Eyeworld

3 January 2018 by Liz Hillman EyeWorld Staff Writer EW ASCRS NEWS "To me this is like the musical Fiddler on the Roof. It takes a village," Dr. Teirstein said. "Payers require MOC because the NCQA requires Maintenance of certification reform and new certification bodies seek to make the process more meaningful, less burdensome T he road to board certification reform is long and complex, but it's happening. Since 1992 when the American Board of Ophthal- mology (ABO)—a member board of the American Board of Medical Spe- cialties (ABMS), which certifies more than 80% of licensed U.S. physicians —put a timeline on its certification and established a 10-year exam/ recertification period along with other requirements, physicians have grumbled about time, expense, ir- relevance, and lack of evidence that such a process was truly resulting in improved patient care. John DeStafeno, MD, Chester County Eye Care, clinical instructor, Wills Eye Hospital, Philadelphia, and ASCRS liaison to the American Board of Ophthalmology, said the ABO has made and continues to make strides to show it is hearing its diplomats' concerns. "ABO should be commended for listening to the discontent within ophthalmology and striving to make positive changes," Dr. DeStafeno said. Beyond the ABO, alternative certification options are cropping up and state legislatures are even getting involved to decide on the le- gality of required board certification in certain situations. Current atmosphere of certification and maintenance There is little dispute over the value of initial board certification, Dr. DeStafeno said. Beyond earning a medical degree, completing residen- cy and fellowship, and obtaining a medical license to practice, board certification "is a good measure to show that you've mastered the clinical aspects of your field," Dr. DeStafeno said. "I think it shows that you have the competency to go into medical care and treat patients correctly." It's the current process of so- called maintenance of certification (MOC) that Dr. DeStafeno said many physicians take issue with. In a Mayo Clinic survey conducted between September 2015 and April 2016, 24% of the nearly 1,000 phy- sician respondents said they "agree that MOC activities are relevant to their patients," and 15% said they think they are "worth the time and effort." 1 Twelve percent said they find MOC activities to be well inte- grated into their daily routine, and 9% said they think patients actually care about their MOC. Overall, 81% called MOC activities a burden. What's more, Dr. DeStafeno said some physicians think that quality of care, and thus their competency, is already being reported to and assessed by government regulatory bodies, which may be more practical than 10-year exam assessments. Dr. DeStafeno said assessing the actu- al impact of this 10-year exam on physician competency and patient outcomes is difficult, and the studies out there on this front have seen some criticism. From a cost standpoint, a re- search letter published in the Journal of the American Medical Association compiled the costs of ABMS member board certification and MOC fees, finding the average initial cost for the written examination was $1,846 with an additional $1,694 if an oral examination was required. 2 The av- erage annual MOC fee was $257. For ophthalmology, the initial applica- tion and written exam cost $1,650, the oral exam costs $1,650, and the annual MOC fee was $200. Though said to be voluntary— not required to practice medicine per se—current board certification has become a requirement to be on many insurance companies' payer plans and for privileges at some hospitals. Paul Teirstein, MD, chief of cardiology and director of inter- ventional cardiology, Scripps Clinic, La Jolla, California, and founder of an alternative certification board, the National Board of Physicians and Surgeons (NBPAS), took a deeper look into this factor and discussed what he found at the October 2016 California Medical Association (CMA) House of Delegates meeting. "Why would payers even care about MOC?" Dr. Teirstein asked rhetorically during his presentation. Answering his own question, he said that payers are certified themselves, most by the National Committee of Quality Assurance (NCQA), which requires that they contract with physicians who are board certified and have MOC. Taking a hard look at board certification and recertification continued on page 8 CAUTION: Federal (USA) law restricts this device to the sale by or on the order of a physician. INDICATIONS: The AcrySof ® IQ aspheric intraocular lens ("AcrySof IQ") is intended for the replacement of the human lens to achieve visual correction of aphakia in adult patients following cataract surgery. This lens is intended for placement in the capsular bag. WARNING/PRECAUTION: Use the UltraSert ™ Pre-loaded Delivery System ("UltraSert") at temperatures between 18° C (64° F) and 23°C (73° F). Use only Alcon viscoelastic qualified for this device. Do not use the UltraSert if the nozzle appears damaged or deformed. Follow the Directions for Use for correct order and sequence of steps to avoid damage to the IOL or the UltraSert. Careful preoperative evaluation and sound clinical judgment should be used by the surgeon to decide the risk/benefit ratio before implanting a lens in a patient with any of the conditions described in the Directions for Use. Caution should be used prior to lens encapsulation to avoid lens decentrations or dislocations. Studies have shown that color vision discrimination is not adversely affected in individuals with the AcrySof ® Natural IOL and normal color vision. The effect on vision of the AcrySof ® Natural IOL in subjects with hereditary color vision defects and acquired color vision defects secondary to ocular disease (e.g., glaucoma, diabetic retinopathy, chronic uveitis, and other retinal or optic nerve diseases) has not been studied. Do not resterilize; do not store over 45° C. ATTENTION: Reference the Directions for Use for Model AU00T0 for a complete listing of indications, warnings and precautions. © 2017 Novartis 12/17 US-ULS-17-E-2972a

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