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  • ENT Doc
    replied
















    Maintenance of Certification: The Texas Senate Thursday unanimously approved a bill that would prohibit hospitals and health insurance companies from discriminating against physicians based solely on their maintenance of certification (MOC) status. Senate Bill 1148 by Sen. Dawn Buckingham, MD (R-Lakeway), is a TMA priority. It also would prohibit the Texas Medical Board from requiring MOC for physicians to obtain or renew a medical license. Specifically, the bill states, “A physician is considered a board-certified medical specialist in this state if the physician receives initial certification, regardless of the physician’s maintenance of certification.”

     

    Your state medical association can help with this….
    Click to expand…


    The problem with these bills, and Oklahoma had one fairly similar, is that it does nothing.  No state requires that a physician be board certified, so saying that they don’t require or can’t discriminate based on MOC is meaningless.  A hospital and insurer can still discriminate and not credential based on board certification based on this bill, no?  Any law that has teeth on this matter needs to specifically state that hospitals and health insurers are forbidden to ask about board certification and require it for credentialing purposes.

    As for the intentions of MOC, maybe they weren’t so pure after all.  I can only speak to what our board members have told us – that it was done out of fear that the government would apply standards to us if we didn’t ourselves in wake of the To Err Is Human report.  Turns out the government has a pesky way of applying standards regardless (MACRA, Obamacare, etc.), making this argument moot – especially in light of there being no evidence to support it as an independent marker of quality.
    Click to expand…


    See the bolded section – it very specifically states that hospitals and insurance companies cannot discriminate based on MOC status.
    Click to expand…


    Yes, but if you don’t do MOC you don’t get to keep your board certification.  That is a board-specific decision.  From the hospital’s perspective, they can say “well, we don’t care about MOC, but you don’t have your board certification any more so see ya’”.  Would you honestly risk this if you were a physician in Texas?  I wouldn’t change a thing until the law specifically stated that they cannot discriminate or even inquire (as this induces all sorts of bias that can’t be proved/disproved) about BOARD CERTIFICATION.
    Click to expand…


    Read the post – it says that in the State of Texas, you are considered to be Board Certified if you pass your initial certification, regardless of MOC status. I thing they were very clear on the purpose of this bill and on its wording.

     
    Click to expand...


    Interesting.  Doesn't look like it passed but I'll be curious to see how this plays out in reality.  This is going to be a bit of a mess though.  Not that patients often look this stuff up, but if they look to your ABMS board and search for board certified physicians in the area your name won't pop up.  But you'll advertise that you're board certified because the state views you as such.  Could be a problem for moving out of state to practice.  But for those knowing that they are going to stay in TX, this does look promising.  Thanks for sharing.

    Leave a comment:


  • blowhard
    replied













    Maintenance of Certification: The Texas Senate Thursday unanimously approved a bill that would prohibit hospitals and health insurance companies from discriminating against physicians based solely on their maintenance of certification (MOC) status. Senate Bill 1148 by Sen. Dawn Buckingham, MD (R-Lakeway), is a TMA priority. It also would prohibit the Texas Medical Board from requiring MOC for physicians to obtain or renew a medical license. Specifically, the bill states, “A physician is considered a board-certified medical specialist in this state if the physician receives initial certification, regardless of the physician’s maintenance of certification.”

     

    Your state medical association can help with this….
    Click to expand…


    The problem with these bills, and Oklahoma had one fairly similar, is that it does nothing.  No state requires that a physician be board certified, so saying that they don’t require or can’t discriminate based on MOC is meaningless.  A hospital and insurer can still discriminate and not credential based on board certification based on this bill, no?  Any law that has teeth on this matter needs to specifically state that hospitals and health insurers are forbidden to ask about board certification and require it for credentialing purposes.

