Life Science Compliance Update

April 04, 2016

ABIM Considers Open Book Testing

We have previously written about the 2020 Task Force organized by the American Board of Internal Medicine (ABIM) on Maintenance of Certification (MOC) assessments. ABIM is using the task force in an attempt to continue perfecting their MOC program and setting a new process for internists and subspecialists.

Most recently, ABIM announced that they are looking at permitting access to online resources for a portion of the maintenance of certification assessments. In a blog post written by President and CEO of ABIM, Richard J. Baron, M.D., MACP, he announced that the idea to "make at least a portion of ABIM's assessment 'open-book" was repeatedly suggested from both medical society leadership, and in broad community dialogue. Many who suggested the idea believe that permitting such "open book assessments" may result in test scores that are "truer to a physician's every day experiences."

In response to those suggestions, ABIM has launched a study to examine the ways ABIM diplomats might have access to online resources during a portion of the MOC assessment. For the study, ABIM is seeking physicians who have either passed the Internal Medicine Certification exam or have taken the Internal Medicine MOC exam within the past five years to participate.

While ABIM has no definite answers as to when the open book option or any other alternatives to the current MOC assessment might be implemented, they have made significant progress, and look forward to being able to shed more light on the future in the coming months.

Possibly permitting open-book test taking is not the only thing ABIM is looking at doing to update their MOC testing. Other ideas include:

  • Developing new approaches to assessment; getting physician input about new approaches through society meetings, focus groups, design sessions, and online surveys
  • Surveying all ABIM Board Certified physicians about the MOC experience and alternate assessment ideas they have. ABIM has received thousands of responses and once they have an opportunity to compile the responses, will share the results
  • Inviting all diplomates within a specialty to participate in blueprint review, a key building block to future assessment discussions
  • Inviting more physicians to participate in the standard setting process

What's Next?

In April, the ABIM Board of Directors and Council will be meeting jointly to consider physician recommendations about what the best options are for updating the MOC assessment process. The two groups together will refine a timetable to pilot, test, and implement changes to the assessment process.

It is expected that alternative assessments will require analysis and piloting to ensure that the approach is impartial, fair, and respectful. ABIM recognizes the importance of physician and society input, and as such, will continue to update and engage them.

Dr. Baron emphasizes that he and the Board of Directors are grateful to the individuals and societies who have joined ABIM in trying to make the process better, and also to those who are urging the process to move faster. ABIM has committed to issuing quarterly progress reports so that everyone knows what the expect, and when to expect it, in the process.

If you have ideas about MOC, Dr. Baron encourages you to reach out to him at rbaronmd@abim.org.

March 03, 2016

New ABIM MOC Process: Asking for Physician Input

The American Board of Internal Medicine (ABIM) is setting a new process for internists and subspecialists on various aspects of Maintenance of Certification (MOC) assessments. These changes come in connection with the Assessment 2020 Task Force report, and will align with ABIM's continuous improvement efforts.

As the MOC program continues to evolve, the goal is to ensure that the clinical content is relevant to a broad cross-section of physicians. As such, ABIM board certified physicians can provide input on what topics are most important and most often seen in practice, and some physicians will even be able to participate in the process to set MOC exam minimum passing scores.

In 2015, physicians across the full range of internal medicine practice reviewed the Internal Medicine MOC exam blueprint and rated exam topic areas by relative frequency and importance in practice. The input from those physicians, taken together with data from national databases, helped create updates to the Fall 2015 blueprint aimed at enhancing the assessment's effectiveness at evaluating whether a certified general internist has maintained competence and currency in the knowledge and judgment required for practice.

Now, ABIM is expanding the blueprint review process to subspecialists, by allowing ABIM Board Certified physicians in several subspecialties to provide feedback on their MOC exam blueprints about relative frequency and importance in practice. Their input will be used to update the content of future MOC exams in the same way internal medicine input was used last year.

