Legal update

AOA settles class-action lawsuit

Board certification to be uncoupled from membership; four original plaintiffs receive $15,000 each.

The AOA has agreed to settle a lawsuit brought by four of its members and, after final approval of the settlement, will no longer require that its board-certified physicians maintain membership in the association.

Ironically, the decoupling of membership and board certification was delayed by the ongoing litigation in the case, according to Josh Prober, JD, AOA general counsel. The AOA Board of Trustees voted to decouple in February 2016, before the suit was filed.

“Unfortunately, the timing of this litigation prevented AOA from moving forward with decoupling and halted progress on several initiatives in membership and board certification,” Prober said.

“It’s important to understand that the business practices at issue in the legal case were entirely lawful. Decoupling was a planned strategy to market certification and membership separately and reach broader markets for each.”

A renewed focus on high-value work

AOA has limited board certification to members since it began offering certification in the 1930s. The policy regarding membership and certification has been reviewed—and affirmed—by the House of Delegates approximately every five years since 1979 as part of the House’s sunset review process.

Ultimately, AOA chose to settle the case because the litigation appeared likely to extend for several years, said AOA President William S. Mayo, DO. The legal case prevented AOA from fully implementing strategic initiatives in membership and board certification and severely strained staff resources.

“For two years, the AOA’s human and financial resources have been diverted to defending this lawsuit rather than to refining our organization to meet the needs of a rapidly growing profession,” Dr. Mayo said. “Settling this lawsuit allows us to focus on high-value work that is only done by AOA, like protecting practice rights and providing legal assistance and federal advocacy for DOs.”

Ending the case allows AOA to put the organization’s full focus on members’ priorities, said AOA CEO Adrienne White-Faines, MPA, FACHE. “We appreciated the decision by the Board of Trustees to settle the case because of its prolonged, extensive drain on staff resources. This ends the delay on implementation of key strategies, which will benefit our members and the profession as a whole.”

The plaintiffs’ attorneys, Philadelphia-based Duane Morris, LLP, will receive fees and costs in an amount not to exceed $2,617,000. Monetary awards of $15,000 each were granted only to the four original plaintiffs—Albert Talone, DO, Craig Wax, DO, Richard Renza, DO, and Roy Stoller, DO—and will be paid out of the Duane Morris attorneys’ fees. There is no other monetary settlement.

Dues reduction

A $90 reduction of membership dues was part of the settlement agreement. Recently approved by the AOA House of Delegates, the dues reduction applies to regular members for three years starting June 1, 2019. AOA is a physician-led organization in which members set their own dues, which necessitated the vote. The AOA also will suspend board certification maintenance fees of $90 for three years.

Further, the AOA will recognize online continuing medical education (CME) as equivalent to live CME for the purpose of meeting membership requirements and will offer AOA members two free online CME courses for three years, a value of $40 to $150 per year, depending on specialty.

The AOA will also continue its brand awareness campaign for osteopathic physicians through May 31, 2021.

51 comments

    1. I have my doubts that they really were going to decouple. That sounds more like a comment meant to save face than an actual plan that was to be implemented.

      1. “The AOA Board of Trustees voted to decouple in February 2016, before the suit was filed.”

    1. LOL what? Have you even read an article? AOA lost and paid millions to lawyers. This is a clear disaster – showing AOA can’t even defend itself from simple lawsuits. How can it defend us?

      1. A settlement is not a loss, are you an attorney? It means both parties came to an agreement to not to continue with the suit.

  1. Online CME is now the same as live… 1A? You mean I don’t have to close the office, spend two days traveling and pay for expensive flights and overpriced hotels to get the same info. Awesome.

    1. I agree. With rVU payments as basis for compensation, there’s no free lunch and no paid days off. Take 4 or 5 days off and you eat it the next month or quarter. Nice to be able to do it the way we do everything else…. online.

    1. But again, learning is an individual preference on how one learns. And CME is meant to be educational, and what you prefer we learn may not be what we are interested in. Adult learners do NOT do well sitting in conferences all day, nor can we make a living closing an office or not round for a week at a time for a mandatory conference.

    2. As long as HMO’s, those whose pay your patients health care costs, and hospital medical staff boards require that you maintain licensure and certification, you will have to MOC. Currently I have letters on my desk from insurers who pay my bills to patients that require me to prove I have MOC from my 3 certifications. If you want to sue someone, sue them.

