A Crack in the MOC Armor

This just came in from the NBPAS (alternate board):

Dear Colleagues,

This week, the U.S. Department of Justice Antitrust Division issued a landmark opinion about MOC, vindicating NBPAS’s long-held position that alternative organizations are needed to promote competition in physician certification. In an opinion letter, the DOJ validated the NPBAS four year struggle to make continuous physician certification more meaningful and less burdensome. This public position by the DOJ should be emphasized by physicians and other stakeholders as they ask hospital boards and insurance companies to accept alternative certification organizations when setting criteria for hospital privileges and payer contracts.

The DOJ opinion letter came in response to a pending Maryland bill promoting competition in physician certification that was introduced by NBPAS board member and Maryland legislator Dr. Dan Morhaim. The DOJ explained that the ABMS Program on MOC may have the effect of “harming competition and increasing the cost of healthcare services to customers.” ABMS may do so “by imposing overly burdensome conditions on physicians who wish to maintain their certification.” The DOJ added, with respect to ABMS, “[the] vast majority of [its] board members are medical doctors”—i.e., “active market participants”—who may have incentives to limit competition through “industry self-regulation.” As a result, the DOJ warned, “there would be competition concerns, if dominant certifying bodies [like ABMS] set de facto participation requirements that did not sufficiently correspond to health, safety, or other procompetitive justifications.”

As physicians familiar with MOC know, current ABMS MOC programs have not been shown to correlate with quality of practice or patient outcomes, and yet the burden they impose on doctors is severe. NBPAS provides a more meaningful form of continuous certification. The DOJ urges such competition. It encourages legislatures to promote competition by recognizing “additional, legitimate certifying bodies” such as NBPAS, whose recognition the DOJ believes “could allow for a competitive alternative to ABMS in certifying medical specialists.” Such competition may provide a host of benefits, including physicians’ passing on “extra time and lower costs in the form of savings or extra care for consumers”, physicians’ “seek[ing] additional subspecialty certification or [staying] in practice longer”, and “further encourage[ing] the incumbent certifying body to continue refining their processes to be competitive.”

The DOJ was strongly supportive of competition in MOC stating “If other new bodies, unaffiliated with ABMS or NBPAS, can offer a more (or similarly) efficient and accurate way to certify medical specialists, the interests of competition may be better served if they have an opportunity to compete on the merits of their approach with physicians, hospitals, payers, and consumers, without needing new, ad hoc legislation to support their entry.”

NBPAS applauds the DOJ for addressing the important issues surrounding MOC. The DOJ’s legislative comment is a watershed moment. It lends powerful support for the positions NBPAS continues to press with all stakeholders in the industry.

For the full text of the letter, see the link below from the DOJ

From: Haar, Daniel <[email protected]>
Sent: Monday, September 10, 2018 4:57:27 PM
To: Morhaim, Dan Delegate
Subject: RE: Response regarding MD 857 </[email protected]>

Delegate Morhaim,

To follow up, I wanted to let you know that our letter responding to your inquiry is also now available publicly at the following link:


All the best,

If you add to this the Wes Fisher lawsuit and I think we finally are getting somewhere.

There is hope.

Get one of our Be Well t-shirts here

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  4 comments for “A Crack in the MOC Armor

  1. Kurt
    September 19, 2018 at 2:45 pm

    Please donate to Dr. Fishers initiative (along with the PPA) to attack this MOC thing. The only way to do it is by legislation AND litigation. Pressure is going to have to be placed from both directions.
    I did five bills and I’ve seen residents donate $50.00. https://www.gofundme.com/practicing-physicians-of-america They did reach their initial goal but this is going to be an ongoing fight.
    I bought a T-shirt too. This is the real deal folks. I will be retired by the time anything comes to fruition but I will take perverse pleasure when these perverse medical board mafiosi are taken

  2. JRDO
    September 16, 2018 at 10:25 am

    A big step in the right direction.

  3. Sudha Prasad
    September 16, 2018 at 9:16 am

    Hallelujah!!! But I don’t want to get ahead of myself…how long will it take for this decision to trickle down to little people like me?

  4. PW
    September 16, 2018 at 9:07 am

    My state (Ohio) is passing legislation preventing MOC to be required by hospitals, insurance companies, etc for docs to be in their panels. I hope this fight continues until MOC is defeated.

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