I saw this article about employee wellness programs and I was struck by the analogy I could draw to Maintenance of Certification (MOC) programs:
So I wrote the piece below which I think draws attention to the major similarity between the two issues, which involves the simple rule that coercion elicits reactive pushback. I also think it would be instructive for readers to have a look at a recent article about the MOC controversy that was recently published just last month and which highlights the major issues nicely.
Compare my post with the Wall Street Journal article on wellness programs. See what you think. I’m not opposed to employee wellness programs by the way. Our hospital’s LiveWell program actually paid for my recent Mindfulness Based Stress Reduction course, which I still practice.
The American Board of Medical Specialties (ABMS) and other medical specialty boards are trying to figure out how far they can go to keep their doctors competent in their respective fields.
Maintenance of Certification (MOC) programs, designed to motivate physicians to get and maintain competent across defined categories including medical knowledge, patient care, systems-based practice, practice-based improvement, interpersonal skills and communication, and professionalism. Among the goals are improving patient safety and health care quality as well as reducing healthcare costs.
The MOC Physician Quality Reporting System (MOC: PQRS) is a major initiative of the Centers for Medicare and Medicaid Services (CMS) to provide payment incentives for doctors to participate in MOC. Moreover, in 2015 CMS will levy financial penalties to physicians not participating in MOC programs. MOC is increasingly required in order to obtain and keep hospital privileges, to remain on third-party payer panels, and may be required in the future to maintain a medical license in the form of Maintenance of Licensure (MOL).
Despite the lack of concrete, high-level research showing that MOC actually improves patient care outcomes, these “carrot and stick” methods to enforce participation in MOC are being applied due in part to the Affordable Care Act, which mandated the MOC: PQRS. Doctors could be subject to a 2% penalty.
Many physicians find the MOC programs burdensome and one organization, the Association of American Physicians and Surgeons (AAPS), has filed a lawsuit in April of 2013 against the ABMS regarding MOC, citing violation of antitrust laws, claiming it interferes with patient access to physicians who are competent but who choose not to participate in MOC.
ABMS says the lawsuit is without merit but it’s still being pursued by AAPS.
The American Board of Internal Medicine (ABIM) has been under fire from doctors who find the recent changes to MOC to be unacceptably time-consuming and wasteful. ABIM leaders claim they are listening to physicians and are working to make the evolving process less onerous—although they also warn that MOC is not going away.
The Federation of State Medical Boards (FSMB) has been promulgating the MOL, a program which would make it necessary for doctors to prove they are participating in some kind of “continuous professional development (CDP)” program in order to get and maintain medical licensure. While FSMB leaders have claimed that MOC is not necessarily the only required component of a physician’s CPD, most doctors believe otherwise. This has led to many state medical societies adopting resolutions opposing both MOC and MOL, ironically including most of the states which originally made agreements to collaborate with FSMB on implementing MOL.
The low participation rate of these states in pushing the MOL initiative has so far not led to a significant change in the FSMB vision for the process despite the apparent lack of interest in it (as well as vigorous opposition).
Physicians are wary of anything that smacks of coercion or discipline, the latter of which is a function of state medical boards in any case, begging the question of how MOL would protect the public from incompetent physicians since incompetence is a very rare reason for board action. There are petitions with thousands of signatories indicating that the ABIM needs to change its MOC process and pledging noncompliance with it.
On the other side of the equation, despite the lack of research evidence for effectiveness of MOC per se, the ABMS and FSMB continue to promote and endorse enforcement of the controversial process.
The average, rank-and-file physician believes that justification for requiring participation in MOC is lacking and essentially says “We’re just not there yet and given everything that’s going on, I’m not sure it’s a good place to be.”