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Research & Commentary: Florida Considers Medical Maintenance of Certification Reform

April 19, 2017

In this Research & Commentary, Matthew Glans discusses a proposal now being considered in the Florida Legislature that would limit the influence of maintenance of certification in the state.

In some states, medical boards require additional testing and programs for doctors, a process now known as “maintenance of certification” (MOC). Providing certification for doctors has become a profitable industry for the medical boards administering the certifications. Because of these problems, the Florida Legislature is now considering new legislation that would limit the influence of MOCs in the state.  

Florida’s bill is similar in many ways to a bill passed in Oklahoma in 2016 that forbids requiring MOC as a condition of licensure, reimbursement, employment, or admitting privileges at a hospital in the state. According to the Florida Senate’s bill analysis, the new reforms being considered prohibit “the medical board, osteopathic board, the Department of Health (DOH), health care facilities, and insurers from requiring physicians to maintain board certification in a subspecialty as a condition of licensure, reimbursement, employment, or admitting privileges.” The bill also emphasizes the new prohibition does not impact the boards’ ability to require continuing medical education.

According to the Florida Medical Association, the new amendment, which was unanimously adopted by the Senate Health Policy Committee, would require medical boards to obtain a certificate from the Department of Health to be allowed to bestow board certification on Florida physicians.

In order to receive the certificate from the state, the board would be prohibited from requiring its maintenance of certification process for board recertification. The amendment also limits the frequency of testing for recertification and caps the costs; a board would not be allowed to charge more than $500 every two years for recertification. Medical boards would still be allowed to set requirements for continuing medical education hours.

Critics of MOCs argue the new requirements are excessive, costly, time-consuming, and unnecessary. Groups administering MOC programs say they improve health care outcomes, but Dr. Paul S. Teirstein argues in an article published in The New England Journal of Medicine these results are far from clear. “In fact, close examination of the reports cited by the American Board of Internal Medicine reveals that the data are ambiguous at best: in a meta-analysis of 33 studies, 16 described a significant association between certification status and positive clinical outcomes, 14 found no association, and 3 found a negative association,” wrote Teirstein. The National Board of Physicians and Surgeons has emerged as a result of the American Board of Internal Medicine’s excessive MOC requirements.

In a statement, the Florida Gastroenterologic Society (FGS) argues doctors do not object to continuing education requirements. FGS says MOCs have simply grown out of control.

“This bill would ensure that patients have access to their doctors by controlling how Maintenance of Certification (MOC) is used in Florida,” reads the statement. “The wealthy Board certification corporations are making tens of millions on needless testing to ‘re-certify’ doctors that used to be certified for life. Many doctors are not opposed to doing the 40 hours of regular CME as required by Florida law, but hospitals and insurance companies should not require doctors to do the onerous MOC tasks simply to help large private boards make money.”

MOC certifications were designed with the intention of ensuring physicians are educated on the latest health research and methods, not to act as a profit center for medical board organizations. While a certain degree of certification will always be necessary, physicians should not be required to pass through a quagmire of costly and expensive tests that may be unnecessary. physicians.

The following documents examine maintenance of certification in greater detail.
 

Association Between Physician Time-Unlimited vs Time-Limited Internal Medicine Board Certification and Ambulatory Patient Care Quality
http://jamanetwork.com/journals/jama/fullarticle/2020370
In this journal article, John Hayes, Jeffrey L. Jackson, and Gail M. McNutt examine whether there are differences in primary care quality between physicians holding time-limited or time-unlimited certification. Their results found “no differences in outcomes for patients cared for by internists with time-limited or time-unlimited certification for any performance measure.”

More States Consider Outlawing Forced Maintenance of Certification
https://www.heartland.org/news-opinion/news/more-states-consider-outlawing-forced-maintenance-of-certification
Michael Hamilton writes in Health Care News about the growing trend in many states to prohibit maintenance of certification from being used as a condition of medical licensure or hospital-admitting privileges.

