Anti-MOC Victories at Michigan State Medical Society House of Delegates

Friend of IP4PI Dr. Meg Edison writes in:

Michigan State Medical Society House of Delegates was last weekend, Martin Dubravec and I ran around like crazy, testifying in support of 4 anti-MOC resolutions and against a resolution to join the FSMB Compact. The outcome was very successful:

  1. The delegates reaffirmed strong opposition to the FSMB Compact (making me very happy, since it was my resolution from 2 years ago that we oppose the compact).
  2. We passed a resolution to engage legal counsel to investigate anti-trust violations against ABMS/insurers/hospitals in Michigan.
  3. We passed a resolution calling for an end to the direct-to-consumer advertising of the ABMS MOC product.
  4. We passed a resolution calling for public access to initial board certification status on ABMS websites.
  5. A resolution asking the AMA to amend their MOC policy to require informed consent from patients before conscripting them into ABMS MOC QI projects was referred to the board for more study, disappointing…but not surprising given how many academics are delegates. Ken Fisher was on the committee that heard this, he fought like mad and got it approved…but the delegates extracted it and referred it to the board on the house floor. Still, the conversation on the ethics of MOC & research was started.

I’ve attached the resolutions (see links embedded in list above) for your future reference if you’d like to share and pass similar resolutions in your state medical societies. I want to point out, it is a small handful of us (me, Martin Dubravec, Ken Fisher). There were no other docs testifying. We don’t need an army to make change…just a few can do this. Yes, it’s a pain to give up a few hours on Saturday, these meetings are confusing and intimidating, but find a friend, become delegates and make this happen.
-Meg

I’ll add a 6th victory that came from years of getting the right people involved in organized medicine and our House of Delegates…

6.) On the same page as the “Oppose IMLC” resolution attached below, the resolution 24-17 to “study single payer” was “amended” to remove all language on “single payer” and approved with broad language to study all alternative payment models…which includes DPC and other free market innovations. Just 3 years ago, this same body voted to approve single payer…we’ve come a long way.

Principles for individual citizen healthcare freedom

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IP4PI Physicians support the following resolutions for the legislative, executive and judicial branches of the US:

1.  The full repeal, nullification or reconciliation of ACA/Obamacare as it was:

A. Not passed by majority but buy a partisan Congress by reconciliation. B. Changed by the executive branch 43 times without appropriate congressional action. C. Changed by SCOTUS to be a tax bill. D. Tax bills must originate in the House and ACA originated in the Senate. E. ACA has changed healthcare from a professional physician-patient interaction into merely an act of government HHS/CMS unelected bureaucratic compliance. F. ACA lead to an uncontrolled rise in costs for all citizens through increased taxes, insurance costs, hospital costs, physician costs, use of narrow networks and severely limited ACA approved options. G. IRS and tax penalties for any American citizens violate the US Constitution. H. Mutually accepted individual customer-vendor purchases are the ideal way to allow personal choice, encourage excellence and establish price completion for best citizen consumer value. Continue reading

ABA Has Failed to Stand Up to ABMS on MOC

Friend of IP4PI, Jef Fernley, DO shares his correspondence with the American Board of Anesthesiology.

Esteemed colleagues of the ABA,

You should have left well enough alone. For decades it was believed that being “Board Certified” was actually a hallmark of a quality Physician, something to set himself/herself apart from the rest, something to inspire confidence, a feather in one’s cap, and print on one’s business card.  The field of Anesthesiology has a proud history of independence and innovation.  The ABA used to be a reflection of that. But you failed to stand up to the ABMS on MOC. I think everyone understands that staring a novel multi-million dollar stream of revenue in the face is a very hard thing to reject.  You should have rejected it.  With the absence of any unbiased supportive evidence for MOC, and let’s be realistic, anyone who has a job taking care of patients rather than publishing papers knows that physician quality can’t be measured by any single test, therefore there won’t ever be any such real evidence. Continue reading

Final MACRA rule still byzantine and unworkable, patients lose.

The final MACRA rule expands exemptions, flexibility, claims ModernHealthCare.com but it is still byzantine and unworkable. Patients lose.

The 2,398 page rule can be downloaded here: https://qpp.cms.gov/docs/CMS-5517-FC.pdf

We haven’t read the all 2,398 pages yet but here are a few initial notes:

  • The low-volume threshold is now < $30,000 in Part B billings OR < 100 Part B Patients.The proposed rule was < $10,000 AND < 100 Patients.
  • The infamous table from the proposed rule showing 87% of solo docs would face a negative adjustment under MIPS has been “bleached.” The sanitized table no longer lists solo physicians separately, and claims that only 10% of practices from 1 to 9 physicians will will face negative adjustment.  Click here for image combining both new table and old table. Supposedly, overall, 94.7% of eligible clinicians will get a positive or neutral adjustment with 5.3% receiving a negative adjustment.

