The American Board of Internal Medicine won’t be dusting off the disputed components of its Maintenance of Certification (MOC) requirements any time soon. Several elements of the program for certifying physician competency that were suspended temporarily in February will remain in cold storage until 2018, while the ABIM works to develop a plan that is more acceptable to its physician members.
“Based upon feedback from the internal medicine and subspecialty community, as well as ABIM’s commitment to ensuring the MOC program does a better job recognizing meaningful activities physicians are already doing in practice, the ABIM board of directors determined at its December 2015 meeting that it would continue the current practice whereby no internist will have his or her certification status changed for not having completed activities in Practice Assessment, Patient Voice or Patient Safety through December 31, 2018,” the ABIM wrote in a statement Wednesday.
Whereas years ago physicians could be certified for life, the ABIM has sought to upgrade standards to make continuous study and assessment a requirement for certification. The introduction of the Assessment, Voice, and Safety elements of the MOC in 2014 met with stout protest from the physician community. They contended the new MOC requirements were burdensome and neither relevant nor meaningful. The more lengthy suspension announced Wednesday does not mean that the ABIM has decided to abolish the controversial additions to MOC, but it does suggest that the ABIM believes there is some salvageable value in the disputed items.
“We have heard from many stakeholders that it is good for patients when physicians regularly evaluate and improve the quality of their care, but we have learned that there are a myriad of ways physicians do this today, and that our MOC program should credit clinically meaningful activities,” ABIM President and CEO Richard J. Baron, MD, said in the statement.
“ABIM will continue to provide MOC credit for quality improvement activities physicians choose to do and expand the list of activities we recognize for MOC credit while we partner with others to increase clinically relevant opportunities for doctors to engage in this important work,” he said.
All three of the suspended items would have involved substantial commitments from physicians in order to qualify for MOC.
The Voice element required physicians to demonstrate that they are incorporating the values and preferences of patients and their families when medical decisions are made. It involved surveys and other forms of data collection, and could take from 3 to 6 months to complete.
The Assessment part required physicians to find an opportunity for improving patient care in their practices, implement that change, and then measure the improvement.
The Safety piece required physicians to demonstrate foundational knowledge of patient safety practice, prevention techniques, and teamwork and care coordination.
The Medical Knowledge requirement, of course, remains a part of the MOC, though the ABIM has previously stated that it will broaden the ways by which physicians can demonstrate attainment of medical knowledge.
“Diplomates still need to take and pass an examination every 10 years and earn 100 MOC points every five years as well as complete some MOC activity every two years to participate in the program,” this week’s announcement said.
Over the past year the ABIM has been subject to criticism that its MOC revision process was a closed-doors affair that excluded input from the many physicians who form its constituency. The statement included a nod to this criticism: “ABIM will work to expand pathways to complete meaningful quality improvement activities with the continued commitment that all decisions about these and other MOC requirements will be informed by community input.
“In addition, ABIM is also participating in the American Board of Medical Specialty (ABMS)’s Improvement in Medical Practice Task Force as part of ongoing MOC program quality improvement initiatives and continues to participate in the ABMS Multi-Specialty Portfolio Approval Program in which physicians can receive MOC credit for quality improvement activities occurring in their practice environments.” The ABIM said it would continue to work with physicians to develop ways of assessing knowledge on a more regular, lower-stakes basis than happens with the current 10-year MOC examination. “At this time, however, the 10-year exam remains our best approach for assessing physicians’ knowledge.”
Those physicians whose certification expires next year will have to take and pass the exam and earn 100 MOC points next year, the statement said.
It said the ABIM has established a relationship with the Accreditation Council for Continuing Medical Education to expand options for physicians to earn MOC points.
“As we have continued to increase the types of CME activities that attest to knowledge assessment, we have made it easier for physicians to get MOC credit for a broader range of CME activities,” said Clarence H. Braddock III, MD, chair of the ABIM board of directors. “Our focus is now on involving physicians in various efforts to ensure that our exams reflect what they see in daily practice. We are also engaging societies and physicians to help us explore the feasibility and potential implementation of more frequent, lower stakes assessments.”
The ABIM has made the following changes to the MOC over the past two years:
More Continuing Medical Education activities approved for MOC credit
Discontinued requirement for maintaining underlying certification
Made Internal Medicine MOC exam more relevant to internists in practice today
Internists participated in process for standard setting
Score reports that provide more feedback to exam takers
One year grace period for physicians who fail an MOC test
Fees & Enrollment
Reduced the MOC exam retake fee