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8/23/2019 MOC, MOL, OCC and now C-MOC: the certification industrial complex
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MOC, MOL, OCC and now C-MOC
Beyond mere Board Certification
Paul M Kempen, MD, PhD
Board certified 1989, 2005
And never again!
1457 1305
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First certification
with 2 year
cycles of profit
NO license=
useless document
Does an
anesthesiologist
really need
this?
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ACLS circular 2
min. cycle
Circulation 2010, 122:S729-S767
PEA, Ventricular tachycardia (VT) fibrillation (VF)
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Historical overview 100 years ago
No licenses or certifications
Lifelong learning and apprenticeships
1960s
Medicare/-caid government as new payer-need to document
AMA strong horse and CME-PRA as documentation (75%)
2000
Board certification switch to 10 year cycles prevalent
First steps to regulatory capture of physician CME as MOC
2010 MOL and significant resistance, MOC @ 50% participation
2014-MOC to become C-MOC, AMA declined to 15% membership
MOC points vs CME
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http://www.medibid.com/blog/2013/04/medicrats-increase-
healthcare-costs/
Physician vs Administrator growth in Healthcare
Parallels The increasing need to document in healthcare
http://www.medibid.com/blog/2013/04/medicrats-increase-healthcare-costs/http://www.medibid.com/blog/2013/04/medicrats-increase-healthcare-costs/http://www.medibid.com/blog/2013/04/medicrats-increase-healthcare-costs/http://www.medibid.com/blog/2013/04/medicrats-increase-healthcare-costs/http://www.medibid.com/blog/2013/04/medicrats-increase-healthcare-costs/http://www.medibid.com/blog/2013/04/medicrats-increase-healthcare-costs/http://www.medibid.com/blog/2013/04/medicrats-increase-healthcare-costs/http://www.medibid.com/blog/2013/04/medicrats-increase-healthcare-costs/http://www.medibid.com/blog/2013/04/medicrats-increase-healthcare-costs/8/23/2019 MOC, MOL, OCC and now C-MOC: the certification industrial complex
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The Certification industry
Millions for nothing but a promise!
CME PRA R
AMA recognition Award
Licensure and credentialing confer, inthe eyes of the public a GoodHousekeeping Seal of Approval
(To Err is Human 1999 page 3)
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Lifelong Education or testing?
Pursuit of Journals cutting edge IN YOUR
area of expertise!
Or Review regurgitation of textbook factoids
Does one size fit all and with 168 different
board certifications-how is that equal/fair?
Multiple certifications to become extinct?
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License and certification:
Limiting competition/Guilds
Milton Friedman, (1962)
the pressure on the legislature to license an
occupation rarely comes from the members of the
public . . . On the contrary, the pressure invariablycomes from the occupation itself.
Harold Demsetz, (1968)
regulation has often been sought because ofthe inconvenience of competition.
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ABIM, with the FSMB leads
the Certification industrial
complex
_______________________
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State Medical Boards have been doing this for
decades as well!
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MOC and MOL vs CPD
little difference
Goal is to provide documentation to unwitting
external agents and make money in the process
Like its predecessor, the CPD program has three
major (non-validated) components:
1) self-evaluation of the components of clinical
competence, (CME)
2) evaluation of essential knowledge and clinicaljudgment, (TESTS for $$$)
3) verification of credentials and attestation of
institutional and community good standing
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Voluntary recertification failed
progressively fewer diplomates opted to
participate in each recertification cycle:
3355 in 1974
2240 in 1977
1947 in 1980
1403 in 1986
Only 8945 diplomates, less than 10% of those
eligible, elected to undertake voluntary
recertification.
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Voluntary recertification failed
This decrease occurred despite strenuous
efforts to make the process more relevant and
attractive by:
linking it with the American College of Physicians
Medical Knowledge Self-Assessment Program,
offering modular formats and choice of content,
charging low fees.
SO the answer is to just FORCE
everyone into high cost compliance!
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Subspecialty or added qualification
Recertification in a subspecialty, such as
cardiology or gastroenterology, will not
require the maintenance of an active internal
medicine certificate;
Certificates of added qualifications, such as
geriatric medicine or clinical cardiac
electrophysiology, will continue to require anactive certificate in the underlying discipline.
