June 26, 2017

Inside the growing debate over 'maintenance of certification' requirements

Daily Briefing

In growing numbers, providers from different specialties are coming together to advocate for legislation to ban mandatory maintenance of certification (MOC) requirements—especially for hospital credentialing and insurance network membership, Neil Chesanow writes for Medscape.

5 myths physicians believe about patient experience

About MOC requirements

Among the key supporters of current MOC requirements, according to Chesanow, is the American Board of Medical Specialties (ABMS), which writes the standards for physician certification in partnership with 34 member boards, as well as a few hospitals and insurers.

Susan Morris, ABMS director of communications, told Medscape that MOC requirements are critical to ensuring that physicians who were first certified years ago continue to possess up-to-date skills. "The ABMS Boards concluded decades ago," Morris said, "based on substantial evidence, that ongoing assessment is necessary to assure that their knowledge and clinical judgment are up to date in their specialty."

If MOC requirements were repealed, Morris said, then "faced with a physician ... who has not kept the certificate current, patients will be in the dark. They will not know whether that physician chose not to participate, or failed to earn recertification, or was denied the certificate for unprofessional behavior."

Growing discontent

But according to Chesanow, MOC opponents contend that while initial board certification is a legitimate requirement, MOC has become an unnecessary, time-consuming, costly process that doctors have to complete too often.

Westby Fisher—director of cardiac electrophysiology at NorthShore University Health System, who's a leading opponent of MOC—said, "Every time you reach into your wallet to get $2,800 to pay for recertification every 10 years, you start thinking, 'Why am I doing this?'" He added, "Each time, it has gotten more laborious, with more time away from my patients and family. Who are these people to tell me how to practice medicine? I've been doing this for 30 years."

Prominent MOC opponents include the:

  • Association of Independent Doctors;
  • American Association of Physicians and Surgeons (AAPS);
  • American Medical Association;
  • National Board of Physicians and Surgeons; and
  • Practicing Physicians of America.

Where the anti-MOC movement stands now

A grassroots movement by physicians around the country has led medical societies to propose legislation to ban mandatory MOC requirements from hospitals and insurers in at least 17 states this year. Chesanow spotlights four measures in particular:

No more MOC: One state bans the controversial credential requirement—and others may follow

1. Tennessee: According to Chesanow, the Tennessee Medical Association last year passed a resolution that said the organization would "oppose and defeat efforts by [ABMS] and the Federation of State Medical Boards to require physicians to impose mandatory (MOC) and Maintenance of Licensure (MOL) as conditions of employment, licensure, reimbursement, or professional insurance coverage." The resolution, Chesanow reports, led to an anti-MOC bill that was introduced in the state Assembly that bars MOC for medical licensure.

2. Oklahoma: Last year, Gov. Mary Fallin (R) signed a measure—supported by the Oklahoma State Medical Association (OSMA)—that made the state the first to enact a law "aiming to remove MOC as a requirement for physicians to obtain a license, get hired and paid, or secure hospital admitting privileges," Chesanow writes. According to OSMA, the new law "would still allow hospitals and health plans to 'fast track' someone who has MOC, but it would say MOC can't be the only way in and would require them to have some alternate pathway by which physicians could be credentialed." But the law ultimately fell short of curbing MOC's influence, Chesanow reports. According to Meg Edison, a Michigan-based pediatrician and MOC opponent, the bill's language allows hospitals "to continue forcing MOC on some doctors while exempting 'grandfathered' doctors." Moreover, a subsequent bill that would have clarified the language faced a last-minute opposition campaign from ABMS and failed to pass. According to Edison, the current law is still in effect but sits "in legal limbo."

3. Florida: The Florida Medical Association (FMA) wrote a bill that was introduced in the state Legislature in April that would have precluded the state medical board, health department, licensed health care facilities, and insurers in the state from requiring recertification "as a condition of licensure, reimbursement, employment, or admitting privileges for a physician who practices medicine and has achieved initial board certification in a subspecialty." However, FMA had to rewrite the measure to get it past committee, and according to Chesanow, the rewritten measure not only failed to address the anti-MOC doctors' concerns—it directed the state to regulate subspecialty boards under a complex plan to control MOC as opposed to making it optional. Jeffrey Scott,FMA's general counsel, said stakeholders plan to try for a new bill again for 2018, when FHA will next be able to propose a measure addressing MOC requirements.

4. Georgia: Georgia earlier this year became the only state that removes MOC requirements for staff privileges at "certain" hospitals, insurance network membership, and medical licensure, Chesanow reports—a legislative move that Edison characterized as "a pretty big win." However, according to Chesanow, while the bill was originally written to apply to all hospitals in the state, its scope—under pressure from insurers and hospitals—was narrowed so that it only applies to state hospitals. As a result, the legislation applies to only six hospitals in the state, out of nearly 150 acute care hospitals, 17 long-term and rehabilitation hospitals, and 20 psychiatric and substance misuse facilities.

Meanwhile, according to Chesanow, states where anti-MOC legislation has been introduced or remains pending include:

  • Alaska;
  • California;
  • Maine;
  • Maryland;
  • Massachusetts;
  • Missouri;
  • New York;
  • North Carolina;
  • Rhode Island; and
  • Texas (Chesanow, Medscape, 6/21).

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Excellent patient experience is a critical piece of modern medicine, reflected clearly in outcomes. And more than amenities, clean rooms, or quiet during night, the factors that most inflect patient experience all relate to communication and coordination among the care team—factors that physicians are in a unique position to influence.

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