Oklahoma Frees Physicians from Forced Maintenance of Certification
https://www.heartland.org/news-opinion/news/oklahoma-frees-physicians-from-forced-maintenance-of-certification
Jenni White writes in Health Care News about Oklahoma’s recent passage of legislation limiting the power of maintenance of certification, how medical boards can use them, and how several states are considering similar protections. “Oklahoma will become the first state to protect physicians without maintenance of certification (MOC) from losing their licenses, reimbursement, employment, or hospital-admitting privileges,” wrote White.

First State Goes MOC-Free, Others May Follow
http://www.medscape.com/viewarticle/862331
Robert Lowes, reporting for Medscape Medical News, discusses the new anti-MOC laws being considered in several states and how the debate has progressed over time.

No More MOC: One State Bans the Controversial Credential Requirement—and Others May Follow
https://www.advisory.com/daily-briefing/2016/04/27/no-more-moc
Oklahoma legislators recently passed legislation that removes maintenance of certification (MOC) as a requirement for physicians to be hired, get paid, obtain a medical license, or secure hospital admitting privileges. The Advisory Board Company examines the new law and other similar laws being proposed in other states in this briefing.

Oklahoma Bans Forced MOC, Becomes the First ‘Right to Care’ State
https://d4pcfoundation.org/oklahoma-bans-forced-moc-becomes-the-first-right-to-care-state/
Docs4PatientCare examines a recently passed bill in Oklahoma that ends the forced use of MOCs, a policy they call “Right to Care.”  “In a time when gridlock is a given, MOC is something that unites us all,” wrote authors for Docs4PatientCare. “The funny thing is, this law shouldn’t be revolutionary. It simply legislates exactly what ABMS says about board certification: that it is voluntary.”

Boarded to Death: Why Maintenance of Certification Is Bad for Doctors and Patients
http://www.nejm.org/doi/full/10.1056/NEJMp1407422 - t=article
Paul S. Teirstein argues in an article published in The New England Journal of Medicine against the expansion of MOCs. Teirstein explains how these unnecessary requirements negatively harm the health care industry. “More broadly, many physicians are waking up to the fact that our profession is increasingly controlled by people not directly involved in patient care who have lost contact with the realities of day-to-day clinical practice. Perhaps it's time for practicing physicians to take back the leadership of medicine.”

Negative Secular Trends in Medicine: The ABIM Maintenance of Certification and Over-Reaching Bureaucracy
https://www.heartland.org/publications-resources/publications/negative-secular-trends-in-medicine-the-abim-maintenance-of-certification-and-over-reaching-bureaucracy?source=policybot
Robert M. Doroghazi writes in the American Journal of Medicine about the negative effect of bureaucracy in the medical field. Doroghazi focuses on the many issues created by MOCs: “But I think there is no better example of this trend of ever-expanding, over-reaching, and arbitrary bureaucracy than the recently proposed changes in the Maintenance of Certification (MOC) requirements by the American Board of Internal Medicine (ABIM).”

Maintenance of Certification: Important and to Whom?
https://www.heartland.org/publications-resources/publications/maintenance-of-certification--important-and-to-whom?source=policybot
Paul M. Kempen writes in the Journal of Community Hospital Internal Medicine Perspectives about MOCs, how and why they emerge, and who they truly benefit. “Certification is at best a slight, or possibly false, promise, recently openly admitted by the ABMS: ‘FACT: ABMS recognizes that regardless of the profession – whether it is healthcare, law enforcement, education or accounting – there is no certification that guarantees performance or positive outcomes.’”
 

Nothing in this Research & Commentary is intended to influence the passage of legislation, and it does not necessarily represent the views of The Heartland Institute. For further information on this subject, visit Health Care News, The Heartland Institute’s website, and PolicyBot, Heartland’s free online research database. 

If you have any questions about this issue or The Heartland Institute’s website, contact John Nothdurft, The Heartland Institute’s government relations director, at john@heartland.org or 312/377-4000.

Author
Matthew Glans joined the staff of The Heartland Institute in November 2007 as legislative specialist for insurance and finance. In 2012, Glans was named senior policy analyst.
mglans@heartland.org @HeartlandGR