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Year 2000
Active participation in CPD was made
mandatory for continuing ABIM directors
regardless of whether their certificates are
permanent or time-limited.
Directors will receive no special treatment,
financial or otherwise.
Really????
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Dr. Christine Karen Cassel
Certification AreaCertification
StatusCertification History Comments
Internal Medicine Certified
Certified09/12/1979,
Certificate valid
indefinitely
Certificates awarded in
Internal Medicine prior to1990 do not require
renewal. However, ABIM
encourages all diplomates
voluntarily to renew
certificates relevant to their
practice.
Geriatric Medicine Certified
Certified 01/01/1998,Certificate valid through
12/31/2004
Certified 02/17/2005,Certificate valid through
12/31/2015
Ex-President of the ABIM was a member of the same 2000 ABIM Task Force
on Recertification and originally certified in medicine in 1979,
(re-) certification in geriatrics occurred only in 1998 and 2005,
without the recommended primary recertification in internal medicine.
Requires basic IM
certification for validity
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Dr. Humayun Javaid Chaudhry
Certification Area Certification Status Certification History Comments
Internal Medicine
Not
Certified
Certified 08/21/1996,
Certificate valid through12/31/2006
Humayun J. Chaudhry, DO, MS,
MACP, FACOI
SecretaryFSMB President/CEO
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Specialty or
Subspecialty Certification History Status as of 1/13/2013Neurology
Certificate No.
29063
Certified on
01/30/1987certificate validindefinitely
Certification Status: Certified
MOC Status: Not Meeting MOC Requirements
and Is Not Required To Do SoClinical Status: Unknown
Lois Margaret Nora, MD, JD, MBA
President and Chief Executive Officer
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We identified officers in various internal
medicine organizations using official websites
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Meta-analytic statistics were not feasible due to
variability in outcome measures across studies.
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Board Certification and Clinical Outcomes:
The Missing Link
Purpose: no systematic review has examined
the link between certification and clinical
outcomes.
Method. Data sources consisted of studies
cited between 1966 and July 1999
identified 1,204 papers;
selected 237 based on subject relevance;
reduced to 56 based on study quality
identified only 13 that met inclusion criteria
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First comprehensive review
2000
Overwhelmingly retrospective data base
review as method
Little real data to be presented
Conclusions typically favorable in spite of
limited science
Overwhelming influence from ABMS
in sponsorship and authors noted!
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ABMS statement on certification
ABMS 2012: FACT: ABMS recognizes that
regardless of the profession - whether it ishealth care, law enforcement, education or
accounting - there is no certification that
guarantees performance or positive
outcomes
http://www.abms.org/Maintenance_of_Certification/pdfs/ABMS_MOCMythsFacts12_26_2012_final_revised01092013.pdf
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Awareness of Whether or Not Primary Doctor
is Board-Certified
DK=Dont know RF=Relative frequency??
From:2003 THE GALLUP
ORGANIZATION
for
The American
Board of Internal
Medicine
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Incidence of Having Researched A
Physicians Credentials
Q.13 Have you ever asked or checked with anyone, such
as a receptionist, nurse, doctor, friend, or coworker, if a
doctor was board-certified?
Q.14 Have you ever visited a web site or other source of
information to verify a doctors credentials?
Very low rate (33%) of
checking vs
knowledge (72%)of certification on last slide!
From:
2003 THE GALLUP ORGANIZATION
for The American Board of Internal Medicine
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Testing Frequency
From:
2003 THE GALLUP ORGANIZATION
for The American Board of Internal
Medicine
_____________________________________________
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Nurses
Colleagues
Patients & families
Private interest groups
Also: Hospital boards, other physicians, nurses, Better business bureau, etc
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Regulatory Capture:
Regulatory capture occurs when special
interests co-opt policymakers or political
bodies regulatory agencies, in particular
to further their own ends.
ABMS and FSMB have declared themselves as
Sole official agents of verification of physician
abilities-yet provide NO educational materials-this is left to the national specialty societies
who are coerced for the $$$$$$$$$$
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FSMB planning for MOL
FSMB is planning pilot projects with 11 states
starting early 2012, including:
Ohio. Calif.(D.O.), Colo., Del., Iowa, Mass.,
Mississippi, Okla. (D.O.), Ore., Va., Wis.
