If it becomes law, a little-discussed bill would reap significant benefits for Florida physicians.

State Rep. Julio Gonzalez, MD, an orthopedic surgeon from Venice, sponsored House Bill 723 centering on Maintenance of Certification practices. The bill prohibits certain parties from requiring particular certifications as conditions of licensure, reimbursement, employment, or admitting privileges. Those parties include Boards of Medicine and Osteopathic Medicine, respectively, and the Department of Health, healthcare facilities and insurers.

"Maintenance of Certification is a long-time concern among the physician community," said Gonzalez, whose wife is also a physician. "The current law makes it extremely burdensome for physicians to access the full complement of insurance programs and hospitals throughout the state. By doing so, it interferes with patients' abilities to access those physicians and hospitals. Oklahoma has taken some innovative steps to make sure that Maintenance of Certification and board recertification wasn't used as a condition for privileges, participation insurance programs and licensure. I thought it was time for Florida to take a similar step."

Jason Pirozzolo, DO, director of sports medicine and trauma for Orlando Hand Surgery Associates, said the bill would remove the mandate for physicians to abide by arbitrary Maintenance of Certification standards "dictated by private special associations run by highly-paid board members that do a poor job of representing their constituent physicians and their unique practices."

"Physicians have long supported the State Board licensure requirements of Continuing Medical Education," said Pirozzolo, also an assistant clinical professor at Florida State University, a diplomate for the American Board of Family Medicine and National Board of Physicians and Surgeons, and a member of the Florida Medical Association (FMA) Board of Governors. "In fact, most doctors surpass this minimum requirement. Physicians also support the initial board certification process, which is typically accomplished by successfully completing a rigorous post-residency fellowship training program and passing the corresponding initial Board Certification exam."

FMA, American Medical Association and more than 20 other medical associations have passed formal resolutions against Maintenance of Certification, Pirozzolo said.

"Resolutions eventually lead to legislation," he emphasized. "In Oklahoma now, physicians are allowed to choose to take part in the ABMS proprietary and self-created Maintenance of Certification programs, or an alternate Maintenance of Certification pathway provided by competing specialty boards. This competition allows physicians to maintain certification through a pathway that better suits their individual practice."

Various Boards of Medicine certification examination groups nationwide and specialty societies have benefitted the most by Florida's current Maintenance of Certification environment, Gonzalez said.

"Certification boards get greater participation in their programs in improving that co-dependence between the board certification process and the organizations ... to the tune of millions of dollars," he said. (Cumulatively, 2015 Maintenance of Certification standards will cost physicians $5.7 billion over 10 years, according to an industry study). "They're the greatest beneficiaries of this out-of-control freight train."

Hospitals and large multi-specialty practices also benefit, noted Gonzalez.

"It's a very easy way to claim they're maintaining quality by making sure physicians are board-certified," he said. "It's like a crutch." He also noted that hospitals routinely measure quality by gauging physician performance. "They measure outcomes, so all those things are still in order."

Gonzalez shared the example of a physician who decided not to seek recertification. "Perhaps his hospital didn't require board recertification and he decided for some reason to let it drop," he explained. "He's been practicing well, a fine physician. Then he moves from his community to another and he's suddenly restricted because so many hospitals are requiring that Maintenance of Certification or recertification."

Even though action hasn't been taken, Gonzalez has heard conversations about certification being a prerequisite for participation with certain insurance companies.

"Ostensibly, it gives them the false reassurance that perhaps they're getting higher-quality physicians by making this a requirement for participation," he explained.

HB 723 does absolutely nothing to prevent primary board certification, said Gonzalez, who doesn't anticipate strong opposition. "Support has been phenomenal," he said. "We've gotten so many testimonials, letters of support, letters of encouragement, phone calls. You can really sense the frustration among the physician community by their overwhelmingly positive response to this bill."

The greater hurdle may involve passage of HB 723 in the Senate, Gonzalez pointed out. "Only because no doctors serve in the Senate. It's a lot easier to explain these very technical issues to member colleagues," he said, referencing two other physicians who serve in the State House of Representatives and have helped explain the fine points to House colleagues.

If this legislation passes, said Pirozzolo, physicians will no longer be required to travel across country and sit for very expensive, high-stakes recertification exams that frequently involve testing material completely irrelevant to their individual practices.

"At its heart, this bill simply parallels the ideologic principles of our legislative leadership in Tallahassee," said Pirozzolo. "It transforms the current monopolistic physician certification system into a free-market certification system that forces competing boards to re-invent the way physician education and certification is offered. It re-invigorates the competitive self-education of physicians. It reduces arbitrary and costly regulatory burdens on physicians, thereby reducing physician burnout and ultimately increasing access to care."

Central Florida Physicians' Legislative Agenda

Support:

Direct Primary Care - Less Paperwork, More Care - SB 240 (Lee) and HB 161 (Burgess) One of the most promising developments in health care delivery in recent years has been the Direct Primary Care (DPC) movement. A growing number of primary care physicians nationwide are adopting this innovative model because they are frustrated by the excessive paperwork and regulatory burdens imposed by insurance companies. They are attracted to direct primary care because of their desire to spend more time with patients.

