MOC Decredentialing Role Strikes Sparks at AMA Meeting

Ken Terry

June 15, 2017

CHICAGO – The house of delegates of the American Medical Association (AMA) on Tuesday failed to adopt the key parts of a resolution that would have required the AMA to become more involved in state legislative battles over the role of maintenance of certification (MOC) programs in the decredentialing of physicians by healthcare plans and the loss of hospital privileges by some doctors.

Whatever the AMA does, however, it seems likely that these conflicts will continue across the country, even as specialty boards start to relax their MOC requirements in the face of vociferous protests from doctors.

The resolution at issue, entitled Action Steps Regarding Maintenance of Certification, would have mandated that the AMA do the following:

  • Affirm that lifelong learning is a fundamental obligation of physicians;

  • Recognize that lifelong learning is best achieved by ongoing participation in a program of high-quality continuing medical education (CME) relevant to each physician's practice and specialty;

  • Develop model state legislation that would bar hospitals, healthcare insurers, and the state medical licensing board from using nonparticipation in MOC programs that include "high-stakes testing" as an exclusionary criterion for credentialing;

  • Join with state medical associations and specialty societies in directly lobbying state licensing boards, hospital associations, and healthcare insurers to accept the satisfactory demonstration of lifelong learning through high-quality CME for credentialing, rather than the MOC process;

  • Partner with state medical associations and specialty societies to study the establishment of a CME program that could substitute for MOC in the credentialing of doctors, to start by 2020.

Following a contentious hearing on this resolution on Sunday, the AMA Council on Medical Education recommended that the first two sections be adopted; that the third be dropped in lieu of an existing AMA policy on model state legislation; and that the fourth and fifth planks be referred back to the council. The house of delegates approved these recommendations after a brief floor tussle.

Physician Autonomy

The opposition to the MOC resolution came mainly from physicians who were concerned that, if state legislatures got involved in board certification and credentialing, physicians would lose their ability to regulate their own profession. Proponents of the measure said that doctors needed help from the AMA to prevent insurers, hospitals, and large group practices from decredentialing and dropping physicians who failed to participate in MOC or who didn't pass the exams.

During the hearing on Sunday, Mike Munger, MD, president-elect of the American Academy of Family Physicians (AAFP), said his association had endorsed the resolution because "MOC should not be used as exclusionary criteria. So we support legislation to ensure that docs aren't excluded from credentialing because of MOC." He rejected the idea that this approach would reduce physician autonomy.

Later, in an interview with Medscape Medical News, Dr Munger said, "AAFP has always advocated that decisions on privileging and credentialing be based on documented experience and knowledge. Board certification is one factor, but any legislative action should center on not allowing board certification to be the sole criterion for hospital and plan credentialing."

Dr Munger said that in traveling around the country, he'd encountered family doctors who told him they'd been kicked out of health plans because they hadn't met the MOC requirements. "The plans say, 'If you're not board certified, you're not in the network.' " He had also heard that hospitals and large groups are removing the hospital privileges of physicians who have not successfully completed the MOC process. If the board certification of employed doctors lapses, he said, they could even lose their jobs.

Meg Edison, MD, a board member of the Kent County Medical Society in Grand Rapids, Michigan, said that if a pediatrician fails to pass any of the four MOC steps, the American Board of Pediatrics will strip that doctor of board certification and will no longer include that person on its list of board-certified pediatricians. This can damage a doctor's relationship with patients who can't find his or her name on the list, she said.

The Michigan state medical society, she noted, took the AMA's position that hospital and plan credentials shouldn't depend on whether a doctor has passed MOC and been recertified. The medical society got a bill introduced in the state legislature, but it didn't gain traction because of health plan opposition, she said.

"It could be very helpful," she added, if the AMA would support state medical societies that sponsor such legislation, which is one reason why she supported the MOC resolution.

Robert J. Mills, a spokesman for the AMA, told Medscape Medical News that the AMA is willing to assist any state medical society that asks for its help in this endeavor, but he couldn't say where that has happened. He said he was aware of similar bills that have been introduced in Oklahoma, Tennessee, and Florida. In Florida, he said, health plans and hospitals have fought the legislation.

The threat of decredentialing was not the only MOC issue at the annual AMA conference. Some delegates also complained about the high cost of the process. That included not only the fees charged by the certifying boards — which some called exorbitant — but also the cost of gathering the information they needed. One urologist said it had cost him $5000 to pull the requisite data from the five hospitals with which he is affiliated. He can afford it, he said, but he knows urologists in rural areas who can't.

American Medical Association (AMA) 2017 Annual Meeting.

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