All Politics are local and
changes must beaddressed primarily ---
at the state level!
---------------------
------
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States with anti MOC/MOL resolutions
Fighting as professionals
Ohio
Michigan
New York
Texas
North Carolina
Iowa
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Medical Society of the State of New
York: resolutions 2013 RESOLVED, That the Medical Society of the State of New York
acknowledges that the certification requirements within theMaintenance of Certification process are costly, time intensive and resultin significant disruptions to the availability of physicians for patient care;and be it further
RESOLVED, That MSSNY acknowledges and affirms the professionalism of
individual physicians to self-determine the best means and methods formaintenance of their knowledge and skills; and be it further
RESOLVED, That MSSNY communicate to the American MedicalAssociation (AMA) and American Board of Medical Specialties (ABMS)examples of disproportional fees, onerous time requirements andunnecessary fragmentation of commonly recognized specialties; and be
it further RESOLVED, That MSSNY oppose mandating Maintenance of
Certification until such time as evidence-based researchdemonstrates MOC is linked to improved patient outcomes;and be it further
RESOLVED, That a copy of this resolution be transmitted to the AMA
House of Delegates for its consideration.
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How to organize
States have rights to legislate licenses-the battle willbe drawn here
Organization of State opposition among physicians-DATABASES/EMAIL!
Proactive measures to meet real needs
Define the truth-expose the lieswith States owndata!
Require only Certification and NOT recertification for: Hospital privileges
Group membership
Insurance payment and participation
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Testimonial to cost
National specialty societies/academics are becomingthe MOC Franchise supporters of the ABMS Testing
industry:
"On Sunday I spent 5 hours on the computer
completing a course to be accepted as my Part IVmodule for maintaining my board certification in
Family Medicine. The course was free. Today I found
out that in order for the course to be credited to my
MOC I have to pay the American Board of
Family Medicine $625 !! How do they justify this?"
Dr. M
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American Society of Anesthesiologists
http://www.asahq.org/http://www.asahq.org/8/23/2019 MOC, MOL, OCC and now C-MOC: the certification industrial complex
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American Society of Anesthesiologists
http://www.asahq.org/http://www.asahq.org/8/23/2019 MOC, MOL, OCC and now C-MOC: the certification industrial complex
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American Society of Anesthesiologists
http://www.asahq.org/http://www.asahq.org/8/23/2019 MOC, MOL, OCC and now C-MOC: the certification industrial complex
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STATEMENT
________________________________________________________________________________
2010
With CMS: any "carrot" will quickly become a "stick" of penalty
_____________________________________________________
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2013 0.5% if no MOC, 1% if MOC(performance year for 2015penalty)
2014 0.5%2015 -1.5%2016 -2%
Medicare Physician Quality Reporting System
PQRS-MOC Incentives and Penalties
https://www.ama-assn.org/ama/pub/physician-resources/clinical-practice-
improvement/clinical-quality/physician-quality-reporting-system.page
The 9 ABMS (all subspecialties) qualified for the 2012 Physician
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The 9 ABMS (all subspecialties) qualified for the 2012 Physician
Quality Reporting System Maintenance of Certification Program
Incentive.Allergy and Immunology
DermatologyEmergency Medicine
Internal Medicine
Neurological Surgery
Nuclear Medicine
Obstetrics and GynecologyOphthalmology
Radiology
American Osteopathic Association-
The following boards are qualified:
Internal Medicine
Obstetrics and Gynecology
Pediatrics
Radiology
https://www.ama-assn.org/ama/pub/physician-resources/clinical-practice-improvement/clinical-quality/physician-quality-reporting-system.page
http://moc2014.abim.org/8/23/2019 MOC, MOL, OCC and now C-MOC: the certification industrial complex
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Coming January 2014:
A more continuous ABIM MOC program
( Cert i f icat ion w il l become only an entrypoint for subscr ip t ions to MOC):
"Certified, Not Meeting MOC Requirements."
Questions and Answers
http://moc2014.abim.org/q-and-a.aspx
These Weren't The Rules When I Certified Why
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Certification and MOC have been and continue
to be evolutionary processes. In order to help
you keep pace with the changes in the scienceof medicine and assessment,ABMS and ABIM
believe that a more continuous MOC program
is vital tofulfilling our mission ofassuringpatients that Board Certified physicians are
committed and qualified to provide high-
quality care.
