ABIM Budges on Maintenance of Certification Program

August 11, 2014

Striking a humbler tone in the face of physician blowback, the American Board of Internal Medicine (ABIM) is promising to ease up on several financial and course work requirements for its revamped maintenance of certification (MOC) program.

And more changes are under consideration.

In a July 28 letter to 14 medical societies, ABIM president and chief executive officer Richard Baron, MD, said that MOC's restructuring this year comes at a time when physicians already feel harried adjusting to the Affordable Care Act, pay-for-performance, the electronic-health-record era, a new team approach to medicine, and other professional sea changes.

"Given these mounting pressures, the timing for releasing the changes in our MOC program was hardly propitious," wrote Dr. Baron to 14 medical societies, who had laid out their concerns in a joint letter. The new version of MOC only "magnified [physicians'] sense of siege and stress."

The ABIM has essentially sped up the board recertification process for those physicians with a 10-year certification. Before 2014, they could earn MOC credits for exercises in lifelong learning and self-assessment, testing, and practice improvement in the year before their recertification exam every 10 years. Now they must earn points for accredited education modules on a continual basis — at least 10 every 2 years and 100 every 5 years. The ABIM's goal is to help these physicians stay professionally sharp and up-to-date throughout the 10-year cycle.

Physicians who boarded on a lifetime basis before 1990 can ignore MOC, but they will be listed as "certified, not meeting MOC requirements" on the ABIM Web site. Physicians who first became board certified by ABIM in 2013 and beyond can by no means blow off MOC. Their recertification, which is not time limited, hinges on enrolling in MOC this year.

All told, almost 150,000 physicians signed up for the program by a May 1 deadline out of a possible 200,000 to 220,000 who hold some form of certification, according to the ABIM.

Talk of Creating New Internal Medicine Board

Almost 20,000 physicians in internal medicine and its subspecialties have signed a petition that calls on the ABIM to undo the recent changes to MOC, which they consider burdensome busywork without any clinical value. One bullet point in the petition is basing recertification simply on an exam every 10 years.

The leader of the petitioner drive, cardiologist Paul Teirstein, MD, in La Jolla, California, told Medscape Medical News that another 3500 physicians have signed a pledge to boycott the MOC program. Still other physicians talk about suing the ABIM or creating a new certification board, said Dr. Teirstein.

"There's a palpable sense of anger," said Dr. Teirstein, the chief of cardiology and director of interventional cardiology for the Scripps Clinic.

To placate this anger, the ABIM unveiled its laundry list of reforms last month. One involved the recertification exam. If a physician with a 10-year certification takes it early — as opposed to waiting until the last year — and fails it, he or she will receive an extra year to try again. In the meantime, the ABIM will not label that physician as "not certified" or "not meeting MOC requirements." In addition, the fee for retaking the exam for the first time will decrease from $775 to $400 beginning in 2015.

ABIM also is trying to make it easier for physicians to earn MOC points for medical knowledge. Physicians have complained that ABIM-created MOC activities duplicate the continuing medical education (CME) they receive under the auspices of the Accreditation Council for Continuing Medical Education (ACCME). Such CME can count toward MOC credit, but only if the ABIM reviewed and approved it beforehand. This credit-transfer process will be streamlined, according to the ABIM's letter of July 28.

"ACCME-accredited product providers can register with us to have their products count in our program and will then be able to designate which of their products meets our standards," the ABIM stated. In addition, the ABIM will explore giving physicians a discount on their MOC fee if they substitute outside CME for an MOC activity. MOC fees, which cover a 10-year recertification cycle, are $1940 for internal medicine, $2060 for hospitalists, and $2560 for any internal medicine subspecialty. The fees can be paid annually on a prorated basis.

The ABIM also promised to discuss how it describes someone as complying or not complying with MOC requirements on its Web site. Dr. Baron said that some physicians with lifetime certification have complained that although the Web site notes that they do not need to participate in MOC, they nevertheless are tagged as not meeting its requirements. "They say that's confusing," the ABIM's Dr. Baron told Medscape Medical News.

The ABIM letter tried to assuage anti-MOC ire on one other point. The board said it does not believe that "MOC should be required for MOL [maintenance of license]."

"In states where licensure includes required CME, MOC should count for those and any other knowledge or [quality improvement] requirements," the ABIM said.

A number of states are contemplating MOL programs along MOC lines that go beyond physicians racking up traditional CME credits to keep their licenses. Many physicians as well as some medical societies are just as much anti-MOL as they are anti-MOC, and they fear that MOC could be a prerequisite for MOL.

ABIM in Listening Mode

In his interview with Medscape Medical News, Dr. Baron emphasized, as he has in the past, that the ABIM is listening to complaints about MOC and is attempting to address them. At the same time, he said, MOC serves a purpose that physicians respect. "Internists by and large are lifelong learners," he said. "They're proud of their [board] certification. They work to get it and keep it."

So far, the ABIM's letter is receiving positive, if not enthusiastic, reviews.

Patrick O'Gara, MD, president of the American College of Cardiology, said in a recent blog post on the society's Web site that the ABIM's responses to criticism "are encouraging, but we recognize that much further work needs to be done."

Dr. Teirstein agrees with Dr. Baron that the ABIM is in listening mode. "That's a good thing," he said. "The tone [of the July 28] letter is appropriately conciliatory," he added. "They know they've touched a raw nerve."

He is taking a wait-and-see attitude on the ABIM proposals. "They could be good, but they are early stage," he said. "We need to see what shape they'll take."

The discounted price on the retake exam is a "token" change to MOC's fee structure, he said. "We're looking for substantial reductions in what physicians have to pay."

And again, MOC opponents stress that they want to see the process of board recertification drastically simplified. "We're not interested in spending one more minute on MOC than we have to," said Dr. Teirstein.

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