. Requiring physician board certification and physician hospital privileges does not seem to increase safety of patients undergoing surgical procedures in the office setting.

All incidents in: Florida from March 2000 to January 2010 and in Alabama from December 2003 to December 2009 Filed with the Florida AHCA and Alabama Board of Medical Examiners, respectively, were collected and analyzed.
Dermatol Surg 2012;38:171177

________________________

 There was no pattern of more adverse events in those who were not board certified or had no hospital privileges although the sample sizes of non-board certified physicians and physicians without hospital privileges were too small to analyze. No conclusions can be drawn regarding effect of physician hospital privileges or board certification on overall safety of patients undergoing surgical procedures in the office setting. The overwhelming majority of physicians (93% of Florida and 100% of Alabama) reporting adverse events were board certified.
Dermatol Surg 2012;38:171177

ABIM, with the FSMB leads the Certification industrial complex

_______________________

Voluntary recertification failed

progressively fewer diplomates opted to participate in each recertification cycle:
3355 in 1974 2240 in 1977 1947 in 1980 1403 in 1986

Only 8945 diplomates, less than 10% of those eligible, elected to undertake voluntary recertification.

Voluntary recertification failed

This decrease occurred despite strenuous efforts to make the process more relevant and attractive by:
linking it with the American College of Physicians Medical Knowledge Self-Assessment Program, offering modular formats and choice of content, charging low fees.

SO the answer is to just FORCE everyone into high cost compliance!

 Meta-analytic statistics were not feasible due to variability in outcome measures across studies.

Board Certification and Clinical Outcomes: The Missing Link

Purpose: no systematic review has examined the link between certification and clinical outcomes. Method. Data sources consisted of studies cited between 1966 and July 1999
identified 1,204 papers; selected 237 based on subject relevance; reduced to 56 based on study quality identified only 13 that met inclusion criteria

ABMS statement on certification

ABMS 2012: FACT: ABMS recognizes that regardless of the profession - whether it is health care, law enforcement, education or accounting - there is no certification that guarantees performance or positive outcomes
http://www.abms.org/Maintenance_of_Certification/pdfs/ABMS _MOCMythsFacts12_26_2012_final_revised01092013.pdf

Standard Contract American Board of Pathology

All rights to board-none to you!

AM Board Pathology Standard Contract Excerpt

_______ ___________________________________________________ _____________ _________________________

Testimonial to cost
National specialty societies/academics are becoming the MOC Franchise supporters of the ABMS Testing industry: "On Sunday I spent 5 hours on the computer completing a course to be accepted as my Part IV module for maintaining my board certification in Family Medicine. The course was free. Today I found out that in order for the course to be credited to my MOC I have to pay the American Board of Family Medicine $625 !! How do they justify this?" Dr. M

Thank you!
Questions?
WWW.CHANGEBOARDRECERT.COM
Paul Martin Kempen, MD, PhD

kmpnpm@yahoo.com

 Thank you Questions?

First comprehensive review 2000

Overwhelmingly retrospective data base review as method Little real data to be presented Conclusions typically favorable in spite of limited science

Overwhelming influence from ABMS in sponsorship and authors noted!

Awareness of Whether or Not Primary Doctor is Board-Certified

DK=Dont know RF=Relative frequency??
From:

2003 THE GALLUP ORGANIZATION for The American Board of Internal Medicine

Incidence of Having Researched A Physicians Credentials

Q.13 Have you ever asked or checked with anyone, such as a receptionist, nurse, doctor, friend, or coworker, if a doctor was board-certified? Q.14 Have you ever visited a web site or other source of information to verify a doctors credentials?