These Weren t The Rules When I Certified. Why
Do I Have To Do This Now?
http://moc2014.abim.org/q-and-a.aspx
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For all ABIM Board Certified physicians, ABIM andABMS will begin reporting whether or not you are"Meeting MOC Requirements" (i.e., completing anMOC activity every two years, earning 100 points
every five years, etc.). In order to be reported as "Meeting MOC
Requirements", you will be required to complete anMOC activity to earn ABIM MOC points every twoyears and earn 100 ABIM MOC points in the correct
distribution every five years. The points earned everytwo years will count toward your five-yearrequirement.
The exam requirement has not changed. You need topass the exam in each certification area you want tomaintain every 10 years
What Are The Changes To ABIM's MOC
Program In 2014?http://moc2014.abim.org/q-and-a.aspx
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To maintain more than one certification, thecost will be the fee of the most expensivecertification plus half for each of the others.
For no additional cost, you may be eligible for
CME credit for the completion of ABIM MOCproducts. MOC, in one of the internalmedicine specialties, ranges from $206- $257
per year.
Keep in mind that,for most ABIMCertifications, you do not need to maintaininternal medicine certification to remaincertified in the subspecialty.
How Much Does It Cost?
http://moc2014.abim.org/q-and-a.aspx
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The secure exam, taken once every 10years, can earn 20 MOC points.
(VS CME???) You will now have the option of paying
for the program on an annual basis orfor the full 10 years in advance at adiscount.
Your MOC fee includes unlimited accessto all of ABIM's self-evaluationproducts, many of which earn CMEcredit.
Will Any Of These Changes
BenefitMe?
http://moc2014.abim.org/q-and-a.aspx
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ABIM will honor all certifications already issued, and diplomateswho received certifications that are valid indefinitely will remaincertified (assuming you hold a current and valid license).
However, for all ABIM Board Certified physicians, regardless ofwhen they were initially certified, ABIM and ABMS will beginreporting whether or not they are "Meeting MOC Requirements."
In addition to the "Meeting MOC Requirements" requirement,diplomates with a certification that is valid indefinitelywill need to pass the MOC examin their certificationarea by 12/31/23 in order to be reported as "Meeting MOC
Requirements." This is in addition to continuing to meet the pointrequirements of the MOC program.
Grandfathers who do not meet the MOC program requirements willbe reported as "Certified, Not Meeting MOCRequirements."They will NOT be reported as Not Certified forfailing to meet MOC requirements.
I Hold Certification That Is Valid Indefinitely. Why Are You
Reporting That I Am Not Meeting MOC Requirements
When I Don't Have Any Requirements To Meet?
http://moc2014.abim.org/q-and-a.aspx
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What Is The Evidence That Supports The Need To Meet MOC
Requirements On A More Continuous Basis? How Do You Know
The Public Wants This?
The Institute of Medicine (IOM) has argued that in a profession
with a "continually expanding knowledge base" a mechanism is
needed to ensure that practitioners remain up-to-date with
current best practices.
The growing knowledge base requires that training and ongoing
licensure and certification (????) reflect the need for lifelong
learning and evaluation of competencies.
Research has shown that the public expects that physicians
undergo a rigorous, periodic examination of knowledge.
http://moc2014.abim.org/q-and-a.aspx
I ABIM Th O l ABMS B d Wi h A
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No, ABMS is requiring that all of its 24
member Boards implement a more
continuous MOC program. The AmericanBoards of Colon and Rectal Surgery,
Dermatology, Family Medicine,
Ophthalmology, Pediatrics, and Physical
Medicine and Rehabilitation are just a few ofthe Boards which currently provide or are
working to provide continuous programs.
Is ABIM The Only ABMS Board With A
Continuous Program?
Five Things Physicians and
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g y
Patients Should Question
Participating Internists
American Academy of Allergy, Asthma & Immunology
American Academy of Family Physicians
American College of Cardiology
American College of Physicians
American College of Radiology American Gastroenterological Association
American Society of Clinical Oncology
American Society of Nephrology
American Society of Nuclear Cardiology
Other specialties sure to follow!just say no? To what? Patient satisfaction? Lawsuits?