    3. Yep. At least the Radiology Board wised up to its members and dropped OCC.

      I can’t not pay and jump the hoops the AOBFP is insisting I do, so my only recourse, to make my feelings known, is to drop my AOA membership, which I have had for over 20 years.

      If they can’t control the Boards, then the body who is supposed to speak and avdocatr for us, will pay the price.

  2. Call me uninformed but what does decoupling mean to its members? Where do I read about the actual effect of that happening? I train 5 residents and I need to know for them and myself.

    1. Decoupling AOA membership as a requirement to maintain AOA board certification.

      ABMS boards do not require AMA membership for board certification.

      1. But, AMA is not in the enterprise of Board Certification business. There is a slight difference. We are dealing with two different formats.

    2. Decoupling is the separation of AOA membership from board certification. Since the inception of AOA board certification in the 1930s, AOA has offered certification only to members. Board certified diplomates are required to maintain AOA membership to keep their certification active. After decoupling, AOA certification will be open to non-members – DOs and MDs – and diplomates will no longer be required to maintain membership in the AOA.

      Decoupling is one of the provisions in the settlement agreement. The effective date for implementing the settlement is 30 days after the settlement is fully approved by the court. The earliest this could happen is December 2018 if there are no appeals or delays.

      On the effective date after the settlement is fully approved by the court, DOs can stop their AOA membership without jeopardizing their board certification.

  3. I’ve always wondered why I needed too be a member of the AOA to maintain my board certification if I fulfilled my educational requirements. I’ve often been reminded by the AOA of all the value I receive from membership along with keeping track of my CME, which was mandatory to stay board certified. I always keep my records of CME activity for obvious reasons and didn’t feel this benefit to be of much value. I must admit that I will seriously have to reconsider whether or not future membership will continue without the threat of losing certification (considering the annual costs I spend with various medical groups). Financially I get discounts for AOA sponsored CME activities which help offset cost of membership. I believe it’s good to support our parent organization but am not always convinced of the benefits that are touted.

    1. The AOA is the world’s largest community of physicians and students dedicated to advancing osteopathic principles and practices. It is the only national organization protecting practice rights for all DOs, including public policy and payor advocacy to ensure recognition of DO licensure and certification; reimbursement for osteopathic treatments; and advocacy for international practice rights of US educated DOs.

      Members also receive a broad array of services, benefits and discounts that support DOs in their professional and personal lives, from practice management and financial/insurance products, to discounts on travel, cars and appliances. Other benefits include members-only continuing medical education resources; a comprehensive online CME activity report; and grant opportunities to support research. Learn more here: https://osteopathic.org/about/aoa-membership/

  4. If I choose not to remain a member, who will keep track of my CME credits in order to maintain my FM board certification?

    I need further clarification regarding, “now accepting on-line CME.” Do they mean that 1A credit mandate will be dissolved?

    Further clarity is needed by our leadership please!

    1. Nonmember physicians will need to keep comprehensive records to document completion of the required CME and provide such documentation to the applicable certifying board. AOA’s popular TraCME service is available only to members.

      Under the terms of the settlement, AOA can no longer suspend a physician’s membership for failing to meet a CME requirement, provided the physician satisfies the CME requirements for state licensure. However, each AOA certifying board will continue to set CME requirements for maintaining certification.

      Each AOA certifying board sets its own CME requirements. Most require some amount of Category 1-A CME. Some online CME programming qualifies for Category 1-A. Information about CME requirements for board certification is available here: https://osteopathic.org/cme/cme-guide/

  5. If the AOA had already decided to decouple in February 2016, why did the suit continue to the tune of $2,617,000. It looks like the big winners here are the plaintiff’s lawyers with the plaintiffs getting only a total of $60,000 from that figure.
    I assume the AOA attorney’s fees were in the same ballpark. Over $5M for something that should have been settled right off? Please justify your tactics.

    1. Decoupling is one of the provisions in the settlement agreement. The effective date for implementing the settlement is 30 days after the settlement is fully approved by the court. The earliest this could happen is December 2018 if there are no appeals or delays.

  6. What happens to all of these “agreements” after 3 years?

    Will certification and membership be linked again? Board fees go back up? Back to requiring live CMEs?

