Life Science Compliance Update

February 15, 2017

ABIM Increases Physician Choice with New Assessment Option

ABIM

The American Board of Internal Medicine (ABIM) is providing more choice to physicians who are working to maintain their board certification. ABIM has decided to take this step after physicians asked for more flexible options that affirm to themselves, their patients, and their peers that they are staying current in medical knowledge.

As ABIM has been re-thinking the process for continuous certification, the organization invited all 200,000 ABIM Board Certified physicians and twenty-seven medical societies to share input. This first phase of dialogue guided the ABIM Council, a body of practicing physicians from several internal medicine subspecialties, to update the assessment process.

The option that emerged as the one that provided the most choice, relevance and convenience was short assessments every two years emerged. This will help physicians to maintain their certification and confidence that they are staying current in their education.

Physicians will able to choose to take assessments every two years or every 10 years. 

Details about the two-year assessment

  • You can choose to take the two-year assessment on your personal or work computer – or at a testing center.
  • You do not need a passing score on every two-year assessment. However, if you are unsuccessful twice in a row or if there is a longer gap between assessments, you will need to take additional steps to maintain certification.
  • You will have more dates from which to choose when scheduling the two-year assessment.
  • This “knowledge check-in” offers more continuous learning, feedback and improvement. Results will be available immediately after the assessment. More feedback will follow.

General Details

  • Beginning in 2018, physicians certified in Internal Medicine can choose to take shorter “knowledge check-ins”—at the location they choose—every two years.
  • To assist physicians with adjusting to changes—and for ABIM to learn from the process— there will be no consequences for unsuccessful performance on the two-year assessment in 2018.
  • ABIM will share updates on availability of these options for subspecialties in the coming months.
  • Physicians can still choose to take an assessment every 10 years in a testing center. ABIM is continuing to collaborate with physicians to make this option more reflective of practice.
  • ABIM is also working to make the 10-year assessment open book.

Dr. Richard J. Baron, President and CEO of ABIM, created a video message about these changes, which can be found here.

Industry Reaction

 “ABIM is changing because physicians are changing it. We are very proud to be collaborating with the many doctors who are constructively helping us update the assessment process,” said Richard J. Baron, MD, ABIM’s President and CEO and a board certified internist who practiced for 30 years in his Philadelphia community.

“Doctors want a certification program that integrates into their daily routine, while affirming to their patients and peers that they have up-to-date medical knowledge. That is exactly why ABIM is introducing assessment options.”

“By involving physicians in every step of the process, ABIM has been able to simplify its programs to focus on meaningful activities that increase knowledge, provide doctors confidence in their practice, and allow doctors more time to devote to patient care,” said Jeanne M. Marrazzo, MD, Chair of ABIM Council. “This work is constantly evolving as we move forward, and we’re proud that the steps we’re taking are informed by physicians who are dedicated to improving patient care.”

“The number of activities is just unprecedented in terms of ways we've been partnering with the physician community. Again, not abandoning the core principle of saying board certification means something,” said Clarence H. Braddock, III, MD, Chair of the ABIM Board of Directors. “It’s a badge of honor to have mastered a body of clinical knowledge and skills that you want to be able to proudly display, but at the same time, we want to make sure that it’s realistic and relevant through the eyes of the practicing physician.”

December 09, 2016

AMA Calls for End to Manditory Secured Exam for MOC

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In June 2016, at the AMA House of Delegates meeting in Chicago, one of the topics discussed was Maintenance of Certification. However, what was not mentioned in the AMA press (or really, any other press) was the fact that the AMA officially opposes mandatory ABMS recertification exams.

Interestingly, the position took place with little fanfare: it wasn’t listed in the Top 10 Stories from the AMA 2016 Meeting, nor was it listed in the coverage of the MOC resolutions that passed. It was only mentioned in tweets by attendees. AMA only focused on publicizing the following MOC resolutions:

  • Examining the activities that medical specialty organizations have underway to review alternative pathways for board recertification
  • Determining whether there is a need to establish criteria and construct a tool to evaluate whether alternative methods for board recertification are equivalent to established pathways
  • Asking the American Board of Medical Specialties to encourage its member boards to review their MOC policies regarding the requirements for maintaining underlying primary or initial specialty board certification in addition to subspecialty board certification to allow physicians the option to focus on MOC activities most relevant to their practice.

While the AMA House of Delegates Reference Committee C did try to amend the resolution that called for an “immediate end of any mandatory, recertifying examination by the American Board of Medical Specialties (ABMS) or other certifying organizations as part of the recertification process,” the HOD rejected modifications made by the committee, extracted it to a full vote on the house floor, and restored the language of the resolution. The resolution language, as passed, reads:

RESOLVED, That our American Medical Association call for the immediate end of any mandatory, secured recertifying examination by the American Board of Medical Specialties (ABMS) or other certifying organizations as part of the recertification process for all those specialties that still require a secure, high-stakes recertification examination.