    As for the intentions of MOC, maybe they weren’t so pure after all.  I can only speak to what our board members have told us – that it was done out of fear that the government would apply standards to us if we didn’t ourselves in wake of the To Err Is Human report.  Turns out the government has a pesky way of applying standards regardless (MACRA, Obamacare, etc.), making this argument moot – especially in light of there being no evidence to support it as an independent marker of quality.
    Click to expand…


    See the bolded section – it very specifically states that hospitals and insurance companies cannot discriminate based on MOC status.
    Click to expand…


    Yes, but if you don’t do MOC you don’t get to keep your board certification.  That is a board-specific decision.  From the hospital’s perspective, they can say “well, we don’t care about MOC, but you don’t have your board certification any more so see ya'”.  Would you honestly risk this if you were a physician in Texas?  I wouldn’t change a thing until the law specifically stated that they cannot discriminate or even inquire (as this induces all sorts of bias that can’t be proved/disproved) about BOARD CERTIFICATION.
    Click to expand...


    Read the post - it says that in the State of Texas, you are considered to be Board Certified if you pass your initial certification, regardless of MOC status. I thing they were very clear on the purpose of this bill and on its wording.

     

    Leave a comment:


  • ENT Doc
    replied










    Maintenance of Certification: The Texas Senate Thursday unanimously approved a bill that would prohibit hospitals and health insurance companies from discriminating against physicians based solely on their maintenance of certification (MOC) status. Senate Bill 1148 by Sen. Dawn Buckingham, MD (R-Lakeway), is a TMA priority. It also would prohibit the Texas Medical Board from requiring MOC for physicians to obtain or renew a medical license. Specifically, the bill states, “A physician is considered a board-certified medical specialist in this state if the physician receives initial certification, regardless of the physician’s maintenance of certification.”

     

    Your state medical association can help with this….
    Click to expand…


    The problem with these bills, and Oklahoma had one fairly similar, is that it does nothing.  No state requires that a physician be board certified, so saying that they don’t require or can’t discriminate based on MOC is meaningless.  A hospital and insurer can still discriminate and not credential based on board certification based on this bill, no?  Any law that has teeth on this matter needs to specifically state that hospitals and health insurers are forbidden to ask about board certification and require it for credentialing purposes.

    As for the intentions of MOC, maybe they weren’t so pure after all.  I can only speak to what our board members have told us – that it was done out of fear that the government would apply standards to us if we didn’t ourselves in wake of the To Err Is Human report.  Turns out the government has a pesky way of applying standards regardless (MACRA, Obamacare, etc.), making this argument moot – especially in light of there being no evidence to support it as an independent marker of quality.
    Click to expand…


    See the bolded section – it very specifically states that hospitals and insurance companies cannot discriminate based on MOC status.
    Click to expand...


    Yes, but if you don't do MOC you don't get to keep your board certification.  That is a board-specific decision.  From the hospital's perspective, they can say "well, we don't care about MOC, but you don't have your board certification any more so see ya'".  Would you honestly risk this if you were a physician in Texas?  I wouldn't change a thing until the law specifically stated that they cannot discriminate or even inquire (as this induces all sorts of bias that can't be proved/disproved) about BOARD CERTIFICATION.

    Leave a comment:


  • Zaphod
    replied







    Maintenance of Certification: The Texas Senate Thursday unanimously approved a bill that would prohibit hospitals and health insurance companies from discriminating against physicians based solely on their maintenance of certification (MOC) status. Senate Bill 1148 by Sen. Dawn Buckingham, MD (R-Lakeway), is a TMA priority. It also would prohibit the Texas Medical Board from requiring MOC for physicians to obtain or renew a medical license. Specifically, the bill states, “A physician is considered a board-certified medical specialist in this state if the physician receives initial certification, regardless of the physician’s maintenance of certification.”

     

    Your state medical association can help with this….
    Click to expand…


    The problem with these bills, and Oklahoma had one fairly similar, is that it does nothing.  No state requires that a physician be board certified, so saying that they don’t require or can’t discriminate based on MOC is meaningless.  A hospital and insurer can still discriminate and not credential based on board certification based on this bill, no?  Any law that has teeth on this matter needs to specifically state that hospitals and health insurers are forbidden to ask about board certification and require it for credentialing purposes.

