UPDATE: OSMA advocacy efforts related to Maintenance of Certification 

Dear OSMA Members,

This communication provides an update on OSMA advocacy efforts related to Maintenance of Certification (MOC).

As previously reported, the OSMA supports HB 273, currently pending in the Ohio House Health Committee. The OSMA testified in support of the bill which prohibits using MOC for licensure, privileging and health insurance contracting. Opponents also testified arguing:

• The ABMS is working with all of the affected stakeholders to update MOC requirements (and therefore the legislation is unnecessary).

• The ABMS and others contend there is a growing body of evidence that MOC “improves care.”

• Physicians should not relinquish to the legislature their “self-governing role” as a hospital medical staff to determine staff privileges or employment qualifications.

• Employers, not the government, should determine the qualifications for its employees.

The OSMA will regularly report on advocacy steps in support of this legislation.

Separately, OSMA General Counsel, Nancy Gillette, and I attended a December 4 meeting in Chicago with national medical societies, state associations and boards. The purpose of this meeting was to dialogue with the ABMS and specialty boards and to air physician concerns. 

The American Society of Anesthesiologists’ auditorium was filled to capacity with standing room only (150+ participants).  

Donald Palmisano, Jr., CEO of the Medical Society of Georgia, and Hal Lawrence III, MD, ACOG organized this meeting with ABMS and specialty board as a result of informal sessions on MOC during the 2017 interim and annual meetings of the AMA. 

Dr. Lois Nora (1), current President and CEO of the American Board of Medical Specialties spoke first.  In her 20 minute remarks, Dr. Nora acknowledged each of the points raised in the letter penned by the state and specialty societies to the ABMS earlier this year. Dr. Nora’s key points were:

1. The ABMS is committed to improving continuing certification
2. Add state society representation to the Committee on Continuing Certification
3. Admits that the current MOC process is problematic
4. MOC should not be used as the only criteria for licensure, credentialing, or employment
5. Agrees that professional self-regulation is valuable
6. Asked that states not support anti-MOC legislation (citing the possible unintended consequences)

Next, various state and specialty society representatives gave remarks summarized as follows:

1. Physicians insist on trust, input, transparency, and improved communication from the boards. There is not enough communication with the grassroots about what the certification boards are doing.
2. The boards need to create a process that is developed with physicians and not forced upon physicians.
3. Board processes should not be punitive.  Use the carrot not the stick.
4. MOC is an irrevocably tarnished brand.
5. Following initial certification, a high stakes exam should be only one of several options for maintaining certification.
6. Create a process that is fair to physicians holding more than one certification.
7. Several specialties have already implemented processes that offer ongoing demonstrations of competency as an alternative to the high stakes exam.
8. Two specialty societies (Family Medicine and Psychiatry) stated that they were considering standing up their own boards as a solution.
9. Anesthesia was the only specialty that admitted that reducing the burden on physicians had a negative effect on their bottom line.
10. Multiple states vowed to continue legislative efforts until tangible change in the MOC process can be seen.
11. There is a need for due process for physicians whose ability to work has been adversely affected by inappropriate use of MOC by hospitals, employers or insurers.
12. The hospitals (AHA) and insurers (AHIP) should be invited to the discussion as they are the entities most likely to use MOC inappropriately.

Finally, I spoke personally to the organizers of this meeting to request that Ohio be included in any future discussions regarding MOC at the national and board level.

As we move into 2018, the OSMA will aggressively fight for passage of HB 273 at the state level and will participate in the ongoing dialogue with the state and specialty societies, ABMS and national board on how life-long physician learning should be structured and deployed to best serve practicing physicians. 

Kind regards,

Robyn F. Chatman MD, MPH

Ohio State Medical Association

1. Dr. Nora’s term ends on December 30, 2017.  Her successor is Richard E. Hawkins MD, who is leaving his position as Vice-President of Medical Education Outcomes at the AMA to take this position.