There were several delegates that opposed the house action, saying that it shouldn’t try to do away with secure exams. Donna Sweet, MD, stated, “Secure simply means that it guarantees that you or the person are the person who is taking the test.”

ABMS, of course, opposes the AMA resolution. In a statement released by the Association, they stated:

Consumers, patients, hospitals and other users of the Board Certification credential expect board certified physicians to be up-to-date with the knowledge, judgment and skills of their specialty—both at the point of initial certification and along the physician’s career path – and to verify it through an external assessment. The privilege to self-regulate which physicians enjoy demands that we meet that expectation with more than just continuing medical education.

Continuing medical education is an important component of a physician’s continuous learning and an important part of Maintenance of Certification (MOC), but by itself is not sufficient to verify that a physician is up to date. The other components of MOC—professionalism, external assessment of knowledge, judgment and skills, and improvement in medical practice—are also important.

The AMA also approved a resolution to continue working with ABMS to “encourage the development by and sharing between specialty boards” of alternate ways to assess medical knowledge, other than by a secure exam. The AMA HOD also bolstered its support of using appropriate continuing medical education (CME) courses to maintain quality assessments of physicians.

June 24, 2016

Interstate Medical Licensure Compact – Expands to 17 States

Seventeen states have enacted legislation in an attempt to expand access to health care through expedited medical licensure. The Interstate Medical Licensure Compact offers an expedited licensing process for physicians that are interested in practicing medicine in multiple states. The Compact was created with the goal of expanding access to health care, especially to those in rural and underserved areas of the country, and to facilitate the use of telemedicine technologies in the delivery of health care.

According to the Interstate Medical Licensure Compact website, among the issues driving the need for the Compact include:

[P]hysician shortages, the expected influx of millions of new patients into the health care system as a result of the Affordable Care Act, and the growing need to increase access to health care for individuals in underserved or rural areas through the use of telemedicine. Proponents of telemedicine have often cited the time-consuming state-by-state licensure process for multiple-license holders as a key barrier to overcome in order for telemedicine to continue to grow and thrive. The Compact would make it easier and faster for physicians to obtain a license to practice in multiple states, thus helping extend the impact and availability of their care at a time when demand is expected to grow significantly.

A total of seventeen states have adopted the Compact legislation, with Colorado, New Hampshire, Arizona, Kansas, and Mississippi being the most recent. Other states who have passed the compact include Alabama, Idaho, Illinois, Iowa, Minnesota, Montana, Nevada, South Dakota, Utah, West Virginia, Wisconsin and Wyoming.

Compact legislation is currently either being discussed by the legislature or awaiting the signature of the governor in an additional ten states. States that participate in the Compact agree to share information with each other and work together in new ways to streamline the licensing process.

The Compact has been endorsed by a broad coalition of health care stakeholders, including the American Medical Association (AMA) and the American Osteopathic Association (AOA). The Interstate Medical Licensure Compact Commission is made up of two appointed Commissioners from each state that joints the Compact. The Commission is charged with administering the Compact, creating bylaws and rules for its operation, and otherwise implementing the expedited licensure of physicians as the Compact directs.

In order to be considered eligible to seek licensure through the Compact process, physicians must meet certain requirements, including: possess a full and unrestricted license to practice medicine in a Compact state; possess specialty certification or be in possession of a time unlimited specialty certificate; have no discipline on any state medical license; have no discipline related to controlled substance; not be under investigation by any licensing or law enforcement agency; have passed the USMLE or COMLEX within three attempts; and have successfully completed a graduate medical education (GME) program.

Each license to practice medicine obtained through the Compact will be issued by a state medical board. A license obtained through the expedited procedure will provide the same licensing currently provided for physicians by state medical boards: the only difference is that the process of obtaining a license will be streamlined.

A physician will apply for expedited licensure by designating a member state as the state of principal licensure and select the other member states in which a medical license is desired. The state of principal licensure will then verify the physician's eligibility and provide credential information to the Interstate Commission. The Commission will then collect the applicable fees and transmit the physician's information and licensure fees to the additional states. Upon receipt in the additional states, the physician will be granted a license.

Notably, the Commission may assess processing fees for expedited licensure, helping to off-set any burden on the member states. The Commission is also enabled to seek grants and secure outside funding, through private grants, or federal appropriations in support of license portability.

Effect on MOC

According to the Federation of State Medical Boards (FSMB), the Compact does not require a physician to participate in Maintenance of Certification (MOC). However, with the exception of the declining number of physicians who hold a lifetime certificate, MOC is required to maintain specialty board certification, and thus required to be licensed through the Compact.

While the Compact does not make any specific reference to Maintenance of Certification, its own definition of physician requires MOC for most of the physicians that will participate in the Compact.

According to Jeremy Snavely of the Association of American Physicians and Surgeons, the Compact puts physicians who do not participate in ABMS and AOABOS products at a competitive disadvantage and a state legislature should not be passing laws that are handouts to such private, unaccountable organizations.

The Commission has started to formally meet and is working on implementing the administrative processes that are needed to begin the expedited licensure process, but licenses via the Compact process have not started to be issued yet.

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