MOCA Required for JPP/Military MD by 2015?

[BLADEMDA]

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Another possible income opportunity: the PQRI bonus for MOCA participation
We have received some reader questions about qualifying for the additional 0.5% PQRI bonus for participating in an approved maintenance of certification program. A bullet point in the July 6th Alert mentioned the bonus, which CMS discussed at length in the proposed Medicare Fee Schedule Rule for 2011. This is one of the many innovations of the Patient Protection and Affordable Care Act that we will feature in upcoming ABC Alerts.
The basic principle is that under the PQRI, an additional bonus payment of 0.5% per year, beginning in 2011, is available to physicians who:

1. Participate in a maintenance of certification (MOC) program required for board certification by a recognized physician specialty organization for at least one year,
2. Complete a MOC practice assessment, and
3. Otherwise report PQRI measures successfully.

The American Board of Anesthesiology offers a MOC-Anesthesiology (MOCA) program in which ABA diplomates who obtained time-limited certification in 2000 and subsequent years must participate, and in which diplomates certified before 2000 may participate. MOCA is a ten-year program; boarded anesthesiologists with a time-limited certificate must complete the requirements before their current certification expires in order to maintain their diplomate status.
To qualify MOCA for PQRI purposes, the ABA, like all the certifying organizations, will need to formally nominate the program to CMS by January 31, 2011 and receive CMS approval. As part of the nomination process, CMS has proposed that the ABA will need to include the following in its self-nomination letter:

• The duration and frequency of a cycle;
• The first year of availability of the MOCA practice assessment;
• Data collected under the patient experience of care survey
• Method of monitoring that a diplomate has implemented a quality improvement process for his or her practice; and to
• “Describe the methods, and data used under the [MOCA], and provide a list of all measures used in the [MOCA] for 2010 and to be used for 2011, including the title and descriptions of each measure, the owner of the measure, whether the measure is NQF [National Quality Forum] endorsed, and a link to a website containing the detailed specifications of the measures, or an electronic file containing the detailed specifications of the measures.”

MOCA consists of four elements that are fully described on the ABA website and that need only be listed here:

1. Professional Standing Assessment
2. Lifelong Learning and Self-Assessment
3. Cognitive Expertise Assessment, and
4. Practice Performance Assessment.

These elements include the critical practice assessment and quality improvement, but nothing on the ABA website points to any patient-experience survey or to specific performance measures such as the PQRI measures endorsed by the NQF. We anticipate, however, that the ABA will likely obtain the requisite approval for MOCA based on two factors: (a) the PQRI requirements are subject to public comment and refinement before they are finalized, and anesthesiology leadership is probably going to weigh in so that MOCA will qualify, and (b) the ABA may well already be preparing to survey patient experience as well as to capture performance measurement data. (Whether the ABA itself opts to create a registry through which anesthesiologists can submit their PQRI information to CMS instead of including PQRI codes on every Medicare claim remains to be seen, given the progress in that direction of the Anesthesia Quality Institute organized under the ASA.)
Assuming that MOCA seeks and receives CMS approval, the ABA will additionally have to provide CMS, by March 31, 2012, with the names and NPIs of each anesthesiologist who would like to participate and receive the 2011 bonus, and attest that s/he has met the individual PQRI-MOC requirements.
The PQRI-MOC requirements for individual ABA-certified anesthesiologists are:

1. Successfully participate in a qualified MOC practice assessment “more frequently than in necessary to maintain board certification.” That means that if the anesthesiologist has not had to do a practice assessment for the MOCA previously, s/he will have to do one in 2011. If that anesthesiologist has already done the practice assessment during his or her certification cycle, s/he will have to do another one in 2011 to meet the “more frequently” standard, and
2. Successfully participate in the MOCA for 2011.

Thus the MOCA program’s qualifying is not automatic, and no physicians will be eligible for the 0.5% bonus merely because they are maintaining their certification through their specialty board. If the ABA’s MOCA is approved after it self-nominates, every anesthesiologist hoping to earn the bonus will need to do the practice assessment in 2011. Even a diplomate whose board certification is not time-limited, or one who must be recertified or is first certified in 2010, will need to complete the practice assessment – and will also need to report the regular PQRI measures successfully over the full 12 months of the calendar year. It is important to remember that underlying condition, and also to note that the MOCA bonus incentive will only be available for the years 2011-2014.
Some of these details are subject to change because CMS has just published the proposed rule for public comment. The central role of the MOCA itself and the “more frequently” requirement are in the statute so those will still be there after CMS finalizes the regulations, but the details of reporting on patient experience and each MOC program’s own performance measures will not be finalized until November at the earliest. The only action we recommend that you take now is to avoid banking on the MOCA payment while watching for further developments on earning that 0.5 percent bonus.

