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

No Mandatory MOC – A physician pushes for reform in Maryland

Received from Maryland physician Jef Fernley, DO:

I have just got off the phone with Mary Beth Carozza, my State Delegate. Following in the wake of legal actions against MOC in OK, MI, Florida, and others, I expressed to her that I wish to have her champion legislation ending compulsory MOC in Maryland. The bill I’d offer basically says, if you wish to participate in Maintenance of Certification efforts, you are welcome to, if you do NOT, no employer, payer, etc. can use your board certification status to hire, fire, pay, not pay, promote, demote, etc. you. It makes MOC voluntary.

If you love MOC, truly believe that it’s improved the quality of your patient care, made you a better doctor, and that it’s completely worth the time, effort, and $$ you’ve invested, and you care not one bit how your board has used that tremendous surge in their income, then I apologize for having bothered you with this, feel free to delete without reading further. 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!

AOA is at Critical Point in Its History

Stuart Damon, DO shares his recent correspondence with then-AOA President (now Immediate Past President) John Becher, DO:

From: Stuart Damon
Date: April 13, 2016
To: John Becher
Subject: Re: What makes you and me different?

Dr. Becher –

Thank you for your reply. I do appreciate your response.

With respect, a HOD resolution isn’t enough. From what I have heard so far, the ACOFP has forwarded a recommendation encouraging review of OCC. Tactically and strategically inadequate. OCC and recertification both need to be done away with by immediate action of the AOA leadership.

OCC and the manner in which came into being is a symptom of a larger problem (more to follow).

There are virtually no data that compare lifetime with time-limited diplomates; I have found two such studies. Neither involved a large sample space, and both demonstrated similar results: though the marker of quality was different between the two studies, there were no differences between lifetime and time-limited certification holders. Continue reading

Anti-Trust Class Action Filed Against AOA by Osteopathic Physicians

Update: For more details and contact info related to this ground-breaking suit:
http://www.duanemorris.com/site/osteopathclassaction.html

anit-oocA group of the nation’s osteopathic doctors – including IP4PI founder, Craig M Wax, DO, along with Albert A. Talone, DO,  Richard Renza, DO, and Roy Stoller, DO – filed suit against the American Osteopathic Association (AOA) to recover millions of dollars in annual membership fees that the doctors have been forced to pay for years to the organization. The money is paid as a condition of obtaining and maintaining physicians’ board certification in any advanced medical specialty. The physicians—who have filed the suit as a class action—contend that the requirement that they purchase memberships is illegal, has no reasonable connection to the advanced certification and violates the antitrust laws.

Class-action lawsuit filed against American Osteopathic Association over membership fees Philadelphia Business Journal, August 2, 2016
Doctors of Osteopathic Medicine in Certification Dispute Philadelphia Inquirer, August 2, 2016

Duane Morris Press Release: Osteopathic Physicians Sue to Recover Millions of Dollars in Membership Fees Paid to the AOA to Maintain Their Board Certifications

Class Action Complaint: Filed on August 1, 2016 in the U.S. District Court for the District of New Jersey