On January 9, 2014, a bipartisan group of sixteen senators sent a letter to the Federation of State Medical Boards commending it for “advancing solutions toward multistate practice through more efficient sharing of medical licensure information.”
The letter was in response to the FSMB’s continuing efforts to overcome issues facing the concept of telemedicine. As the name implies, telemedicine is the practice of providing medical care at a distance. This encompasses everything from a simple phone consultation to something as complex as remote surgery via robotics, often referred to as telesurgery.
Specifically, the senators were addressing a piece of model legislation being drafted by the FSMB that would come to be known as the Interstate Medical Licensure Compact. Purportedly, the compact is designed to streamline the process of licensing physicians who seek to practice in multiple states. As it stands, this can be tricky. Each state has its own certifications a physician must hold to be legally allowed to practice there. So in theory, a doctor providing telemedical care across state lines—say, a routine checkup via Skype—could potentially be violating state law if the requisite licenses weren’t in order.
So here we have a problem, specific to our modern age, being taken on through a concerted, common sense measure. Clearly, this compact is nothing more than the honest attempt at facilitation it appears to be, right? Well, as it turns out, perhaps not.
On January 26 of this year the Association of American Physicians and Surgeons sent a letter to the United States Senate in direct response to the one sent by senators to the Federation of State Medical Boards a year earlier. By this time, the final draft of the FSMB’s Interstate Medical Licensure Compact had been published and publically endorsed by the American Medical Association.
The AAPS’s letter asserts that, far from being a tool through which doctors can more effectively serve their patients, the FSMB’s licensing compact is in fact “little more than a pretext for transferring state sovereignty to out-of-state private, wealthy organizations that are neither transparent nor accountable to the voters.” In short, it’s a power grab.
At this point you may be asking yourself a basic question: What exactly is the Federation of State Medical Boards? The answer is more interesting than you might think.
The FSMB is a private, non-profit organization representing each of the fifty states’ medical boards, as well as those of the American territories. As stated on the group’s own website, the FSMB is “an innovative catalyst for effective policy and standards” and strives toward “promoting excellence in medical practice, licensure, and regulation as the national resource and voice on behalf of state medical boards in their protection of the public.”
Some find it highly interesting that medical policy for the individual states is influenced by a private organization that, as the folks at the AAPS claim, is “neither transparent nor accountable” to the public. That’s eyebrow-raising stuff. But as interesting as the “what” of the FSMB is, it’s nowhere near as interesting as the “who.”
And the “who” is doctors, of course. Doctors of all stripes. Lawyers, too, but that goes without saying. In fact, the FSMB leadership roster is uncannily similar to that which you’d find at just about any other of the innumerable healthcare non-profits scattered throughout the country. And this, according to the Association of American Physicians and Surgeons, is a significant part of the problem. In their letter to the Senate, they point to the “incestuous relationship” the FSMB has with the “self-credentialed ‘patient safety’ or ‘medical quality’ industry.”
What the AAPS is getting at may be best understood via the ordeal involving CareFusion.
A FAMILY AFFAIR
On January 9, 2014—yeah, the same day the senators sent that glowing letter to the FSMB—the Department of Justice announced that CareFusion Corporation had agreed to shell out $40 million to the United States government. The payment was in response to allegations that the company had bribed, to the tune of $11.6 million, an influential member of the National Quality Forum into promoting a CareFusion product to health care providers.
The NQF is another one of these non-profit, non-governmental organizations. That group’s current CEO, Dr. Christine Cassel—who, as it happens, is the former head of the American Board of Internal Medicine and sits on the President's Council of Advisors on Science and Technology—came under scrutiny herself last year when it was revealed that she’d been paid hundreds of thousands of dollars by two medical companies that had a stake in National Quality Forum policy.
Naturally, Cassel swore up and down that no conflict of interest existed at the NQF. This was backed up by Brent James, MD, former member of NQF’s Strategic Framework Board. Dr. James asserted that there were “never any allegations of inappropriate financial inducement” regarding which quality measures were actually endorsed by the organization. James, by the way, in addition to serving as Chief Quality Officer for Intermountain Healthcare (an NGO), is also a member of the Institute of Medicine (an NGO).
It isn’t difficult to see the kind of “incestuous relationship” the AAPS is talking about. These various private organizations, influencing policies and practices in the various medical fields while maintaining deep connections to healthcare companies, seem to be headed by a shared network of industry bigwigs. As Dr. Michael Katz of Strong Memorial Hospital in New York put it on his personal blog: “each of these organizations has representatives and delegations to the other. I’ve attended many meetings where an individual says something to the effect of ‘Well, wearing my one hat, I think this, but wearing my other hat, we should totally do the opposite thing.’”
Which brings us back to the Interstate Medical Licensure Compact. Because if the AAPS is right and the compact is indeed an attempt to override state sovereignty and centralize power within a single, private, non-governmental organization, then how exactly would it work? In this instance, the control mechanism of choice would be the Maintenance of Certification program.
THE WAY IN
MOC is the process by which physicians stay up-to-date on their certification requirements. These requirements are set by specialty boards, each approved of by the American Board of Medical Specialties—an NGO, in case you were wondering—and professed to increase a physician’s knowledge of a particular field. The people of the AAPS, however, fundamentally disagree with this assertion. “While irrelevant to good patient care,” states the AAPS in their letter, “Maintenance of Certification (MOC) activities promoted by ABMS and its member boards…are extremely lucrative to the executives who administer them. Practicing physicians uniformly find MOC to be of minimal or no value. There is near unanimity that MOC’s only effect is to drain physicians’ time and money.”
And the AAPS isn’t alone in this opinion. In the fall of 2013 the Journal of American Physicians and Surgeons published an article titled “Maintenance of Certification (MOC): the Elite’s Agenda for Medicine.” The author, Dr. Kenneth Christman, used public sources to examine the practice of MOC as conducted by the specialty boards of the ABMS. Apart from identifying multilayered connections between MOC policy and organizations such as FSMB and NQF, Christman discovered that in 2011 alone ABMS boards took in $320 million in certification-attributed revenue.
“The elite medical establishment correctly foresaw,” writes Christman, “that there was a huge treasure in the medical certification business.” And while the MOC program is technically voluntary, things such as insurance policies and hospital privileges often require doctors to participate in order to gain employment. You don’t pay, you don’t play, as it were.
But the truth is, the FSMB isn’t breaking any new ground with their power grab. One has only to take a casual look around to see the pattern. Look at Common Core, and how the federal government is trying to control education through uniform testing standards. Look at Net Neutrality, and how the FCC is trying to open the door to federal regulation of the internet. It’s hardly surprising. The trend for government is always toward greater hegemony.
So far the Interstate Medical Licensure Compact has been introduced in twelve state legislatures, but as the FSMB declares on its website: “Support is growing among legislators and health policymakers…” The organization cites the letter from the bipartisan group of senators as evidence of the strengthening endorsement, and unfortunately for those of us who find labyrinthine bureaucracy and centralized power to be a detriment to society, it’s hard to argue that logic.