Life Science Compliance Update

April 17, 2015

MOC Controversy Continues, As Newsweek Unveils ABIM’s Troubled Financials


Newsweek writer Kurt Eichenwald last month wrote an op-ed entitled “The Ugly Civil War in American Medicine,” in which the author derided the American Board of Internal Medicine’s (ABIM) certification process for doctors. The author accused the ABIM of requiring unnecessary testing requirements “to fatten the board’s bloated coffers.” The ABIM quickly fired back that the Newsweek article contained "numerous and serious misstatements, selective omissions, inaccurate information and erroneous reporting.” They also accused Eichenwald of being biased because his wife was an internist, and condemned Newsweek for posting the article.

This did not sit well with Eichenwald, who recently wrote another article, this time with the help of an accountant, that contended ABIM has used physician certification fees, paid up front, to fund “the massive losses from the program itself.” The article states that “ABIM and the ABIM Foundation lost $39.8 million on program services in the five years ending in 2013—a nonprofit indeed. Yet during that same time, the organizations paid $125.7 million to its senior officers and staff.” 

ABIM also faced  scrutiny regarding their purchase of a $2.3 million luxury Philadelphia condo . 

Eichenwald concludes that the ABIM is a “financial corpse.” This realization explains ABIM’s attempt to increase re-certification rates last year (which ABIM has since taken back):

ABIM’s announcement in January 2014 that it was changing the MOC process into something so onerous and expensive that it set off a doctor rebellion… had nothing to do with improving medical education. It was all about trying to fix the fiscal mess at ABIM by compelling doctors to deliver more cash faster.

Rather than a 10-year program, the January 2014 plan declared that MOC would be ongoing, with doctors required to complete new requirements every two, five and 10 years. Doctors could pay their new fees annually, and ABIM would recognize the money as revenue when it was paid. Money from doctors who prepaid would be counted as revenue evenly, year after year. In other words, if a physician prepaid for 10 years, rather than booking revenue when ABIM provided the certification services, the group would count one tenth of the payment each year.

Had ABIM not been forced to back down on this idea, it was an approach that might have cleaned up the disaster caused by ABIM’s accounting practices—that is, if the group can accomplish that without first falling into bankruptcy. Not even the most secretive organization can keep piling up losses forever while carrying negative asset values on its books. Of course, no one will know what accounting changes ABIM is using to get out of its self-created crisis until next year, when it files its new audited financials, or whether it will continue to rely on deferred revenue.

"But there are bigger questions ABIM and [the American Board of Specialty Medicine] have to consider," according to Eichenwald. "Why should doctors be forced to keep ladling out cash and spending time away from their practices studying useless information simply because the ABIM is managerially incompetent? And when will ABIM finally start telling the truth to the doctors it supposedly represents?"

The initial Newsweek story put the spotlight on Dr Paul Teirstein, "a nationally prominent physician who is chief of cardiology at Scripps Clinic and who is now leading the doctor revolt." Teirstein has organized the National Board of Physicians and Surgeons, an alternative to the MOC. Dr. Teirstein states: “We don’t want to do meaningless work and we don’t want to pay fees that are unreasonable and we don’t want to line the pockets of administrators."

Teirstein recently was interviewed by Health Leaders Media in an article entitled "The Doc Behind the Mutiny Against the MOC."

His major problem has to do with the wasted time he believes physicians spend on MOC. "I see a barrage of questions I don't need to learn. But I have to take a course to answer them because the [required] answer is a way I would never treat my patients," he states. "A lot of the questions are based on outdated material. One example, from a fellow who took the test in June, asked about anti-platelet 2B3 inhibitors, which we hardly use anymore; they don't have the benefit doctors thought they did 10 years ago."

The article also addresses continuing medical education (CME):

Q: You've said current continuing medical education credit requirements are sufficient for board certification. I'd heard concerns that CME was getting too easy.