    1. After three years, the AOA regains the right to recommend and establish membership fees based on market demand and fiscal assessment. Membership dues recommendations must be approved by the House of Delegates.

      There are no plans to re-couple board certification and membership, and the settlement terms require court approval for AOA to reinstate the policy requiring membership for board certification.

  7. I would like more information regarding the significance of maintaining the brand awareness ad campaign through May 31, 2021. This has been something that I see as important, and I’d like to see it continue even longer.
    I’m not privy to the plaintiffs’ motives for the lawsuit, but in light of the struggles to maintain osteopathic hospitals and residency programs and combining ACGME with our AOA residencies, it appears to me that there is a lot more at stake than paying dues and uncoupling board certification here.
    I can understand why some DOs would like to have on-line CME equal 1A credits, especially if they are in an area where osteopathic education isn’t readily available. However, I have seen the value and experienced the difference many times over the years in a live lecture hall versus reading an article at home or online. They are not the same. I have found the value of interacting with ones’ colleagues and live discussions that often ensue during or following a formal presentation to be important and necessary. I would hate to see this disappear.
    It seems that there are challenging struggles going on within our profession, as we strive to maintain our uniqueness, while working and coexisting with our allopathic colleagues.
    Yes, $2.6 million seems a terribly excessive amount of money, but sometimes legal action is what it takes to be heard and obtain compromise or resolution. Hopefully everyone can move forward now for the common good.

  8. When the lawsuit was filed I told Craig Wax that decoupling of Board certification had already been approved by the Bureau of Osteopathic Specialists and had probably already been approved by the Board of Trustees. This meant that you didn’t need to be an AOA member to become certified by the Osteopathic Boards. The lawsuit was a massive waste of money, As a former representative of the BOS, I can personally tell you how much time and effort was lost because of that boondoggle.

  9. I’m 74yr old member of AOA . I was wondering isn’t there a rule that if you’re over 70 yrs old you don’t have to pay dues? Can someone clarify this.

  10. Unfortunately, this was handled and settled badly….except for the lawyers who are celebrating.
    I have no doubt this was about egos, control, and power. The best interests of us, DOs, wasn’t priority one. Very sad but hopefully a valuable lesson was learned by the board, trustees, executive leadership, and our membership. We will NOT survive as a unique medical entity and profession if we do not put aside petty differences for the greater good, i.e., the sake of our own survival and for the sake of our patients.
    Like I learned in medical school, “cooperate and graduate”!
    Otherwise, what’s the point? We can surrender now, like they did in California years ago, and convert our medical schools to Allopathic institutions and ourselves to MDs.
    Just one DOs opinion.

    1. Unification of Residency was the Start of the End of AOA. Why do we need AOA now? After the DO medical schooling, there really is no need for AOA now? In private practice, still no one cares about AOA boards in most university hospital settings.

      1. The AOA is the world’s largest community of physicians and students dedicated to advancing osteopathic principles and practices. It is the only national organization protecting practice rights for all DOs, including public policy and payor advocacy to ensure recognition of DO licensure and certification; reimbursement for osteopathic treatments; and advocacy for international practice rights of US educated DOs.

        Members also receive a broad array of services, benefits and discounts that support DOs in their professional and personal lives, from practice management and financial/insurance products, to discounts on travel, cars and appliances. Other benefits include members-only continuing medical education resources; a comprehensive online CME activity report; and grant opportunities to support research. Learn more here: https://osteopathic.org/about/aoa-membership/

  11. Please understand I’m not an activist or express my opinion in public forums except in rare situations.
    I’m not clear how a reasonable thinking individual could ask to be “certified” by an organization but expect this to be done without being a member of that organization, or its parent organization. This being said, I’ve never had a bit of confidence in the “virtues” and “benefits” of being a member that have been proclaimed. I’m like many other professionals who feel that we’re being $500 -$700 to death all while reimbursements continue to plummet and documentation demands simply to justify decisions re; CYA.

    I’ve been privileged to return to practicing the art of medicine again by retraining and working in the field of Addiction and Mental Health. Far cry from Orthopedic Surgery, however I’m happier and healthier with a third of the income of the first two decades of my medical career. I truly believe I’ve experienced these past 7 years what my father enjoyed as a smaller community Family / General Practice Physician.

