Florida: Realpolitik or Act of Betrayal?
A bill drafted by the Florida Medical Association (FMA) was introduced in the Florida legislature in Tallahassee in April. It precluded the state board of medicine, department of health, licensed healthcare facilities, and health insurers operating in Florida 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."
"Finally, legislators are taking notice of the abuse of MOC in Florida and proposing laws to stop it," proclaimed St Petersburg neurosurgeon David McKalip, MD, president of the Florida chapter of AAPS, which had helped to shape the legislation.
But then something unexpected happened.
Florida has more doctors (over 52,000) than any state except California and Texas. With a constituency that large, and with ample funding to lobby state legislators, FMA should have had the clout to get the legislation passed, Dr McKalip contends. It didn't. To get the bill out of committee, FMA was forced to rewrite it from scratch.
The new version did not address the MOC concerns of Florida doctors at all. On the contrary, it directed the state to regulate its subspecialty boards, with a complicated plan to control MOC rather than make it voluntary. As long as a subspecialty board registers with the state, is a 501(c)(3) corporation, has a brick-and-mortar building with full-time employees, and doesn't require additional testing, the doctors under its aegis could be compelled to maintain their certification in order to say they are board-certified.
For Dr McKalip, the completely rewritten legislation was an act of betrayal. "No one in medicine wants that," he told Medscape. "Why would we ever want the government to have more authority to put a seal of approval on MOC?"
The final draft of the legislation "was made to differ from the initially filed bill because we were told that if the bill wasn't changed, it wasn't going to get a hearing," explains Jeffrey Scott, JD, FMA's general counsel. "It would have died exactly as it was. So we took our direction from the committee chairman, who was also the bill sponsor. When the sponsor who chairs the committee the bill's being heard in tells you to do something if you want to have any chance of moving forward, you do it."
FMA was directed to rewrite the legislation because ABMS, the Florida Hospital Association, and the Florida Healthcare Association, representing the state's insurers, applied significant pressure, Scott maintains. "A number of senators on the Health Policy Committee expressed some concern," he says. "To get the bill out of that committee, it needed to be less controversial."
The earliest FMA could introduce a new bill that addresses MOC requirements in the Florida state legislature is 2018, Scott says. "We're going to be meeting with all the folks who have an interest in coming up with a game plan," he adds. "I can't say at this point what it will be. We're going to study it over the summer."
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Cite this: Neil Chesanow. The War Over MOC Heats Up - Medscape - Jun 21, 2017.