Another trouble spot to look out for (Page 1513):

“One commenter supported the inclusion of ABMS board certification and participation in Maintenance of Certification (MOC) Programs on Physician Compare. Another commenter recommended MOC participation as a measure in future rulemaking as part of quality performance data publicly reported on Physician Compare … We appreciate the points, concerns, and suggestions raised by commenters and, if feasible and appropriate under the statute, we may possibly consider these issues in future rulemaking. ”

Some other low-lights:

Re Privacy:

“We disagree with commenters who maintained that the disclosure of PHI to ONC or an ONC-ACB (authorized certification body) could be inconsistent with reasonable privacy or other organizational policies or would otherwise be an unjustified invasion of privacy or any other interest. As noted, the disclosure of this information would be authorized by law on the basis that it is a disclosure to a health oversight agency (ONC) for the purpose of determining compliance with a federal program (the ONC Health IT Certification Program). In addition, we note that any further disclosure of PHI by an ONC-ACB or ONC would be limited to disclosures authorized by law, such as under the federal Privacy Act of 1974, or the Freedom of Information Act (FOIA), as applicable.” (page 67)

Data-Collection from all-payers:

“In addition, we are finalizing our approach of including all-payer data for the QCDR, qualified registry, and EHR submission mechanisms because we believe this approach provides a more complete picture of each MIPS eligible clinician’s scope of practice and provides more access to data about specialties and subspecialties not currently captured in PQRS” (page 468)

“We desire all-payer data for all submission mechanisms, to create a more comprehensive picture of the practice performance. Section 1848(q)(5)(H) of the Act authorizes the Secretary to include, for purposes of quality measurement and performance analysis, data submitted by MIPS eligible clinicians with respect to items and services furnished to individuals who are not Medicare beneficiaries. As discussed in section II.E.5.b. of this final rule with comment period, we are finalizing our proposal to require MIPS eligible clinicians to report allpayer data on quality measures where possible.” (pg1396)

CMS will be accepting comments for 60 days, however the online comment portal is not yet open as far as we can determine.  Stay tuned!

Comments Due 9/23 on Proposed Rule Requiring Certification for Compact Licensure

As we’ve warned before, The Interstate Medical Licensure Compact, is not going to solve the problem it claims to fix. It simply creates a new bureaucratic entity with little meaningful accountability.

The Commission in control of the Compact appears to be making a minor concession on the issue of MOC in an upcoming rule. The proposed rule currently under consideration requires that a physician seeking Compact licensure:

Holds specialty certification or a time-unlimited specialty certificate recognized by the ABMS or the AOA’s Bureau of Osteopathic Specialists. The specialty certification or a time unlimited specialty certificate does not have to be maintained once a physician is initially determined to be eligible for expedited licensure through the Compact.

Because of the above wording, the Commission will now claim they aren’t requiring MOC for Compact participation. However as board certification is required at the time of initial determination of eligibility, physicians not participating in onerous recertification schemes when applying for a compact license may find their ability to obtain a license via the compact in jeopardy.
Continue reading

Oklahoma Governor Signs Anti MOC/OCC Legislation!

An Oklahoma physician writes in:

Yesterday, April 11, 2016 our Governor signed a bill preventing entities from using MOC or OCC as a condition for licensure, reimbursement, employment or admitting privileges at a hospital.

Click here to read SB 1148.

This is HUGE!!! We essentially blocked ABMS and AOA lobbying efforts and hopefully blocked the Interstate Compact law (which we successfully squashed for this year’s legislative efforts).

This may be a model to squash MOC and OCC forever.

Note: This victory follows Kentucky’s anti-MOC, bill SB 17, passed earlier this year.

Educating Legislators about Dangers of Interstate Medical Licensure Compact

Is your state considering entering the Interstate Medical Licensure Compact?  Educate your legislators about why this is a bad idea. Below is a sample letter you can use to assist your outreach efforts.  Even if your state isn’t yet a target start educating your legislators and colleagues today!

Dear Members of the Colorado House of Representatives,

Thank you for your dedicated service to the citizens of Colorado.

We are writing to voice concerns about HB 16-1047 which, if passed, will sign Colorado on to the Interstate Medical Licensure Compact. The Interstate Medical Licensure Compact “may seem like a positive step” at first glance, warns CATO adjunct scholar Shirley Svorny, PhD.  She continues, “[t]he compact is being promoted, disingenuously, as addressing license portability and access to interstate telemedicine…. Adding the Compact Commission creates another layer of bureaucracy and costs.”

States that are closely looking at the Compact are increasingly rejecting it and exploring other state-controlled policy options to better accomplish the goal of license portability. Continue reading