  12. what does AOA do with all membership fees? do they build new schools or participate in public policy? what does AMA do as well? I like the idea of being board certified, it forces us to study like crazy and to be somewhat up to par with minimum competency, but at the same time it’s very expensive and every day practice doesn’t really change much from studying for boards,… maybe few weeks, but depending on practice type, not really… it’s not practical at all. I think our Raf scores, CSGs, Hedis, NCQA, etc those are at least little more clinical based rather than just random medical knowledge based. I think we should do away of retaking boards as well.

  13. Fun Fact Alert !!!!!!!!

    Over 90% of attorneys are NOT board certified and they take the bar exam once. No exam every 8-10 years.

    Just thought I’d mention.

  14. I nominate the 4 plaintiffs including Dr Wax to donate their settlement check to an AOA OCC task force dedicated to making the OCC process more physician friendly. It would be only 60k total but I think the gesture would be an appropriate one at this point.

    It’s a sequela of their original complaint.

  15. I totally agree with this settlement. Question: What does AOA membership have to do with board certification competency? Answer: none…except you used to need one to have the other. Question: Why doesn’t online CME (courses, uptodate, etc…) count the same as any other CME? Answer: Because the AOA NEEDS people to attend osteopathic specific conferences. Guess what…. the allopathic conferences are have better lecturers, better participation, better sponsorship, and a better experience. Maybe we shouldn’t compete over philosophy and join together like the ACGME has? Just a serious thought!

    1. Unfortunately, YOU did not get accepted to an MD school, or all of this would be mute to you.
      WE WANT DOism and WE LIKE DOism.

  16. Florida still require live conference for state mandatory requirements. A pain for sure since I’m retired — I go sit & read the Wall Street Journal & listen to podcasts.

  17. What will happen to the High Stakes written Re-Certification exam?

    Lets hope it goes away.

    Having some DO’s need to continuously take this and some “Grand Fathered” exempt, is causing a big divisive feeling among many.

    1. OCC will continue to be required to maintain board certification. AOA certification and OCC reflect your commitment to ongoing evidence-based education that results in high-quality, whole-person care and improves patient outcomes and satisfaction. Efforts are underway to make board certification and OCC more cost efficient, easier to maintain and more relevant to today’s practicing physicians.

      Individual certifying boards are making changes to CME requirements and exploring opportunities to leverage technology for cognitive assessment. The American Osteopathic Board of Radiology recently announced a new pilot format for cognitive assessment that eliminates the 10-year OCC examination: https://thedo.osteopathic.org/2018/07/osteopathic-certification-board-nixes-10-year-occ-exam-for-2019.

      1. Is it true that the AOBFP may do away with 1 High Stakes written Re-Certification exam and RE-PLACE IT WITH 3 HIGH STAKES EXAMS?

  18. Finally some good news for physicians. Now if we can get rid of board re-certification and MOCA and base recert on maintaining CME’s, that would be a real win for over worked and over stressed physicians. Once certified always certified! The recert is only a money making affair, only not for doc’s, only for AOA/AMA. Also, forget about AOA CMe’s and just take all CME’s would bring more DO’s back into the fold. I am DO with allopathic trained residency and fellowship and had to get BC thru ABMS instead of AOA. Why join the AOA? They need to expand their horizens and bring in allopathic and osteopathic docs into the CME fold.

    1. Why join the AOA? The AOA is the world’s largest community of physicians and students dedicated to advancing osteopathic principles and practices. It is the only national organization protecting practice rights for all DOs, including public policy and payor advocacy to ensure recognition of DO licensure and certification; reimbursement for osteopathic treatments; and advocacy for international practice rights of US educated DOs.

      Members also receive a broad array of services, benefits and discounts that support DOs in their professional and personal lives, from practice management and financial/insurance products, to discounts on travel, cars and appliances. Other benefits include members-only continuing medical education resources; a comprehensive online CME activity report; and grant opportunities to support research. Learn more here: https://osteopathic.org/about/aoa-membership/

  19. Hello,

    To the DO who asked: “Is it true that the AOBFP may do away with 1 High Stakes written Re-Certification exam and RE-PLACE IT WITH 3 HIGH STAKES EXAMS?”

    The AOBFP is evaluating models to address the assessment component of recertification. To better align physician-centered learning with continued competence, the Board is considering increasing the frequency of assessments and making them available on accessible, convenient testing platforms.

    Thank you.

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