MOC Battles in Arizona, Kentucky, and Michigan
Meg Edison, MD, a pediatrician in Grand Rapids, Michigan, is author of the blog Rebel MD, in which she tracks legislative skirmishes over MOC in the states. "The states are laboratories of democracy," Dr Edison observes, "and as these MOC battles demonstrate, each state tackles the issue in different ways that best suit their legislative climate."
Last year, medical societies in Arizona, Kentucky, and Michigan tried to get legislation passed to stop MOC from being used as a precondition for hospital credentialing and insurance network membership. But the bills that were passed fell short of this goal. They only stipulated that state medical boards "may not require a specialty certification or maintenance of a specialty certification as a condition for licensure," as the Arizona law put it. Any mention of hospitals or insurers was dropped.
Decoupling MOC from medical licensure is a solution in search of a problem, Dr Edison believes, because no state currently conditions medical licensure on MOC. But in 2012, the Federation of State Medical Boards (FSMB) sought to convince the Ohio legislature to require MOC for medical licensing renewal in the state. Over 15,000 Ohio doctors rebelled, uniting 15 Ohio medical organizations to successfully defeat the measure.
This factual account was meticulously detailed in an article in the Journal of Community Hospital Internal Medicine Perspectives by Paul Kempen, MD, PhD.
However, Lisa Robin, FSMB's Chief Advocacy Officer, disputes this version of events. "We never advocated that any state medical board require MOC for renewal of licensure," she insists. "There was no effort in Ohio to require MOC for licensing renewal. That simply did not happen. It was a myth that just went viral."
Be this as it may, many doctors fear this could happen in other states, so passing a law that explicitly forbids it does address a real concern, even if removal of mandatory MOC requirements by hospitals and insurers are battles to be waged another day.
In Michigan, Dr Edison's state, where she had high hopes, the result was even more disappointing. "The legislation didn't go anywhere," she says. "We had a hearing, and it never went to a vote or even get out of committee, because the pressure from the insurers and the hospitals was just too great. So we had to put ours on pause."
This year, four significant attempts to get anti-MOC legislation passed have already taken place—in Oklahoma, Tennessee, Florida, and Georgia.
Oklahoma: A Win Overturned on a Technicality
In 2016, the Oklahoma State Medical Association (OSMA) supported anti-MOC legislation coauthored by Rep Mike Ritze, DO, a family physician. "For many physicians, MOC makes sense," OSMA said in a statement. "But it is not a one-size-fits-all solution for all physicians. [The bill] 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."
For example, NBPAS offers an alternative to ABMS testing for recertification. A doctor is required to take 100 hours of continuing medical education (CME) in the previous 24 months, and prove it with either CME certificates or transcripts from the CME provider. The cost of a recertification certificate is $169.
The bill passed the state House of Representatives and the state Senate unopposed. On April 12, 2016, Governor Mary Fallin signed it into law. Oklahoma thus became the first state to enact legislation aiming to remove MOC as a requirement for physicians to obtain a license, get hired and paid, or secure hospital admitting privileges.
"Oklahoma stunned everyone last year when they passed the first Right-to-Care legislation protecting patients and their doctors from MOC red tape, in bipartisan fashion, without a hitch," Dr Edison observes. "Unfortunately," she adds, "the language was not as tight as first thought, and hospitals found wiggle room to continue forcing MOC on some doctors while exempting 'grandfathered' doctors."
Dr Ritze introduced a new bill earlier this year to clarify the language for hospitals.
"The bill looked like a slam dunk," Dr Edison recalls. "The hospitals didn't seem to oppose it. The medical society didn't even make it a priority for physicians to call prior to the vote." But in the final 24 hours before the vote, she says, ABMS and Oklahoma hospitals "went on a lobbying and misinformation tirade, pouring incredible amounts of lobbying pressure and money upon the legislature."
"The bill, as drafted, unnecessarily interferes with the ability of Covered Hospitals to select the best-trained and most appropriate individuals to staff their facilities and unduly burdens their ability to contract with such individuals," countered an ABMS legal analysis that offered talking points to hospitals and insurers opposed to the legislation. "Please do not let Oklahoma become the only state in the nation that puts its patients' quality of care at risk by removing Maintenance of Certification requirements for physicians practicing specialized medicine."
"The doctors were caught off guard and were completely flatfooted to respond to such an outpouring of lobbying power and misleading information," Dr Edison blogged. In the end, the bill "failed miserably 71-22." The previously passed anti-MOC law still stands but remains "in legal limbo."
"Not surprisingly, those who are profiting from MOC don't want their gravy train to end and have launched a disinformation campaign to scare my fellow legislators into blocking this needed reform," Dr Ritze responded. "And unfortunately, they have succeeded in stopping [the revised bill] this year." He vowed to keep fighting. "Take a moment today and contact your state legislators and ask them to support MOC reform in 2018," he urged Oklahoma doctors.
"The takeaway point here," Dr Edison concludes, "is that ABMS will spare no expense to stop state legislation."
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Cite this: Neil Chesanow. The War Over MOC Heats Up - Medscape - Jun 21, 2017.