Very low rate (33%) of checking vs knowledge (72%) of certification on last slide!
From: 2003 THE GALLUP ORGANIZATION for The American Board of Internal Medicine

Testing Frequency
From: 2003 THE GALLUP ORGANIZATION for The American Board of Internal Medicine

_____________________________________________

American Society of Anesthesiologists

American Society of Anesthesiologists

American Society of Anesthesiologists

The 9 ABMS (all subspecialties) qualified for the 2012 Physician Quality Reporting System Maintenance of Certification Program Incentive.
Allergy and Immunology Dermatology Emergency Medicine Internal Medicine Neurological Surgery Nuclear Medicine Obstetrics and Gynecology Ophthalmology Radiology American Osteopathic AssociationThe following boards are qualified: Internal Medicine Obstetrics and Gynecology Pediatrics Radiology
https://www.ama-assn.org/ama/pub/physician-resources/clinical-practiceimprovement/clinical-quality/physician-quality-reporting-system.page

Coming January 2014: A more continuous ABIM MOC program

( Certification will become only an entry point for subscriptions to MOC ) :

"Certified, Not Meeting MOC Requirements."

Questions and Answers

http://moc2014.abim.org/q-and-a.aspx

These Weren't The Rules When I Certified. Why Do I Have To Do This Now?

Certification and MOC have been and continue to be evolutionary processes. In order to help you keep pace with the changes in the science of medicine and assessment, ABMS and ABIM believe that a more continuous MOC program is vital to fulfilling our mission of assuring patients that Board Certified physicians are committed and qualified to provide highquality care. http://moc2014.abim.org/q-and-a.aspx

I Hold Certification That Is Valid Indefinitely. Why Are You Reporting That I Am Not Meeting MOC Requirements When I Don't Have Any Requirements To Meet?
ABIM will honor all certifications already issued, and diplomates who received certifications that are valid indefinitely will remain certified (assuming you hold a current and valid license). However, for all ABIM Board Certified physicians, regardless of when they were initially certified, ABIM and ABMS will begin reporting whether or not they are "Meeting MOC Requirements." In addition to the "Meeting MOC Requirements" requirement,

diplomates with a certification that is valid indefinitely

area by 12/31/23 in order to be reported as "Meeting MOC Requirements." This is in addition to continuing to meet the point requirements of the MOC program. Grandfathers who do not meet the MOC program requirements will be reported as "Certified, Not Meeting MOC Requirements." They will NOT be reported as Not Certified for failing to meet MOC requirements.
http://moc2014.abim.org/q-and-a.aspx

will need to pass the MOC exam in their certification

Is ABIM The Only ABMS Board With A Continuous Program?

No, ABMS is requiring that all of its 24 member Boards implement a more continuous MOC program. The American Boards of Colon and Rectal Surgery, Dermatology, Family Medicine, Ophthalmology, Pediatrics, and Physical Medicine and Rehabilitation are just a few of the Boards which currently provide or are working to provide continuous programs.

What Is The Evidence That Supports The Need To Meet MOC Requirements On A More Continuous Basis? How Do You Know The Public Wants This? The Institute of Medicine (IOM) has argued that in a profession with a "continually expanding knowledge base" a mechanism is needed to ensure that practitioners remain up-to-date with current best practices. The growing knowledge base requires that training and ongoing licensure and certification (????) reflect the need for lifelong learning and evaluation of competencies. Research has shown that the public expects that physicians undergo a rigorous, periodic examination of knowledge.
http://moc2014.abim.org/q-and-a.aspx

What Are The Changes To ABIM's MOC Program In 2014?

http://moc2014.abim.org/q-and-a.aspx

For all ABIM Board Certified physicians, ABIM and ABMS will begin reporting whether or not you are "Meeting MOC Requirements" (i.e., completing an MOC activity every two years, earning 100 points every five years, etc.). In order to be reported as "Meeting MOC Requirements", you will be required to complete an MOC activity to earn ABIM MOC points every two years and earn 100 ABIM MOC points in the correct distribution every five years. The points earned every two years will count toward your five-year requirement. The exam requirement has not changed. You need to pass the exam in each certification area you want to maintain every 10 years

How Much Does It Cost?

To maintain more than one certification, the cost will be the fee of the most expensive certification plus half for each of the others. For no additional cost, you may be eligible for CME credit for the completion of ABIM MOC products. MOC, in one of the internal medicine specialties, ranges from $206- $257 per year. Keep in mind that, for most ABIM Certifications, you do not need to maintain internal medicine certification to remain certified in the subspecialty.
http://moc2014.abim.org/q-and-a.aspx

Will Any Of These Changes Benefit Me?

