Sample letter

October 3, 2018

Dear XXX,

I am contacting XXX to advocate for XXX acceptance of an alternative continuing board certification pathway. Most contracts between payers and provider groups require adherence to the payer’s credentialing standards. XXX credentialing standards require board certification by an ABMS or AOA member board. ABMS board certification requires two parts, initial certification and maintenance of certification (MOC). There is controversy surrounding the requirements for MOC. Many physicians believe current MOC requirements are onerous, time-wasting, not meaningful and unnecessarily expensive. In response to this discontent, an alternative board, the National Board of Physicians and Surgeons (NBPAS) was formed. NBPAS provides an alternative pathway for the maintenance phase of certification. I am writing to request XXX credentialing requirements accept NBPAS certification as an alternative to ABMS certification.

Importantly, many published studies have found no association between MOC or recertification and improved patient outcomes (see references below).  Most physicians participating in MOC activities find they learn very little from the experience. Most of the time spent studying for the computer modules and exam is spent studying aspects of medicine that are irrelevant to their practice. In fact, in response to criticism from NBPAS, various medical societies and other organizations, many ABMS member boards are now starting to change their MOC processes, thereby validating NBPAS criticism. The American Board of Anesthesiology has discontinued the 10 year re-certification exam and the American Board of Internal Medicine’s own task force has recommended the same.

Important points for consideration:

1) Endorsing an alternative certifying organization like NBPAS will not open the door to numerous competing “fly by night” boards. NBPAS requires initial ABMS certification, therefore NBPAS actually supports ABMS and requires a rigorous secure initial certifying test.

2) There is no evidence, or even common belief that the ABMS member board MOC process protects the public from bad doctors. In fact, most, if not all of the recent scandals in medicine involved ABMS board certified physicians.

3) CMS, the nation’s largest payer does NOT require board certification/recertification or MOC.

4) The role of payers in this controversy is central. Currently, many hospitals are resisting acceptance of NBPAS certification for hospital privileging due to concerns regarding contractual obligations with payers.

 

The NBPAS criteria for board certification are listed below.

  • Candidates must have been previously certified by an American Board of Medical Specialties or AOA member board.
  • Candidates must have a valid, unrestricted license to practice medicine in at least one US state. Candidates who only hold a license outside of the U.S. must provide evidence of an unrestricted license from a valid non-U.S. licensing body.
  • Candidates must have completed a minimum of 50 hours of continuing medical education (CME) within the past 24 months, provided by a recognized provider of the Accreditation Council for Continuing Medical Education (ACCME). CME must be related to one or more of the specialties in which the candidate is applying. Re-entry for physicians with lapsed certification requires 100 hours of CME with the past 24 months. Fellows-in-training are exempt.
  • For some specialties (ie interventional cardiology, electrophysiology, surgical specialties), candidates must have active privileges to practice that specialty in at least one US hospital or outpatient facility licensed by a nationally recognized credentialing organization with deeming authority from CMS (ie Joint Commission, HFAP, DNV).
  • A candidate who has had their medical staff appointment/membership or clinical privileges in the specialty for which they are seeking certification involuntarily revoked and not reinstated, must have subsequently maintained medical staff appointment/membership or clinical privileges for at least 24 months in another US hospital licensed by a nationally recognized credentialing organization with deeming authority from CMS (ie Joint Commission, HFAP, DNV).

 

NBPAS believes in the value of Continuing Medical Education (CME) for life-long learning. Organizations providing recognized CME programs are regulated by a rigorous accreditation body (ACCME) requiring each CME offering provide an educational gap analysis, “needs assessment,” speaker conflict of interest, course evaluations and many other performance standards. CME can provide education in both established knowledge and also future directions that keep the physician on the “cutting edge.” CME offerings are highly competitive and provide choice. Therefore, using CME to fulfill life-long learning requirements provides efficiency and minimizes redundant activities

To view recent research studies examining the impact of MOC on patient outcomes see articles and links below from Circulation and JAMA:

Association of Physician Certification in Interventional Cardiology With In-Hospital Outcomes of Percutaneous Coronary Intervention
Paul N. Fiorilli, MD et. al. Circulation. 2015; 132: 1816-1824
http://circ.ahajournals.org/content/132/19/1816.abstract

Association Between Physician Time-Unlimited vs Time-Limited Internal Medicine Board Certification and Ambulatory Patient Care Quality
John Hayes, MD JAMA. 2014;312(22):2358-2363. doi:10.1001/jama.2014.13992.
http://jama.jamanetwork.com/article.aspx?articleid=2020370

Association Between Imposition of a Maintenance of Certification Requirement and Ambulatory Care–Sensitive Hospitalizations and Health Care Costs
Bradley M. Gray, PhD  JAMA. 2014;312(22):2348-2357. doi:10.1001/jama.2014.12716
http://jama.jamanetwork.com/article.aspx?articleid=2020369

 

For a more complete discussion of the board certification controversy please use the links below to recent NEJM publications.

