Life Science Compliance Update

September 21, 2015

Maintenance of Certification: American Board of Anesthesiology Ends 10-Year Exam; ABIM Considers New Continuous Testing Model As Well


Recently, the American Board of Anesthesiology (ABA) announced it will become the first medical board to restructure its Maintenance of Certification (MOC) program. The Maintenance of Certification in Anesthesiology Program, or MOCA, has required physicians to take a recertification test every 10 years. It will be replaced by a program known as “MOCA 2.0,” which will allow anesthesiologists to continuously assess themselves and identify knowledge gaps through an online portal, including a "MOCA Minute" that allows physicians to answer multiple-choice questions at their own convenience.

This shift is noteworthy because over the past few years, the MOC recertification process has been under a great deal of scrutiny by specialists who have expressed dissatisfaction in the process. Hospitals often require their specialists to be board certified; however, the recurring exams are time consuming, costly, and--according to many physicians--often test on topics with little relevance to their own practice. For example, last year thousands of doctors signed a petition for the American Board of Internal Medicine (ABIM) to recall changes to their MOC activities that would further increase the testing frequency. Further, a series of Newsweek articles criticized the ABIM's certification process and financial decision-making. 

ABIM and the ABA are both part of the American Board of Medical Specialties' (ABMS) 24 specialty member boards. ABA is the first specialty to officially break the mold. “We understand that once-every-10-year exams kind of promoted people studying for a couple of months, cramming for the exam, passing it and then moving on,” said Dr. James Rathmell, secretary for the ABA and chair of the department of anesthesiology as quoted in Modern Healthcare. “We all felt that wasn't a very good way of keeping physicians up to date and it probably didn't translate into tremendously better patient care.” 

ABA's changes are summarized on their website, as follows:


Soon after ABA's announcement, the ABIM also announced that it will consider replacing its 10-year MOC exam with shorter, more frequent testing that physicians could take when and where they wanted to. Richard Baron, MD, ABIM's president and CEO, told Medscape Medical News that the ABA's new continuous online testing model could be a good model for replacing ABIM's s 10-year exam. "But the execution issues aren't trivial," Dr Baron said to Medscape. "We'll be monitoring what the ABA does with considerable interest."

The proposal to replace the 10-year MOC exam "quickly garnered praise from the American College of Cardiology (ACC), which represents a major subspecialty in internal medicine," Medscape writes.

The Cardiology Society wrote:

[T]he ACC strongly agrees with the report about the need to develop a new, externally-validated process for measuring competence to replace the 10-year exam – with all deliberate haste! Additionally, the ACC is committed to continuing work with ABIM to research best practices for the maintenance and demonstration of competence with eventual links to patient outcomes, cost and cost-effectiveness.

View the ABIM's Press Release on their MOC discussions here. View their comprehensive report entitled "A Vision for Certification in Internal Medicine in 2020," here

Newsweek's Kurt Eichenwald, who authored the widely publicized MOC critiques, also recently weighed in on ABIM's announcement entitled "To the Barricades! The Doctors' Revolt Against ABIM is Succeeding!"

August 14, 2015

ABIM and ACCME Announce Collaboration in Support of Physician Lifelong Learning

  Accme logoAccme logo

On August 12, the American Board of Internal Medicine (ABIM) and the Accreditation Council for Continuing Medical Education (ACCME) announced a collaboration to support physicians who are engaged in lifelong learning by enabling them to use those activities to satisfy requirements for ABIM’s Maintenance of Certification (MOC) program.

“This collaboration will expand the options available to physicians to receive MOC credit and will enable continuing medical education (CME) providers to offer more lifelong learning options with MOC credit to internists and subspecialists,” according to a new press release from ACCME and ABIM.  This also means a more streamlined process for accredited CME providers—ABIM will no longer require them to submit applications for activity approval and peer review to ABIM. Instead, accredited CME providers will be able to use one unified shared system to record information about CME and ABIM MOC activities. Importantly, this system will help lower the burden on CME providers who wish to register activities for MOC credit. 

