In the 13 years since she first passed her boards, Dr. Megan Edison has gone from “super proud” to frustrated.
The reason: What was once an optional certification and represented a “feather in the cap” has become a burdensome, ongoing process that’s costly and takes time away from her patients. And if she fails to complete the process, she will not get paid by health insurers, which require physicians to maintain board certification to receive reimbursement.
“(Certification boards) have really overstepped their bounds to almost the point of being absurd now,” said Edison, a pediatrician at Brookville Pediatric and Internal Medicine in Wyoming, Mich. “It’s just ramped exponentially to the point where physicians are saying, ‘What are we doing here?’”
Edison is a leading voice in Michigan to enact proposed legislation to ease the maintenance-of-certification process on physicians.
At one time, Edison had to earn certification only once for her private professional board. Over the years, the American Board of Medical Specialties raised that requirement to once every seven years, and then every five years with a pilot program for weekly testing, she said.
Citing board certification as an indicator of quality, hospitals and health insurers also have adopted policies requiring maintenance of certification for doctors to get paid, receive practice privileges and remain employed.
“It is not voluntary at all, and they can really harm physicians significantly if you choose to just not participate,” Edison said.
Two bills pending before the House Health Policy Committee would prohibit health insurers from requiring physicians to maintain board certification in their practices or specialty areas to receive reimbursement payments. Hospitals could no longer require board certification for doctors to receive privileges to practice at a hospital, and the state could not require it to obtain a medical license.
The bills have the support of the Michigan State Medical Society, but are opposed by the Michigan Health & Hospital Association and Blue Cross Blue Shield of Michigan.
Blue Cross Blue Shield of Michigan opposes the legislation because it would eliminate the ability of health plans to create “reasonable credentialing standards to determine credentialing and physician network participation,” Director of State Relations Kristen Kraft said in testimony submitted to the Health Policy Committee.
The insurer believes the maintenance-of-certification process “has merit,” although it does “acknowledge the genuine concerns” that the American Board of Medical Specialties “has fallen short of its goals,” Kraft said.
Issues with the process, however, need to get addressed directly with the credentialing board, she said.
The American Board of Internal Medicine, for instance, recently relaxed several components of its process through 2018 and began to look at changes that are “more acceptable to the provider community,” Kraft said. The American Board of Medical Specialties also has begun to re-evaluate its standards “to determine whether they should be modernized, made less burdensome and less costly, and brought in line with today’s medical standards,” she said.
Kraft urged lawmakers not to act on the legislation “at this time.” Blue Cross Blue Shield believes maintenance of certification “remains a viable credentialing process.”
“Until it is re-evaluated or improved, we support its use by hospital systems and insurers as a standard quality measure,” Kraft said.
In a legislative hearing last month, Michigan Health & Hospital Association Vice President of Government and Political Affairs Chris Mitchell called the proposed legislation an “unnecessary regulation.” The association believes decisions about requiring maintenance of certification “should remain with each individual hospital,” Mitchell said.
“As of today, there is not a hospital in Michigan that solely uses maintenance of certification to determine hospital privileges for physicians,” Mitchell said. “This legislation inherently restricts the right of Michigan hospitals to develop their own standards of practice and care.”
However, Edison and others say the state medical licensing board in Michigan has stringent requirements for continuing education of 150 hours over three years that physicians must meet to keep their license. They argue that research is nonexistent to connect private board certification to provider quality.
“It’s such a non-essential part of practicing medicine that it’s kind of ridiculous that they have this much power,” Edison said.
Moreover, not every hospital sides with the Michigan Health & Hospital Association.
James Barker, CEO of West Shore Medical Center in Manistee, said the legislation “would relieve rural hospitals such as West Shore Medical Center from the fear that their providers could be dropped from the (insurance) network in which they have had years of participation, leaving hundreds of patients without their physicians to focus on what matters most — patient care.”
“Prohibiting insurers from requiring board certification as a condition of reimbursement would eliminate an artificial gauge of quality health care,” Barker wrote in testimony to the Health Policy Committee. “Other measures are in place to ensure that hospitals are providing the very best quality to patients.”
Maintenance of certification may also contribute to a growing physician shortage. Edison said she hears more doctors talking about retiring, rather than going through the certification process again.
Edison hopes private certification boards will make changes to ease the burden on physicians, although she wonders whether they will actually do so without legislation such as what’s pending in Michigan or has been passed in Oklahoma and Kentucky.
“I don’t think these boards are going to change until they start feeling the heat, which would mean physicians not participating,” she said. “Right now, physicians can’t stop participating because they will lose their jobs, they will lose their insurance participation, and they will lose their ability to have privileges at a hospital. Until we are free to choose, I don’t think they are going to change.”