BOARDED TO DEATH — WHY MAINTENANCE OF CERTIFICATION IS BAD FOR DOCTORS AND PATIENTS
http://www.nejm.org/doi/full/10.1056/NEJMp1407422

MAINTENANCE OF CERTIFICATION 2.0 — STRONG START, CONTINUED EVOLUTION
http://www.nejm.org/doi/full/10.1056/NEJMp1409923

NBPAS Board Members:
The NBPAS Advisory Board Members are high profile, physician thought leaders who value patient care, research, and lifelong learning. Board members (all unpaid) believe continuous medical education is the most meaningful means for staying current in medicine.

Paul Teirstein, M.D., President NBPAS, Chief of Cardiology, Scripps Clinic
John Anderson, M.D., Past President, Medicine and Science, American Diabetes Association, Frist Clinic, Nashville, TN
David F. Dies, M.D., MBA, Medical Director of Liver Transplantation, John C. McDonald Regional Transplant Center
David John Driscoll, M.D., Professor of Pediatrics, Mayo Clinic College of Medicine
Daniel Einhorn, M.D., Past President, American College of Endocrinology; Past President, American Association of Clinical Endocrinologists
Bernard Gersh, M.D., Professor of Medicine, Mayo Clinic College of Medicine
C. Michael Gibson, M.D., Professor of Medicine, Harvard Medical School
Michael R. Jaff, D.O., Massachusetts General Hospital, Professor of Medicine, Harvard Medical School
Paul G. Mathew, M.D., FAHS, Director of Continuing Medical Education, Brigham & Women’s Hospital/Harvard Medical School, Department of Neurology
Jordan Metcalf, M.D., Professor and Research Director, Pulm. & Crit. Care,  Oklahoma University Health Sciences Center
Dan Morhaim, M.D., Sinai Hospital Baltimore, MD; Maryland State Legislator – House of Delegates
Jeffrey W. Moses, M.D., Professor of Medicine at Columbia University Medical Center, New York, NY
Jeffrey Popma, M.D., Professor of Medicine, Harvard Medical School
Harry E. Sarles Jr., M.D., FACG, Immediate Past President for the American College of Gastroenterology
Hal Scherz, M.D., Chief of Urology- Scottish Rite Children’s Hospital, Assoc Clinical Professor of Urology Emory University
Karen S. Sibert, M.D., Associate Clinical Professor: UCLA Health; Immediate Past President: California Society of Anesthesiologists
Gregg W. Stone, M.D., Professor of Medicine, Columbia University College of Physicians and Surgeons
Eric Topol, M.D., Chief Academic Officer, Scripps Health; Director, Scripps Translational Science Institute
Bonnie Weiner, M.D., Professor of Medicine, University of Massachusetts Medical School
Mathew Williams, M.D., Chief, Division of Adult Cardiac Surgery, New York University Medical Center

 

List of hospitals where credentials committees, Medical Executive committee and/or hospital board have voted to accept NBPAS as an alternative to ABMS certification:*

