Lawmakers in several states in the Midwest are considering following Oklahoma’s lead by passing reform legislation prohibiting maintenance of certification (MOC) as a condition of medical licensure and hospital admitting privileges.
Starting November 1, Oklahoma will become the first state to protect physicians without maintenance of certification (MOC) from losing their licenses, reimbursement, employment, or hospital admitting privileges. (See page 7)
A pair of Michigan bills similar to the new Oklahoma law would protect doctors from state MOC licensure requirements and forbid hospitals from denying admitting privileges to a physician solely because the physician chooses to forego MOC, which board-certified doctors in multiple states describe as a costly and time-consuming process. House Bill 5090 and Senate Bill 609 would also prevent the state boards of medicine and osteopathic medicine from requiring licensed physicians to “maintain a national or regional certification.”
A second pair of bills in Michigan would prohibit insurers from withholding payment or reimbursement from physicians without MOC.
In Missouri, lawmakers have proposed House Bill 2304, which would prohibit state agencies from requiring MOC as a condition of licensure, although it would not restrict hospitals from admitting only physicians with MOC.
Missouri legislators are also considering Senate Bill 772, which mandates “current requirements including continuous medical education shall suffice to demonstrate professional competency.” SB 772 also says “there shall be no discrimination” by the state board or other state agencies against physicians who forego MOC in their specialization.
The Missouri legislation essentially mirrors Kentucky’s Senate Bill 17, which Gov. Matt Bevin (R) signed into law on April 8.
Kentucky SB 17 cosponsor state Sen. Ralph Alvarado (R-Clark County) had introduced similar legislation during the 2015 session. The previous bill, Senate Bill 58, had included a clause protecting doctors from MOC-based discrimination by hospitals.
“It caught a lot of people by surprise,” Alvarado said. “Members of the Kentucky Medical Association, guys I truly respect, expressed their concern, saying they couldn’t back [SB 58]. They were going to view it as a mandate on private hospitals and insurance companies.”
Alvarado removed the clause before reintroducing the legislation in 2016 as SB 17 and said he will consider restoring the clause “if our hospitals start to block a lot of doctors.”
With the state currently suffering a provider shortage, the new law protects physicians from cumbersome state regulations during Kentucky’s provider shortage without saddling private hospitals and insurers with a government mandate, Alvarado says.
“We’re not changing how doctors are licensed,” Alvarado said. “That is key. We’re protecting the status quo and removing an incentive for doctors to quit at a time when Kentucky is facing shortages of 3,000 to 4,000 providers.”
Dr. Meg Edison, a private practitioner in Grand Rapids, Michigan, voluntarily surrendered her American Board of Pediatrics certification in December 2015 instead of completing MOC requirements.
Edison says certain specialty boards under an umbrella organization, the American Board of Medical Specialties (ABMS), established MOC requirements as a money-raising scheme.
“Realizing they’d make more money if doctors had to maintain certification, some boards introduced the MOC program, which grandfathered certain age classes of doctors and required the younger doctors to keep taking tests, paying more money, and complete research projects,” Edison said. “For those of us who are not grandfathered, if we do not participate in any portion of MOC, we are completely stripped of all board certification, regardless of how many times we have passed the exams, and we are erased from their websites.”
MOC Restricting Patient Access
The burden of MOC drives older physicians into early retirement, depriving patients of access to their physician of choice, Edison says.
“Access is the ability of a patient to stay with a doctor that they would choose, or their ability to choose a doctor that’s local,” Edison said in a video posted on the website of Right2Care.org, a project of the Michigan State Medical Society. “MOC is a major driver of early retirement among physicians. That we’re actually losing some of these older physicians for something as ridiculous as MOC is heartbreaking.”
Alvarado says tying licensure to MOC would push out of the industry doctors who believe they are capable physicians who provide patients with high-quality care without maintaining their specialty certification.
“The average person thinks licensure and certification are the same,” Alvarado said. “You would see a lot of grandfathered doctors quit if their licenses became linked to MOC.”
Busywork Doesn’t Work
Alvarado says MOC forces doctors to jump through hoops instead of equipping them to provide better patient care.
“There are aspects of the [MOC] research process that I find just busywork,” Alvarado said. “They don’t improve quality.”
Edison says states that free physicians from cumbersome MOC requirements enable doctors to spend more time researching solutions that benefit their patients directly.
“They will be free to choose their own continuing education that best suits their patients, rather than the proprietary products of the ABMS boards,” Edison said. “They will be free to pursue their own novel clinical research, rather than conscript their patients into the research projects created by the boards.”
Michael Hamilton ([email protected]) is The Heartland Institute’s research fellow for health care policy and managing editor of Health Care News. Jenni White ([email protected]) contributed to this story.
Maintenance of Certification Draft of Kentucky Senate Bill 58, February 25, 2015: https://www.heartland.org/policy-documents/maintenance-certification-draft-kentucky-senate-bill-58-2015
Maintenance of Certification Draft of Michigan House Bill 5090, December 1, 2015: https://www.heartland.org/policy-documents/maintenance-certification-draft-michigan-house-bill-5090-2015
Matthew Glans, “Michigan Should Move Away from Maintenance of Certification,” Research & Commentary, The Heartland Institute, May 16, 2016: https://www.heartland.org/policy-documents/research-commentary-michigan-should-move-away-maintenance-certification