CRYING FOUL OVER MAINTENANCE OF CERTIFICATION

CRYING FOUL OVER MAINTENANCE OF CERTIFICATION

At the recent American Academy of Dermatology (AAD) meeting in San Francisco, Maintenance of Certification (MOC) was a hot topic as many attendees wore buttons protesting MOC requirements. According to the AAD website, “Maintenance of Certification (MOC) shifts emphasis away from simply acquiring knowledge to proving competency. In today's world, learning new information alone is no longer enough—you need to demonstrate that you understand how to apply the knowledge and skills in real-world situations… MOC was also adopted as a professional response to the need for public accountability and transparency in health care. By maintaining ever-evolving high standards for performance and quality care, we increase the level of confidence in patients, other health care professionals, employers, insurers, and government representatives have in our ability to deliver the best care possible.”

The website of the American Society of Plastic Surgeons (ASPS) states, “Physicians benefit from participating in MOC^® because they receive focused learning based on individual practice needs, increase efficiency and reduce malpractice premiums. Patients experience fewer medical errors, better communication and quality clinical outcomes when they choose a board certified physician.”

But not all physicians agree with the said benefits of MOC.Modern Aesthetics^® Co-Chief Medical Editor Heidi Waldorf, MD was involved in a grassroots campaign to educate aestheic doctors to fight what she calls the “onerous MOC requirements.”

While medicine has been confronted by increasing hoops through which to jump in every area of business, aesthetic specialties have been protected from many limitations from insurance companies and Medicare reimbursement, explains Dr. Waldorf. “One of the benefits of aesthetic medicine, and one of the reasons that so many untrained, non-core physicians and non physicians flock to it, has been its ability to remain partially shielded because these are non-reimbursable, market-driven luxury items. However, we need to realize that we are not safe behind the fortress walls.”

Prior to 1991, board certification was awarded after completing an accredited residency program and passing an exam—similar to college degree or bar exam for lawyers. Then, a change was made requiring all taking American Board of Medical Specialties board certification tests to retake the test at intervals to be determined. In dermatology, Dr. Waldorf says, it started as a take-home, open book test every 10 years that was then changed to closed book exam taken at national testing center. Then requirements increased further with the addition of patient safety, peer review, and patient survey modules, among others. All of these requirements are burdensome in time and money, she says, adding that at the AAD meeting, the MOC courses took doctors away from therapeutic courses.

She also notes there is no evidence of any improvement in medical care as a result of MOC, and aesthetic specialties are not the only ones protesting MOC. For example, the American Board of Internal Medicine was sued by its constituents and put new MOC requirements on hold. Meanwhile, an alternate board was created, Dr. Waldorf says, adding that a proliferation of alternative boards will dilute the meaning of ‘true' board certification.

Dr. Waldorf says all doctors should care about this issue, noting that board certification already indicates that a physician has completed a residency and is specialized, and continuing medical education requirements continue that. In the aesthetic specialties, Dr. Waldorf explains, if the boards force physicians to leave the boards or say that physician specialists are no longer maintaining certification appropriately to be called board-certified, it will be difficult to separate true board-certified specialists from non-core physicians.

“The snowball is already rolling down the hill,” says Dr. Waldorf. “We need to slow its momentum now or never.”

For more, visit MATV to hear Dr. Waldorf discuss MOC in the most recent episode of Heideas.

THE PLAYING FIELD: INDUSTRY UPDATE

At this year's Maui Dermatology 2015 meeting, three CEOs from dermatological and aesthetic companies took part in a “Leaders in Industry” session. Allergan CEO David Pyott, Merz President and CEO Bill Humphries, and Elliott Milstein, the president and CEO of Michigan-based Biopelle, participated in an interactive Q&A with George Martin, MD, the event organizer and session moderator.

Introducing himself and discussing his company, Mr. Pyott offered a recap of what had transpired for Allergan over the past year—namely the back-and-forth drama of several bids and legal drama for his company, ultimately ending with an acquisition by Activis.

Actavis' $66 billion purchase of Allergan in November was the largest acquisition in any industry in the world in 2014. Mr. Pyott provided a brief look at how the merger would impact the two companies' reach in the industry through a series of PowerPoint slides.

“This is going to be a very large company,” he said of the combined company that will span more than 100 countries. He emphasized a strong stance that the company would remain committed to dermatology.

Mr. Humphries and Mr. Milstein also introduced their respective companies.

Dr. Martin posed several questions—which had been submitted by the audience—to the three executives. The first question he asked was: “What are the odds that the US will have a single-payer system in five to 10 years? Please support your answer.” The consensus of the group was that this is not likely thanks to political forces and special interests.

“Close to zero,” Mr. Pyott said. “Why do I say that? I think because Americans really do not lack choice.”

“I don't see anything like that coming,” Mr. Milstein added. The next question revolved around how to balance increasing revenue in the face of decreasing reimbursements.

Mr. Humphries said the addition of more physician assistants and nurse practitioners could help increase the bottom line because “it helps the office work harder.” He added, “The faster you can help move people through the waiting rooms the better.”

Mr. Pyott agreed. “You need to find partners,” he said. “You take on an NP or PA. It's how you get greater scale to afford the infrastructure that's required today.”

The question bounced back and forth amongst the trio. “Continuity,” Mr. Humphries said. “Rescheduling like the dentist.”

“Hyper specializing,” Mr. Milstein added. “There's an enormous opportunity there for anybody.”

“Make a name for yourself in one area,” Mr. Pyott said.

—Peter Beisser, Contributing Editor

PHYSICIANS DISAPPOINTED BY SENATE'S FAILURE TO CONSIDER SGR REPEAL

The American Medical Association released a statement about its disappointment that the US Senate did not vote on the Medicare and CHIP Reauthorization Act (MACRA) before leaving for recess in late March. This failure to vote leaves physicians facing a 21 percent cut in Medicare reimbursements as of March 31 when the Sustainable Growth Rate (SGR) payment patch expires.

“The bill, which was overwhelmingly passed by the U.S. House of Representatives, eliminates the flawed SGR formula that all agree was a bad idea in the first place and advances innovative delivery and payment models that will help improve care quality, health outcomes and lower costs.

The policy also assures access to care for children, low income individuals and families by extending funds for the Children's Health Insurance Program and community health centers,” said Robert M. Wah, MD, President, American Medical Association, in a statement, which also urged the Senate to address this situation immediately upon their return from recess.

In a statement from the American Academy of Dermatology, President Mark G. Lebwohl, MD, FAAD also stated disappointment and went on to say, “The draconian level cuts to reimbursement will undoubtedly stifle innovation for new payment models, close or consolidate physician practices, and severely hinder patient access to care. As our nation's population ages, and seniors seek more specialized care, this is a risk dermatologists are not willing to take. We call on the Senate to immediately pass permanent SGR repeal when they return from recess. The status quo is unacceptable.”