View ABIM's medical knowledge assessment recognition program here

“All accredited CME providers in the ACCME system already use the ACCME Program and Activity Reporting System (PARS) to enter data about each of their CME activities,” ACCME states. “With this collaboration, CME providers will also be able to use PARS to register activities for ABIM MOC. As part of this registration process, providers can attest to compliance with ABIM-specific requirements for the Medical Knowledge Assessment Recognition Program and submit learner data.”

ABIM and ACCME will begin testing the technology later this month, and they expect to have the process open for accredited CME providers that meet standards set by ABIM by the end of 2015. The ACCME will maintain a list of activities that have met ABIM requirements and are registered for MOC credit. ACCME states that this list will be publicly available on their website, “providing a one-stop resource for ABIM diplomates seeking to earn ABIM MOC credits by participating in accredited CME.” Data verifying that diplomates have completed the activity will be communicated through PARS to ABIM.

This collaboration offers additional choices for CME providers and internists without adding any new ACCME requirements. “While ABIM already offers more than 300 medical knowledge options to physicians engaged in MOC, our diplomates have asked for a more streamlined process to enable them to more seamlessly combine their ongoing educational activities with MOC requirements,” said Richard J. Baron MD, President and CEO of ABIM. “By collaborating with ACCME, ABIM will open the door to even more options for physicians engaged in MOC and will allow them to get MOC credit for high-quality CME activities they are already doing.”

Under the new system, diplomates will have the option to pursue CME activities that have been registered for MOC credit, while ACCME providers have the option—but are not required—to offer accredited CME that meets ABIM MOC requirements and to submit activity and learner data through PARS to ABIM, states the announcement. 

Graham McMahon, MD, MMSc, President and CEO of the ACCME stated:

“The ACCME has long supported the goals of MOC and the alignment of accredited CME and MOC. We share a common mission to facilitate the continuing professional development of physicians. We celebrate this collaboration because it will make a real and meaningful difference to physicians and educators who are working every day to improve healthcare in their communities. This collaboration will generate many more opportunities for accredited CME providers to serve as a strategic resource by delivering relevant, effective, independent, practice-based education that counts for MOC. I look forward to working together with ABIM, our community of accredited CME providers, and our community of diplomates to leverage the power of education to drive quality in our medical profession and improve care for the patients we serve."

MOC Update

In another big change, ABIM is reversing its policy requiring physicians who have passed their initial Certification exam in 2014 or later to have enrolled in the MOC process in order to be listed as board certified. Effective immediately, physicians who are meeting all other programmatic requirements will not lose certification simply for failure to enroll in MOC.

The American College of Cardiology wrote that earlier this year, ACC leadership was made aware that ABIM had sent emails to early career cardiologists who had passed the Cardiovascular Disease Certification Exam in 2014. The email informed them of the need to enroll in MOC by March 31, 2015, in order to be publicly reported as certified in Cardiovascular Disease, and also that their certification would remain valid only as long as they were participating in MOC. “Concerned about the implications of this new process, ACC leadership engaged ABIM leaders immediately, encouraging them to level the playing field for all diplomats,” the College wrote. “The current policy reversal that affects all recent ABIM diplomats, not only cardiologists, is a direct result of ACC intervention.”

"By tying together board certification and enrollment in Maintenance of Certification, the American Board of Internal Medicine appeared to devalue the secure examination passed by recently certified physicians, by setting different standards for them compared to those certified in previous years. The ABIM should be commended for recognizing the negative impact of this policy on current and future employment opportunities, particularly for those in the early stages of their careers, and taking the steps necessary to reverse it," said ACC President Kim Allan Williams, Sr., MD, FACC.

April 17, 2015

MOC Controversy Continues, As Newsweek Unveils ABIM’s Troubled Financials


Newsweek writer Kurt Eichenwald last month wrote an op-ed entitled “The Ugly Civil War in American Medicine,” in which the author derided the American Board of Internal Medicine’s (ABIM) certification process for doctors. The author accused the ABIM of requiring unnecessary testing requirements “to fatten the board’s bloated coffers.” The ABIM quickly fired back that the Newsweek article contained "numerous and serious misstatements, selective omissions, inaccurate information and erroneous reporting.” They also accused Eichenwald of being biased because his wife was an internist, and condemned Newsweek for posting the article.

