ABIM on Maintenance of Certification program: ‘We got it wrong’

The American Board of Internal Medicine announced immediate and significant changes to its Maintenance of Certification program as a result of concerns expressed by the clinical community that new requirements were onerous and did not effectively ensure they stayed up to date in their fields.

The announcement came 1 year after the American Board of Internal Medicine (ABIM) changed its Maintenance of Certification (MOC) requirements from once every 10 years to continuous requirements.

Many physicians had spoken out against MOC. They questioned the value of ongoing learning programs, and voiced concerns about the financial burden and time commitment necessary to meet the new requirements.

“Simply put, as constructed, our current MOC program failed to actualize a set of shared values centered on ‘keeping up,’” David H. Johnson, MD, MACP, FASCO, chair of the department of internal medicine at UT Southwestern Medical Center, past president of ASCO and chairman of the ABIM board of directors, told HemOnc Today. “We are encouraged to hear from leaders … expressing support for the concepts of continuous learning, improvement and self-regulation. We are committed to working with the community in new ways to better achieve these shared goals.”

ABIM officials said they will seek to better align its program with the needs of physicians.

“ABIM clearly got it wrong,” Richard J. Baron, MD, ABIM’s president and CEO, said in a press release. “We launched programs that weren’t ready and we didn’t deliver an MOC program that physicians found meaningful. We want to change that.”

Program improvements

ABIM will immediately suspend the Practice Assessment, Patient Voice and Patient Safety program for 2 years. Diplomates will not have their certification statuses changed if they do not complete these activities for at least the next 2 years.

Further, the language ABIM uses to report a diplomate’s MOC status will change within the next 6 months from “meeting MOC requirements” to “participating in MOC.” Under the MOC changes released last year, physicians who did not complete the additional activities were to be listed as not meeting MOC requirements, which some physicians felt could be considered a restraint of trade.

The MOC exam also will be updated beginning in fall 2015 to more closely reflect what current practices do, and new and flexible ways for physicians to validate their self-assessment of medical knowledge will be available by the end of 2015.

Enrollment fees will stay at or less than current rates through 2017.

“The points mentioned in their communication are important, but the devil will be in the details,” Samuel M. Silver, MD, PhD, MACP, FASCO, professor of internal medicine at the University of Michigan and HemOnc Today’s Health Policy and Value of Care section editor, told HemOnc Today. “How will the exams change? Will they now be open book?  The Practice Assessment is being suspended for at least 2 years, but it was so poorly developed it is hard to understand if there is a meaningful substitute. I was confused by how to proceed with MOC [prior to these changes].  I am no less confused today.”

The ABIM states it will work with medical societies and diplomates through meetings, webinars, forums, online communication channels, surveys and other avenues to develop a more effective MOC program.

Although Baron said that updates will take time, he urged diplomates to visit the ABIM’s frequently asked questions page for more information about the changes and to learn how to get involved in the program’s reformation.

“The ABIM Board of Directors, staff and I are fully committed to doing a better job to ensure that ABIM and MOC evolve to better reflect the changing nature of medical practice,” Baron said in the release.

Support for change

ABIM — perhaps seeking renewed physician support after the changes — will be responsive to additional concerns, Baron said.

“We got it wrong and we sincerely apologize,” Baron wrote. “We are sorry.”

This apology may go a long way.

“I was surprised and pleased that Dr. Baron issued an apology,” Silver said. “The ABIM has been particularly tone-deaf — and that is putting it mildly — in its previous responses to the practicing community regarding MOC.”

The ABIM announcement follows the January launch of the National Board of Physicians and Surgeons alternative certification program, spearheaded by Paul Teirstein, MD, the chief of cardiology and director of interventional cardiology at Scripps Clinic.

J. Philip Kuebler, MD, an oncologist with Columbus Oncology and Hematology Associates and HemOnc Today’s Independent/Private Community Practice section editor, said the MOC changes may not be enough to encourage his participation in the program.

“Most of us out here think they are merely reacting to the alternative certification now perhaps available,” Kuebler told HemOnc Today. “My opinion has not changed.”

Following the ABIM announcement, David A. Williams, MD, president of ASH, issued a statement supporting the changes to the MOC program, though he noted additional work is needed.

“While action taken by ABIM … marks a critical first step toward addressing concerns voiced by ASH, several additional steps must be taken by ABIM and other boards requiring MOC, including moving away from a closed-book examination delivered in a secure location to an examination experience that reflects current access to medical information,” Williams wrote.

Julie M. Vose, MD, MBA, FASCO, chief of the oncology/hematology division in the department of internal medicine at the University of Nebraska Medical Center and president-elect of ASCO, agreed more work is needed, particularly to reflect the needs of internal medicine subspecialties, such as oncology and hematology.

“I am very pleased that the ABIM has chosen to suspend the MOC requirements for the next 2 years for the Practice Assessment, Patient Voice and Patient Safety requirements, and that they indicated that they will assure more flexible ways to demonstrate self-assessment of medical knowledge,” Vose told HemOnc Today. “However, now the work must begin for ABIM to work with the subspecialty societies on the specifics of a modified MOC.  Issues to be addressed include medical knowledge assessment of highly specific subspecialty practice, a less onerous and confusing process, and a flexible way to include the CME and other medical quality programs that all practicing physicians participate in at their own institution or hospital.  We look forward to working as a team with ABIM to produce an improved MOC process.”

Silver also agreed subspecialties should be an area of focus.

“How will MOC deal appropriately with the sub-, sub-specialist, the basic scientist–clinician [or] the physician administrator?” Silver said. “Each has a key role in patient care and in the education of trainees. We do not want to lose these important physicians because of more MOC mistakes.”

Physicians who have concerns have an opportunity to play a role in continued improvements.

“The practicing community obviously has ABIM’s attention,” Silver said. “This is now the time for continued pressure to exact more change in the process, from the practicing community, specialty societies and sitting members of the ABIM specialty boards.  Much needs to change!” – by Alexandra Todak and Casey Hower

For more information:

David H. Johnson, MD, MACP, FASCO, can be reached at UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, Texas 75390; email: david.johnson@UTSouthwestern.edu.

J. Philip Kuebler, MD, can be reached at Columbus Oncology and Hematology Associates, 810 Jasonway Ave., Suite A, Columbus, OH, 43219; email: pkueb@colombus.rr.com.

Samuel M. Silver, MD, PhD, MACP, FASCO, can be reached at University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, MI 48109; email: msilver@umich.edu.

Julie M. Vose, MD, MBA, FASCO, can be reached at 987680 Nebraska Medical Center, Omaha, NE 68198-7680; email: jmvose@unmc.edu.

Disclosure: Johnson, Kuebler, Silver and Vose report no relevant financial disclosures.