May 23, 2017

MOC - It's All About the $$ - Yes to SB 1148

Oppose Vendor Greed That Isn’t Shown
to Improve Quality

Senate Bill 1148, scheduled for debate on the floor of the Texas House of Representatives today, clearly states that hospitals and health plans cannot use maintenance of certification (MOC) to differentiate among physicians for payment, contracting, or credentialing. The bill prohibits the state from using MOC as a requirement for state licensure or renewal. It would, however, allow MOC requirements if facilities or teaching faculty need them for specialty designation or accreditation.

The bill's author is Sen. Dawn Buckingham, MD (R-Lakeway). As a practicing opthalmologist, Senator Buckingham knows a thing or two about the bureaucratic hassles that get in the way of physicians taking care of their patients.

SB 1148 stops the discrimination against physicians who elect to skip the burdensome, often-irrelevant, monopolistic MOC process. MOC claims to ensure quality, but in reality the components tested often are not applicable to medical practices. It’s a revenue generator for testing companies. So if you are wondering why the certifying boards are fighting so hard against SB 1148, remember, it’s all about the money.

"It's a money-making operation," says Texas Medical Association President Carlos J. Cardenas, MD.

In 2014, MOC generated $27 million for the American Board of Internal Medicine (ABIM) (48 percent of total certification testing revenue, 44 percent of total revenue). And, until the backlash really started to hit in 2015, MOC fees have been a steadily rising source of income for ABIM.



And this is personal for the organization. ABIM’s reported staff expenses (salaries, benefits, and other) increased 53 percent from 2009 to 2016, to $34.1 million. In 2015, ABIM spent $30 million on salaries and benefits and only $6.3 million on actually administering MOC.



As of 2016, the ABIM’s staff retirement plan net assets were $27.1 million, double the organization’s $13.6 million total net assets.

Mandatory MOC amounts to unnecessary overregulation of medicine. There is no proof at all that MOC improves patient care. Two peer-reviewed studies published in the Dec. 20, 2014, issue of the Journal of the American Medical Association compared physicians who had and had not completed MOC. Those studies found no differences in patient outcomes or in the number of hospitalizations that could have been prevented due to better quality of outpatient care.

Almost all other published studies evaluate initial board certification, not recertification or MOC, and the rigorous requirements for initial certification should not be equated with the busywork required for MOC every two years.

SB 1148 does NOT eliminate the state’s strict standards for physicians to earn continuing medical education credits to maintain our licenses. It does NOT change the status of, negate, or in any way minimize the initial board certification that physicians work so hard to achieve.

And if you haven't done it yet, please use the TMA Grassroots Action Center to ask your state representative to vote “YES” on SB 1148

May 11, 2017

Mandating MOC to practice medicine is an appalling overstep of nonexistent authority

By Carlos J. Cardenas, MD
TMA President

This article was originally published at KevinMD.com.

Maintenance of certification (MOC) for something as significant as the practice of medicine seems like a harmless enough idea. But for physicians across the country who dedicate thousands of hours to study, earn licensure, achieve board certification, and practice medicine, MOC is not only unnecessary but also a resource-consuming mandate that does nothing to improve patient outcomes and quality of care.

According to the American Board of Medical Specialty’s (ABMS’) own website: “Board certification is a voluntary process, and one that is very different from medical licensure … Board certification demonstrates a physician’s exceptional expertise in a particular specialty and/or subspecialty of medical practice.” In other words, physicians who pursue board certification self-identify as professionals committed to ongoing learning and subject-matter mastery. The vast majority of Texas physicians willingly pursue and obtain their initial certification for just that reason.

ABMS introduced MOC in the past 20 years, granting a lifetime certification to physicians board certified at the time of its creation. The rationale for the arbitrary “grandfathering” date is murky and ambiguous at best.

In the past 12 months, several states have passed laws specifically disallowing reliance on MOC for credentialing, payment, and contracting. More are considering legislation this year. Serendipitously, Oklahoma had success with Senate Bill 1148 — the same bill number for legislation courageously authored by Texas State Sen. Dawn Buckingham, MD, a physician in the Austin area. Texas’ SB 1148 prohibits the state from using MOC as a requirement for state licensure or renewal. It prohibits hospitals and insurance companies from relying on MOC for credentialing or contracting. That bill is working its way through the Texas Legislature this week.

The Medical Credentialing System in 2014 reported revenues of more than $2.5 billion — $1 billion of which is attributed to ABMS entities alone. The American Board of Internal Medicine (ABIM) is the largest of ABMS’ credentialing agencies and is responsible for credentialing one-quarter of all physicians.

