American Society of Plastic Surgeons
For Consumers

Attacks on MOC Reemerge

Recent anti-Maintenance of Certification (MOC) legislation in some states may signal the reemergence of a troubling trend. Efforts to repeal MOC usurp the right of state medical boards to determine which standards are applied to the practice of medicine in their jurisdiction and carry the potential to adversely impact both patients and providers. ASPS actively opposed those efforts when they crescendoed in 2017 and 2018 and remains committed to protecting the right of professional self-regulation in medicine.

The issue

American Board of Medical Specialties (ABMS) member boards determine their own MOC requirements, historically with only loose guidance from the ABMS. Unfortunately, some ABMS member boards instituted requirements that were not well-received by some members of their respective specialties, as they were seen as being overly expensive and time consuming.

In response to questions and controversy surrounding the cost and value of MOC requirements within some ABMS boards, some state legislatures moved to prohibit hospitals and insurers from using initial board certification or maintenance of certification as criteria in their credentialing and privileging decisions.

The Society's position

Anti-MOC legislation hamstrings both hospitals and insurers in their efforts to build the best physician panels possible, while also depriving patients of the confidence to know that their physician has the current knowledge and skills necessary to provide safe and effective care.

Because board certification and MOC are based on academic and practical training that improves care and enhances patient safety, their availability as credentialing and privileging criteria must be preserved and states should avoid outright prohibition of their use. Instead, states should seek to prevent policies that use board certification as the sole or overriding criteria in credentialing decisions.

Previous state efforts

The most significant movement in statehouses around limitations on how MOC could be used occurred in 2017, when similar bills in the Ohio and Florida state legislatures sought to repeal maintenance of certification requirements in their respective states. The legislation proposed to prohibit a physician from being required to secure maintenance of certification as a condition of obtaining licensure, reimbursement, employment, or obtaining admitting privileges or surgical privileges at a hospital or health care facility. ASPS provided comments and worked to actively oppose the bills.

Also in 2017, Tennessee lawmakers passed legislation prohibiting the state from requiring maintenance of certification for a physician to receive state licensure. Despite opposition from ASPS as it moved through the legislature, the bill was ultimately signed into law; instructing a bipartisan task force to establish limitations on the ability of hospitals and insurance companies to require maintenance of certification and determine whether further legislation was necessary.

While 2017 saw a surge in anti-MOC legislation, these efforts ultimately slowed as ABMS certifying boards responded to their diplomates' concerns.

A familiar trend reemerges

Earlier this month, ASPS joined with the Northeastern Society of Plastic Surgeons (NESPS) to oppose legislation in Rhode Island that would regulate MOC standards. In a letter to ranking members of the State of Rhode Island General Assembly's House Committee on Health & Human Services, ASPS and NESPS stated that, "board certification, maintenance of certification, and continuous certification represent appropriate criteria for hospitals, insurers, and state regulators undergoing credentialing" and cautioned that government should not, "dictate standards to experts on credentialing and privileging committees, as these determinations are made through highly-specialized evaluations."

On March 12, ASPS opposed similar legislation proposed in Missouri. In a letter to legislative leaders, the Society stressed that, "Board certification is unquestionably an appropriate criterion to consider in licensure and for credentialing a physician to a hospital staff or an insurance network, and legislative efforts to undermine its relevance are unwise."

ASPS will continue to monitor legislative activity at the state level around this issue and work with state plastic surgery societies to oppose policies that bar the use of board certification status and/or maintenance of certification status in credentialing decisions.