At least 21 states now have passed or considered bills to protect physicians who choose not to fulfill American Board of Medical Specialties requirements for Maintenance of Certification (MOC) from losing their hospital privileges, insurance eligibility and/or state licensure. As of press date, three states had passed bills this year addressing the requirement to maintain certification for a variety of purposes, in addition to the five that did so in 2016.
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Georgia lawmakers passed a bill in May that prohibits MOC from being used for state licensure, eligibility for health insurance panels, eligibility for malpractice insurance and staff privileges at state-owned hospitals. Texas lawmakers passed a bill that was awaiting the governor’s signature at press time, which addresses licensure and insurance plans, as well as staff privileges at hospitals that are not either academic medical or designated cancer centers. And Tennessee lawmakers passed a bill in May that addresses licensure.
This legislative success pleases Paul Teirstein, MD, president of the National Board of Physicians and Surgeons (NBPAS). Founded as an alternative to the ABMS maintenance of certification process, the group has been monitoring the progress of 19 bills across the nation including the three that passed this spring.
“I am very optimistic about the bills currently pending,” he said in an e-mail. “Hopefully, passage of this legislation in many states will inspire other states to create similar legislation. It is inspiring to see so many physicians support this new legislation.”
NBPAS formed in 2014 in opposition to MOC programs that some physicians had begun to view as too costly and not useful or relevant to their practices. Teirstein, chief of cardiology at Scripps Clinic in San Diego, asserts MOC has become “onerous, expensive and has no impact on medical care.”
Board certification gives patients the comfort level that their physician is up-to-date on the latest procedures and technology, says Lois Margaret Nora, MD, JD, MBA, president and chief executive officer of ABMS. “Legislation being introduced in states across the country increases the potential for patients and families to receive substandard care by either reducing access to board certified medical specialists, or by lowering the standards for specialty medical practice,” Nora told Medical Economics in an email.
Grant Greenberg, MD, MHSA, medical chairman at Lehigh Valley Health Network in Allentown, Pennsylvania, believes state legislators should steer clear of hospitals’ decisions about staff privileges and leave those to medical administrators.
“Board certification is establishing a minimum standard of competency, based on the expertise of physicians practicing in the field, who are knowledgeable about the field, who teach in the field, about what someone should know to be deemed competent in that field,” he says. The anti-MOC movement has come about, in his view, “because there’s a few bitter people who don’t like having to pay money to the board, or take a test or do a quality improvement project.”
Greenberg also notes that some of the ABMS boards, including the American Board of Internal Medicine and the American Board of Family Medicine, have attempted to address at least a few of the concerns of people who find the testing process onerous.
They are doing so “by providing a wider array of easier, more accessible options that still maintain the integrity in terms of minimum standards, and yet make it administratively less difficult or time-consuming,” he adds. “Boards are going in a good direction with respect to that.”
But until they encountered opposition from NBPAS, the ABMS boards had been aggressively expanding their testing regimes and advocating their use, says Jane Orient, MD, executive director of the American Academy of Physicians and Surgeons (AAPS), and an internist based in Tucson, Arizona.
“Since doctors don’t think their program is that worthwhile, they need to have it forced upon them by state legislation, or by hospitals,” she says, adding that the AAPS favors using state legislation to limit the use of MOC for purposes such as admitting privileges.
She adds that when MOC is required by hospitals or insurers, “One day you’re qualified, the next day you missed one too many exam questions and you’re no longer qualified, and patients are left without their doctor.”