The War Over MOC Heats Up

Neil Chesanow

Disclosures

June 21, 2017

In This Article

Other States to Watch This Year

Anti-MOC legislation is currently pending in Maryland, Missouri, North Carolina, and Texas, and bills have been introduced earlier this year in Alaska, California, Maine, Massachusetts, New York, and Rhode Island.

California, with over 100,000 physicians, is often a bellwether state.[14] The California Medical Association considered but didn't pass an anti-MOC resolution at its October meeting, according to Los Angeles anesthesiologist Karen Sullivan Sibert, MD, who reports on anti-MOC legislation in the state in her blog A Penned Point.[20] "However," she says, "there is enthusiasm for pursing the resolution again in 2017, and it appears to have a strong chance of passing." The title of the resolution: "Maintenance of Certification should not be used as criteria to assess physician competence."

In Alaska, passage of anti-MOC legislation is a practical necessity, Dr Edison believes. "It doesn't make any sense that nonprofit companies in the lower 48 states should have any influence on a doctor's ability to practice medicine in Alaska," she reasons. "If you try to do your MOC, and you live and practice a long way from a city where you can attend a board review class and then take your exam, as many doctors in Alaska do, it would mean taking weeks off from work. It's a big deal, and you'd be leaving patients in your community for significant periods of time without a doctor."

In Texas, "an anti-MOC bill unanimously passed in the House and went to the Senate, where their public health committee passed it on May 16," Dr Edison reports. "Now it's just waiting to be scheduled for a vote. But it's moving forward despite significant opposition from different special interest groups. I'm very confident in Texas being able to do this." People in Alaska and Texas are fiercely independent, she says.

Last year, the movement got a boost from the House of Delegates of the American Medical Association (AMA), which adopted a policy stating that "MOC should not be a mandated requirement for licensure, credentialing, reimbursement, network participation or employment."[21]

In April, the AMA's leadership went a step further, proposing model anti-MOC legislation. Medscape obtained a copy via a personal communication. It is difficult to find online. Called "The Right to Treat Act," it provides state legislators with a template for drafting new anti-MOC laws, and it lends medical establishment legitimacy to the anti-MOC movement. "No facility...shall deny a physician a hospital's staff or admitting privileges based solely on the physician's decision not to participate in maintenance of certification," a key clause reads. States another, "A health insurance entity...shall not deny reimbursement to or prevent a physician from participating in any of the entity's provider networks based solely on a physician's decision not to participate in maintenance of certification."

Meanwhile, What Recourse Do Doctors Have?

As the movement seeks to involve more doctors and broadens its fight to other states, what about in the meantime? Do you have any option other than to periodically recertify, and pony up the fee, if hospitals and insurers in your state require it?

Dr Fisher doesn't beat around the bush. "No option," he flatly states. "And therein lies the problem."

Dr Edison actually tried to buck the system. "On December 17, 2015, in the middle of my busy day seeing patients, I voluntarily gave up my American Board of Pediatrics (ABP) certification," she recalls. "They say recertification is voluntary. So I said, 'Let's see how voluntary it is.'"

Dr Edison had passed her pediatrics boards twice. She had recruited patients for research projects and submitted her data to the board, as she was asked to do. She had completed the mandatory CME. "It came down to them saying, 'Give us $1300 or you lose your certification,' she told Medscape. From an educational standpoint, I didn't need to recertify until 2023. Yet every few years, they want me to give them more money. So I said, 'You know what? I'm not going to pay.' It's ridiculous!"

Last year, she sent an outraged letter to ABP and posted it on her blog for other physicians to read. "Within days, I had 40,000 views," she claims. "Within weeks, I had 100,000. Clearly, I had hit a nerve."

Her name abruptly vanished from the database of board-certified pediatricians on the ABP website. "You cease to exist," Dr Edison says. "It's as if you never passed your boards to begin with. And it caused all sorts of grief with insurers."

Within days after her name was removed, Blue Cross Blue Shield of Michigan, the state's largest insurer, contacted her. "They aggressively hunt down doctors, and if you aren't doing MOC, they kick you off their panels, Dr Edison explains. "They told me I was no longer board-certified. I had to pay the money or I wasn't going to see my patients. Right away, they were sending letters to my patients telling them that I was no longer a Blue Cross provider and that they were going to be reassigned to a new doctor. My patients were calling the office, upset. My billers were stressed out. I couldn't put my patients and staff through that. So I paid the money—$1300, plus a $200 late fee. Within seconds, I was emailed a PDF file saying that I was magically board-certified again. Within hours, Blue Cross backed down. It's all about the money."

"What some doctors in Michigan who don't want to do MOC are doing is hiring nurse practitioners (NPs) and physician assistants (PAs) to see their patients, because the insurance company will credential an NP or PA," Dr Edison says. "But they won't credential a doctor with years of experience, and who has passed multiple board exams, but who finally decides that they're done with MOC."

The only other alternative is to join the fight. "If you live in a state where MOC is mandatory, it's all about getting anti-MOC legislation to a vote," Dr Edison says. "It's calling up your lawmakers. Doctors, like most people, often don't know who their lawmakers are, so it can be intimidating. But once you jump in, it's nice. You get to talk to people who are creating the laws in your state, and they care about you calling. I don't think doctors call that much, so when one of us does, they listen to our concerns."

The movement is gaining momentum, Dr Fisher believes. "There's a growing group of us who get up every day and head out to work, and in brief moments of quiet, we are sending messages to our friends and working hard to get the word out that we need to stop this," he says. "If nothing else, it's helped us regain our profession and understand what really matters."

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