    As for the intentions of MOC, maybe they weren’t so pure after all.  I can only speak to what our board members have told us – that it was done out of fear that the government would apply standards to us if we didn’t ourselves in wake of the To Err Is Human report.  Turns out the government has a pesky way of applying standards regardless (MACRA, Obamacare, etc.), making this argument moot – especially in light of there being no evidence to support it as an independent marker of quality.
    Click to expand...


    Exactly. They were going to prevent nothing, the government will do whatever it wants anyway in accordance with the prevailing sentiment/money.

    Leave a comment:


  • blowhard
    replied







    Maintenance of Certification: The Texas Senate Thursday unanimously approved a bill that would prohibit hospitals and health insurance companies from discriminating against physicians based solely on their maintenance of certification (MOC) status. Senate Bill 1148 by Sen. Dawn Buckingham, MD (R-Lakeway), is a TMA priority. It also would prohibit the Texas Medical Board from requiring MOC for physicians to obtain or renew a medical license. Specifically, the bill states, “A physician is considered a board-certified medical specialist in this state if the physician receives initial certification, regardless of the physician’s maintenance of certification.”

     

    Your state medical association can help with this….
    Click to expand…


    The problem with these bills, and Oklahoma had one fairly similar, is that it does nothing.  No state requires that a physician be board certified, so saying that they don’t require or can’t discriminate based on MOC is meaningless.  A hospital and insurer can still discriminate and not credential based on board certification based on this bill, no?  Any law that has teeth on this matter needs to specifically state that hospitals and health insurers are forbidden to ask about board certification and require it for credentialing purposes.

    As for the intentions of MOC, maybe they weren’t so pure after all.  I can only speak to what our board members have told us – that it was done out of fear that the government would apply standards to us if we didn’t ourselves in wake of the To Err Is Human report.  Turns out the government has a pesky way of applying standards regardless (MACRA, Obamacare, etc.), making this argument moot – especially in light of there being no evidence to support it as an independent marker of quality.
    Click to expand...


    See the bolded section - it very specifically states that hospitals and insurance companies cannot discriminate based on MOC status.

    Leave a comment:


  • ENT Doc
    replied




    Maintenance of Certification: The Texas Senate Thursday unanimously approved a bill that would prohibit hospitals and health insurance companies from discriminating against physicians based solely on their maintenance of certification (MOC) status. Senate Bill 1148 by Sen. Dawn Buckingham, MD (R-Lakeway), is a TMA priority. It also would prohibit the Texas Medical Board from requiring MOC for physicians to obtain or renew a medical license. Specifically, the bill states, “A physician is considered a board-certified medical specialist in this state if the physician receives initial certification, regardless of the physician’s maintenance of certification.”

     

    Your state medical association can help with this….
    Click to expand...


    The problem with these bills, and Oklahoma had one fairly similar, is that it does nothing.  No state requires that a physician be board certified, so saying that they don't require or can't discriminate based on MOC is meaningless.  A hospital and insurer can still discriminate and not credential based on board certification based on this bill, no?  Any law that has teeth on this matter needs to specifically state that hospitals and health insurers are forbidden to ask about board certification and require it for credentialing purposes.

    As for the intentions of MOC, maybe they weren't so pure after all.  I can only speak to what our board members have told us - that it was done out of fear that the government would apply standards to us if we didn't ourselves in wake of the To Err Is Human report.  Turns out the government has a pesky way of applying standards regardless (MACRA, Obamacare, etc.), making this argument moot - especially in light of there being no evidence to support it as an independent marker of quality.

    Leave a comment:


  • Zaphod
    replied
    It would be great if they got rid of the board as well, I'll repeat myself here, but doing away with moc is treating the symptom, the disease is the board. What value or good do they actually provide? What makes them necessary outside of everything else we do?

    They appear to be rent seeking and benefiting off of inertia only.

    Leave a comment:


  • blowhard
    replied
    Maintenance of Certification: The Texas Senate Thursday unanimously approved a bill that would prohibit hospitals and health insurance companies from discriminating against physicians based solely on their maintenance of certification (MOC) status. Senate Bill 1148 by Sen. Dawn Buckingham, MD (R-Lakeway), is a TMA priority. It also would prohibit the Texas Medical Board from requiring MOC for physicians to obtain or renew a medical license. Specifically, the bill states, “A physician is considered a board-certified medical specialist in this state if the physician receives initial certification, regardless of the physician’s maintenance of certification.”