  1. Advanced Surgical Hospital: Washington, PA
  2. Arctic Surgery Center: Anchorage, AK
  3. Arkansas Heart Hospital: Little Rock, AR
  4. Baptist Health Lexington: Lexington, KY
  5. Baptist Medical Center Princeton: Birmingham, AL
  6. Bayhealth Medical Center: Dover, DE
  7. Baylor St. Luke’s Medical Center/Texas Heart Institute: Houston, TX
  8. Bozeman Health Deaconess Hospital: Bozeman, MT
  9. Brandon Regional Hospital: Brandon, FL
  10. Capital Region Medical Center: Jefferson City, MO – (affiliated w/ Univ. of Missouri)
  11. Centennial Medical Center: Nashville, TN
  12. CHI St. Vincent: Hot Springs, AR
  13. Christus Highland Medical Center: Shreveport, LA
  14. Clinton Memorial Hospital: Wilmington, OH
  15. Columbia Basin Hospital: Ephrata, WA
  16. Community First Medical Center: Chicago, IL
  17. Community Memorial Hospital: Ventura, CA
  18. Cuyuna Regional Medical Center: Crosby, MN
  19. Eisenhower Medical Center: Rancho Mirage, CA
  20. Emory Healthcare: Atlanta, GA
  21. Florida Hospital Heartland Division: Sebring, FL
  22. Florida Memorial Hospital: Daytona Beach, FL
  23. Frederick Memorial Hospital: Frederick, MD
  24. Habersham Medical Center: Demorest, GA
  25. Halifax Medical Center: Daytona Beach, FL
  26. Hoag Hospital: Newport, CA
  27. Holmes Regional Medical Center: Melbourne, FL
  28. Huntington Hospital: Pasadena, CA
  29. Integris Baptist Medical Center: Oklahoma City, OK
  30. Lawrence & Memorial Hospital: New London, CT
  31. McAllen Medical Center: McAllen, TX
  32. Memorial Hospitals and Healthcare Systems: ,
  33. Mendocino Coast District Hospital: Fort Bragg, CA
  34. Mercy Health – St. Elizabeth Boardman Hospital: Fort Bragg, CA
  35. Mercy Health – St. Elizabeth Youngstown Hospital: Youngstown, OH
  36. Mercy Medical Center: Cedar Rapids, IA
  37. Miller County Hospital: Colquitt, GA
  38. Mission Hospital: Mission Viejo, CA
  39. Monarch Healthcare: Irvine, CA – IPA, subsidiary of Optum/United
  40. Norman Regional Hospital: Norman, OK
  41. Oklahoma Heart Hospital: Oklahoma City, OK
  42. Palm Bay Hospital: Palm Bay, FL
  43. Parrish Medical Center: Titusville, FL
  44. Pennsylvania Medical Society: , PA
  45. Phoenix St. Luke’s Hospital: Phoenix, AZ
  46. Plaza Park Hospital: Houston, TX
  47. Presbyterian Hospital: Albuquerque, NM
  48. Providence Little Company of Mary: Torrance, CA
  49. Saddleback Memorial Hospital: Laguna Hills, CA
  50. Sentara Halifax Regional Hospital: South Boston, VA
  51. Shawnee Mission Medical Center: Kansas City, MO
  52. Sibley Memorial Hospital – Johns Hopkins Medical System: Washington, DC.
  53. Southeast Missouri Hospital: Cape Girardeau, MO
  54. Southern New Hampshire Medical Center: Nashua, NH
  55. Southern Tennessee Regional Health Systems: Lawrenceburg, TN
  56. St Luke’s Hospital: Cedar Rapids, IA
  57. St. Jude Medical Center: Fullerton, CA
  58. St. Mary Medical Center: Langhorne, PA
  59. Surgery Center of Oklahoma: Norman, OK
  60. Texas Health Presbyterian: Rockwall, TX
  61. Texas Neurological Society: Austin, TX
  62. Tidelands Georgetown Memorial Hospital: Georgetown, SC
  63. Tidelands Waccamaw Community Hospital: Murrels Inlet, SC
  64. University of Pittsburgh Medical Center Hamot: Erie, PA
  65. Virginia Gay Hospital: Vinton, IA
  66. Willis Knighton Health System: Bossier City, LA
  67. World Trade Center Health Program: New York, NY
  68. Wuesthoff Hospital: Melbourne, FL
  69. Yavapai Regional Medical Center: Prescott, AZ
  70. Yukon-Kuskokwim Health Corporation: Bethel, AK

*Note: Some of the above hospitals have changed their bylaws to allow alternatives to ABMS certification that include NBPAS without specifically naming NBPAS.

 

The Washington State Medical Association has recognized NBPAS as an alternative pathway for board recertification. To view the official announcement, click on the link below:

https://wsma.org/doc_library/AboutWSMA/TheOrganization/HouseOfDelegates/HOD_2015_official_actions_final.pdf

NBPAS has now been selected as the certifying body for over 6,000 physicians.  NBPAS offers certification in all ABMS specialties. Physicians across the country are crying out for change and asking for endorsement of NBPAS. Acceptance of NBPAS by XXX will be extremely helpful to physicians throughout the country. Conversely, rejection by XXX will be very harmful.  We ask XXX to change its credentialing requirements to either specifically endorse NBPAS for continuing certification or limit its certification requirements to initial certification.

Thank you for your consideration.

Sincerely yours,

 

XXX  XXX, M.D.