The secure exam, taken once every 10 years, can earn 20 MOC points. (VS CME???) You will now have the option of paying for the program on an annual basis or for the full 10 years in advance at a discount. Your MOC fee includes unlimited access to all of ABIM's self-evaluation products, many of which earn CME credit.
http://moc2014.abim.org/q-and-a.aspx

Needless testing and Choosing Wisely

Stop wasting money on testing in patients Yet Test physicians yearly to screen out the very few marginal ones Would the ABMS or MOC have mattered in Kermit Gosnells case???

Standard Contract American Board of Pathology

All rights to board-none to you!

P4: YOUR obligations!

I understand and agree that, if I meet all of the qualifications for certification, my certificate will be valid for 10 years contingent upon my timely satisfaction of all requirements of the American Board of Pathology Maintenance of Certification program. I agree to be legally bound by the foregoing. Signature

Solicitation from 5/16/2013

The American Board of

Anesthesiology
Phone: (866) 999-7501 | Fax: (866) 999-7503 | Email: MOCA@theABA.org

4208 Six Forks Road, Suite 1500 Raleigh, NC 27609-5765 | Website: www.theABA.org

RE: Register for MOCA Cognitive Examination

We greatly appreciate your voluntary participation in the ABAs Maintenance of Certification in Anesthesiology Program (MOCA)! reminder, you are eligible to register for the July 2013 MOCA Cognitive Examination. As a

If you wish to register for the July 2013 MOCA Exam, the deadline is May 21, 2013. Please log into your ABA portal account at www.theABA.org to register.
The 4-hour, computer-delivered examination will be administered to candidates at test centers in more than 300 cities located throughout the United States, Canada and the U.S. Territories. Registration Deadline and Fees: To register for the MOCA Cognitive Examination, please log in to your portal account via the ABA website, www.theABA.org, and click the link labeled Register for a MOCA Cognitive Exam. Exam Dates (Select One): July 13-27, 2013 Registration Deadline: May 21, 2013

Fee: $2,100

Re-Examination Fee: $800

NOTICE: This message contains information from the American Board of Anesthesiology that may be confidential and legally privileged. If you are not an intended recipient, please notify the sender immediately, then destroy this email and refrain from any disclosure, copying, distribution or use of this information. Thank you.

 State Medical Boards have been doing this for decades as well!

MOC and MOL vs CPD little difference

Goal is to provide documentation to unwitting external agents and make money in the process Like its predecessor, the CPD program has three major (non-validated) components:
1) self-evaluation of the components of clinical competence, (CME) 2) evaluation of essential knowledge and clinical judgment, (TESTS for $$$) 3) verification of credentials and attestation of institutional and community good standing

Subspecialty or added qualification

Recertification in a subspecialty, such as cardiology or gastroenterology, will not require the maintenance of an active internal medicine certificate; Certificates of added qualifications, such as geriatric medicine or clinical cardiac electrophysiology, will continue to require an active certificate in the underlying discipline.

Year 2000
Active participation in CPD was made mandatory for continuing ABIM directors regardless of whether their certificates are permanent or time-limited. Directors will receive no special treatment, financial or otherwise.

Really????

boilerplate disclamer covers ABP

I hereby release, discharge, covenant not to sue, and hold harmless the ABP, its trustees, officers, members, examiners, representatives, agents, and any person who supplies information regarding my credentials from any actions, suits, claims, demands, or damages arising out of, or in connection with any action taken by any of them regarding this application, the gathering, collecting, and use of information about my practice or education, ..

..disclaimer Continued
..the grade or grades given with respect to any examination, the failure of the ABP to certify me, or the revocation of any certificate. It is understood that all decisions as to my credentials and qualification for admission to the examination and for certification rest solely and exclusively in the ABP, that its decision is final, and my exclusive appeal from any adverse decision is pursuant to the ABP's rules and procedures.

