Shelley Wood

April 01, 2014

UPDATE: Late Monday, the last day to register for the American Board of Internal Medicine (ABIM) Maintenance of Certification (MOC), the deadline to register before being reported as "Certified, Not Meeting Requirements" was extended until April 30, 2014. Our original story from yesterday is below.

WASHINGTON, DC — Many American cardiologists woke up this morning to a reminder in their email inboxes: today is the last day to register for their "Maintenance of Certification (MOC)." After today, the American Board of Internal Medicine (ABIM) will begin publicly reporting that cardiologists who are not registered are "Not Meeting MOC Requirements."

For cardiologists who do register, they now have until December 1, 2015 to complete at least one MOC activity to avoid being labeled as not meeting the requirements.

"It's relatively easy to do," Dr Kenneth Rosenfield, American College of Cardiology (ACC) governor, Massachusetts chapter, said in his email to members today. "There remain many questions, even controversy, regarding this new requirement. It is obviously up to each individual whether they decide to sign up. That said, my position is that it is better to enroll and then work with ACC and other subspecialty organizations to change the system for the better."

More Hoops

The new ABIM requirements have faced a rocky road, with cardiologists and other physicians decrying what some see is more hoops to jump through, more intrusion on their daily activities, and more dollars spent. In April 2013, the Association of American Physicians and Surgeons (AAPS) announced it was suing the American Board of Medical Specialties (ABMS) "for restraining trade and causing a reduction in access by patients to their physicians."

The AAPS also alleges that the MOC program will bring in "tens of millions of dollars in revenue" to the ABMS and 24 allied corporations, "who then pay prodigious salaries to their executives, often in excess of $700 000 per year."

Several years ago the ABIM introduced mandatory recertification every 10 years. MOC requirements were introduced this year, with shorter deadlines, the idea being to ensure physician education remains continuous.

Cardiologists need to register before the end of today, then demonstrate that they've accrued 10 "points" of accredited education modules within two years and a total of 100 points every five years.

Even cardiologists who were "grandfathered" within the ABIM requirements for having been board certified prior to 1990 will now need to participate in MOC or otherwise face being listed as "Certified, Not Meeting MOC Requirements."

So, what?

It remains to be seen what the impact of "meeting or not meeting" the MOC requirements will be.

What different states plan to do "varies widely," ACC president-elect Dr Kim Williams (Wayne State University School of Medicine, Detroit, MI), told heartwire . "There are no states that require MOC and board certification, but the federation of state licensing boards is considering working with the ABMS to link maintenance of licensure and maintenance of certification."

Williams wouldn't comment on the likelihood of that happening, other than to say: "It will be politically very difficult to take all of your licensed physicians and say, you must pass another unfunded mandate." That said, he continued, "As more physicians buy into it, it becomes easier down the road."

In his letter to members, Rosenfield wrote: "ACC and others are working aggressively to develop educational modules within this program that enable us to accrue credit through the ongoing learning and practice-improvement activities we engage in regularly. Examples of this could include review of our individual and group NCDR performance data, participation in peer review activities, and involvement with patient-centered practice improvement programs."

Here at the American College of Cardiology 2014 Scientific Sessions , the program has been packed with MOC modules. There's also a yawning corridor—conspicuously quiet early this morning—with the banner "MOC Complex" looming above.

 

"The ACC is committed to serving its members," Williams said. "In this regard, we are not the drivers of MOC but we believe in lifelong learning, however that's done, and to that extent that MOC is a process that is being required we will help our members obtain the MOC credits."

In an "ideal world," he continued, "we would have to recognize that medical knowledge doubles every three to five years. And so to the extent that that's true, one would need to have . . . personalized programs, journal reading, courses, coming to national meetings, getting online—you'd have to have some method of being up to date. But people want verification that physicians are actually doing this."

Hence, the MOC. "The ABIM believes that they are a public trust and that there are people who are concerned about how up-to-date their physicians are."

Also speaking with heartwire , Dr Richard Becker (University of Cincinnati College of Medicine, OH) highlighted the pace of new evidence and innovations as well. "The idea is to say that each year there is new information that practicing physicians should know and know well enough to pass modules that one has to pass," he said. "Patients come first, and board credentials [are required] on behalf of the people that physicians serve. It's all about the patient. If the field moved slowly, that would be one thing, but medicine moves very, very quickly. . . . Part of it is maintaining the integrity of the profession, and part of it is a acknowledging that it is a rapidly moving landscape in CVD."

Sitting for board exams is expensive, Becker noted, as are the prep courses, running into the thousands of dollars. But by contrast, the MOC course costs are "nominal," although they still add up.

Asked if the ACC will make money off members taking ACC-offered modules, Williams said: "Not much." But he added, the ACC's business model is such that "Whatever activities we do, there should be some profit margin to make sure that [the activity] doesn't lose money and that we do programs that benefit members and our patients."

"The challenges of the practicing physician right now are the speed of new information and requirements that are being placed on cardiologists at a time when they are seeing more patients. This leaves less time for education, so it's the polar opposite of what you would want," Becker observed.

The irony, he added, is that, although physicians may feel this is just another requirement being asked of them on top of so many other "burdens" unrelated to direct patient care, continuing education is actually the one thing they should probably be making time for.

"People may say, 'this is just one more thing,' but it's the one more thing that will make the difference in terms of a person practicing medicine according to best evidence rather than what they learned 10 years ago."

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