MOCs and hospital bylaws

By Bradley Evans, MD posted 11-09-2017 17:06

I am on a Bylaw Revision Committee for my hospital. Our hospital bylaws mandate MOC. There are strong physician advocates for this. Their reasoning, I think, is that physicians need to keep up with the latest scientific advances. There's data that shows that physicians have trouble keeping up with the advance of science. 

I found very interesting things in our Bylaws concerning the MOC requirements. As best as I can tell, these requirements started with medical school-affiliated hospital staffs, and have spread. You can compare your hospital's bylaws or you can go online and get a pdf of a medical school's bylaws. I have been using Stanford's, but I think U of M is similar. Here's what I have found:

1) There is no dollar limit. Who would sign an agreement, or contract, where the potential cost to them is unlimited? That's crazy. My guess is that no lawyer would ever be party to a contract like this. My guess is that the lawyers we are dealing with would say, "Well, if it's a problem, you can always apply for a waiver, from the medical staff leaders."

2) It does not say who must pay for the cost of the MOC or for the physician's time. You might say, "Well, duh, it's going to be the physician," but wait. These requirements started with medical schools, where the physicians are employed. Does the employer pay? It's obvious that the employer pays if it says so explicitly in the contract. So, if you have a contract, you have the ability to specify that the hospital or medical school pays. Lucky you. What if the contract does not say? I think that the hospital implicitly pays anyhow. They advertise for "board-certified" physicians, so they are paying more to get these physicians. I think in economic theory the hospital pays anyhow. (Does the hospital realize that their potential liability is unlimited?)

3) There's rumors that BCBS either pays hospitals directly if the physicians at the hospital are all board-certified, or they give these hospitals a better deal in terms of insurance payments. If it is true, I think it fits the definition of a kickback.

I don't know if BCBS pays hospitals or not. The question is: Is it good or bad for BCBS to pay hospitals? I think it's good. What you want, as a physician affected by all this, is for the people advocating MOC maintenance to pay the cost. In Michigan, that's BCBS. You want hospitals to see the cost, preferably as a line item in their P&L. You want every physician contract to state that the hospital pays for MOC maintenance and physician time, and you want all of that cost to flow through to that line item. Even better, you want the hospital to agree to pay for MOC cost and time spent for every physician, every NP, and every PA on the staff. You want the hospital to compare what BCBS is paying them, if anything, with what they are paying for MOC for staff physicians and other medical personnel.

It's in the aggregate that there is hope. An individual physician, or even a group of physicians, has little hope of changing policy, but hospitals might. No one cares if an individual physician has to pay $1000 a year in total costs for MOC. Except the physician. However, if there's 400 physicians and it's costing the hospital $400,000 for MOC, then it might be different. A thousand here, a thousand there, pretty soon you're talking real money.

4) There's no provision in the Bylaws to monitor MOC costs. And I don't think that anyone does, except the individual physician, who has little power to change things.

5) There's no provision in the Bylaws to monitor performance. And, I think no one does. There's no accountability. No wonder academic studies have trouble showing any benefit from MOC. What a great deal the Boards get from the Bylaws. There's no limit on what they charge, and no one asks them for data to show if they are really doing what they say they are doing. It's gets weirder if you think that these Boards are supposed to be teaching physicians the basics of evidence-based medicine, where one of the basic tenets is that the physician is supposed to ask "Where's the data?", yet, no one asks the Boards to provide data.