P2: I understand that:

(1) the giving or receiving of aid in an examination as evidenced either by observation or by statistical analysis of incorrect answers of one or more participants in the examination; or (2) the unauthorized possession, reproduction, or disclosure of any materials, including, but not limited to, examination questions or answers, before, during, or after the examination; or

P2 recourse
.(3) the offering of any benefit to any agent of the ABP in return for any right, privilege, or benefit which is not usually granted by the ABP to other similarly situated candidates or persons may be sufficient cause to terminate my participation in such examination, to invalidate the results of my examination, to withhold or revoke my scores or certificate, to bar me from future examination, or to take other appropriate action.

Paragraph 3
I understand that the ABP may require me to retake one or more portions of an examination if presented with sufficient evidence that the security of the examination has been compromised, notwithstanding

the absence of any evidence of my personal involvement in such compromise.

P 3: Legal protections ABP

I understand that the examination and all test questions are the exclusive property of the ABP and are protected by copyright law. Because of the confidential and proprietary nature of these copyright materials, I agree not to retain, copy, disclose, or reveal any part of these examination materials. Under threat of lawsuit-ABIM

10 shortcomings of medical certification

This complicated system for the recognition of specialists has become a subject of controversy within the medical profession. Critics have noted 10 shortcomings of medical certification-from:
Douglas A. Wallace, Occupational Licensing and Certification: Remedies for Denial, 14 Wm. & Mary L. Rev. 46 (1972), http://scholarship.law.wm.edu/wmlr/vol14/iss1/3

10 shortcomings of medical certification

First, the existence of numerous sharply defined specialties and subspecialties has resulted in overlapping jurisdiction among the boards, necessitating arbitration of the inevitable jurisdictional disputes. Second, the membership of the boards is unrepresentative. (all grandfathers!) Third, the members are not accountable for their decisions.

10 shortcomings of medical certification

Fourth, some requirements for certification are arbitrary Particularly objectionable is the requirement that an applicant for certification obtain references from certified men in his local community; this may enable a specialist who has already attained "diplomate" status to "blackball" a local competitor." Fifth, the examination system is unnecessary and redundant to the residency programs, especially since some boards tend to pass almost every candidate while others fail 40 to 50 percent of their applicants."'

10 shortcomings of medical certification

Sixth, some boards deny or revoke the certificate without an explanation or hearing."' Seventh, the large number of autonomous boards has caused a lack of unity in educational policy and programs among specialty boards in contiguous fields and has contributed to the absence of an authoritative policymaking body responsible for supervising the development of graduate medical education in terms of the actual demands of medical care.

10 shortcomings of medical certification

The eighth criticism concerns the utility of certification.
It could be an invaluable source of information concerning the qualifications of a medical specialist. Patient and doctor alike are frequently ill-prepared to determine the merits of self-proclaimed specialists; board certification might function as a guarantee that a specialist has advanced training in his chosen field. However, empirical studies of the quality of patient care have shown that the quality of care usually given by certified specialists is not superior to the care given by non-certified physicians.

10 shortcomings of medical certification

Ninth, with the rapid advance of medical technology, the boards typically have failed to require that member specialists keep abreast of developments. Tenth, the specialty certification system tends to increase the incomes of board-certified doctors by restricting hospital staff privileges to boardcertified men, to the exclusion of general practitioners and non-certified specialists.

Studies and science

Contact ABIM American Board of Internal Medicine 510 Walnut Street Suite 1700 Philadelphia, PA 19106-3699

all 3 are ABIM executives and employees

John J. Norcini, Ph.D.

FAIMERs first President and Chief Executive Officer Foundation for Advancement of International Medical Education

Dr. Norcini spent 25 years with the American Board of Internal Medicine serving in various capacities, including Director of Psychometrics, Executive Vice President for Evaluation and Research, and finally, Executive Vice President of the Institute for Clinical Evaluation.
The Foundation for Advancement of International Medical Education and Research (FAIMER) was incorporated as a nonprofit foundation of ECFMG in September 2000

http://www.faimer.org/about-staff.html

Rebecca S. Lipner, PhD, Senior VP of Evaluation, Research and Development, ABIM

Dr. Lipner oversees a team of research design and analysis experts who employ both qualitative and quantitative methods to ensure and enhance the high quality of assessment programs across the ABIM enterprise while disseminating evidence-based research findings to the public In her previous role as Director of Psychometrics for ABIM, she was involved in the implementation of new programs in maintenance of certification and computer-based testing.
http://www.abim.org/about/executives.aspx#lipner

