On Wednesday, November 7, 2018, after months of stakeholder discussions, the Maryland Health Care Commission’s Maintenance of Certification Work Group issued its final report. The American Board of Medical Specialties (ABMS) is encouraged by the overall findings of the work group, as the stakeholders declined to recommend any legislative action on Maintenance of Certification (MOC). The findings of the work group were based on a number of elements:
Specialty boards are reevaluating recertification requirements and processes
The work group heard presentations from ABMS representatives outlining the numerous efforts underway to address physician concerns. Recognizing that these efforts should be given time to take effect and assessed for impact, many stakeholders felt additional regulatory action would be premature and unnecessary. ABMS is pleased that the work group report acknowledges the earnest efforts on the part of the specialty boards to address issues associated with the cost, burden, and relevancy of their respective MOC programs.
Hospitals are able to change their credentialing requirements
In a critical acknowledgement, the stakeholders recognized that hospitals currently have the power to change their privileging requirements. The work group report clarifies that hospitals set certification standards based on patient expectations of quality of care: “independence in setting criteria for employment… is crucial to their ability to meet the unique needs of their community, including patients, physicians, and other stakeholders.” The report further finds that, contrary to the claims of anti-MOC advocates, hospitals are already free to choose the certifying body that best meets their own expectations for quality care and have identified ABMS certification as among the most reliable and legitimate available.
Most health insurers in Maryland do not require board recertification
Contrary to the claims of anti-MOC advocates, the report recognizes that most Maryland health insurers do not use board certification as a criterion for payment. The proponents of MOC legislation had argued that physicians who do not participate in MOC cannot participate in insurance networks. The work group found this to be largely untrue, save for a single integrated system in the state.
There are no barriers to entry for new certifying bodies, and stakeholders should be allowed to continue to select the certificate that best meets their expectations for safe, high quality care
Anti-MOC advocates have long argued that legislation is necessary in order to promote competition for new certifying bodies. This argument was undermined by the work group’s acknowledgement in the report that at least one hospital system in the state already recognizes an alternative certifying board. This fact demonstrated that legislation is unnecessary for new market entries, and that hospitals can select which certification boards they recognize based on the merits of their respective programs. As the U.S. Department of Justice stated earlier this year, anti-MOC legislation may actually diminish free market competition.
While the work group was focused exclusively on how MOC is used within the state of Maryland, many of its findings apply to other states in which anti-MOC legislation has been previously introduced. ABMS applauds the work of the Maryland Health Care Commission, especially its ability establish a set of objective facts on how MOC is used today, how specialty boards are changing, and the options and alternatives that are already available to physicians who wish for more flexible and practice-relevant continuing certification programs.
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