Richard J. Baron, MD, President and CEO of ABIM, said,

Internists and subspecialists will have a hand in shaping the content of MOC assessments so they better reflect what physicians need to know to provide the best care for their patients. Moving forward, ABIM will continue to invite physicians to review assessment content, and, through their timely and representative responses, we will be able to create an even more meaningful credential that is a source of price for those staying current in medical knowledge and practice.

As mentioned previously, ABIM invited a group of ABIM Board Certified internists from various geographic regions, practice settings, and age ranges, who spend at least half of their work time in direct patient care, to participate in ABIM's process for establishing the ABIM Fall 2015 Internal Medicine MOC examination minimum passing score. The internists worked with ABIM Internal Medicine Exam Committee members to set a new standard for the exam, which reflects the level of performance required to pass the exam. ABIM still does not set pass rates, instead, they rely on a evidence-based, peer-defined approach to set the exam's minimum passing score.

Nick Fitterman, MD, Chair of the ABIM Internal Medicine Exam Committee, is thrilled with the outcome,

It was incredibly valuable to hear perspectives from physicians who participated in the standard setting process for the Fall 2015 Internal Medicine MOC exam. This enhanced process is quite reliable and representative, and we heard from several participants that they appreciated the opportunity to learn more about the exam. More physicians will be invited to participate in standard setting as other subspecialty MOC assessments are updated.

ABIM also collaborated with physicians to create Score Reports that feature a more user-friendly design with detailed descriptions of exam performance, so physicians taking the exam better understand their score. These new Score Reports are sent electronically to physicians.

ABIM plans to continue collaborating with physicians to update its approach to knowledge assessments and is continuing to look for ways to adapt assessments to embrace advances in medical practice and technology. You can learn more about ABIM's ongoing conversations with the internal medicine community and opportunities to provide input by visiting the Transforming ABIM blog.

Additionally, if you are a physician who is interested in participating in the blueprint review, you can get more information here. The estimated time to rate each blueprint section varies, and ranges from approximately fifteen minutes to approximately one hour. You can choose to review just one section of the blueprint, multiple blueprint sections, or the entire blueprint. You are free to submit your review responses at any point, and can save your work and return to it later. The following subspecialties are currently open: Cardiovascular Disease; Endocrinology, Diabetes, & Metabolism; Medical Oncology; Nephrology; and Rheumatology. More subspecialties are slated to open in Spring 2016 and Fall 2016.

January 15, 2016

AMA House of Delegate Recommendations on Maintenance of Certification and Licensure

During November's American Medical Association (AMA) House of Delegates (HOD) meeting in November, many resolutions and recommendations were adopted, some of which we have previously touched upon.

In addition to the aforementioned HOD actions relating to price control measures on pharmaceutical products and banning direct to consumer advertising, the AMA House of Delegates also adopted some changes recommended by the Council on Medical Education Report. Council on Medical Education Report 2 reviewed and consolidated existing AMA policy on Maintenance of Certification (MOC), Osteopathic Continuous Certification (OCC) and Maintenance of Licensure (MOL) to ensure that the policies are current and coherent.

AMA Principles on Maintenance of Certification (MOC)

The AMA voted to amend Policy H-275.924, Maintenance of Certification. Some of the changes made were for clarification purposes, such as the change that now requires any changes to the MOC process for a given medical specialty board to occur no more frequently than the "intervals used by that specialty board" for MOC. Previously that requirement had used "intervals used by each board" for MOC, possibly creating some confusion as to whether the longest interval by any specialty board controlled, or the interval used by the specialty board in question.

A new statement was added into the policy, #10. The new statement reads,

"In relation to MOC Part II, our AMA continues to support and promote the AMA Physician's Recognition Award (PRA) Credit system as one of the three major credit systems that comprise the foundation for continuing medical education in the U.S., including the Performance Improvement CME (PICME) format; and continues to develop relationships and agreements that may lead standards accepted by all U.S. licensing boards, specialty boards, hospital credentialing bodies and all other entities requiring evidence of physician CME."

MOC's importance was also clarified, with the AMA now saying that MOC is

"but one component to promote patient safety and quality. Health care is a team effort, and changes to MOC should not create an unrealistic expectation that lapses in patient safety are primarily failures of individual physicians."

