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Bill on certification pits doctors against hospitals

A bill slated to hit the Texas House floor on Tuesday would bar hospitals and health plans from differentiating between physicians who have undergone a widely-used recertification process and those who haven't.

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*Editor's note: This story was updated to indicate that the House passed the bill. 

*Correction appended.

A bill moving through the Legislature in the last week of the session is pitting doctors against hospitals over how much testing doctors should have to undergo to maintain their certification.

Currently, Texas physicians must undergo the Maintenance of Certification (MOC) program, which tests physicians on medical knowledge and practice every five to 10 years, to maintain their certification with national certification boards. Many hospitals and other employers also require doctors stay current on their MOC. 

Senate Bill 1148 would ban the Texas Medical Board from using the program as a requirement for physicians to obtain or renew their medical license. It would also bar hospitals and health plans from differentiating between physicians who have undergone the process and those who haven't in matters related to workforce selection, payment, contracting or credentialing. 

The bill's author, state Sen. Dawn Buckingham, a Lakeway Republican, is a practicing physician.

The Texas Senate passed the bill in April. The House is scheduled to take up the bill on Tuesday. (The House gave tentative approval to the bill on Tuesday night.) 

The Texas Medical Association, which represents more than 50,000 physicians and medical students, supports the bill and views the tests as burdensome, expensive and an unnecessary overregulation of medicine. 

Carlos Cardenas, the group’s president, called the requirements a "money-making operation" and said studies published in the Journal of the American Medical Association have shown there are no differences in patient outcomes between those treated by physicians who kept up with national MOC requirements and those who didn't.

Cardenas said the legislation doesn’t diminish the quality of care patients will receive because physicians would still be required to adhere to other rigorous requirements, including a Continuing Medical Education program.

Kim Monday, a Houston neurologist who testified for the measure on behalf of the Texas Medical Association in April, said the cost of maintaining MOC can be as high as $10,000 per physician for fees, materials, travel and time away from the practice. 

Many hospitals, employers, and public and private payers require MOC as a condition for working with a physician, Monday said.

The Texas Hospital Association, which represents more than 85 percent of the state's acute-care hospitals and healthcare systems, worries the bill could impact patients negatively.

“Preventing Texas hospitals from requiring their physician workforce to maintain board certification in their chosen specialties — whether it’s obstetrics or neurosurgery or any of a number of other highly skilled fields — could put patient care at risk," said Ted Shaw, president of the association, in a statement to the Tribune.

Shaw said the current process ensures doctors are up-to-date in their knowledge and allows hospitals to determine the caliber of its own workforce.

Marc Boom, a practicing doctor who runs a network of hospitals at Houston Methodist, says the legislation is indicative of "overly intrusive government regulations."

Boom said medical staff at each of the eight hospitals that are part of his hospital system decided through their bylaws to require board certification in order to maintain a higher quality of practitioners on their team. Under Buckingham's bill, all of those hospitals will no longer be able to continue that requirement of its physicians.

"It's government intrusion into what should be an independent medical staff's ability to make this determination," Boom said. "You’re taking the ability of a medical staff to decide the quality and caliber of their own physician group and workforce away from them."

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Disclosure: The Texas Medical Association and Texas Hospital Association have been financial supporters of The Texas TribuneA complete list of Tribune donors and sponsors can be viewed here. 

Correction: An earlier version of this story incorrectly described the physician certification process in Texas.

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