Changes Coming to MOC: Will Physicians Get Relief?

Leigh Page


June 05, 2018

In This Article

Calls to Revise Part IV "PIP" Exercises

One of the most contentious areas of the MOC process is the quality improvement exercises in MOC Part IV—specifically the Performance in Practice (PIP) module, in which physicians compare what they are doing in their own practice with clinical standards identified by the boards.

PIPs go by different names, depending on the board, including performance improvement modules, performance in practice modules, and practice quality improvement (PQI) activities. They're also called improvement in medical practice modules or practice assessment activities, based on names for Part IV.

PIP exercises vary by board, but basically they go like this:

  1. Physicians choose from among available modules, each focusing on a particular clinical topic.

  2. Then they pull several charts that deal with that topic, determine whether they have met the standards, and create an improvement plan, which they are then expected to use.

  3. After a period of time, such as 2 years, they pull several more charts on the topic and see if they have improved in meeting the standards. They are not penalized for not improving.

In the ABPN version, "they survey you, and you then come up with an improvement plan,” says Frank McDonald, MD, a neurologist in Gainesville, Georgia, and current president of the Medical Association of Georgia. "It's a lot of busy work."

Neurologists were so irritated with these exercises that, in February 2015, the board of directors of the AAN called on the ABPN to revoke Part IV. "The AAN heard what its members were saying, and we agree with them," said Timothy A. Pedley, MD, AAN president at the time.[41]

Even some board leaders have been very critical of Part IV and PIPs. "Part 4 PQI remains the most elusive, confounding component of MOC for some participants, and frankly it's confounding to us, too," Guiberteau, the ABR president, said in 2015.[35]

"A lot of this is Mickey Mouse, check-the-boxes sort of thing," said George Bartley, MD, then the new president of the ABOp, in 2017. "People hate them. We're trying to get this thing revamped and make it useful for you."[42]

Boards' Changes in Part IV

Boards heard the complaints. In February 2015, Baron, the ABIM president, issued an apology for introducing tighter PIP requirements the year before and suspended all Part IV requirements for ABIM physicians. They can still use Part IV activities to qualify for MOC points, but they're no longer a must. The suspension has been extended and still continues indefinitely.

In February 2016, the ABPN changed requirements for its Part IV. Previously, physicians had to use the "clinical module," the ABPN's version of the PIP, but now they can choose between the clinical module and a feedback module. In the feedback module, they collect opinions about their work from peers, patients, or a supervisor.[43]

In addition, the plastic surgery board has stopped requiring use of its clinical case log, a 6-month exercise much like a PIP.[33]

Meanwhile, many more boards have added activities that count for Part IV credit. For example, many boards now give credit for use of clinical registries, such as the AAN's Axon Registry.[44]

Physicians can also get Part IV credit for quality improvement activities they are already doing within their own institutions. Physicians have complained that Part IV activities overlap with this work. Now they can get MOC points for it through the ABMS's Multi-Specialty Portfolio Program.

For physicians to participate in the portfolio program, their institution needs to agree to monitor their work. By January 2016, 20 of the 24 boards were using the portfolio program, and 64 sponsoring organizations were overseeing more than 1300 physician projects, according to the AMA Council on Medical Education report.[3]

Ray Callas, MD, an anesthesiologist in Beaumont, Texas, has taken advantage of his board's portfolio program. In his project, he created a pathway for assessing antinausea medications after cesarean sections, says Callas, who is president-elect of the Texas Society of Anesthesiologists and a TMA trustee. He received 25 MOC points for the work.


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