Another change made was the addition of the following statement, "Our AMA will include early career physicians when nominating individuals to the Boards of Directors for ABMS member boards."

Additionally, the AMA has also advocated policy so that physicians with lifetime board certification are no longer required to seek recertification and no qualifiers or restrictions should be placed on diplomats with lifetime board certification recognized by the ABMS related to their participation in MOC.

Members of the AMA House of Delegates are encourage to increase awareness of these, and other proposed changes to physician self-regulation, through their specialty organizations and other professional member groups.

AMA Principles on Maintenance of Licensure (MOL)

The AMA House of Delegates recommended a new chunk of requirements be added to these principles.

One new requirement reflects the aforementioned change in MOC above. The new requirement asks that the AMA:

"Continue to support and promote the AMA Physician's Recognition Award (PRA) Credit system as one of the three major CME credit systems that comprise the foundation for continuing medical education in the U.S., including the Performance Improvement CME (PICME) format, and continue to develop relationships and agreements that may lead to standards accepted by all U.S. licensing boards, specialty boards, hospital credentialing bodies, and other entities requiring evidence of physician CME as part of the process for MOL."

Additionally, the AMA is to advocate that if state medical boards move forward with a more intense or rigorous MOL program, each state medical board shall be required to accept evidence of successful ongoing participation in the ABMS MOC and AOA-Bureau of Osteopathic Specialists (AOA-BOS) Osteopathic Continuous Certification (OCC) to have fulfilled all three components of the MOL, if performed.

The AMA will also advocate for acceptance by state medical boards of programs created by specialty societies as evidence that the physician is participating in continuous lifelong learning. The AMA will also encourage state medical boards to allow physicians to choose which programs they participate in to fulfill their MOL criteria.

Lastly, the AMA agreed to oppose any MOL initiative that creates barriers to practice, is administratively unfeasible, is inflexible with regard to how physicians practice (clinically or not), does not protect physician privacy, or is used to promote policy initiatives about physician competence.

An Update on Maintenance of Licensure

The AMA is also set to amend Policy D-275.957. The AMA has agreed to continue to monitor the evolution of Maintenance of Licensure (MOL), continue its active engagement in discussions regarding MOL implementation, and report back to the House of Delegates on the issue. The AMA will also continue to review published literature and emerging data as part of the Council on Medical Education's efforts to review MOL issues and work with the Federation of State Medical Boards (FSMB) to study whether principles of MOL are important factors in a physician's decision to retire or if they have a direct impact on the U.S. physician workforce.

The AMA will also encourage the FSMB to continue working with individual state medical boards to accept physician participation in the American Board of Medical Specialties MOC and the AOA-BOS OCC as meeting the requirements for MOL and also to develop alternatives for physicians who are not certified or recertified, and advocate that MOC or OCC not be the only pathway to MOL for physicians.

The AMA will also continue to encourage rigorous evaluation of the impact on physicians of any future proposed changes to MOL processes, including cost, staffing, and time.

Maintaining Medical Specialty Board Certification Standard

Policy H-275.926 will be amended to signify AMA's opposition of discrimination against physicians based solely on lack of ABMS or equivalent AOA-BOS board certification. The AMA also opposed discrimination that may occur against physicians involved in the board certification process, including those who are in a clinical practice period for the specified minimum period of time that must be completed prior to taking the board certifying examination.

The AMA is also encouraging member boards of the ABMS to adopt measures aimed at mitigating the financial burden on residents related to specialty board fees and fee procedures, including ideas like shorter preregistration periods, lower fees, and easier payment terms.

Rescinded Policies

The AMA will rescind a list of policies, including: H-275.923, Maintenance of Certification/Maintenance of Licensure; H-275.944, Board Certification and Discrimination; H-405.974, Specialty Recertification Examinations; and D-275.971, American Board of Medical Specialties – Standardization of Maintenance of Certification Requirements. Most of these rescinded policies contained ideas mentioned above that were added to other policies and standards.

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