An Update from the Right to Safe Care Coalition

A mid-2018 update is described in this article, which is intended to inform readers about activities of The Right to Safe Care Coalition (RTSCC). RTSCC, according to the coalition’s website, is “a group of organizations and individuals who are concerned about legislation recently enacted in some states to undo current systems established to assure the public of the competence of health care professionals.”

Questions were posed by the author, who is the Vice President of Examinations for the National Board for Respiratory Care and a member of the ICE Editorial Committee. Responses representing the Coalition were provided by Grady C. Barnhill, MEd, who is vice chair of ICE Board of Directors.

While those who have deregulated, or intend to deregulate, health professionals should articulate the rationale for their movement, what do you understand to be the reasons?

Professionals involved in advancing anti-maintenance of certification legislation primarily seem to feel the current requirements are too burdensome, costly, and not sufficiently relevant to their practice. We do not, for the most part, think that professionals wish to be deregulated, but rather, they wish to reduce or eliminate what they consider to be burdensome recertification requirements. In addition, we don’t think most professionals want to eliminate a licensure requirement, as that would throw open the floodgates for anyone to practice their profession, potentially resulting in an influx of people who are unqualified.

Specialization and sub-specialization is a contributing issue. Say you’re an orthopedic specialist who deals exclusively with the hand. You don’t want to be tested on the shoulder after spending years treating hands. However, your credential is broad-based, allowing your practice to include both the hand and the shoulder. Your credential says to your employer and your patients that you are qualified to work in both areas. Potentially, you could change your practice tomorrow from one area to the other. Sadly, patient safety or public protection don’t seem to be a part of these deliberations. We’re left with the question of how we can best ensure that health care professionals are up to date.

Earlier legislation seemed to be aimed at specialty certifications that require maintenance of certification. States had legislation introduced that would have precluded states, hospitals, or employers from requiring continued certification for employment or to grant hospital privileges. Recent legislation seems aimed directly at certification and/or state licensure, establishing strict requirements for continuing or establishing new licensure structures. The purpose behind such legislation is described in terms of economic opportunity, reducing regulatory burden, and increasing competition to reduce prices. Some proposed legislation included requirements for strong evidence to show significant and ongoing danger to the public in order to start or continue a licensure program. The proposed requirements would have made it nearly impossible to continue almost any licensure program. 

Is there a common thread explaining why this type of deregulation was taken up in the states in which legislation has passed and the states in which such legislation remains under consideration?

My understanding is that medical societies have been primary supporters of anti-maintenance of certification legislation, and the bills are often introduced by physician legislators.

Things have happened fast in this arena so it’s hard to keep up to date. Legislative sessions are winding down for 2018. Clearly, it will be an advantage to introduce future bills in ways that go unnoticed by those who might oppose them.

In addition to physicians, to what other health professions are deregulation efforts justifiably expected to spread?

Bills have been introduced in at least two states that oppose the use of testing as a recertification requirement for licensure of physician assistants. Clearly this kind of activity can be expected to appear only for those professions which include a relatively stringent recertification component. We would not expect anti-recertification legislation to be introduced for professions that only require periodic completion of continuing education.

The righttosafecare.org website declares that continuing education is widely discredited as a surrogate for competence. Who has discredited the assertion that continuing education is enough?

We are not saying that all continuing education is ineffective. Authors like Bloom and Davis have written about continuing education that does not change behaviors or patient outcomes. Characteristics of these ineffective experiences include the following:

• Untargeted

• Single session

• Didactic format disconnected from a learning plan

• Lacking interactivity

In contrast, continuing education programs that have the following characteristics are more likely to have a positive (I hope) impact on behaviors and patients:

• Multiple sessions rather than a single session

• Reminders, such as takeaway posters, cards or emails that remind learners of key points

• Interactive sessions allowing the learner to practice or rehearse what they have learned

The righttosafecare.org website declares that consumers expect that renewed competence occurs as frequently as every other year, but no longer than every five years. What can be said about the rigor with which these consumer studies were done?

I have personally observed two, carefully conducted focus groups that addressed this topic. One group included Medicaid-eligible participants, while the other group included participants of average socio-economic status. Outside consultants were contracted to administer carefully worded questions to elicit responses. The two groups gave remarkably similar answers. Both groups expect high quality healthcare and assume that licensing or certifying bodies are ensuring that their practitioners are being retested or undergoing some other meaningful and rigorous process to ensure they remain up to date on a regular basis. The American Association of Retired Persons has also conducted survey studies whose results support these conclusions.

What should an individual or organizational leader expect after joining the RTSCC?

The RTSCC is composed of very dedicated credentialing professionals, with their collective interests focused on public protection. A person or organization can expect the following opportunities after joining:

• Receive regular updates, usually by regularly scheduled conference calls, regarding the status of existing legislation.

• Review or develop educational materials.

• Receive information about conferences or other educational experiences intended to maintain an awareness of these critical issues.

• Develop special projects or presentations.

What else should the ICE community know?

One of our biggest concerns is that attention seems to have shifted away from patient safety/protection to emphasizing money. Rather than mentioning money directly when advocating legislation, the following phrases are used:

• Economic opportunity and growth

• Lack of restraint on trade

• Removing unnecessary burdens

• Increasing access to care

• Lowering costs by increasing competition

However, as a patient, I am willing to pay a little more for a practitioner whose qualifications can be readily verified and who has demonstrated that he or she is up-to-date. I am not interested in taking my chances with a practitioner who may not be current.

That said, I observe credentialing organizations that are developing and implementing new recertification processes that are more meaningful, relevant, and less burdensome. Some of the programs include assessments that help focus learning, or even allow the practitioner to exempt required learning experiences as appropriate. Some innovative programs are designed to fulfill both a formative and summative role, which helps keep the practitioner current in a more convenient manner. These programs are often available online or on a smartphone and can be completed one question at a time. These programs can fulfill the credentialing mission of helping to keep practitioners up-to-date, while at the same time being less burdensome, less costly, and more relevant to practice.

Related Resources 

Maintenance of Certification Legislation

ICE Virtual Town Hall – Maintenance of Certification Legislation 

ICE Handbook Chapter 9: Recertification & Continuing Competency

RESEARCH: Methods for Ensuring Continuing Competence, Part 1 & Part 2

EXECUTIVE WEBINAR: Evaluating Your Continuing Competence Program

RESEARCH: Continuing Competence Framework Document  

RESEARCH: Continuing Competency Initiatives: Lessons Learned & Evolving Outcomes