DPC is an alternative to the traditional fee-for-service model in which patients are charged a simple, affordable flat monthly fee for comprehensive coverage of all primary care services. DPC physicians have been able to control costs by managing chronic illnesses and reducing administrative expenses. A growing body of evidence suggests that DPC leads to better patient care at a lower cost. The OCMS & SCMS strongly support legislation which would allow DPC to grow by defining direct primary care agreements as a medical service outside the scope of insurance regulation.

Right Medicine, Right Time - SB 530 (Steube) HB 877 (Harrison) The OCMS & SCMS support efforts by patient advocates to ensure that appropriate prescriptive treatments are based on a physician's recommendation. Each year, thousands of Floridians are subjected to "fail first" protocols, whereby insurance companies impose their own treatment decisions ahead of treating physicians' medical judgment. This causes delays in care that can lead to unnecessary hospitalizations and sometimes devastating consequences for patients.

Florida needs legislation that allows physicians and patients to override step therapy protocols when deemed medically necessary and in patients' best interests. In addition, if a patient is currently stable on a drug, step therapy should not be required to continue usage of that drug because of changes in a health care benefit or plan. Finally, the FMA supports shortening the amount of time for a step therapy override to be granted. It is time to stop insurance companies from practicing medicine and getting in the middle of the patient-physician relationship. A recent report from the Annals of Internal Medicine found that, for every hour a physician spent seeing patients, another two hours were spent on paperwork. These excessive mandates have dramatically increased the cost of running a medical practice.

Retroactive Denials - SB 102 (Steube) HB 579 (Hager) The OCMS &SCMS support legislation that eliminates the ability of insurance carriers to retroactively deny Claims when they have provided a physician with authorization and the physician renders that service in good faith.

Maintenance of Certification - HB 723 (Gonzalez) The OCMS & SCMS supports legislation that prohibits maintenance of certification (MOC) as a condition for medical licensure, medical staff membership or participation in an insurance plan. While our organizations support the value of initial board certification, continuing medical education and competency standards, the MOC process is not scientifically proven to judge ongoing competency and improved relevant performance for practicing physicians.

Oppose:

Independent Practice for Advanced Registered Nurse Practitioners and Physician Assistants The OCMS and SCMS are committed to a high-quality standard of care for all Floridians regardless of their economic status or health insurance coverage. We must protect the safety of Florida patients and ensure they receive care from the most qualified people trained to deliver that care. We firmly believe that high-quality

care can only be achieved by a well-trained team of professionals under the supervision of a physician. Nonphysician practitioners are valuable members of the health care team but they are limited by their education and training. Physicians are the only members of the health care team who have the broad clinical experience and training to exercise independent judgment and provide overall direction of a patient's care. Under certain circumstances it may be appropriate for a physician to delegate care to a lesser-trained allied health professional, but only with proper supervision. We are committed to enhancing this collaborative team-based care approach and creating efficiencies in our health care system, but only if those efficiencies do not compromise the safety of Floridians. The OCMS & SCMS oppose any scope of practice expansion beyond that which is safely permitted by a non-physician practitioner's education, training and skills.

PIP Repeal - SB 156 (Brandes) - The OCMS & SCMS support maintaining the current automobile no-fault system due to the potential harm that can be caused to our emergency and trauma system in return for minimal financial relief for consumers. The Pinnacle study released last fall notes that drivers in Florida would save $82 a year with the repeal of PIP. However, without PIP or some other form of mandated emergency med pay coverage, more injured drivers and passengers would rely on commercial insurance to cover the cost of their medical care while they litigated fault in the accident. Most patients carry commercial coverage with far higher deductibles and co-pays that would have to be utilized for care currently provided under their PIP benefit. Emergency Physicians and On-Call Specialists would likely face increased unfunded care and extended delays in reimbursement as fault is determined in each accident. While the current PIP system is far from ideal, it does provide a relatively in-expensive medical benefit that contributes significantly to our current trauma care system.

Additional Issues:

Workers Compensation Reform - Florida has the lowest Workers Compensation Patient Satisfaction scores compared to all of the states studied according to research from the Workers Compensation Research Institute. Poor patient experiences in the Workers Compensation system leads to increased litigation. According to NCCI, 25% of injured workers seek legal representation to guide them through the system. The OCMS & SCMS believe litigation can be reduced and return to work enhanced by providing greater access to quality care by addressing physician reimbursement, providing more freedom for patients to select their treating physician and ancillary services, and requiring insurance carriers to authorize or deny treatment within the statutory timeframes. Reimbursement for physician services in Florida is the lowest in the nation and due to carrier selection of treating physicians, actual reimbursement is often below Medicare levels according to WCRI. The statutory timelines for responding to treatment authorization requests should be tightened to facilitate timely provision of care and rapid return to work.

Telemedicine - The OCMS & SCMS support expanded utilization of telemedicine services as a means of enhanced access to care and care coordination. We support a process where the Board of Medicine retains jurisdiction over the quality of care rendered to Floridians. We support measures to ensure telemedicine services are reimburseable from payers so the physician community can invest in the infrastructure to advance utilization of the technology.

Courtesy Orange County Medical Society and Seminole County Medical Society