Monday, September 10, 2012

Maintenance of Licensure- another tool to ensure social justice?

Most physicians probably have never heard of the Federation of State Medical Boards (FSMB) though all are aware of their own state board and its requirements for licensure and the requirements for continuing medical education (CME).

In the June 26, 2012 issue of the Annals of Internal Medicine readers learn their latest plans. Let me focus on the third of three components of their current work in progress for their Maintenance of Licensure ( MOL) project. Writing about the third component which involves "How am I doing" the article says:

"...or over time submission of practice activities adhering to regional or national performance improvement benchmarks"

The authors continue to mention the adoption of electronic medical records would enable "easier volunteer sharing of practice performance records with state board "

"Volunteer sharing" indeed. More likely share and conform if you want your license renewed when the final plans are put into place.

A perfect storm is brewing for control of physicians' practices which is the holy grail of third party payers.

Let's see some of what is in place or in preparation.

1) changing medical ethics is well under way. The Physician Charter is now 10 years old (see here for comments regarding its anniversary) .This established social justice as one of the three ethical precepts of the practicing physician. Over a hundred medical professional organizations have signed on to this, the American College of Physicians have included social justice in its latest version of medical ethics and the catechism is being taught to medical students and house officers. When the Charter was first published some may have wondered just how practicing physicians were to bring about the "just distribution of finite resources"; many thought their days were adequately filled with trying to do what was right for individual patients. That problem has been solved. A just distribution will be achieved when physician comply with guidelines that are formulated by cost effectiveness methods. Doing what is good for the collective will be what is good for the patient even though,for example, the treatment he forgoes in the interest of collective good may have benefited him.

2)The Maintenance of Licensure activities of the FSMB will eventually include the mandatory reporting of the degree to which the physician complies with the social justice compatible, cost effective, parsimonious guidelines.

3) For those physicians who continue to treat Medicare and Medicaid patients their reimbursements will depend in part on reporting selected guideline compliance data.
(Do not rule out the possibility of one day there being a MOL requirement for physicians to see their fair share of the Medicaid patients).


4) ACGME has done its share in changing the mindset of physicians in training in part by disabusing them of the archaic notion that a physician should stay on duty in the hospital when her patient is in a critical, dynamic situation which requires a physician to be physically in attendance.Simply hand off those patients to the next "team". Now there are teams in charge not an individual physician in charge.

The title of this commentary could as easily be Maintenance of Certification-another tool to control medical costs .



4 comments:

Anonymous said...

Don't forget the tool of the "Disruptive Physician" to silence critics of the latest that the suits and their cronies in white coats dream up to improve care by limiting it.

james gaulte said...

anon,
You are right.The disruptive physician notion is a very useful tool to control physicians who question and challenge various hospital policies and initiatives that are cost containment efforts masquerading as improving quality.

James Gaulte

Soon to retire doc said...

The MOL may well become the ultimate tool to solve the "herding cats" problem that continually pestered the third party payers.

Michel Accad said...

Excellent post, James. But I'm more optimistic than you (if one may call this optimism!)...I think Obamacare is the last hurray for central planners; the logjams and financial turmoil that we are likely to experience in the next few years will terminally incapacitate state bureaucracies and defund the medical cronies that come up with such plans...but who knows? You may be right...Besides, if my prediction is correct, it won't be a cakewalk either...