Drilling down further into those numbers is eye-opening. ABIM reports $58 million in revenue for 2015, nearly $27 million of which came from MOC fees. With $30 million spent on salaries and benefits that year and only $6.3 million on actually administering the MOC, one could easily draw the conclusion that the push for MOC is nothing more than self-serving largesse. Well, that and the luxury three-bedroom condominium purchased in downtown Philadelphia in December 2007. The money these boards collect and spend — on expenses like first-class, cross-country airfare for their staff — just adds to physicians’ ire over MOC mandates.

In fact, some specialty boards have emerged as a direct result of the revenue-generating opportunities MOC offers. Forty-two medical specialty boards now exist to conduct MOC courses. Forty-two. Providing employment for test proctors does nothing to improve patient care and outcomes. “Do no harm” is not just an oath to be sworn by physicians. It is also a standard to which MOC should be held. If it truly is voluntary, as ABMS asserts, stop punishing physicians who elect not to pursue it.

From the extraordinary dedication physicians demonstrate by initially achieving board certification, to meeting and exceeding continuing medical education requirements, to continuously putting patient care first and foremost, mandating MOC to practice medicine is an appalling overstep of nonexistent authority. Not only that, it is driving experienced, caring physicians from practice.

Texas physicians are determined to end this over-testing tyranny and ensure Texas remains a “right to care” state.

May 5, 2017

Stop HB 4011: Health Insurance Wolf in Sheep's Clothing

House Bill 4011 amounts to unnecessary overregulation of the business of medicine, and the Texas House of Representatives should reject it.

HB 4011 would require physicians to receive from the patient a signed disclosure form with an itemized statement of the amounts to be billed for nonemergency medical services before those services are provided. If a physician does not obtain this signed document, the physician is prohibited from providing information to a consumer reporting agency regarding the patient's outstanding medical debt.

Write or call your state representative now.

Eight reasons to oppose HB 4011:

  1. The bill would overregulate the business of medicine via a law that is really unneeded. This is an anti-free market piece of legislation. No other business is subject to these requirements.
  2. It removes any accountability for health insurers to pay an out-of-network benefit for the patient, discouraging patient choice of physicians.
  3. HB 4011 sets up an impossible hurdle for many physicians to meet. It could force us into the position of either delaying treatment while we wait for a signed disclosure form or making it less likely that we receive payment for the medical care we provided.
  4. State and federal law already provide the protections this bill is aiming for – and they do it in a much simpler manner.
  5. Current state law contains extensive protections to help prevent unpaid medical bills from hurting consumers’ credit. Those protections were included in Senate Bill 1731, which was passed in 2007 to strike a balance between protecting patients from medical debt and maintaining their personal financial responsibilities.
  6. Among the many consumer protections enacted in the 2007 law, physicians upon request must give a patient an estimate of charges for any health care services or supplies if the patient has no insurance or is receiving services out-of-network. Even more stringent requirements apply to hospital-based physicians.
  7. Federal law, the Fair Credit Reporting Act, prohibits states from passing laws or imposing restrictions “relating to information contained in consumer [credit] reports.”
  8. In the current legislative session, medicine is strongly supporting a package of much better insurance reform measures to make it easier for patients to prevent or challenge “surprise medical bills.”


Apr 15, 2017

Mandate? Hardly.

As in a bad Freddy Krueger movie, rumors of a binding, incestuous relationship between the Interstate Medical License Compact and Maintenance of Certification (MOC) just will not die.

Let’s set the record straight.

The Interstate Medical License Compact is a multistate agreement that allows physicians to obtain a license in a new state faster and with fewer hassles. Here are some basic facts to remember:

1.      The Compact does not replace, override, or reduce the need for the physician to meet the licensing requirements of the new state.

2.      Physicians who, for any reason, do not want to use the Compact still may apply for a license in the new state using the traditional route.

3.      Physicians who want to use the Compact must have an active board certification at the time of the license application through the compact. The Compact does not require MOC before, during, or after that procedure.

Mandate? Hardly.

