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

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.”