Life Science Compliance Update

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.

February 15, 2017

ABIM Increases Physician Choice with New Assessment Option

ABIM

The American Board of Internal Medicine (ABIM) is providing more choice to physicians who are working to maintain their board certification. ABIM has decided to take this step after physicians asked for more flexible options that affirm to themselves, their patients, and their peers that they are staying current in medical knowledge.

As ABIM has been re-thinking the process for continuous certification, the organization invited all 200,000 ABIM Board Certified physicians and twenty-seven medical societies to share input. This first phase of dialogue guided the ABIM Council, a body of practicing physicians from several internal medicine subspecialties, to update the assessment process.

The option that emerged as the one that provided the most choice, relevance and convenience was short assessments every two years emerged. This will help physicians to maintain their certification and confidence that they are staying current in their education.

Physicians will able to choose to take assessments every two years or every 10 years. 

Details about the two-year assessment

  • You can choose to take the two-year assessment on your personal or work computer – or at a testing center.
  • You do not need a passing score on every two-year assessment. However, if you are unsuccessful twice in a row or if there is a longer gap between assessments, you will need to take additional steps to maintain certification.
  • You will have more dates from which to choose when scheduling the two-year assessment.
  • This “knowledge check-in” offers more continuous learning, feedback and improvement. Results will be available immediately after the assessment. More feedback will follow.

General Details

  • Beginning in 2018, physicians certified in Internal Medicine can choose to take shorter “knowledge check-ins”—at the location they choose—every two years.
  • To assist physicians with adjusting to changes—and for ABIM to learn from the process— there will be no consequences for unsuccessful performance on the two-year assessment in 2018.
  • ABIM will share updates on availability of these options for subspecialties in the coming months.
  • Physicians can still choose to take an assessment every 10 years in a testing center. ABIM is continuing to collaborate with physicians to make this option more reflective of practice.
  • ABIM is also working to make the 10-year assessment open book.

Dr. Richard J. Baron, President and CEO of ABIM, created a video message about these changes, which can be found here.

Industry Reaction

 “ABIM is changing because physicians are changing it. We are very proud to be collaborating with the many doctors who are constructively helping us update the assessment process,” said Richard J. Baron, MD, ABIM’s President and CEO and a board certified internist who practiced for 30 years in his Philadelphia community.

“Doctors want a certification program that integrates into their daily routine, while affirming to their patients and peers that they have up-to-date medical knowledge. That is exactly why ABIM is introducing assessment options.”

“By involving physicians in every step of the process, ABIM has been able to simplify its programs to focus on meaningful activities that increase knowledge, provide doctors confidence in their practice, and allow doctors more time to devote to patient care,” said Jeanne M. Marrazzo, MD, Chair of ABIM Council. “This work is constantly evolving as we move forward, and we’re proud that the steps we’re taking are informed by physicians who are dedicated to improving patient care.”

“The number of activities is just unprecedented in terms of ways we've been partnering with the physician community. Again, not abandoning the core principle of saying board certification means something,” said Clarence H. Braddock, III, MD, Chair of the ABIM Board of Directors. “It’s a badge of honor to have mastered a body of clinical knowledge and skills that you want to be able to proudly display, but at the same time, we want to make sure that it’s realistic and relevant through the eyes of the practicing physician.”

December 09, 2016

AMA Calls for End to Manditory Secured Exam for MOC

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In June 2016, at the AMA House of Delegates meeting in Chicago, one of the topics discussed was Maintenance of Certification. However, what was not mentioned in the AMA press (or really, any other press) was the fact that the AMA officially opposes mandatory ABMS recertification exams.

Interestingly, the position took place with little fanfare: it wasn’t listed in the Top 10 Stories from the AMA 2016 Meeting, nor was it listed in the coverage of the MOC resolutions that passed. It was only mentioned in tweets by attendees. AMA only focused on publicizing the following MOC resolutions:

  • Examining the activities that medical specialty organizations have underway to review alternative pathways for board recertification
  • Determining whether there is a need to establish criteria and construct a tool to evaluate whether alternative methods for board recertification are equivalent to established pathways
  • Asking the American Board of Medical Specialties to encourage its member boards to review their MOC policies regarding the requirements for maintaining underlying primary or initial specialty board certification in addition to subspecialty board certification to allow physicians the option to focus on MOC activities most relevant to their practice.

While the AMA House of Delegates Reference Committee C did try to amend the resolution that called for an “immediate end of any mandatory, recertifying examination by the American Board of Medical Specialties (ABMS) or other certifying organizations as part of the recertification process,” the HOD rejected modifications made by the committee, extracted it to a full vote on the house floor, and restored the language of the resolution. The resolution language, as passed, reads:

RESOLVED, That our American Medical Association call for the immediate end of any mandatory, secured recertifying examination by the American Board of Medical Specialties (ABMS) or other certifying organizations as part of the recertification process for all those specialties that still require a secure, high-stakes recertification examination.

There were several delegates that opposed the house action, saying that it shouldn’t try to do away with secure exams. Donna Sweet, MD, stated, “Secure simply means that it guarantees that you or the person are the person who is taking the test.”

ABMS, of course, opposes the AMA resolution. In a statement released by the Association, they stated:

Consumers, patients, hospitals and other users of the Board Certification credential expect board certified physicians to be up-to-date with the knowledge, judgment and skills of their specialty—both at the point of initial certification and along the physician’s career path – and to verify it through an external assessment. The privilege to self-regulate which physicians enjoy demands that we meet that expectation with more than just continuing medical education.

Continuing medical education is an important component of a physician’s continuous learning and an important part of Maintenance of Certification (MOC), but by itself is not sufficient to verify that a physician is up to date. The other components of MOC—professionalism, external assessment of knowledge, judgment and skills, and improvement in medical practice—are also important.

The AMA also approved a resolution to continue working with ABMS to “encourage the development by and sharing between specialty boards” of alternate ways to assess medical knowledge, other than by a secure exam. The AMA HOD also bolstered its support of using appropriate continuing medical education (CME) courses to maintain quality assessments of physicians.

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