Life Science Compliance Update

July 24, 2017

AAFP and ABFM Collaborate to Create Unified Credit Reporting Process

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Earlier this month, the American Academy of Family Physicians (AAFP) announced a collaboration with the American Board of Family Medicine (ABFM) to create a more seamless credit-reporting experience for family physicians. The new process will allow AAFP members to use the AAFP as a one-stop shop for all of their Continuing Medical Education (CME) credit reporting needs.

It is hoped that this new process will make it easier for providers to claim their credit for performance improvement CME activities with both the AAFP and the ABFM.

The AAFP – as one of the nation’s three CME accrediting bodies – will work with CME provider organizations that wish to have their CME activities (including performance improvement activities) certified for AAFP Prescribed and/or Elective credit. CME providers can seek approval for those activities through the AAFP Credit System.

The AAFP and ABFM are currently working together to allow CME providers to apply for AAFP Performance Improvement CME Credit and ABFM Certification Activity credit for their performance improvement activities through the AAFP Credit System using a single application process. Starting in October, CME providers who apply for dual credit using the new unified process will no longer have to pay an additional fee for ABFM Certification Activity credit approval.

In addition to meeting AAFP performance improvement activity requirements, to be eligible to receive Certification Activity credit from the ABFM, each performance improvement activity must comply with the ABFM's Industry Support Policy and meet the ABFM Requirements for Performance Improvement activities, and the provider must agree to periodic audits by the ABFM.

From the physician-learner's perspective, the unified process means that ABFM diplomates will have more performance improvement activities to choose from. In addition, when the physician reports CME credit for a dually approved performance improvement activity to the AAFP, the ABFM will automatically be notified that the performance improvement certification activity has been completed.

The AAFP was created as a national professional association to protect the rights of general practitioners, and is the oldest national CME accreditor. Each year, the AAFP produces over 100 CME activities, including the Family Medicine Experience, live events, as well as journal and online CME sessions that are designed for family physicians with input from members. AAFP also reviews more than 3,000 activities from about 1,300 different organizations for accreditation annually to ensure they meet the needs of family physicians.

July 17, 2017

CME Continues to Grow and Evolve

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The Accreditation Council for Continuing Medical Education (ACCME®) recently released the ACCME Data Report: Growth and Evolution in Continuing Medical Education — 2016. The 2016 report includes data from a community of over 1,800 accredited continuing medical education (CME) providers that offer physicians and healthcare teams an array of resources to promote quality, safety, and the evolution of healthcare.

Key Report Takeaways
The report highlights the fact that CME is a vibrant – and growing – community. Last year, ACCME along with more than 1,800 accredited CME providers offered close to 159,000 educational activities, comprising more than one million hours of instruction and interactions with 27 million health care professionals.

Since 2015, the number of educational events has increased 7% while hours of instruction increased by 9% and interactions with clinicians increased by 5%. Even more impressive, the number of activities and interactions have increased each year since 2010, despite some consolidation among CME providers.

The numbers of physician interactions have either increased over the years, or remained stable. The number of interactions with non-physician health care professionals such as nurses, physician assistants, and pharmacists shows steady growth.

Accredited CME providers represent a range of organizations from national physician membership organizations to rural hospitals. Some specialize in local, community-based health issues, others focus on national and international health priorities, and others advance interprofessional continuing education (IPCE) and team-based care. The ACCME recently began accrediting organizations outside the US, and this report includes their data as well.

The geographic distribution and diversity of CME providers means that clinicians and teams have access to education where they live and work that addresses local, national, and international healthcare priorities.

“Every day, across the country, clinicians can choose from more than 3,000 hours of accredited CME. Accredited CME is a tremendous resource — offering clinicians, educators, and health leaders the power and capacity to address many of the challenges we face in our changing healthcare environment,” said Graham McMahon, MD, MMSc, President and CEO, ACCME.

In his introduction to the report, Dr. McMahon also noted,

I’m delighted about the growth because it means that clinicians are increasingly engaged in education that promotes quality, safety, and the evolution of healthcare. Behind the numbers in the ACCME Data Report are educators who work every day to engage clinicians where they live, work, and learn. CME providers are creating “educational homes” that tackle health challenges while nurturing the professional development — and passion — of clinicians and teams.

He continues,

As this report demonstrates, accredited CME aims at changing more than knowledge—CME providers design and evaluate activities for meaningful change in skills, performance, and patient health outcomes. Organizations ranging from small, rural hospitals to national institutions such as the Food and Drug Administration and Centers for Medicare & Medicaid Services have recognized the value of accredited CME in advancing public health imperatives.

Dr. McMahon created a video introduction to the data, which can be found here.

Excel tables with data used to create reports can be found here.

ACCME Data Report Addendum can be found here.

