The War Over MOC Heats Up

Neil Chesanow

Disclosures

June 21, 2017

In This Article

Tennessee: An 'Elegant' Bill Rendered 'Impotent'

In 2016, the Tennessee Medical Association passed a resolution to "oppose and defeat efforts by American Board of Medical Specialties and the Federation of State Medical Boards to require physicians to impose mandatory Maintenance of Certification (MOC) and Maintenance of Licensure (MOL) as conditions of employment, licensure, reimbursement or professional insurance coverage."[10]

"Imposing such certification requirements upon the practice of medicine in Tennessee amounts to interference in the patient-physician relationship and threatens to interpose needless regulation between physician and patients in Tennessee," the resolution continued.[10] "There is no evidence that MOC and MOL requirements improve patient care, but rather decrease access to physicians by excluding non-certified licensed physicians who do not repeatedly re-certify, thereby placing an undue time and financial burden on physicians and encouraging early retirement."

The resolution became the basis of an anti-MOC bill that was introduced in the Tennessee State Assembly in April.[11]

"An elegant MOC bill," Dr Edison deemed it.[2] But, she continued, "the hospitals and insurers had such a fit and lobbied so hard against the bill, pushing delay upon delay, that the senate subcommittee had to strip any mention of hospitals and insurers from the bill for it to move forward. The sad, impotent Tennessee bill now simply says that MOC can't be required for a medical license."

"We were running into a lot of opposition," concedes cardiothoracic surgeon Richard Briggs, MD, the Tennessee state senator who sponsored the bill. "It was going to be a tough sell—with two or three insurance companies; some hospitals; and HCA Healthcare, a for-profit hospital chain headquartered here, opposed to it."

Cigna led the opposition among insurers. BlueCross BlueShield of Tennessee, the state's largest insurer, doesn't require its member physicians to maintain their certification. "They have said they couldn't maintain their networks if they did," Dr Briggs says. An ABMS representative also flew down to Knoxville, the state capital, to testify against the bill, he recalls.

Dr Briggs could have made a convincing case to his colleagues in the General Assembly about the problems with mandatory MOC, based on his own experience.

"Even though I'm a cardiothoracic surgeon, I haven't done heart or lung transplants since the 1980s," he explains. "We don't even admit children to my hospital. But if I have to take maintenance of certification, I've got to take courses on heart transplants, lung transplants, and congenital heart surgery. That's very expensive, and it has nothing to do with my specialty. Why not do the things I need to do for my continuing medical education that actually affect my patients—transarterial valve replacements, for example, and robotic coronary artery bypass grafts, robotic mitral valves, and minimally invasive lung surgery that would really improve the quality of care in our entire region?"

"The other issue I have as a state senator is that ABMS is usurping our authority to decide who practices medicine here in Tennessee and who doesn't," Dr Briggs says. "ABMS is a testing company. It's not a professional organization. It isn't the American College of Surgeons. It isn't the American Association for Thoracic Surgery. We should not be allowing a for-profit corporation to decide who practices medicine in the state of Tennessee. It needs to be our own Board of Medical Examiners."

But those arguments, for the most part, didn't get made. "I had several other bills I was sponsoring, and I couldn't work on all of them at once," Dr Briggs admits. However, "we plan to have a 'summer study,' where we sit down with the folks from ABMS this summer and look at this together, because we're going to bring the bill back next year. It's the number-one legislative priority of the Tennessee Medical Association, and I think we have a good chance of getting this thing through."

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