 Specifically, our retrospective chart review study compared certified and self-designated family practitioners, internists, and cardiologists (no assurance of equal trainingespecially in 1993) in-hospital mortality rates (adjusted for severity of illness) the characteristics of the hospitals the physicians worked in; physicians own characteristics:
time since graduation from medical school number of AMIs they each treated in 1993.

Retrospective chart reviews and Science

Designed to examine raw data and assess if formal study via Randomized Controlled Study method is warranted to confirm assumptions Is Highly susceptible to systematic design flaws which introduce bias/prejudice Validity of adjustments? Corporate sponsorship suspicious of influence:
Negative finding suppression Intrinsic design to confirm desired outcome

Statistics and significance

Grouped all three into one group for analysis:
Cardiologist and FP better than IM care!

Predicted mortality always less in Non Certified group, while maximal risk severity always greatest there

Very different care settings

BC have more advanced care, different Volume factor settings and payor mix and more & significance recently/younger trained Docs

DISCUSSION Quotes
Purpose of this study:
determine differences certified vs non-certified or self-designated

We found lower patient mortality from AMI was associated with treatment:
by an attending physician who was a cardiologist, cared for larger numbers of patients, Was closer to his or her year of graduation from medical school, and was certified.

DISCUSSION Quotes
However, there are a variety of issues having to do with data collection that could potentially influence the findings of this study. Because to become certified physicians must satisfactorily complete accredited training and pass rigorous examinations.
In 1993 self-proclaimed specialists may not have had complete or significant training, unlike today, when certification expires

DISCUSSION Quotes
More primary care physicians than cardiologists are uncertified, so contrasting the two groups will overstate the magnitude of their differences.
(so we lumped them together)

Certification is associated with the quality of the medical schools physicians attend, as well as a variety of graduate experiences, including facultyresident ratio and length of training.
Not true today with certification expiration

DISCUSSION Quotes
Lower mortality rates among patients with AMI might be obtained by limiting their treatment to those physicians who are certified, are relatively recent graduates from medical school, and have considerable experience with this condition. Not surprisingly, certified cardiologists best fit this description
(So see the one with most experience and experience with most advanced equipment ???)

DISCUSSION Quotes
it is possible that more than one doctor may have contributed to clinical outcomes in some instances. However, where this occurs, its effect is to obscure differences among physicians, thereby working against the ability to make distinctions based on specialization and certification status.

DISCUSSION Quotes
There are limitations in the risk-adjustment procedures the PHC4 used, including the inability to fully distinguish between complications and coexisting conditions, variations in coding, and categorization of the Admissions Severity Group score.

DISCUSSION Quotes
In any retrospective study such as this, not all of the factors that lead to a particular patients outcome can be captured. Although the major causes of mortality were captured, it is not possible to rule out other uncontrolled factors.

DISCUSSION Quotes
certification should not be used as a sole marker of competence,

 Repeated study from same data Using Certification data after completion of residency in all cases We compared certified (passed the examination) and self-designated (failed the examination but self-identified their specialty) internists and cardiologists with respect to their characteristics, the illnesses of their patients and the nature of the hospitals in which they worked.

Five Things Physicians and Patients Should Question Participating Internists

Other specialties sure to follow! just say no? To what? Patient satisfaction? Lawsuits?

