Statewide tests on the role of MOC multiply

Based on a partnership with Urology Times, articles from the American Association of Clinical Urologists (AACU) provide updates on legislative processes and issues affecting urologists. We welcome your comments and suggestions. Contact the AACU government affairs office at 847-517-1050 or info@aacuweb.org for more information.

For years, many state medical boards, hospitals, and private payers have used specialty certification as a requirement for licensing, privileging, and network participation. Yet, through the years, "Community urologists in smaller group practices have found it more difficult to meet the administrative burden and afford the costs attributed to the recertification process," according to AACU President Charles McWilliams, MD.

Most urologists believe specialty certification is important. "Although imperfect, it is necessary to preserve the integrity of our profession," Dr. McWilliams said.

Grassroots sentiment concurs with this assessment, but a nearly equal number wish that maintenance of certification (MOC) be done away with, according to a number of studies, including a 2016 Urology Times survey that found 84% of urologists were dissatisfied with the current MOC process.

Lawmakers across the country began to respond to calls for an end to MOC in 2016. At the time, five states sought limits on the role of specialty certification in licensing, privileging, and reimbursement decisions. The American Board of Medical Specialties (ABMS) expressed "disappointment" with a law passed in Kentucky and affirmed its stance that "neither specialty nor subspecialty certification should be the sole determinant in granting and delineating the scope of a physician's clinical privileges."

MOC supporters' resolve was further tested in 2017 as grassroots campaigns to erode the ubiquitousness of recertification sprouted in at least 19 states. A new Georgia law passed this May prohibits MOC from influencing licensure, health insurance panel participation, eligibility for malpractice insurance, and privileges at state-owned hospitals. In Texas, a similar measure included exceptions for academic medical and certain cancer centers. Oklahoma legislators failed to close a loophole in a landmark law passed last year that was being exploited by hospitals and insurance companies-two powerful industries that generate jobs and political contributions.

Lois Margaret Nora, MD, JD, MBA, president and chief executive officer of ABMS, meanwhile, told Medical Economics: "Legislation being introduced in states across the country increases the potential for patients and families to receive substandard care by either reducing access to board certified medical specialists, or by lowering the standards for specialty medical practice."

Next: A dangerous precedent

Like-minded physicians worry that involving politicians in matters previously regulated within the profession sets a dangerous precedent. If the value of rigorous oversight by specialty boards is diminished, patients may be driven to Yelp! and other disreputable and inconsistent sources for "reviews." Equally problematic, according to Yul Ejnes, MD, an internist in North Scituate, RI, "We're trying to get the government out of our business and here we are giving the government some of our business." (Dr. Ejnes was one of two physicians defending MOC in an August 2017 Physicians Practice article.)

The American Board of Urology is responding to the community's concerns, according to AACU ABU Trustee Mark Austenfeld, MD. During a town hall meeting held in conjunction with the 2017 AUA annual meeting, the ABU committed to making the MOC process "more meaningful and of greater value to our diplomates, while protecting the public," Dr. Austenfeld said.

Read - QPP implementation: CMS has begun to listen

"We are shifting away from MOC and toward lifelong learning," Dr. Austenfeld added. The AACU ABU trustee further reported that this may include transitioning from a pass/fail exam and using the test to prescribe particular continuing medical education programs.

Such a switch would be welcomed by physicians who attest that high costs, administrative burdens, and sub-specialization have made it more difficult to maintain certification. The question remains, however: Do providers require state intervention to ensure that their ability to practice medicine is not tied to permanent participation in the recertification process?