Tennessee Law Focuses on Licensure
The Tennessee law enacted in May addresses only licensure, although an earlier version would have prohibited use of MOC to determine hospital privileges or insurance eligibility, says Dave Chaney, vice president of the Tennessee Medical Association.
Popular online: Top 10 challenges facing physicians in 2017
But Chaney suspects those provisions may be revived in the next legislative session. “This is something that has been brewing for a number of years,” he says. “We’ve heard from a lot of our members who incur what they feel is excessive cost and an unnecessary burden to complete the exams and the studies to maintain their specialty board certification.”
The Tennessee Medical Association believes board certification should be entirely voluntary, “yet [doctors] don’t feel they have a choice when the hospitals and payers say it’s a requirement,” he adds. “Our members are happy we’re taking up the flag and doing something about it. As with any advocacy issue, you don’t always hit a home run on the first swing.”
State Senator Richard Briggs, MD, a cardiothoracic surgeon and sponsor of the bill, says he “absolutely” intends to revive the other aspects of the original bill related to hospital privileges and insurance eligibility.
As an adult open heart surgeon, Briggs says he has had to answer questions about everything from heart transplants to pediatric heart surgery on MOC exams. “Why should I take time and money to take courses on those [issues]?” he says. “You’re spending time that has absolutely nothing to do with your practice.”
At least three other states had bills pending that did not pass in the spring of 2017. A Florida bill that would have prohibited MOC from being used in determining hospital privileges and insurance eligibility made it through a House committee, but not the full House.
The Florida bill enjoyed the support of three physician-legislators, including State Rep. Julio Gonzalez, MD, an orthopedic surgeon in Venice, Florida, and the bill’s sponsor. “All three of us were in lockstep in espousing and believing in the virtues of this bill,” he says. “The concept was very straightforward.”
But the state’s Senate, which does not have any doctors among its members, changed the bill significantly and it did not pass, Gonzalez says. “Number one, they don’t understand the economics and industry dynamics because they don’t have a physician in their chamber,” he says of the Senate. “Number two, pressure was applied by the hospitals and insurance industry, and ABMS hired a lobbyist to lobby against the bill.” He adds that he plans to reintroduce the bill in 2018.
Further reading: Physicians take MOC fight to state level
Rhode Island’s legislature held hearings on a bill but has tabled it for further study. House minority leader Patricia Morgan still hopes it will progress. “[Doctors] don’t think [MOC] improves their skills and knowledge, but it certainly adds a lot of cost and time,” she says. “They say it’s just an added layer of requirements on them.”
However, Peter Hollmann, MD, vice president of the Rhode Island Medical Society, says he doesn’t think many doctors in his state see the need for legislation limiting the use of MOC, and hopes the legislation doesn’t pass.
“In general, we support medical staffs being autonomous” to make decisions on what’s needed for hospital privileges, says Hollmann, a geriatric internist and chief medical officer of University Medicine, a medical center affiliated with Brown University. “We’d rather not have legislators telling us what to do.”
But Hollmann adds that the feeling isn’t quite unanimous and that a minority of physicians saw the bill as a bulwark against what they view as onerous requirements. “In our community, there are a small number of doctors who are very, very, very concerned about this,” he says.