Medical recertification is expensive, considered to be arduous by physicians, and has yet to establish a recognized causal impact on patient outcomes. The backlash against the maintenance of certification (MOC) exams has largely been driven by physicians, thus creating a discourse that highlights their challenges, but missing is the perspective of patients, the end consumer in the healthcare chain.
A key consequence to consider as the American Medical Association (AMA) partners with the American Board of Medical Specialties (ABMS) and the Federation of State Medical Boards to conduct an impact study of physicians’ recertification is the out-of-pocket costs to patients.
As an increasing number of hospitals and insurance companies require recertification and government policies tie reimbursement rates to recertification, patients may face a shrinking pool of options for their healthcare providers, higher premiums for out-of-network physicians or specialty procedures, and higher service fees.
Speaking to physicians’ need for a more convenient way to prepare for these exams that doesn’t cause significant interference with patient care, BoardVitals has developed a platform that boasts a reduction of preparation time by almost 20% and a user pass rate that is almost 10% higher than the national average. The question is – can the widespread usage of such a platform reduce the interference board exams cause on patient care and prevent the increase of patients’ payments?
Recertification – Pros and Cons
Maintenance of certification proponents argue that recertification can improve the quality of care offered to patients and make practices more cost effective. The fundamental principle of this argument is that the quality of care a physician provides is directly linked to his or her theoretical knowledge of their field. To maintain certification, physicians must partake in additional activities ranging from integrating quality improvement programs into their clinics to surveying patients.
“It’s clear that for physicians doing high-stakes clinical practice, a credential issued once at the beginning of the career is neither relevant nor meaningful to their patients, institutions, or themselves,” says Richard Baron, president and chief executive officer of the American Board of Internal Medicine. “Having a more continuous program helps them keep track of their own learning and benchmark it against professional expectations.”
In theory, recertification allows for a speedier implementation of best practices, enhances quality of care measures that determine reimbursement rates, and allows patients to feel confident in their choice of providers – something particularly important with the growing usage of review sites like ZocDoc.
Demonstrated in a survey of patients who use online review sites like HealthGrades or Vitals, Certification(s) was the second most important demographic metric patients base their decisions on after years of experience. In fact, a 2004 Gallup poll reported that seventy percent of consumers considered board certification “important” or “very important” leading to a JAMA article declaring that “a physician’s current certification status should be among the evidence-based measures used in the quality movement.”
While founded in robust objectives and supported by the public, board certifications have their drawbacks for physicians – less face time with patients, less time for self-guided study on current topics, and steep fees as each exam averages around $2,000 and must be taken every ten years. Physicians also often complain that boards are unnecessary as all the medical information needed is online or in programs used within the office. The usage of these platforms aims to target similar inefficiencies like prescribing errors and unnecessary procedures, as do the board exams.
“Continuing medical education and lifelong learning make better doctors, but not maintenance of certification,” writes Dr. Wes Fisher, a cardiologist from Illinois who has blogged extensively about the new requirements. “Medical practice is supposed to be evidence based. There are no data that the maintenance-of-certification program makes any difference in what matters: patient outcomes.”
In addition to being unable to substantiate MOC with data, medical associations fail to provide cost effective means of retraining. Dr. Arlen Myers, President of the Society of Physician Entrepreneurs, argues that “medical societies have to adapt to the times and their overly bureaucratic, top heavy structure makes it hard to pivot.”
Different from medical licenses, board certifications are nominally voluntary although the majority of health care systems and payers adhere to policies that effectively blacklist physicians with expired certifications. This makes business exponentially more difficult for doctors who choose not to become recertified and smaller practices; it may also drive up costs for hospitals that employ them as well as insurance companies that offer patients out-of-network plans. Ultimately, patients end up paying higher premiums, higher deductibles, and higher service fees without the guarantee of better outcomes or an overall health care experience.
Making It Easier for Physicians & Cheaper for Patients
Capitalizing on the need for a less disruptive and relevant method of reviewing content for board exams, BoardVitals has created a test prep platform for physicians in over twenty specialties including cardiology, dermatology, emergency medicine, ENT, gastroenterology, internal medicine, neurology, OBGYN, psychiatry, radiology, and surgery. Most of their specialty preparation modules cost under $150 per month compared to the $3,000 review sessions offered by each specialty’s Association.
Addressing the complaint that many of the exam questions are antiquated, the platform integrates questions from major publishers and user-submitted and rated questions from the medical community. Crowdsourcing questions and references from a group of over 250 vetted medical professionals ensures that the materials doctors are studying from are the most current and relevant. In the pasty year alone, over 30,000 doctors and 150 institutions have used the platform, now being referred to as the ‘Wikipedia of Medicine’.
BoardVitals is one of the few medical resources with a continual feedback loop, processing thousands of feedback items on content every year. The goal behind developing an interactive and constantly evolving platform is better-trained physicians, and ultimately, better medical care for patients.
The company’s entrance into an overpriced market with a much lower user price point is just one reason to pay attention. It estimates that the medical test preparation and certification market they’ve taken by storm is about $1 billion and that the general medical education industry has a compound annual growth rate of seven percent. Recognizing its tremendous growth potential, Rock Creek Capital closed BoardVitals’ Series A round at $1.1 million earlier this month.
CEO Dan Lambert states that, “we’re facing an impending shortage of physicians, in part because training is so cost prohibitive. Eventually, a low cost, high yield digital solution like BoardVitals should replace the cumbersome Maintenance of Certification exams. It’s cheaper, easier, and statistically a better solution.”
Usage of the platform as well as other emerging digital solutions decreases a physician’s costs related to taking the boards, increases their time to interact with patients in a meaningful way, gives an accurate understanding of their strengths and weaknesses, can ensure longevity of institutional employment, and provides an incentive for better performance by comparing each physician with their peers.
Conclusion
As the medical recertification industry enjoys a healthy growth rate and patients are increasingly aware of and concerned with their physician’s credentials, it seems that crafting niche solutions is the best possible outcomes for all stakeholders – physicians, patients, healthcare systems, and insurance companies. Though patients suffer the ultimate cost burden of physicians not choosing to become recertified, they aren’t the only ones in the current healthcare architectural landscape. There is no doubt that in the coming years, since the launch of these digital solutions, there needs to be a cohort study of physicians who do and do not choose to become recertified and the long term effects on their patients’ out-of-pocket payments. Will recertification lower overall healthcare costs or will the neglect of its imposition raise them?
Komal Garewal is a consultant for health tech looking to raise rounds via crowdfunding or sites like Healthfundr, where she is a Marketing and Growth Strategist. Get in touch with her on LinkedIn or follow her on Twitter.