EHRs to MOC: Physicians tackle practice issues in new policy

AMA Wire
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During the third day of policymaking at the 2016 AMA Annual Meeting, physicians discussed a range of topics that affect their practice of medicine. Among them were maintenance of certification (MOC) concerns, the desire to improve patient safety amid the difficulties of electronic health records (EHR) and the need to ensure coverage of telemedicine services.

Minimizing EHR-related patient safety risks

EHRs vendors have been required to make changes to EHR products at such a rapid pace in order to comply with required meaningful use certification that there hasn’t been enough time to align new functionalities with efficient practice work flows.

Poor usability and a lack of interoperability between EHR systems carry patient safety risks and efforts at the local and state levels have been ineffective to reduce these risks.

In order to improve patient safety, physicians Tuesday adopted policy to support efforts of the Office of the National Coordinator for Health IT to implement a Health IT Safety Center to minimize EHR-related patient safety risks through collection, aggregation and analysis of data reported from EHR-related adverse patient-safety events.

Ensuring payment parity for telemedicine services

Telemedicine and telehealth services offer an opportunity for physicians to improve health outcomes among their existing patients, particularly for those with chronic conditions or who need routine follow-up care but have mobility issues. For instance, when physicians conduct home monitoring of chronic conditions, such as diabetes, they are better able to keep their patients healthy and reduce hospital admissions and emergency department visits.

Delegates voted to adopt policy that calls for private health insurers to cover telemedicine-provided services that are comparable to that of in-person services and not limit coverage to services provided by select corporate telemedicine providers.

“The AMA has supported state medical societies in developing telemedicine policies, which have provided tremendous benefit to rural communities. But these benefits will continue to be limited if patients must pay out of pocket for the services that should be covered by insurance,” AMA Board Member Russell W. H. Kridel, MD, said in a news release.

The AMA in 2014 released model legislation to support states’ efforts to achieve parity in telemedicine coverage policies, ensure telemedicine is appropriately defined in each state’s medical practice statutes and that its regulation falls under the jurisdiction of the state medical board. The resolution adopted today reflects the great interest in the safe and effective practice of telemedicine, and the AMA will continue to work with state medical societies to accomplish this goal.

Improving MOC and OCC

A new report from the AMA Council on Medical Education examines the current state of maintenance of certification (MOC) and osteopathic continuous certification (OCC), noting both the physician concerns around such elements as cost effectiveness and relevance to practice and the professional imperative to ensure patients are receiving high-quality care.

The report notes that the council will continue to work with the relevant associations and member boards to identify and suggest improvements to the MOC and OCC programs. Additionally, the council “is committed to ensuring that MOC and OCC support physicians’ ongoing learning and practice improvement.”

“The AMA will continue to advocate for a certification process that is evidence based and relevant to clinical practice as well as cost effective and inclusive to reduce duplication of work,” the report said.

Delegates adopted policy to further these efforts, including:

  • Examining the activities that medical specialty organizations have underway to review alternative pathways for board recertification
  • Determining whether there is a need to establish criteria and construct a tool to evaluate whether alternative methods for board recertification are equivalent to established pathways
  • Asking the American Board of Medical Specialties to encourage its member boards to review their MOC policies regarding the requirements for maintaining underlying primary or initial specialty board certification in addition to subspecialty board certification to allow physicians the option to focus on MOC activities most relevant to their practices
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Interesting that AMA Wire chose to ignore the strong language of Resolution 309 calling for "the immediate end of any mandatory, secured recertifying examination by the ABMS". I bet you're hoping the members won't know about this policy, because then you'll actually have to fight for us.
E H R inter operability worked for Kansas because the users, physicians, were the chief designers. Requests for "top down" solutions from the Office of Healthcare Technology or CMS in the beltway might only complicate already overburdened E H R vendors and E H R systems, rather than offering real solutions. Improving MOC and OCC is an oxymoron for any monopoly testing industry; meaningful relief from these costly, unvalidated measures will only follow by immediate recognition of competitors such as the National Board of P and S (San Diego) which does the same at < 15% of the cost of the ABMS MOC (tm) commercial operations. Best, just abolish or end all specialty board recertifications altogether, as before 1990. After initial board certification, the most creative and focused lifelong learning and scholarship careers should be recognized and applauded through specialty societies, medical society awards, and CME. Discussions w ABMS for "improvements" have been ongoing since 1995, going nowhere. Over 95% of practicing physicians would prefer "No MOC", that the AMA walk away from the ABMS MOC moneyball programs, substituting independent lifelong learning and academic research activities more relevant to the diverse private, public, and university practice situations serving diverse patient groups across the nation.
Thank you, Dr Edison, for noting the true wording of Resolution 309. Members need to ask their leaders and public relations folks, including the Council on Medical Education, for accountability. Truthful accountability listening to the will of the HOD can be challenging if the AMA's internal legal support team and P R folks receive funds also from a billion dollar testing and certification industry (such as the ABMS). Yet again, a clear conflict of interest (COI) hurting practicing physicians, our patients, and US healthcare.
Resolution 309 IS what matters...
How do you turn this resolution into this press release??? It's an embarrassment and slap in the face to all the delegates and state societies that fought so hard for resolution 309:<br/> <br/> <br/> RESOLVED, That our American Medical Association call for the immediate end of any mandatory, recertifying examination by the American Board of Medical Specialties (ABMS) or other certifying organizations as part of the recertification process (Directive to Take Action);<br/> and be it further<br/> RESOLVED, That our AMA support a recertification process based on high quality, appropriate CME material directed by the AMA recognized specialty societies covering the physician's practice area, in cooperation with other willing stakeholders, that would be completed on a regular basis as determined by the individual medical specialty, to ensure lifelong learning<br/> (Directive to Take Action); and be it further<br/> RESOLVED, That our AMA reaffirm Policies H-275.924 and D-275.954 (Reaffirm HOD Policy);<br/> and be it further<br/> RESOLVED, That the AMA voice this policy directly to the ABMS and other certifying organizations (Directive to Take Action); and be it further<br/> RESOLVED, That there be a report back to the AMA HOD by the 2017 Annual Meeting. (Directive to Take Action)
I am fast becoming anti-AMA as a member. They better start standing up for the front line providers that have had enough of MACRA and MOC and the massive regulatory burden placed on us. Hey AMA we hate MOC and we hate MACRA. We cannot be any clearer. Stop being wishy washy and stand up for us.
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