This did not sit well with Eichenwald, who recently wrote another article, this time with the help of an accountant, that contended ABIM has used physician certification fees, paid up front, to fund “the massive losses from the program itself.” The article states that “ABIM and the ABIM Foundation lost $39.8 million on program services in the five years ending in 2013—a nonprofit indeed. Yet during that same time, the organizations paid $125.7 million to its senior officers and staff.” 

ABIM also faced  scrutiny regarding their purchase of a $2.3 million luxury Philadelphia condo . 

Eichenwald concludes that the ABIM is a “financial corpse.” This realization explains ABIM’s attempt to increase re-certification rates last year (which ABIM has since taken back):

ABIM’s announcement in January 2014 that it was changing the MOC process into something so onerous and expensive that it set off a doctor rebellion… had nothing to do with improving medical education. It was all about trying to fix the fiscal mess at ABIM by compelling doctors to deliver more cash faster.

Rather than a 10-year program, the January 2014 plan declared that MOC would be ongoing, with doctors required to complete new requirements every two, five and 10 years. Doctors could pay their new fees annually, and ABIM would recognize the money as revenue when it was paid. Money from doctors who prepaid would be counted as revenue evenly, year after year. In other words, if a physician prepaid for 10 years, rather than booking revenue when ABIM provided the certification services, the group would count one tenth of the payment each year.

Had ABIM not been forced to back down on this idea, it was an approach that might have cleaned up the disaster caused by ABIM’s accounting practices—that is, if the group can accomplish that without first falling into bankruptcy. Not even the most secretive organization can keep piling up losses forever while carrying negative asset values on its books. Of course, no one will know what accounting changes ABIM is using to get out of its self-created crisis until next year, when it files its new audited financials, or whether it will continue to rely on deferred revenue.

"But there are bigger questions ABIM and [the American Board of Specialty Medicine] have to consider," according to Eichenwald. "Why should doctors be forced to keep ladling out cash and spending time away from their practices studying useless information simply because the ABIM is managerially incompetent? And when will ABIM finally start telling the truth to the doctors it supposedly represents?"

The initial Newsweek story put the spotlight on Dr Paul Teirstein, "a nationally prominent physician who is chief of cardiology at Scripps Clinic and who is now leading the doctor revolt." Teirstein has organized the National Board of Physicians and Surgeons, an alternative to the MOC. Dr. Teirstein states: “We don’t want to do meaningless work and we don’t want to pay fees that are unreasonable and we don’t want to line the pockets of administrators."

Teirstein recently was interviewed by Health Leaders Media in an article entitled "The Doc Behind the Mutiny Against the MOC."

His major problem has to do with the wasted time he believes physicians spend on MOC. "I see a barrage of questions I don't need to learn. But I have to take a course to answer them because the [required] answer is a way I would never treat my patients," he states. "A lot of the questions are based on outdated material. One example, from a fellow who took the test in June, asked about anti-platelet 2B3 inhibitors, which we hardly use anymore; they don't have the benefit doctors thought they did 10 years ago."

The article also addresses continuing medical education (CME):

Q: You've said current continuing medical education credit requirements are sufficient for board certification. I'd heard concerns that CME was getting too easy.

Teirstein: It's the opposite. CME is more difficult and is taken more seriously. You can't have industry-directing talks. You have to fill out evaluation forms or you don't get CME credit. You have to do a gap analysis to determine the need for what is taught, and you have to have all conflict of interests disclosed. The only thing that's a valid criticism—not substantial, though—is that we don't take attendance and we don't measure that you're actually paying attention during the CME conference. You could just tune out and do e-mail for an hour and get credit.

At some point you have to trust doctors are doing the things they say. We're not dealing with criminals here.






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