New ABIM, ACC MOC Option Offers 10-Year Exam Opt Out

Debra L Beck

May 02, 2019

The American Board of Internal Medicine (ABIM) and the American College of Cardiology (ACC) have announced a new option for maintenance of certification (MOC) for cardiologists.

The option, called the Collaborative Maintenance Pathway (CMP), allows physicians to maintain their ABIM certification by focusing their study on specific areas over the course of several years, rather than having to take a single, all-encompassing test once every 10 years.

"The majority of our members want a continuous learning option [rather than] a 10-year high stakes — all stakes — exam," C. Michael Valentine, MD, senior cardiologist, Stroobants Cardiovascular Center of Centra Health, Lynchburg, Virginia, and immediate past-president of the ACC, told theheart.org | Medscape Cardiology.

The new recertification option was announced to coincide with the College's Annual Scientific Sessions in New Orleans in March.

The pathway utilizes the ACC's Adult Clinical Cardiology Self-Assessment Program (ACCSAP), which offers yearly learning modules focused on topic areas. To start, the 2019 ACCSAP learning module and the ABIM's Performance Assessment will cover arrhythmias.

"We feel that this gives our members the most options available," said Valentine. "If you decide that you don't want ABIM certification, you can opt out and just do ACCSAP or Cath SAP or EP SAP and we'll then give you a certificate from the College saying that you are engaged in online continuous learning through the College…but that may not be accepted by your hospital or your health system or your payment system. All it says is you're engaged in our SAP program and continuous learning."

Commenting for theheart.org | Medscape Cardiology on the new development, Harlan Krumholz, MD, Yale School of Medicine, New Haven, Connecticut, was positive.

"The 10-year high-stakes exam failed to serve the public's needs and stressed physicians," Krumholz said. "A better approach is an ongoing learning platform, with feedback, that helps people stay current and assures the public that their doctors are engaged with peers in keeping pace with an ever growing evidence base."

"This new program should maintain the public's confidence and reduce the stress and burden on doctors to maintain their certification," he added.

ABIM data put the pass rate for first-time takers of the MOC 10-year exam at 90%, and the board notes that the total of all first-time takers since 2008, who have had at least 3 years to pass, is 98%. 

Time for a Change

This new recertification option is a response to multiple surveys that have shown an overwhelming preference for ongoing certification using longitudinal assessment, rather than an intensive, point-in-time examinations.

After years of complaints and a generalized sense that the recertification process offers little value, an independent commission established by the American Board of Medical Specialities (ABMS) released a draft report in early 2019 suggesting that not only should the process change across specialties, but even the term "maintenance of certification" should be abandoned, so tarnished is it at this point.

MOC critics also say the evidence is paltry on whether certification actually improves patient care.

The American Academy of Family Physicians announced a similar change in their MOC procedures last fall, and the American Board of Anesthesiology (ABA) published data in January showing that their redesigned longitudinal CME/recertification program, introduced in 2016, is yielding results: physicians who actively participated in a pilot program scored higher on the traditional written recertification exams.

Things have recently gone beyond the complaint phase and become litigious. Last year, four internists filed a class-action suit on behalf of 100,000 internal medicine doctors against ABIM. As well, the Department of Justice has weighed in and given its support for expanding the number of organizations that can offer specialty certification to increase competition.

Less Stress, Double the Run-Throughs of New Material

Ultimately, with ACCSAP and the ABIM's Performance Assessment, the breadth of general cardiology will be covered in a span of 5 years, such that each 10-year period will see physicians completing two cycles of updating their knowledge.

"The new CMP leverages the respective expertise of the ACC and ABIM to create a literal 'pathway' that meets the ongoing learning needs of cardiologists, while also giving patients, the public, and other stakeholders confidence that the care provided by their physicians is of the highest quality," said Timothy W. Attebery, DSc, MBA, chief executive officer of ACC, in a press release. "We appreciate ABIM working with us on what we believe is a win–win solution for cardiologists and the patients they serve."

Physicians currently certified by the ABIM and not in an MOC exam grace period are qualified to participate in the CMP. They will need to spend at least 7 hours "engaging" in the topic covered by the 2019 CMP Performance Assessment. This includes reading the relevant text and/or watching presentations in ACCSAP, and completing all 94 arrhythmia practice questions, at least 70% of them correctly. This process will be repeated for the years 2020 to 2024.

The 5-year ACCSAP program will cost ACC members $1500 ($1900 for nonmembers and $900 for Fellows in Training/Emeritus Members). The annual ABIM cost to participate is between $128 and $180, regardless of the MOC option chosen.

According to the ACC's recertification information hub, there is no risk involved in trying the CMP process because 2019 is a "no consequences" year. This means that doctors will be considered as maintaining their ABIM certification just by completing the CMP requirements.

In 2020 and beyond, they will be required to pass the Performance Assessment to be considered as meeting their ABIM assessment requirement and will have two chances each year to do so.

"The goal of these [ACCSAP modules] is to have a continuous learning program where you have the information, you have test questions you can learn from — when you miss them you actually learn more than when you get the answer right — and you have the answers," said Valentine.

It is anticipated that CMPs in clinical cardiac electrophysiology, interventional cardiology and advanced heart failure, and transplant cardiology will become available in 2020. The modules have been developed in collaboration with the Heart Rhythm Society (HRS), Heart Failure Society (HFS), and the Society for Cardiovascular Angiography and Interventions (SCAI).

"Through meaningful engagement with the physician community and professional societies, ABIM is proud to continue the evolution of our MOC program in a myriad of ways to better meet the needs of physicians and the patients they serve," Richard J. Baron, MD, president and CEO of ABIM, said in the ACC statement.

"This new offering increases choice, flexibility, and relevance for board-certified cardiologists while also keeping a performance standard that gives patients confidence that their physician possesses the current medical knowledge necessary to deliver high-quality care," Baron says.

American College of Cardiology (ACC) 68th Annual Scientific Session. Presented March 16, 2019.

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