ABIM Maintenance of Certification: Past, Present and Future
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1 ABIM Maintenance of Certification: Past, Present and Future Amy K. Holbrook, MD Abbott Northwestern Chair, MN-ACP Early Career Physicians Committee
2 No disclosures
3
4 HISTORY OF ABIM
5 American Board of Internal Medicine ABIM created in 1936 Certifies Internal Medicine physicians and 20 subspecialties Independent, non-profit Largest medical specialty board $55,000,000/year organization Voluntary Overseen by American Board of Medical Specialties
6 American Board of Medical Specialties Oversees 24 subsidiary medical subspecialties Has lobbied for hospitals and payers to require board certification
7 History of ABIM 1936: one time exam essay questions, oral exam after examining an unknown patient 1946: multiple choice questions replaced essays 1972: oral examinations discontinued 1990: started giving 10 year certifications 1995: MOC modules added 2006: started requiring PIMs 2014: increased cost and number of requirements
8 CURRENT STATE OF ABIM
9 January Changes Increased to 100 points every 5 years Added patient survey and patient safety module Cost increased to $1940 every 10 years $2650 for subspecialists Required to earn points every 2 years Board reports if an MD is meeting MOC requirements Multiple scenarios added personalized MOC portal
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12 Current Requirements 100 points every 5 years 20 in medical knowledge Taking boards is worth 20 medical knowledge points 20 in practice improvement (PIM) Patient survey requirement every 5 years Patient safety module every 5 years Still need to take and pass the exam every 10 years Need to earn some points every 2 years
13 ABIM Board Exam The exam is worth 20 medical knowledge points Still needs to be done every 10 years Test timing isn t related to timing of MOC cycle Offered spring and fall *Resets your cycle if you take it early
14 Earning Points Variety of ways to earn MOC points ABIM online modules ACP online modules Learning sessions Practice Improvement Modules (PIMs)
15 Examples: Medical Knowledge Self Evaluation Modules Web based Open book, can be done alone or in a group Enroll on ABIM website ACP-MKSAP questions NEJM medical cases ACP-SEP sessions
16 Examples: Practice Assessment PIM Practice Improvement Module ABIM PIMs Condition specific Asthma, diabetes, colonoscopy, hypertension AQI Pathway Multiple sponsoring groups ACP, subspecialty groups, universities, CDC Self-directed or completed project PIM
17 Logistics Initial certification 1989 or earlier Listed as certified, not meeting MOC requirements Certified with an end date You stay certified until your end date Newly boarded, or those re-boarding (starting 2014), certification will not list an end date Points earned before 2014 don t count toward the new MOC Money paid before 2014 does count
18 Hospitalist vs IM Can be certified in: Internal Medicine IM with a Focused Practice in Hospital Medicine For Focused Practice in Hospital Medicine Need to be ACLS certified Need 3 years of unsupervised practice as a hospitalist Different exam Costs more ($2060 vs $1940)
19 Medical Licensure MOC vs CME Licensure is governed by state MN requires 75 hours of CME every 3 years MOC accepted in lieu of CME since 2011 Need a license to practice medicine ABIM requires a valid license to be board certified
20 CONTROVERSY
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22 Controversy Physicians are mad Significant increase in requirements in 2014 discriminatory money-making juggernaut without any reasonable proof of efficacy Association of American Physicians and Surgeons is suing ABMS
23 Advocates Board certified doctors have better outcomes Proves commitment to life-long learning Patients and consumers want proof Physicians don t recognize areas of shortcoming Need an independent 3 rd party organization to evolve with changes in medicine 10 year cycle is simply not credible today Multiple pathways to accomplish MOC requirements
24 Criticisms MOC Modules Time & Money Not clinically relevant No proof that MOC process improves patient care PIMs require patient information Significant data entry Privacy concerns Some AQI PIMs underwritten by pharmaceutical companies Some material outdated (cover last 3 years of updates)
25 Criticisms Exam Time & Money Test written by sub-specialists for generalists Responsibilities and decisions that do not exist in the real medical world Test failure rates climbing No direct feedback on actual questions missed
26 Anti-MOC Petition Started in March Over 18,000 signatures Calls for exam every 10 years, no other MOC Letter of response from ABIM CEO MOC is a continuously evolving program focused on improving the value and relevance of the credential we welcome constructive feedback
27
28 July Meeting ABIM met with 24 medical society representatives in person Commitments 1 year grace period after failing exam More financial transparency More feedback re: test scores Evolve the patient survey to a patient voice requirement Reduce PIM data collection requirements Streamline CME/MOC overlap
29 FUTURE OF ABIM
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31 ACP MOC is currently ACP s #1 priority work aggressively to achieve reform in MOC through active discussions with ABIM to be successful in effecting change it is critical for ACP to maintain a positive working relationship with ABIM
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33 Changes? Ongoing conversations between ACP, other specialty organizations and ABIM leadership ABIM in listening mode Exploring changes to the secure exam Unclear where the dust will settle
34 More information American Board of Internal Medicine ABIM ACP
35 References ABIM Website. Baron, Johnson. The American Board of Internal Medicine: Evolving Professional Self-Regulation. Annals of Int Med. 2014; 161: Beck. Doctors Upset Over Skill Reviews: New Learning Requirement to Maintain Certifications Called Costly, Irrelevant. Wall Street Journal. July 21, Centor, Fleming, Moyer. Maintenance of Certification: Beauty is in the Eyes of the Beholder. Annals of Int Med. 2014;161: Change Board Recertification Website. Christman. Maintenance of Certification: the Elite s Agenda for Medicine. Journal of American Physicians and Surgeons. 2013:18(3) Hertz. MOC: Debate intensifies as Medicare penalties loom. Medical Economics June 25, Lowes. ABIM Budges on Maintenance of Certification Program. Medscape. Aug 11, NEJM Knowledge+ Team. ABIM MOC Petition Reveals Escalating Debate Among Physicians. June 26, Weinberger, Centor, Fleming. ACP Update about ABIM s MOC Program. ACP Website.
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