The Cost of MOC: Reasonable or Rip-Off?
The cost of MOC has been met with anger and resentment. The exam fee is $1365 for internal medicine and between $2200 and $2830 for certain subspecialties, which can be paid in annual installments. However, annual payments may be subject to fee increases, and certification status may change if one falls behind on payments. And the ABIM states that it makes no exceptions to its financial policies, even in extenuating circumstances.
"This is legalized extortion, plain and simple," says Dr. Kempen. "The exorbitant cost of the exams comes off the backs of already financially strapped physicians and lines the pockets of the executives of ABMS and boards, as well as the exam facilities."
He notes that physicians also incur indirect costs, such as paying for tutorials and travel to the exam. And one of the most serious costs is the reduction in patient load necessary to create extra time for MOC requirements.
Some physicians regard these costs as a necessary evil that goes with the territory of being a doctor, like office staff salaries or malpractice insurance. "Everything in medicine is based on risk-benefit analysis, and in this case the benefits outweigh the drawbacks," says Dr. Brown, who is the ACP governor for the Northern Illinois chapter.
Other physicians are furious. "I'm devastated by these new regulations," says Dr. Fein. "I'm in solo practice and can't afford to take time away from my patients or close my practice for weeks of studying or completion of other tasks. I don't know what to do."
Dr. Nora states that t exam costs are "in the ballpark" of "other professions with similar requirements, such as accountants, pilots, or lawyers." She acknowledges that "there are costs involved with quality education and quality assessment," but says they're necessary and "money well spent."
How Optional Is MOC?
Everyone agrees: From a strictly legal point of view, MOC is optional. "The only thing required to practice medicine in this country is a valid license," says Dr. Nora. "Board certification is a choice. And if you're a 'grandparent,' recertification is also a choice."
But "choice" isn't always black and white. MOC is increasingly tied to hospital privileges, reimbursements, and network participation. MOC participation is one way that physicians can meet requirements of the Centers for Medicare & Medicaid Services (CMS) Physician Quality Reporting System (PQRS). And an increasing number of medical associations support MOC, including the American Hospital Association, the American Medical Association, the Joint Commission, and the Federation of State Medical Boards, which is looking at incorporating aspects of MOC into licensing requirements.
Moreover, the push for MOC is being taken directly to patients. The ABIM Website urges patients to ask their physician if they are participating in MOC. "If the answer is no, you may want to encourage them to do so." Patients can also verify that their physician is MOC-compliant.
"Calling this 'voluntary' is a farce," comments Dr. Kempen. "These pressure tactics eliminate a physician's freedom to choose."
"I call this 'regulatory capture' -- when special-interest groups use legislation to force purchase of their products under the guise of betterment of society," Dr. Kempen says. "Physicians are forced to submit to the authority of the boards because legal and governmental entities have been talked into demanding it." He adds, "MOC isn't a response to public demand, as ABMS would have us believe. It's the reverse. ABMS and the boards are pushing the public into demanding MOC."
Medscape Business of Medicine © 2014 WebMD, LLC
Cite this: Do Recertification Demands Waste Doctors' Time and Money? - Medscape - Jun 04, 2014.