Originally published by MIRS on January 26, 2016

Tired of forking over thousands of dollars and spending days away from patients on what they call "onerous busy work," Michigan physicians are asking lawmakers to pass new legislation to stop insurance companies from requiring an out-of-state recertification as a reason for payment.

The Michigan State Medical Society (MSMS) is calling the impetus of a pair of identical bills, Click to add MIRS Bill Hound HB 5090and Click to add MIRS Bill Hound HB 5091 in the House and Click to add MIRS Bill Hound SB 0608 and Click to add MIRS Bill Hound SB 0609 in the Senate, a "grassroots" effort by doctors who are tired of going through what they see as a redundant national re-certification process.

But the national licensing association is saying there is value in their Maintenance of Certification (MOC) process. And the hospitals and the state's largest insurance carrier believe its officials should have the power to require recertification if they feel it necessary.

The state of Michigan already requires doctors to go through 50 hours of continuing education class a year. But insurance companies like Blue Cross Blue Shield of Michigan (BCBSM) are requiring they keep up on the recertifications offered by the 24 boards that fall under the American Board of Medical Specialties (ABMS).

"These requirements are irrelevant to what I'm doing," said Dr. Rose RAMIREZ, MSMS president and a family physician from Grand Rapids. "It's a punishing system, but if you don't go through it you lose your certification."

Currently, physicians are licensed by the Michigan Boards of Medicine and Osteopathic Surgery, licenses that need to be renewed every three years and requires a physician to complete a combined 150 hours of continuing education.

However, on top of this state license, BCBSM is among the insurers that require physicians to renew the specialty licenses issued through one of 24 specialty member boards from the for-profit American Board of Medical Specialties (ABMS).

Physicians initially get their specialty certificates after completing their residency programs after weeks of preparations. In recent years, the national boards overseeing these certification have required physicians to renew them every five, seven or 10 years through the MOC process, depending on the specialty.

Physicians are anxious because going through everything they had previously learned turns into at least a week of studying and more than a $1,000 to take the test. It turns into "incredible hoops" and "busy work" that take away doctors' ability to conduct research or see patients, said Dr. Megan EDISON, a Kent County pediatrician.

Edison told the story of a colleague who was two weeks late on paperwork regarding his hand-washing practices. For that, his certification was suspended and BCBSM cut him off.

"We don't need an outside entity to tell us you need a hand-washing module in order to be good at your craft," Edison said.

The ABMS certifications are also limiting the types of professional development physicians can engage in, which may not be in the best interests of either them or the community. For instance, physicians in Flint may want to learn more about the effects of lead poisoning, but attending a seminar on the subject may not count toward their ABMS "maintenance of certification," said spokesperson Matt RESCH.

MSMS is working with Rep. Ed CANFIELD (R-Sebewaing), an osteopathic physician by trade, and Sen. Peter MACGREGOR (R-Rockford) on the bills and Resch Strategies on a public "Right2Care" campaign that features its own website, ""

Colin FORD, senior director of state and federal government relations for MSMS, said his members came to MSMS on this issue.

The bills stop insurance companies from using these national certifications as a condition for working with a physician. It also prevents the state from also requiring doctors renew these national or regional certificates as a condition for their state license or licenses.

BCBSM, the state's largest insurer, is not board with the policy change.

"We understand there are significant concerns in the provider community, and support seeking a reasonable solution that balances requirements and cost with continuing education," reads a BCBSM statement on the bills. "However, we have concerns that this language could hinder our ability to establish reasonable credentialing standards for network participation, and we will continue to work with the bill sponsor to address them."

Likewise, the Michigan Health and Hospital Association (MHA) is not thrilled. Some hospital officials rely on the MOC process in deciding whether to let a doctor practice in their facility.

"We believe that physician certification requirements as a basis for physician admitting privileges or license renewals are best determined at the local level by individual hospitals and health systems," said MHA spokesperson Laura WOTRUBA.

Obviously, the ABMS is pushing back against the bills, as well, and defending the need for its MOC process. The organization put out a statement in which it says it is "sensitive to physician concerns" about the MOC process and is working to address those.

Patients and the public expect physicians to stay abreast of advancements in their respective specialty areas and to be "competent practitioners in a rapidly changing healthcare environment," read the ABMS statement.

"The time and resources associated with MOC participation are a sound investment for a comprehensive program that helps ensure not only that knowledge is assessed, gaps identified and new skills obtained, but also encourages participation in quality initiative that have direct impact in improving patient care and safety," the statement reads.

On the bills, ABMS is saying that it believe health insurers should have the right to use quality measures as ABMS board certification and MOC participation in making decisions on who is "best qualified to care for patients covered by their networks."

The chair of the House Health Policy Committee, Rep. Mike CALLTON (R-Nashville), said today he's sympathetic to the doctors' pleas on this issue and is ready to schedule a hearing on the bills. He noted that some older physicians have "grandfathered out" of needing to be recertified, which he sees as "unequal treatment."

As a chiropractor, Callton said he has not run across the issue in his profession, but can understand why some doctors are throwing up their hands and leaving the profession as opposed to sinking more time and money into a recertification effort.

The Michigan Association of Health Plans has not taken a formal position on the bills, but executive director Rick MURDOCK said his board members responded favorably to the bills when they were presented with the information.

With Medicaid expansion requiring more physicians, now is the time to encourage more doctors to stay in the field, not run away from it, he said.

"They saw it as an access issue," Murdock said. "The good Representative is probably on point with this legislation."