 

[BLADEMDA]

I envision the day in about 5-7 years when CMS dictates everything we do including our educational standards.

Who is John Galt?

Blade

 

[periopdoc]

CMS-JCAHO-SCIP


Who IS John Galt


- pod

 

[Noyac]

I envision the day in about 5-7 years when CMS dictates everything we do including our educational standards.

Who is John Galt?

Blade

Hopelessness and despair is among us now. 😉

 

[gaspasser2004]

I agree with Blade that government shouldn't dictate how we practice medicine. Obamacare makes me shudder. There is nothing wrong with working at the VA, if that is what you want to do. There is nothing wrong with not wanting to work at the VA either.

However, I don't see a problem with hospitals, insurers, the government, etc. mandating participation in a maintenance of certification program for one's specialty.

Rand Paul (Ron Paul's son), the Republican candidate for the Senate from Kentucky, is an opthamologist who was certified under the American Board of Opthamology. The ABO instituted a maintenance of certification process that grandfathered in older opthamologists (Rand Paul was subject to recertification). On purely idealistic grounds, Rand Paul protested this change not because he didn't want to recertify, but because he thought everyone should have to receritfy. The ABO didn't budge, citing potential legal challenges from the grandfathered opthamologists. Rand Paul resigned his board certification and started his own accrediting organization, the National Board of Opthamology, which has mandatory recertification. Unfortunately, his organization is not recognized by the American Board of Medical Specialties, so the certificate is only worth the paper it is printed on. This whole issue came to the surface when his opponent correctly (at least technically) stated that Dr. Paul wasn't board certified in his specialty.

I understand that people who graduated residency before 2000 were promised board certification in perpetuity. I am not advocating that we take that certification away. I also don't think that medical licensing should be tied to board certification or recertification. What I do think is that institutions, be it hospital credentialing boards, third party payors, medical schools, etc. can demand that their physicians participate in a recertification program. If physicians don't want to participate, they can find another job and/or accept less reimbursement.

Furthermore, I don't know why a board certified anesthesiologist who was still in active clinical practice would not want to maintain the highest level of certification in their field (in this case, MOCA). Is it because of laziness? Is it because they think they know everything and don't need to learn new advances within the field? I personally don't think the requirements of MOCA are particularly oppressive.

 

[BLADEMDA]

I agree with Blade that government shouldn't dictate how we practice medicine. Obamacare makes me shudder. There is nothing wrong with working at the VA, if that is what you want to do. There is nothing wrong with not wanting to work at the VA either.

However, I don't see a problem with hospitals, insurers, the government, etc. mandating participation in a maintenance of certification program for one's specialty.

Rand Paul (Ron Paul's son), the Republican candidate for the Senate from Kentucky, is an opthamologist who was certified under the American Board of Opthamology. The ABO instituted a maintenance of certification process that grandfathered in older opthamologists (Rand Paul was subject to recertification). On purely idealistic grounds, Rand Paul protested this change not because he didn't want to recertify, but because he thought everyone should have to receritfy. The ABO didn't budge, citing potential legal challenges from the grandfathered opthamologists. Rand Paul resigned his board certification and started his own accrediting organization, the National Board of Opthamology, which has mandatory recertification. Unfortunately, his organization is not recognized by the American Board of Medical Specialties, so the certificate is only worth the paper it is printed on. This whole issue came to the surface when his opponent correctly (at least technically) stated that Dr. Paul wasn't board certified in his specialty.

I understand that people who graduated residency before 2000 were promised board certification in perpetuity. I am not advocating that we take that certification away. I also don't think that medical licensing should be tied to board certification or recertification. What I do think is that institutions, be it hospital credentialing boards, third party payors, medical schools, etc. can demand that their physicians participate in a recertification program. If physicians don't want to participate, they can find another job and/or accept less reimbursement.

Furthermore, I don't know why a board certified anesthesiologist who was still in active clinical practice would not want to maintain the highest level of certification in their field (in this case, MOCA). Is it because of laziness? Is it because they think they know everything and don't need to learn new advances within the field? I personally don't think the requirements of MOCA are particularly oppressive.

