The evolving maintenance of certification process: update on the financial status of the medical boards.

Medical board organizations have accumulated large asset balances, in part due to the monetization of physician board recertification, as well as capital gains in positive investment conditions. Physicians across the country have raised concerns regarding the effectiveness and efficiency of existing recertification processes, to which the American Board of Medical Specialties and independent accreditation boards have responded with newly instituted changes. The present article analyzes the publicly available F990 tax forms of the medical boards in an effort to provide data to the ongoing debate. Although some boards have begun to mobilize assets in recent years, many continue to accumulate wealth. It remains to be seen whether the new recertification programs will bring about change or perpetuate organizational wealth.

A Cost Analysis of the American Board of Internal Medicine's Maintenance-of-Certification Program.

BACKGROUND: In 2014, the American Board of Internal Medicine (ABIM) substantially increased the requirements and fees for its maintenance-of-certification (MOC) program. Faced with mounting criticism, the ABIM suspended certain content requirements in February 2015 but retained the increased fees and number of modules. An objective appraisal of the cost of MOC would help inform upcoming consultations about MOC reform. OBJECTIVE: To estimate the total cost of the 2015 version of the MOC program ("2015 MOC") and the incremental cost relative to the 2013 version ("2013 MOC"). DESIGN: Decision analytic model. DATA SOURCES: Published literature. TARGET POPULATION: All ABIM-certified U.S. physicians. TIME HORIZON: 10 years (2015 to 2024). PERSPECTIVE: Societal. INTERVENTION: 2015 MOC. OUTCOME MEASURES: Testing costs (ABIM fees) and time costs (monetary value of physician time). RESULTS OF BASE-CASE ANALYSIS: Internists will incur an average of $23 607 (95% CI, $5380 to $66 383) in MOC costs over 10 years, ranging from $16 725 for general internists to $40 495 for hematologists-oncologists. Time costs account for 90% of MOC costs. Cumulatively, 2015 MOC will cost $5.7 billion over 10 years, $1.2 billion more than 2013 MOC. This includes $5.1 billion in time costs (resulting from 32.7 million physician-hours spent on MOC) and $561 million in testing costs. RESULTS OF SENSITIVITY ANALYSIS: Costs are sensitive to time spent on MOC and MOC credits obtainable from current continuing education activities. LIMITATION: Precise estimates of time required for MOC are not available. CONCLUSION: The ABIM MOC program will generate considerable costs, predominantly due to demands on physician time. A rigorous evaluation of its effect on clinical and economic outcomes is warranted to balance potential gains in health care quality and efficiency against the high costs identified in this study. PRIMARY FUNDING SOURCE: University of California, San Francisco, and the U.S. Department of Veterans Affairs.

Maintenance of certification and the financial status of the medical boards.

BACKGROUND: The Maintenance of Certification (MOC) program proposed by the American Board of Medical Specialties (ABMS) gained approval in 2006. The implementation of this program will impact all physicians who are board certified. Therefore, The Financial Status of the Medical Boards is an increasingly relevant topic of discussion amongst all physicians and those interested in medical education and certification. With this study we aim to bring greater attention to the already publicly available financial status of the Medical Boards (MB) so that it can become part of the ongoing discussion of MOC. METHOD: We analyzed the yearly revenue, expenses, net gain or loss and end of year balance for the ABMS and its 24 MB, additional member boards, as well as the Accreditation Council for Graduate Medical Education (ACGME), American Osteopathic Association (AOA) and Accreditation Council for Continuing Medical Education (ACCME) organizations. RESULTS: We have commented on notable trends based on the available IRS Form 990s spanning from 1997 to 2012. When comparing the most recently available reported end of year balance to the first available reported end of year balance, 87% (27/31) of the member boards have reported an increase. All three of the additional organizations studied, ACGME, AOA and ACCME reported an increase as well. CONCLUSIONS: It is clear from the data and analysis that the majority of MB have financially benefited from the MOC program. It remains to be proven whether or not this economic benefit will translate into an improvement in physician education and patient care.

[Outpatient Surgery in German ENT in Teaching Hospitals--Economic Nonsense?]. / Ambulante Operationen in HNO-Ausbildungskliniken - ökonomischer (Un)sinn?

INTRODUCTION: There is an ever-increasing demand to increase efficiency and decrease costs in health care. This leads to an growing number of outpatient surgeries which are less cost effective. Especially in the setting of university teaching hospitals, this may lead to both an undersupply of qualified physicians, as well as to a worsening of clinical training of residents. In order to quantify a possible undersupply and estimate the expense of teaching residents, the time for medical procedures needs to be quantified and compared between board-certified physicians and residents. This was the aim of the current study. MATERIAL AND METHODS: All outpatient adenotomies of children with or without paracentesis or tympanic drainage insertion performed in 2012 in 2 ENT teaching hospitals were analyzed. The length of the surgical procedure as well as the level of training of the surgeon was analyzed. Operating times of residents in training were analyzed stratified by training level and then compared to operation times of board-certified ENT surgeons. RESULTS: 255 procedures were analyzed. Significant differences of the mean operation time could be identified depending on the level of training of residents compared to board-certified ENT surgeons for all investigated training levels. E. g. 1(st) year residents' surgeries required 2.4 times more time than those of board-certified ENT surgeons. CONCLUSION: Based on an analysis of outpatient ENT-surgical procedures it becomes apparent that due to the extended operating times of residents in training outpatient surgery is by far less cost-effective than by board-certified physicians. To cope with the demand of teaching residents for their clinical training, more resources are necessary in the setting of teaching hospitals.