American Academy of Allergy, Asthma & Immunology American Academy of Family Physicians American College of Cardiology American College of Physicians American College of Radiology American Gastroenterological Association American Society of Clinical Oncology American Society of Nephrology American Society of Nuclear Cardiology

NON-ABMS AMERICAN PHYSICIAN BOARDS

gross reciepts (Millions) profits/revenue (Millions) 31.6 5.5 5.5 0.5 0.861 0.573 Net assets (Millions) 12 9.75 2.97

Board of Osteopathic Medical Examiners PODIATRIC SURGERY ORAL AND MAXILLOFACIAL SURGERY AMERICAN ASSOCIATION OF PHYSICIAN SPECIALISTS COLON AND RECTAL FACIAL PLASTIC AND RECONSTRUCTIVE SURGERY LOWER EXTREMITY SURGERY COSMETICS SURGERY HAIR RESTORATION SURGERY Oral Pathology LASER SURGERY SPINE SURGERY PEDIATRIC NEUROLOGICAL SURGERY ABDOMINAL SURGERY EYE SURGERY

2.9 0.702

-0.224 0.094

2 0.589

0.639
0.236 0.223 0.184 0.096 0.063 0.047 0.03 0.025 0.017

0.037
-0.003 -0.085 0.022 15 0.01 -0.009 0.002 0.019 0.015

0.676
-0.026 -0.092 0.06 0.472 0.054 0.064 0.094 0.138 -0.046

Also NON-ABMS AMERICAN paramedical BOARDS

Medical Society actions

Is it possible to contact AAPS membership in ALL states and find out which states HAVE formed anti-MOC/MOL resolutions and activities and perhaps investigate why others have not? Ohio, New York, Texas, Michigan (New Jersy)

 Will AAPS initiate NOW an attempt to get ABMS high ranking officers to commit to an OPEN DEBATE at the AAPS next meeting or at some adequately distant "venue to be decided" so they cannot claim "conflicts of schedule"?

 Should an attempt be made to place such a venue a/through a "more neutral" state medical meeting, say in Georgia or Michigan?

 What is the deal in California with the State Medical Board separating investigations out to the Office of the attorney general? What is the position of AAPS on this? On the one hand this would result in constitutional rights NOT afforded by the Medical boards and legal minds adjucating the matters vs secrret decisions by victorian ethics appointed by the governor doing injustice?? Not sure if this is a good or bad move? In Ohio this could be a good move? See: http://www.latimes.com/news/local/la-me-rx-medicalboard-20130426,0,5663708.story

Physician vs Administrator growth in Healthcare

http://www.medibid.com/blog/2013/04/medi crats-increase-healthcare-costs/

http://en.wikipedia.org/wiki/Health_care_in_the_United_States

Jun 30, 2012 The US has the highest health spending in the world - equivalent to 17.9% of its gross domestic product (GDP), or $8,362 per person.

http://www.rand.org/content/dam/rand/pubs/corporate_pubs/2005/RAND_CP484.1.pdf

http://www.rand.org/content/dam/rand/pubs/corporate_pubs/2005/RAND_CP484.1.pdf

http://www.rand.org/content/dam/rand/pubs/corporate_pubs/2005/RAND_CP484.1.pdf

http://www.rand.org/content/dam/rand/pubs/corporate_pubs/2005/RAND_CP484.1.pdf

http://www.rand.org/content/dam/rand/pubs/corporate_pubs/2005/RAND_CP484.1.pdf

Medicare Is the Dominant Payer for the Elderly, Private Insurance for Those Under 65
http://www.rand.org/content/dam/rand/pubs/corporate_pubs/2005/RAND_CP484.1.pdf

To meet the requirements of IRC 501(c)(6) and Reg. 1.501(c)(6)-1, an organization must possess the following characteristics:

It must be an association of persons having some common business interest and its purpose must be to promote this common business interest; It must be a membership organization and have a meaningful extent of membership support; It must not be organized for profit; No part of its net earnings may inure to the benefit of any private shareholder or individual; Its activities must be directed to the improvement of business conditions of one or more lines of business as distinguished from the performance of particular services for individual persons; Its primary activity does not consist of performing particular services for individual persons; and Its purpose must not be to engage in a regular business of a kind ordinarily carried on for profit, even if the business is operated on a cooperative basis or produces only sufficient income to be selfsustaining.