You are missing the point. I have been practicing longer than Jpp yet have voluntarily recertified. But, the govt. is going to require MOCA for reimbursement (to get 100%) soon. In addition, you must do a practice improvement study in 2011 (regardless if you did one in 2009 or 2010) to qualify. Soon they will add more requirements. Who decides upon these requirements? What is his name? His background? who elected him? How do we talk to him or decide if he even knows what he is doing?

Who is John Galt?

 

[IlDestriero]

I wonder what happens now with the older folks who elected not to recertify with MOCA, and now cannot?

 

[BLADEMDA]

I wonder what happens now with the older folks who elected not to recertify with MOCA, and now cannot?

They are allowed to enter the MOCA pathway anytime. the ABA allows a compressed pathway for older folks to get recertified. It should only take 3 years or so for unlimited certificate holders to sit for the MOCA recertification exam. The ABA allows this fast pathway only ONE time for that select group of people so don't get any ideas.

 

[BLADEMDA]

Question News & Politics

Is British-Style Medical Care Coming To The U.S.? (And Is It Such A Bad Thing?)

by SodaHead Politics Posted 3 hours ago

• 27 answers
• Read all 54 comments
• 
  
  

Despite gripes from some Republicans about the Obama administration bypassing Congress to install a controversial director of Medicare and Medicaid during the July 4 break, the White House said this weekend that Dr. Donald Berwick has no intention of bringing British-style health care
to the U.S.

According to Fox News, Obama used his recess appointment powers to avoid a congressional hearing and floor vote appointing Berwick to the post of administrator of the Centers for Medicare and Medicaid Services. Republicans had objected to Berwick because of his past comments in favor
of “rationing” health care and his avowed love for Britain’s health care system.

White House senior adviser David Axelrod defended the recess appointment – which President Bush used dozens of times during his administration -- in light of the enactment of the health care overhaul, assuring “Fox News Sunday” that a British-inspired system is not coming and that it had to happen after months of GOP foot-dragging.

 

[BLADEMDA]

Obama's Unconfirmed 'Recess' Appointee to Run Medicare Advocated Rationing, Redistribution of Wealth
Wednesday, July 07, 2010
By Terence P. Jeffrey, Editor-in-Chief

This undated handout provided by Goodman Media International, Inc., shows Donald Berwick. President Barack Obama announced on Wednesday that he is using a recess appointment to put Berwick in charge of the Centers for Medicare and Medicaid Services. (AP Photo/ Goodman Media International, Inc.)
(CNSNews.com) - President Barack Obama today circumvented the Senate confirmation process by granting a recess appointment to Dr. Donald Berwick to be director of the Centers for Medicare and Medicaid Services, the federal agency that runs Medicare and Medicaid.

Berwick, a professor at Harvard Medical School and CEO of the Institute for Healthcare Improvement (a think tank), has expressed his disdain for free-market medicine and his “love” for Great Britain’s government-run health-care system, while advocating health-care rationing and using the health-care system to redistribute wealth.

The directorship of CMS normally requires confirmation by the Senate, which currently has a 59-member majority of President Obama’s party (counting Sen. Joe Lieberman, the Connecticut Independent who caucuses with Senate Democrats).

Obama initially sent Dr. Berwick’s nomination to the Senate in April, where it was assigned to the Senate Finance Committee chaired by Sen. Max Baucus, the Montana Democrat, who had worked closely with the Obama White House in developing the national health-care law that President Obama signed in March. Baucus had not yet scheduled a confirmation hearing for Dr. Berwick.

“It’s unfortunate that at a time when our nation is facing enormous challenges, many in Congress have decided to delay critical nominations for political purposes,” President Obama said in a Wednesday statement announcing the recess appointment of Berwick and two other officials. (These were Philip E. Coyle, nominated to be associated director in the Office of Science and Technology Policy--under director John P. Holdren--and Joshua Gotbaum to be director of the Pension Benefit Guaranty Corporation.)

Berwick is known for his staunch defense of Great Britain’s government-run National Health System (NHS)—which he has hailed as a model for the world-- and his penchant for comparing the U.S. health-care system unfavorably to the British system.

In the July 26, 2008 issue of the British Journal of Medicine (BMJ), Dr. Berwick published an article praising the NHS on its 60th birthday and urging Great Britain to reject free enterprise in health care. In the United States, he argued, competition among rival health-care providers had produced an excess supply of health care.

“Please don’t put your faith in market forces,” he said (italics in original). “It’s a popular idea: that Adam Smith’s invisible hand would do a better job of designing care than leaders with plans can. I find little evidence that market forces relying on consumers choosing among an array of products, with competitors fighting it out, leads to the healthcare system you want and need. In the US, competition is a major reason for our duplicative, supply driven, fragmented care system.”