     

    Your state medical association can help with this....

    Leave a comment:


  • PhysicianOnFIRE
    replied


    As for the legitimacy of MOC, it has good intentions.
    Click to expand...


    Does it? Maybe it started out that way, but I'm not sure about the intentions.

    From Dr. Wes' Dear Legislator post:

    "The ABMS MOC program grew from a financial need of the ABMS and their 24 member boards, especially the American Board of Internal Medicine (ABIM) which "certifies" one quarter of all US physicians. The ABIM is currently $50.6 million dollars in debt (according to its most recently-available 2015 public tax returns) while their executives earn three- or four-times the salaries of the average working physician, enjoy complementary spousal air travel, and purchase luxury condominiums complete with chauffeur-driven town cars for themselves - all at working physicians' expense. They then sell our testing information for profit to ABMS Solutions, a for-profit corporation based in Georgia.

    The ABMS and their lobbyists say that a computerized test or a continuous question-and-answer barrage fed to our cell phones or laptop computers is superior to direct patient care experience for maintaining our competency to practice. I would hope you can see through their propaganda.

    Finally, the ABIM and the ABMS have been involved with highly irregular financial dealings, including falsifying tax forms and transferring many of our testing fees to the ABIM Foundation in the Cayman Islands. They also perform "research" on physicians and their practices without informed consent or Institutional Review Board oversight - potentially in violation of federal law."

    Leave a comment:


  • Kamban
    replied


    Believe this is the alternative which is much cheaper and less time. https://nbpas.org/
    Click to expand...


    Both the hospitals here have refused to recognize NBPAS as an alternative to ABMS

     


    My wife just had to take the IM board (reboard) this year so she missed out in the rule changes which start next year . Adding to the pain she’s got two more coming up in her specialty which likely isn’t changing from the 10yr format soon .
    Click to expand...


    I  too had to take IM and 2 specialty exams and decided I did not want to prolong it into a multiyear misery. So one fine October I decided to take all the 3 exams in one go, results be dammed. If I am going to waste my leisure time, family time and time with patients, let it be done and over with in six months of intense preparation. Luckily I cleared all three and it was my final hurrah. I do not plan to take it any more.

    Leave a comment:


  • PenguinMD
    replied
    Believe this is the alternative which is much cheaper and less time.

    https://nbpas.org/

    Like someone said ABMS has been forced to make changes in response.

    Board certified is required by the hospitals (at least around here) but the good news is more and more hospitals are now recognizing the alternative board (nbpas) so you should push the hospital administrators about it.

    My wife just had to take the IM board (reboard) this year so she missed out in the rule changes which start next year . Adding to the pain she's got two more coming up in her speciality which likely isn't changing from the 10yr format soon .

    Makes you wonder, with all the time required to study, who has time to care for paitence!?

    Leave a comment:


  • Zaphod
    replied







    I was recently deposed and they didnt even ask, and Im not and dont care to be. However, its a bit of a totally ridiculous case and the plaintiffs firm sent their most inexperienced person, likely due to not wanting to spend too much on it.

    I can see them trying to attack on that level, but what can truly come of it? They are the first to say its voluntary and no legal protections exist when asked about it specifically (contrary to all their other talk). You either met the standard of care or didnt. It may be slightly uncomfortable, but really how bad could it be, its a meaningless stamp that has zero weight on anything else. Even having just been deposed and possibly going to trial, this is one of the least annoying aspects of the case.