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Needless testing and Choosing Wisely
Stop wasting money on testing in patients
Yet
Test physicians yearly to screen out the veryfew marginal ones
Would the ABMS or MOC have mattered
in Kermit Gosnells case???
http://www.google.com/url?q=http://www.click2houston.com/news/reports-abortion-doctor-guilty-of-firstdegree-murder/-/1735978/20122278/-/2m5dyf/-/index.html&sa=U&ei=uzySUajEMYHu9ASfgIHoDA&ved=0CCwQpwIwAA&usg=AFQjCNHzz0KMNwMTb7_o1-I7FJHkVh8H3Q8/23/2019 MOC, MOL, OCC and now C-MOC: the certification industrial complex
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Standard
Contract
AmericanBoard of
Pathology
All rights to
board-none
to you!
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P4: YOUR obligations!
I understand and agree that, if I meet all of thequalifications for certification, my certificate
will be valid for 10 years contingent upon
my timely satisfaction of all requirements ofthe American Board of Pathology
Maintenance of Certification program.
I agree to be legally bound by the foregoing. Signature
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'I'll make him an offer he can't refuse'
Certification improves nothing: Physicians are and remain competent for many
reasons-NOT because of MOC
By creating legally mandated MOL, MOC becomesan offer you cannot refuse
Protection racketeering:
You dont really need the protection
Until after the need is created
by the offering entity!
Solicitation from 5/16/2013
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Solicitation from 5/16/2013
The American Board of
Anesthesiology4208 Six Forks Road, Suite 1500
Raleigh, NC 27609-5765
Phone: (866) 999-7501 | Fax: (866) 999-7503 | Email:[email protected] | Website: www.theABA.org
RE: Register for MOCA Cognitive Examination
We greatly appreciate your voluntary participation in the ABAs Maintenance of Certification in Anesthesiology Program (MOCA)!As a reminder,you are eligible to register for the July 2013 MOCA Cognitive Examination.
If you wish to register for the July 2013 MOCA Exam, the deadline isMay 21, 2013.
Please log into your ABA portal account at www.theABA.org toregister.
The 4-hour, computer-delivered examination will be administered to candidates at test centers in more than 300 cities located throughout the
United States, Canada and the U.S. Territories.
Registration Deadline and Fees:
To register for the MOCA Cognitive Examination, please log in to your portal account via the ABA website,www.theABA.org, and click the linklabeled Register for a MOCA Cognitive Exam.
Exam Dates (Select One): July 13-27, 2013Registration Deadline: May 21, 2013
Fee: $2,100Re-Examination Fee: $800
NOTICE: This message contains information from the American Board of
Anesthesiology that may be confidential and legally privileged. If you are not
an intended recipient, please notify the sender immediately, then destroy this
email and refrain from any disclosure, copying, distribution or use of thisinformation. Thank you.
ASA 1990 1999
mailto:[email protected]://www.theaba.org/https://portal.theaba.org/https://portal.theaba.org/https://portal.theaba.org/https://portal.theaba.org/http://www.theaba.org/mailto:[email protected]8/23/2019 MOC, MOL, OCC and now C-MOC: the certification industrial complex
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ASA 1990-1999
Closed Claims Project analysis
Analyzed claims from the 1990-1999, before 10 year cycleswere imposed
Board certification status was unknown in 51% of claims.
There were board certified 1330 claims (39%) vs 361 (11%) noboard certification identified
Currently 76% BC vs 24% NBC rates compare to 78% and 22%of claims analyzed in the 50% where known.
There was no statistically significant difference betweengroups: In both groups death occurred in 27% of claims;
permanent injury (6-8) in 22%,
and temporary or non-disabling injury 51% of claims in each group.
1990 Cl Cl i
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1990s Close Claims:
board certified (BC) vs. not certified (NBC)
Information regarding whether a claim was paid ornot includes payments by any defendant, not just theanesthesiologist
Payment reported reflects only payments made onbehalf of the anesthesiologist
Anesthesiologist median payment:
BC: $187,000 (range $3,000 - $2.7 Million) NBC: $150,000 (range $1,000 - $6 Million)
Claims resulted:
BC: 47%