Teirstein: It's the opposite. CME is more difficult and is taken more seriously. You can't have industry-directing talks. You have to fill out evaluation forms or you don't get CME credit. You have to do a gap analysis to determine the need for what is taught, and you have to have all conflict of interests disclosed. The only thing that's a valid criticism—not substantial, though—is that we don't take attendance and we don't measure that you're actually paying attention during the CME conference. You could just tune out and do e-mail for an hour and get credit.

At some point you have to trust doctors are doing the things they say. We're not dealing with criminals here.





February 09, 2015

Maintenance of Certification: ABIM Announces Immediate Changes to MOC Program


In a surprise move, the American Board of Internal Medicine (ABIM) suspended aspects of its maintenance-of-certification program and apologized after many internists and medical specialty societies raised concerns that it was a waste of time and money.

ABIM President and CEO Richard J. Baron, MD, reached out to open a conversation on how to improve MOC. He stated:

A year ago, ABIM changed its once-every-10-years Maintenance of Certification (MOC) program to a more continuous one. This change generated legitimate criticism among internists and medical specialty societies. Some believe ABIM has turned a deaf ear to practicing physicians and has not adequately developed a relevant, meaningful program for them as they strive to keep up to date in their fields.

ABIM is listening and wants to be responsive to your concerns. While ABIM's Board believes that a more-continuous certification helps all of us keep up with the rapidly changing nature of modern medical practice, it is clear that parts of the new program are not meeting the needs of physicians like yourself.

We got it wrong and sincerely apologize. We are sorry.

We wrote last year that thousands of internists had signed a petition to recall the ABIM’s new changes to its MOC requirements. Furthermore, doctors had become frustrated that despite questionable evidence linking MOC to patient protection, participation in MOC is increasingly becoming mandatory for doctors across the country.

ABIM is taking the following steps to improve its processes:

  • Effective immediately, ABIM is suspending the Practice Assessment, Patient Voice and Patient Safety requirements for at least two years. This means that no internist will have his or her certification status changed for not having completed activities in these areas for at least the next two years. Diplomates who are currently not certified but who have satisfied all requirements for Maintenance of Certification except for the Practice Assessment requirement will be issued a new certificate this year.
  • Within the next six months, ABIM will change the language used to publicly report a diplomate's MOC status on its website from “meeting MOC requirements” to “participating in MOC.”
  • ABIM is updating the Internal Medicine MOC exam. The update will focus on making the exam more reflective of what physicians in practice are doing, with any changes to be incorporated beginning fall 2015, with more subspecialties to follow.
  • MOC enrollment fees will remain at or below the 2014 levels through at least 2017.
  • By the end of 2015, ABIM will assure new and more flexible ways for internists to demonstrate self-assessment of medical knowledge by recognizing most forms of ACCME-approved Continuing Medical Education. "We are absolutely interested in finding ways to recognize meaningful clinical work that you do in your practices to earn CME points," states the ABIM, "and we're particularly interested in recognizing CME activities for which there is evidence that they drive learning and/or change practice."

The AMA said in a statement that they was “delighted” that the board was listening to physician concerns and that the ABIM would align the MOC program with policies discussed during the 2014 AMA Interim Meeting in Dallas. There, the AMA House of Delegates voted to update the AMA’s policy on MOC. Their adopted policy outlines principles that emphasize the need for an evidence-based process that is evaluated regularly to ensure physician needs are being met and activities are relevant to clinical practice.

The Alliance for Continuing Education in the Health Profession (ACEP) lauded the move and commented that "o
f particular relevance to our education community, the ABIM will start recognizing most forms of ACCME-approved CME as a way for internists to demonstrate self-assessment of medical knowledge. This significantly expands the relevance of CME to Board certification as up until now, the ABIM had been awarding MOC points for select "ABIM-approved" CME. Going forward, ABIM will not be doing any independent review and will greatly increase the types of CME activities that can be applied to MOC."

View the full statement from ABIM



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