    No one understands, cares, etc…in fact the 2 or 3 that have known to ask have turned out to be terrible pts that I wanted nothing to do with. Its pretty hilarious and simultaneously sad when they ask, and have zero frame of reference or context for which to apply the answer. This is true of all the “q’s to ask your doctor”. The knowledge asymmetry makes it a non starter, similar to consent and letting pts participate in their care, etc…How many times have you let a pt “participate” by choosing a terrible or deadly/dangerous option? Ah, zero? But you let them choose when the two choices are equivalent or dont matter, well thats just patronizing and it surely isnt being a partner in their care. Cant stand that illogical stuff, and so sad to see many docs buying into it.
    Click to expand…


    Like most of this, but I would disagree slightly regarding participating in care.  This is, in my opinion, one of the best ways to control the act of filing a claim.  The decision to file a claim is very much an emotional one that often bears no resemblance to the ideals of tort law.  Given that the patient owns their own life and quality of life, ethically they own the decision rights to them.  When the patient is sitting there post-op with some complication the last thing you want is for them to think that you were the one who made the decision for them.  All sorts of biases fight you here – outcome bias namely – but one particular bias can come to your aid – choice-supportive bias.  If the patient feels like and remembers that they were the one to make the decision to embark on surgery they will be less inclined to be dismayed over the outcome (or will be more pleased with a good result).  I don’t use the consent to check some box.  I use it as a process (sometimes over a few visits) to make sure the patient/parent knows they are the one making the decision.  I never give advice when they ask “what would you do?”  Some leave uncomfortable with being forced to make that decision.  But they almost always come back – with a more firm commitment.  And that’s the person I want on my operating table.
    Click to expand...


    Thats the same way I handle it, if they ask me what they need, I say point blank nothing and I have zero opinion. This is up to you and entirely elective. I dont think it changes if they sue or not at all, people that feel entitled or they can just will. Ymmv depending on the litigious nature of your region and general intelligence level of your patient population. People sue for the dumbest of reasons, and personal responsibility is the last thing that could be counted on for protection at all. If that were the case consents and the like should have a much better effect than they have shown.

    I am just discussing in general like you read about the posts on KevinMD, not the savvy way you describe. We say those things when they are basically equivocal treatments. Even when a patient feels like they made a decision and it was theirs quite often it was framed that way, it isnt truly. Nor should it be unless they have equal understanding as you do, and they dont.

    For example, if you offer a pt standard of care treatment and best tech, yet they said they desired a blood letting because they read about it on a facebook post or something, you wouldnt allow it, its a crazy idea. They can be somewhat participatory in their care, but it is extremely limited as to the extent of their knowledge and experience, which is usually too limited to be taken seriously. If you think about these things honestly you'll understand, its simply fashionable to say otherwise. I mean I dont know if any other physician in my field is actually talented or good unless I spend time shadowing them through all phases of patient care.

    Leave a comment:


  • Kamban
    replied


    I sit on a committee that looks at malpractice cases. We input whether to defend or settle. I am surprised at how often hospitalists get sued so yes it might increase your liability. If you were not boarded a plaintiff attorney would pounce on that fact.
    Click to expand...


    I have been an expert witness in a few cases where one of my patient brings a claim against his employer - Usually Walmart or one of the big box stores. In all instances they start out with my education, the countries I had my education and training, what MRCP means etc. Invariably it ends with "Are you board certified?". The period of time I choose to not take the exams but had done the required booklet Q & A, they invariably asked why and when I plan to take it. I am sure that should I have been a defendant, I might have been more uncomfortable with their grilling.

    Leave a comment:


  • Kamban
    replied
    One of the two hospital systems I hold privileges in has grandfathered physicians who had privileges before 2006 if they were previously board certified or eligible. But the catch was that should you be grandfathered but attempt to take the exam and fail, you come under the new rules and have to be board certified or else lose the privileges.

    The other hospital amended the bye-laws to require all physicians be board certified by the time their reappointment came up. Otherwise they risked losing their privileges. So in order to keep the privileges in one hospital I risked losing the grandfathered status in the other hospital should things go horribly wrong in the exams.

     

    Leave a comment:


  • Kamban
    replied
    Many hospitals and large groups like to advertise on radio or in print " All our physicians are Board certified." as a selling point.  So if you want to be a part of that group or have privileges in that hospital, you need to be board certified. Otherwise they will kick you out or not renew the privileges when they come up for reapplication every 2 years.

    Leave a comment:

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