States attempt to limit importance of MOC

Based on a partnership with Urology Times, articles from the American Association of Clinical Urologists (AACU) provide updates on legislative processes and issues affecting urologists. We welcome your comments and suggestions. Contact the AACU government affairs office at 847-517-1050 or info@aacuweb.org for more information.

Maintenance of certification (MOC) is an increasingly time consuming, expensive, and unnerving exercise.

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According to the Urology Times 2015 State of the Specialty survey, 85% of respondents' ABU certificate is time limited and 77% say certification is required to practice in their hospital. When more than half declare that they will not take the recertification exam at age 60, the impact of MOC on the urologist work force will be far reaching.

While at the federal level, definitions of quality and payment increasingly depend on board certification, state legislators, urged on by grassroots physician activists, are taking the opposite approach, rejecting recertification as a factor in reimbursement and staffing.

Dating back several years, Medicare encouraged participation in MOC programs. Physician Quality Reporting System requirements for 2013 assert that eligible professionals who met Maintenance of Certification Program Incentive requirements "could receive an additional 0.5% incentive payment." The 2015 law that replaced the sustainable growth rate formula likewise rewards MOC.

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While the Medicare Access and CHIP Reauthorization Act does not mandate re-certification, providers will receive bonus payments for clinical practice improvement activities that may include MOC. Since incentives under the Merit-Based Incentive Payment System must be offset by penalties, some physicians' decisions to forgo MOC will negatively impact Medicare reimbursement.

Next: State-based campaigns organized

Passionate physicians, many of whom question specialty boards' financial interests and regulatory power, have organized state-based campaigns to minimize the role recertification plays in licensing, payment, and employment or admitting privileges. These advocates firmly believe that initial board certification and continuing medical education ensure that doctors stay current and competent.

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Responding to physicians' data-driven arguments, including a December 2014 JAMA study showing MOC programs do not improve patient outcomes, state legislators proposed several new laws in 2016.

Kentucky lawmakers approved a measure to "prohibit the Board of Medical Licensure from requiring any maintenance of certification and related continuing education requirements for licensure as a physician." Governor Matt Bevin (R) signed the bill April 8 (Senate Bill 17). Similarly, Maryland Governor Larry Hogan (R) OK’d legislation April 12 to prohibit "the State Board of Physicians from establishing a continuing education requirement that every licensed physician complete a specific course or program as a condition to the renewal of a license" (House Bill 185).

Several bills currently being considered by legislators in Missouri seek the same goal. Two measures advancing through the legislative process were introduced by members who understand this issue first-hand. Senator Bob Onder, MD (R), is board certified in allergy and immunology and internal medicine (official website; campaign website). Elected by his peers to serve as Assistant Majority Floor Leader in his first year in office, Senator Onder's bill declares that the "state shall not require… any form of specialty medical board certification to practice medicine within the state" (Senate Bill 772). The proposal is nearing approval in the Senate, after which the House of Representatives will take it up. Prospects for favorable consideration in the House are very good because an even more substantive "Medical Practice Freedom" bill is on the verge of becoming law.

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Representative Keith Frederick, DO (R), a practicing orthopedic surgeon in Missouri, introduced legislation that is, in part, based on an AACU State Society Network Proactive Campaign (official website; personal website). The original language proposed that licensure of physicians could not be conditioned upon participation in any public or private health insurance (House Bill 1682). In addition to these third-party payer provisions, the bill was later amended to remove the long-standing requirement that a person seeking a license be certified in the applicant's area of specialty. After being approved by both chambers of the legislature, as of this writing, the measure awaits House concurrence with Senate amendments.

Next: Senate Bill 1148

The most aggressive of these state MOC campaigns achieved success April 12, when Oklahoma Governor Mary Fallin (R) signed Senate Bill 1148. The new law forbids any requirement that a physician "secure a Maintenance of Certification (MOC) as a condition of licensure, reimbursement, employment or admitting privileges at a hospital in this state." While nothing in the statute explicitly prohibits a hospital from mandating MOC, the law does allow a physician to challenge such a requirement, asserting that it interferes with the practice of medicine.

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The American Board of Medical Specialties took the unusual step of expressing "disappointment" with the measure, affirming its policy stating "neither specialty nor subspecialty certification should be the sole determinant in granting and delineating the scope of a physician's clinical privileges."

As evidenced by the flurry of activity at the state and federal levels of government, many physicians are fighting back against increasingly burdensome recertification requirements. Since 60% of board certified physicians participate in MOC, it is vitally important to not only stay current with the science of medicine, but the regulation of the profession, as well.

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