Now, as to the position of the Texas Medical Association (TMA):

TMA opposes mandatory MOC requirements for licensing, credentialing, hospital privileges, health plan contracts, or payment. This position was adopted by votes of the TMA House of Delegates in 2013 and in 2016 in adopting these policies:

·         Maintenance of Certification Requirement: TMA supports the American Medical Association’s Principles of Maintenance of Certification (MOC) H-275.924 to ensure physician’s choice of lifelong learning, and will pursue legislation that eliminates discrimination by the State of Texas, employers, hospitals, and payers based on the American Board of Medical Specialties’ proprietary MOC program as a requirement for licensure, employment, hospital staff membership, and payments for medical care in Texas. (2016)

·         Opposition to Maintenance of Licensure: TMA opposes any efforts by the Texas Medical Board (1) that require the Federation of State Medical Boards’ Maintenance of Licensure (MOL) program as a condition of licensure, and (2) that unilaterally implement different Maintenance of Licensure requirements other than those currently in place for physicians in Texas. (2013)

In the current (2017) session of the Texas Legislature, TMA is strongly supporting Senate Bill 1148 by Sen. Dawn Buckingham, MD (R- Lake Travis). That would prohibit the sole use of MOC status to credential, license, or pay physicians. Kim Monday, MD, a neurologist from Houston and former president of the Harris County Medical Society testified for the bill in committee on behalf of TMA. Dr. Monday called the requirement “burdensome, expensive, and filled with irrelevant curriculum.” She noted the combined cost including materials, fees, and time away from patients and the medical practice to undergo the process can be as high as $10,000. Dr. Monday referred to MOC as a “moneymaking scheme” with “little applicability to day-to-day practice.”

The Interstate Medical License Compact provides a route for Texas to recruit and quickly deploy physicians currently licensed in other states. Given the desirability of practicing medicine in Texas and the state’s severe physician shortage, adopting the Compact by the Texas Legislature would have a positive outcome.

In 2015, the TMA House of Delegates considered but did not adopt a resolution calling on the association to “oppose the Federation of State Medical Board’s (FSMB) Interstate Medical Licensure Compact as currently written.”

Apr 6, 2017

Speak Up and Be Heard

By Sara G. Austin, MD
2017 Travis County Medical Society President

This article was originally published in the March/April edition of the Travis County Medical Society Journal.

Gosh, it's time to write this article again! So I was thinking—no worries, I'll just wait until after the first First Tuesday at the Capitol and write about what the House of Medicine is advocating for in this legislative session. There, done, simple. I’ve done that lots of times; it takes about 10 minutes and it's important stuff, stuff you guys need to know something about. Plus the rattlesnake wranglers were at the Capitol and they are fun to watch and make a great picture, and I could talk about that too.

But this First Tuesday seemed different to me. For one, I work at Seton now, and I'm staffing Brackenridge this week. I saw a nice lady with Medicaid (who couldn't have afforded to see me in my private practice) complaining of hand numbness and weakness. Initially I thought it was just carpal tunnel. But after an exam and some testing, it turned out to be ALS. It made me grateful that I was in a place where I can see people who don't always have good insurance. And staffing Brackenridge makes me aware of how much need is out there. So I go down to First Tuesdays and we are fighting some of the same battles we’ve fought for years and we need to continue to fight—fair policies from insurance companies, patient safety and scope of practice, public health (smoking in public places, vaccinations) and funding for Graduate Medical Education. Medicaid is always mentioned but feels like such a losing battle that sometimes it only gets one sentence, like "Please do something with Medicaid."

The Capitol was packed on this First Tuesday! I mean it was difficult to walk through the rotunda and up and down the stairs because the sanctuary cities issue was being debated in both chambers. There was a palpable tension in the Capitol that I've not run across before. I hear the same tension in the news when they are talking about D.C.—people trying to figure out how to get their head around this new administration and wondering what's going on, and perhaps, what's going to change?

I found myself thinking how much easier things were to handle when it was the same old, same old. This conflict, this possibility of doing things differently, this . . . change . . . is now making me nervous. I realize change does that because it brings up the chance of loss, but it has the chance of gain as well. And really, nowhere is change more important to our lives and wellbeing than in health care.

I am still hoping that something breaks lose for the better. That it somehow gets easier to see and care for patients than it is now. That we don't let people suffer for lack of access to health care. It needs to change. And yes, we have got to keep pushing for Medicaid to improve.

I think now is the time to speak up—to be heard—especially for the House of Medicine. When else will we ever have a better chance to actually make a difference for our patients? So work to understand the issues, and tell your stories and your patients' stories. Believe me, there are lots of other folks out there telling theirs. Don't forget that the next First Tuesday is April 4. We had a great turn out this last time and really would love to see even more white coats in the Capitol this next time. Think about it.

Meanwhile, it is comforting that there are still people out there who can mess with a rattlesnake and not (or very rarely) get bit. They may be in the safest place of all this year.