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ABIM MOC linked to better physician performance; still ‘unimpressive’ to expert

Internists who maintained their ABIM certification were slightly more likely to have better scores on a set of performance measures for mammography screening, diabetes and heart disease care, according to research published in Annals of Internal Medicine.

“The value of the ABIM’s Maintenance of Certification program has been questioned by physicians who argue that additional requirements beyond initial certification add unnecessary burden to already overwhelmed physicians without benefiting patients,” Bradley Gray, PhD, from ABIM, and colleagues wrote.

Supporting data

Gray and colleagues evaluated the association between physician MOC status and performance of selected Healthcare Effectiveness Data and Information Set (HEDIS) process measures.

A total of 1,260 internists who were initially certified in 1991 were enrolled in the study. Of the included physicians, 786 maintained their certification between 1991 to 2012 and 474 did not. From 2009 to 2012, the physicians provided care for 85,931 Medicare patients.

Using Medicare claims data, the researchers calculated physician performance scores based on the annual percentage of patients meeting HEDIS performance standards for diabetes care, mammography screening and heart disease care.

Data showed that internists who maintained certification were more likely to have a higher mean annual percentage of HEDIS-eligible patients with diabetes who completed semiannual HbA1c testing than those who did not (58.4% vs. 54.4%; regression-adjusted difference = 4.2 percentage points; 95% CI, 2-6.5).

Physicians who maintained certification also had a higher percentage of patients with diabetes who met the annual standard for LDL cholesterol measurement (83.1% vs. 80.5%; regression-adjusted difference = 2.3 percentage points; 95% CI, 0.6-4.1), as well as all three diabetic standards (46% vs. 41.6%; regression-adjusted difference = 3.1 percentage points; 95% CI, 0.5-5.7).

Additionally, internists who maintained certification had more patients with coronary heart disease (79.4% vs. 77.4%; regression-adjusted differences = 1.7 percentage points; 95% CI, 0.2-3.3) and biennial mammography (72% vs. 67.8%; regression-adjusted differences = 4.6 percentage points; 95% CI, 2.9-6.3) meet measures for LDL cholesterol testing.

For biennial eye examinations, the regression-adjusted difference between physicians who maintained certification and those who did not was statistically insignificant.

“Maintaining certification was positively associated with physician performance scores on a set of HEDIS process measures,” Gray and colleagues concluded.

‘Disturbing’ findings

In an accompanying editorial, Lee Goldman, MD, MPH, from Vagelos College of Physicians and Surgeons at Columbia University, wrote that the findings by Gray and colleagues show that rates of meeting HEDIS standards were low overall and only minimally higher among internists who maintained certification.

Goldman called these findings “disturbing,” but commends the ABIM for acknowledging some of the problems with how MOC is implemented, including its burdensome nature.

“The medical profession would be better off if certifying bodies, with their enormous prestige and moral stature, focused on how the recertification process can add the most true value to the public and their physician constituencies, rather than on trying to prove that physicians who ran the gauntlet of their initial unpopular and often burdensome dictums were statistically associated with unimpressive differences in medical practice,” Goldman wrote. “The recertification glass is not entirely empty, but we all wish it were more full.” – by Alaina Tedesco

Disclosure: Goldman reports receiving personal fees from Goldman-Cecil Medicine. Gray is employed by ABIM. Please see study for complete list of all other authors’ relevant financial disclosures.