ACCME Data Report Addendum Excel tables can be found here

 

June 28, 2017

Anti-MOC Laws Picking Up Steam Across the United States

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Lawmakers across America have started to take a variety of matters into their own hands, the most recent of which is Maintenance of Certification (MOC) licensure requirements. This trend started late last year when Oklahoma became the first state to pass legislation that prohibited MOC as a condition of medical licensure and hospital admitting privileges.

So far seven states (Georgia, Maryland, Missouri, North Carolina, Oklahoma, Tennesse and Texas) have passed laws that prevent hospitals, licensing boards, insurance companies and health systems from requiring MOC.  Bellow is a summary of bills and laws in states taking MOC under consideration.

Alaska

The Alaska State Legislature has introduced legislation, HB 191 – An Act relating to the practice of medicine and osteopathy, that stated, “Maintenance of Certification and osteopathic continuous certification. Nothing in this chapter may be construed to require a physician to secure a maintenance of certification as a condition of licensure, reimbursement, employment, or admitting privileges at a hospital in this state.” The legislation was referred to the Health and Social Services Committee on March 22, 2017, and no further action has been taken.

California

California Senate Bill 487 – Practice of Medicine: Hospitals was introduced in February 2017, and has yet to be heard by the committee, though it was set for hearing twice (and canceled twice). The relevant portion of the legislation reads, “The regular practice of medicine in a licensed general or specialized hospital having five or more physicians and surgeons on the medical staff, which does not have rules established by the board of directors thereof of the hospital to govern the operation of the hospital, which rules include, among other provisions, all the following, constitutes unprofessional conduct: … (c) Provision that the award or maintenance of hospital or clinical privileges, or both, shall not be contingent on participation in a program for maintenance of certification.”

Florida

Florida had legislation introduced in the state House of Representatives that would have prohibited that Boards of Medicine and Osteopathic Medicine and the DOH from requiring certain certifications as conditions of licensure, reimbursement, or admitting privileges. The bill, fortunately, never made it out of Committee discussions.

Georgia

Georgia’s legislation that prohibits MOC from being required as a condition of licensure was signed by the Governor on May 8, 2017, and is effective as of July 1, 2017. The relevant language states, “maintenance of certification shall not be required as a condition of licensure to practice medicine, staff privileges, employment in certain facilities, reimbursement, or malpractice insurance coverage; to provide for definitions; to provide for related matters; to repeal conflicting laws; and for other purposes.”

Maine

Both houses of the Maine legislature have introduced legislation that aims to change the way physicians and surgeons are licensed. Relevant language states, “Nothing in this chapter may be construed to require an osteopathic physician or surgeon licensed under this chapter to secure a maintenance of certification as a condition of licensure, reimbursement, employment or admitting privileges at a hospital in the State.” The passed legislation is currently awaiting the governor’s signature.

Maryland

The Maryland legislation has been passed by both the House and Senate, and was signed by Governor Larry Hogan and will become effective on October 1, 2017. The relevant language states, “The Board may not require as a qualification to obtain a license or as a condition to renew a license certification by a nationally recognized accrediting organization that specializes in a specific area of medicine; or maintenance of certification by a nationally recognized accrediting organization that specializes in a specific area of medicine that includes continuous reexamination to measure core competencies in the practice of medicine as a requirement for maintenance of certification.”

Massachusetts

Bill H.2446 was introduced in the Massachusetts House of Representatives in January 2017, but did not make it into law. The relevant language of the legislation stated, “Nothing in this Chapter shall be construed as to require a physician to secure a Maintenance of Certification (MOC) as a condition of licensure, reimbursement, employment, or admitting privileges at a hospital in this state.”

Michigan

The Michigan legislature introduced two separate bills relating to MOC, HB 4134 and HB 4135. The two bills, neither of which became law, dovetailed off one another, stating, “Notwithstanding any provision of this Act to the contrary, the Department or the Board of Medicine or Board of Osteopathic Medicine and Surgery shall not by order, rule, or other method require a physician applicant or licensee under its jurisdiction to maintain a national or regional certification that is not otherwise specifically required to maintain a national or regional certification that is not otherwise specifically required in this article before it issues a license or license renewal to that physician applicant or licensee under this article,” and “An insurer that delivers, issues for delivery, or renews in this state a health insurance policy or health maintenance that issues a health maintenance contract shall not require a condition precedent to the payment or reimbursement of a claim under the policy or contract that an allopathic or osteopathic physician maintain a national or regional certification not otherwise specifically required for licensure.”

Missouri

Missouri joins Oklahoma as one of the first in the country to enact anti-MOC legislation. In July 2016, the state enacted law that stated, “The state shall not require any form of maintenance of licensure as a condition of physician licensure including requiring any form of maintenance of licensure tied to maintenance of certification. Current requirements including continuing medical education shall suffice to demonstrate professional competency. The state shall not require any form of specialty medical board certification or any maintenance of certification to practice medicine within the state. There shall be no discrimination by the state board of registration for the healing arts or any other state agency against physicians who do not maintain specialty medical board certification including recertification.” In 2017, the legislature introduced a bill that made it so “No provision of law shall be construed as to require any form of maintenance of licensure as a condition of physician licensure, reimbursement, employment, or admitting privileges at a hospital in this state, including requiring any form of maintenance of certification. Current requirements, including continuing medical education, shall suffice to demonstrate professional competency.”