Berwick argued that purposely provided an inadequate supply of health-care—as Britain’s health-care system does—is superior to allowing the market to provide an excess.

“In America, the best predictor of cost is supply; the more we make, the more we use—hospi­tal beds, consultancy services, procedures, diagnostic tests,” Dr. Berwick wrote. “… Here, you choose a harder path. You plan the supply; you aim a bit low; you prefer slightly too lit­tle of a technology or a service to too much; then you search for care bottlenecks and try to relieve them.”

“Avoid supply driven care like the plague,” Dr. Berwick advised the Britsh (italics in original). “Unfettered growth and pursuit of institu­tional self interest have been the engines of low value for the US healthcare system. Oversupply has made care unaffordable and hasn’t helped patients at all.”

Dr. Berwick argued that redistribution of wealth is an absolutely necessary component in any just health-care system and that the British had made the right decision in nationalizing their system.

“You could have had the American plan. You could have been spending 17% of your gross domestic product and making health care unaffordable as a human right instead of spending 9% and guaranteeing it as a human right. You could have kept your system in fragments and encouraged supply driven demand, instead of making tough choices and planning your supply,” he wrote.

“You could have protected the wealthy and the well instead of recognising that sick people tend to be poorer and that poor people tend to be sicker, and that any healthcare funding plan that is just must redistribute wealth,” he said. “Britain, you chose well.”

In an interview published in the June 2009 issue of Biotechnology Healthcare, Dr. Berwick defended the Federal Coordinating Council for Comparative Effectiveness Research, a federal bureaucracy funded by last year’s $787-billion stimulus law--a bureaucracy that some critics argue will become the command center for rationing health-care under the new national health care law.

In the same interview, Dr. Berwick also defended what he views as the necessity of rationing health-care itself--assuming as he did so that it would be "taxpayers" and not private consumers who would be paying for health care. (Under the new health-care law, Americans earning up to 400 percent of the poverty level--or $88,200 for a family of four--will receive federal subsidies to buy health insurance, which they will be compelled by law to buy.)

When the interviewer for Biotechnology Healthcare said to Dr. Berwick that critics had said that federal Comparative Effectiveness Research would “lead to rationioning of healthcare,” Berwick responded: “We can make a sensible social decision and say, ‘Well, at this point, to have access to a particular additional benefit [new drug or medical intervention] is so expensive that our taxpayers have better use for those funds.’ We make those decisions all the time. The decision is not whether or not we will ration care — the decision is whether we will ration with our eyes open. And right now, we are doing it blindly.”

In his BMJ article celebrating the 60th birthday of Britain’s government-run National Health System, Berwick said: “Cynics beware, I am romantic about the National Health Service; I love it. … The NHS is one of the astounding human endeavours of modern times.”

Berwick expressed his belief that it was important for the NHS to continue because it was the model health-care system for the world.

“The only sentiment I feel for the NHS that exceeds my admiration is my hope,” he said. “I hope you will never, ever give up on what you have begun. I hope you realise and reaffirm how badly you need—how badly the world needs—an example at scale of a health system that is universal, accessible, excellent, and free at the point of care—a health system that, at its core, is like the world we wish we had: gener­ous, hopeful, confident, joyous, and just. Happy birthday.”

 

[BLADEMDA]

The only sentiment I feel for the NHS that exceeds my admiration is my hope,” he said. “I hope you will never, ever give up on what you have begun. I hope you realise and reaffirm how badly you need—how badly the world needs—an example at scale of a health system that is universal, accessible, excellent, and free at the point of care—a health system that, at its core, is like the world we wish we had: gener­ous, hopeful, confident, joyous, and just. Happy birthday"

 

[BLADEMDA]

The only sentiment I feel for the NHS that exceeds my admiration is my hope,” he said. “I hope you will never, ever give up on what you have begun. I hope you realise and reaffirm how badly you need—how badly the world needs—an example at scale of a health system that is universal, accessible, excellent, and free at the point of care—a health system that, at its core, is like the world we wish we had: gener­ous, hopeful, confident, joyous, and just. Happy birthday"

These progressives are going to "loot" those who have to pay for those who do not. There is nothing new in Berwick's ideas. They have been tried for Centuries and they always fail. Only the free market (true free market) can restore health care to the level where it can be saved, Our current system is far from a free market. Soon, the govt. will decide what articles/reviews you must do in order to get reimbursed. Berwick will decide what level of training and certification is needed to get paid by the govt. By the way, who voted for him? Did the Senate even approve his appointment?