FSMB Foundation Board of Directors:

http://www.fsmb.org/foundation_leadership.html

Janelle A. Rhyne, MD, MA, MACP Director

Dr. Janelle Arolyn Rhyne Certification Area Internal Medicine

Certification Status
Certified

Certification History Certified 09/10/1986, Certificate valid indefinitely Certified 11/06/1990, Certificate valid through 12/31/2000 Met all recertification requirements 11/03/1999 Certified 12/31/2000, Certificate valid through 12/31/2010 Certified 10/06/2010, Certificate valid through 12/31/2020

Infectious Disease

Certified

History of the ATLS Program

The Beginning: In February 1976, a tragedy occurred that changed the first hour of trauma care for injured patients in the United States and in much of the rest of the world. Dr. Jim Styner, an orthopedic surgeon, crashed his small plane into a cornfield in rural Nebraska. Recognizing how inadequate their treatment was, stated, "When I can provide better care in the field with limited resources than what my children and I received at the primary care facility, there is something wrong with the system, and the system has to be changed. Originally no time limits-but that has changed Complementary Courses Trauma Evaluation and Management (TEAM) for Medical Students Advanced Trauma Care for Nurses (ATCN) for Registered Nurses Pre-Hospital Trauma Life Support (PHTLS) for Pre-hospital care providers Based on ATLS philosophies, these courses allow PHTLS-trained pre-hospital care providers to follow the same principles of care that are core to ATLS.

2013 Anesthesia ACLS

No time limits, NOT AHA-ACLS

Certificate of achievement or license requirement?

Authorization to practice medicine or specialty?

ABMS=501 (c) (6) corporation

ABMS Organization and Leadership American Board of Medical Specialties is incorporated in the State of Illinois as a not-for-profit corporation by the Internal Revenue Service under Section 501(c)(6) of the Internal Revenue Code of 1986. The individual organizations comprising the membership of ABMS are classified as either Regular Members, often referred to as Member Boards, or Associate Members. The Regular Members include 23 Primary Boards and one Conjoint Board. The Associate Members consist of nine national organizations concerned with graduate medical education and specialty practice, but they are not specialty boards. Each Member Board and Associate Member Board pays annual dues and has voting rights.

501 (c) (6) corporation

 Its purpose must not be to engage in a regular business of a kind ordinarily carried on for profit, even if the business is operated on a cooperative basis or produces only sufficient income to be self-sustaining. Nevertheless, it is important to analyze IRC 501(c)(6) cases step-by-step because an organization must possess all the above characteristics to qualify under IRC 501(c)(6).
http://www.irs.gov/pub/irs-tege/eotopick03.pdf IRC 501(c)(6) Organizations page K-4

EARN RECOGNITION OR REWARDS FOR YOUR RECENTLY COMPLETED PIM Did you know you can submit your completed ABIM PIM Practice Improvement Module to a participating health plan to earn reward and/or recognition credit? Health plans recognize the value of ABIM's Maintenance of Certification (MOC) program as a relevant measure of performance and accept completed PIMs for credit in reward and recognition programs. Benefits of submitting your PIM to a health plan:
RECENTLY

By completing a PIM, you can receive recognition from multiple organizations (ABIM and health plans). Reward and/or recognition programs champion physicians who are actively engaged in quality improvement activities. Health plans recognize your PIM completion either by distinguishing you from other physicians in their quality networks or with monetary rewards.* Log on to ABIM's website to submit your completed PIM today. It only takes a few minutes. In addition, you can also earn a financial bonus from CMS for participating in PQRS MOC in 2013. * The health plan program requirements vary by plan.

Protecting public or profits quality control vs forming Guilds

1985 ABA recognized: UK, Israel, S.Africa No entry for acclaimed foreign national Introduction of special pathway for Renown researchers:
8 year pathway via restricted research license

Does a physician shortage exist? Why authorizing medical practice by:

Nurse Practitioners, Physician Assistants, Pharmacists, CRNAs, Midwifes, etc

STATEMENT 2010

_____________ ________________________________________
_______________________________________________________________________ _________ With CMS: any "carrot" will quickly become a "stick" of penalty

PEA, Ventricular tachycardia (VT) fibrillation (VF)

ACLS circular 2 min. cycle

Circulation 2010, 122:S729-S767

Dermatol Surg 2012;38:171177