New York

New York AO4914 states, “It shall be an improper practice for a governing body of a hospital to refuse to act upon an application or to deny or to withhold staff membership or professional privileges of a physician solely because such physician is not board-certified. A health care plan may not refuse to approve an application from a physician to participate in the in-network portion of the health care plan's network solely because such physician is not board-certified.” The legislation was introduced into the Assembly and referred to the health committee.

North Carolina

In Summer 2016, the North Carolina legislature presented HB 728 to the Governor for signature. The Governor signed, and the law states that the North Carolina Medical Board “shall not deny a licensee’s annual registration based solely on the licensee’s failure to become board certified.”

Ohio

The Patient Access Expansion Act (HB 273) prohibits a physician from being required to secure MOC as a condition of obtaining licensure, reimbursement, employment, or obtaining admitting privileges or surgical privileges at a hospital or health care facility. It was introduced in the House in June 2017 and referred to the Health Committee, where it is currently sitting.

Oklahoma

In April 2016, SB 1148 was signed into Oklahoma law. The legislation states: "Nothing in the Oklahoma Allopathic Medical and Surgical Licensure and Supervision Act shall be construed as to require a physician to secure a Maintenance of Certification (MOC) as a condition of licensure, reimbursement, employment, or admitting privileges at a hospital in this state. For the purposes of this subsection, Maintenance of Certification (MOC) shall mean a continuing education program measuring core competencies in the practice of medicine and surgery and approved by a nationally recognized accrediting organization."

Rhode Island

The Rhode Island general assembly introduced H 5671 in January 2017, which states in relevant part, “The state and its instrumentalities are prohibited from requiring any form of specialty medical board certification and any maintenance of certification to practice medicine within the state. Within the state, there shall be no discrimination by the board of medical licensure and discipline, or any other agency or facility which accepts state funds, against physicians who do not maintain specialty medical board certification, including re-certification.”

Tennessee

This legislation was signed into law on May 25, 2017, and states that “No facility licensed under this chapter shall deny a physician a hospital's staff privileges based solely on the physician's decision not to participate in any form of maintenance of licensure, including requiring any form of maintenance of licensure tied to maintenance of certification.  This section does not prevent a facility's credentials committee from requiring physicians licensed pursuant to title 63, chapters 6 and 9, to meet continuing medical education requirements, as outlined in the rules of the appropriate state licensing board.”

Texas

The Texas bill was recently signed by the Governor and will become law on January 1, 2018. The relevant part of the legislation states, Except as otherwise provided by this section, the following entities may not differentiate between physicians based on a physician's maintenance of certification: if the facility or hospital has an organized medical staff or a process for credentialing physicians; …. (b) An entity described by Subsection (a) may differentiate between physicians based on a physician's maintenance of certification if: (1) the entity's designation under law or certification or accreditation by a national certifying or accrediting organization is contingent on the entity requiring a specific maintenance of certification by physicians seeking staff privileges or credentialing at the entity; and (2) the differentiation is limited to those physicians whose maintenance of certification is required for the entity's designation, certification, or accreditation as described by Subdivision (1). (c) An entity described by Subsection (a) may differentiate between physicians based on a physician's maintenance of certification if the voting physician members of the entity's organized medical staff vote to authorize the differentiation. (d) An authorization described by Subsection (c) may: (1) be made only by the voting physician members of the entity's organized medical staff and not by the entity's governing body, administration, or any other person; (2) subject to Subsection (e), establish terms applicable to the entity's differentiation, including: (A) appropriate grandfathering provisions; and (B) limiting the differentiation to certain medical specialties; and (3) be rescinded at any time by a vote of the voting physician members of the entity's organized medical staff.

Conclusion

The anti-MOC rhetoric is real, and heated. A quick google search shows at least two websites dedicated to the anti-MOC movement. Change Board Recertification, seems to collect articles about MOC and re-publish them all in one convenient website. The DOCS4Patient Care Foundation shows that – presumably in an attempt to gain more followers – proponents of anti-MOC legislation like to frame the issue as “right to care” laws, an interesting tactic.

Proponents of the anti-MOC laws believe that MOC restricts patient access by forcing older physicians into early retirement. It is our belief, however, that with the speed of innovation today, MOC is a critical part of patient care and upholding the Hippocratic Oath. By allowing physicians to continue practicing medicine without requiring MOC, patients may be put at risk.

In an attempt to keep up with the changing landscape, we will provide regular updates of bills introduced, passed and the subsequent regulations that are adopted.

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