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Okla. first state to remove MOC requirement


Oklahoma has become the first state to enact a law  to remove maintenance of certification (MOC) as a requirement for physicians to obtain a license, get hired and paid, or get hospital- admitting privileges.

Medscape reported that Kentucky’s governor has signed a more limited measure that prohibits making MOC a condition of licensure.

Similar laws are proposed in other states as the  rebellion against hated MOC programs operating under the American Board of Medical Specialties (ABMS)  becomes more intense. Physicians have long complained about the cost in time and money of these programs.

Internists and internal medical subspecialists have been the fiercest critics, protesting that the MOC program of the American Board of Internal Medicine (ABIM) in particular wastes their time and money and does little to nothing to improve their patient-care abilities.


Some ABIM MOC rules put off


The American Board of Internal Medicine’s board unanimously voted to extend a February 2015 decision to suspend the Practice Assessment, Patient Voice and Patient Safety requirements for Maintenance of Certification an extra year, through the end of 2018, reports Becker’s Hospital Review.

“This means no internist will have their {ABIM} certification status changed for incomplete Practice Assessment, Patient Voice or Patient Safety activities through Dec. 31, 2018. To maintain certification status, internists are still required to take and pass an exam every 10 years, earn 100 MOC points every five years and complete an MOC activity every two years,” Becker’s reported.

Many physicians hate the ABIM’s MOC rules; they see them as  too intrusive and time-consuming.

ABIM might replace hated 10-year MOC exam


The American Board of Internal Medicine (ABIM)  says it might replace  its much reviled 10-year maintenance of   certification (MOC) exam with shorter, more frequent testing that physicians could take at home or in the office.

Medscape reported that “the proposal to eliminate the 10-year exam is one of several recommendations issued today by ABIM’s ‘Assessment 2020 Task Force,’ convened in 2013 to improve its controversial MOC program for internal medicine (IM) physicians and IM sub-specialists. ABIM released the task force report less than a week after the American Board of Anesthesiology (ABA) announced that it would replace its 10-year MOC exam with continuous online testing next year.”

“Many physicians dislike the 10-year MOC exam because of its high-stakes nature. Mess up, and one’s job or hospital privileges may be on the line, because many healthcare organizations use board certification to vet their physicians.”

“Performance on the replacement to the 10-year exam envisioned by the ABIM task force would have career consequences as well.

“The results of the smaller, more frequent lower-stakes assessments would provide insight into performance and accumulate in a high-stakes pass/fail decision,” the task force said in its report. “A failure at this point may necessitate taking a longer exam or another form of assessment in order to maintain certification.”


MOC about to be even more hated



The American Board of Internal Medicine (ABIM)’s changes to its  widely detested maintenance of certification (MOC) program in 2014 will increase time commitments by about 20 percent and expenses (including the cost of their time) more than 15 percent for physicians who need to complete it, says a study  led by Dhruv S. Kazi, M.D., MSc, of the University of California  at San Francisco.

As MedPage Today noted: “In recent years the cost of the MOC program has been a point of contention among physicians, many of whom have called for evidence that the program helps physicians provide better quality care, and for financial transparency from the ABIM.

The publication said that “In February 2015, the ABIM responded to physician complaints with five modifications to the 2014 update, promising more flexibility, locking in the 2014 fees till 2017, and suspending the patient voice, patient safety, and practice assessment portions of the program for 2 years. The current study did not take these changes into account, but they do not appear likely to affect the results markedly.”




Tug of war on physician assessment



By SHEFALI LUTHRA, for Kaiser Health News

When choosing a doctor, patients have long relied on the idea of board certification. It’s a stamp of approval meant to assure them their provider knows current medical practices.

But a rebellion among doctors over recertification requirements has put that stamp in flux, potentially complicating what patients can expect to know about their doctors.

The national credentialing organization has directed the 24 boards that oversee specific medical specialties, such as surgeons, anesthesiologists and internal medicine doctors, to toughen their requirements for renewal of board certification. But pushback from a number of doctors — especially internists — has sparked a debate in the medical community about the best way to evaluate what doctors know and how effective they are at treating patients.

Specialist and primary care doctors who want to stay board certified – a guideline hospitals and insurance plans often look to when evaluating a physician’s quality – already must pass a written exam every 10 years and take classes intended to keep them studying medicine. But the American Board of Medical Specialties is seeking to boost those efforts.

Following the ABMS guidance, the American Board of Internal Medicine last year moved to add a new component to its maintenance of certification program, requiring certified internists to provide information every five years about how they interact with patients and keep them safe. That was supposed to start this year. But the heavy criticism it elicited from a number of doctors led the ABIM to suspend the requirement.

Now, the board is starting over, soliciting more input, said Richard Baron, ABIM’s president.

All 24 specialty boards have been required to expand maintenance of certification. Internal medicine, which is the largest of the groups, is the only one so far to suspend its requirements. However, the Association of American Physicians and Surgeons, a trade group of private physicians that advocates limiting government influence on medical care and more independence for individual doctors, filed a lawsuit against ABMS challenging the recertification efforts in all specialties in 2013. The U.S. District Court in Chicago is weighing  the suit.

But while many internists have praised the ABIM decision to take a harder look at what’s required to maintain board certification, patient advocates have expressed concern that the move could potentially foreshadow a diminished focus on elements such as patient safety.

“ABIM is issuing a mea culpa to physicians, that they’ve held them to too many standards,” said Leah Binder, president of the Leapfrog Group, a nonprofit organization that emphasizes patient safety. “And I think that message has some hazards to it.”

More thorough standards for physicians are worth the effort, said Robert Wachter, a professor of medicine at the University of California at San Francisco who previously chaired ABIM and is now a trustee at the ABIM Foundation, the board’s nonprofit arm. The board, he said, correctly thought that “the public deserved and would want to know that physicians were doing more [to stay certified] than a process that they were doing for a few months every 10 years.”

The goal was to develop ways to assess patient care and patients’ perceptions of their doctors.

Physicians say, however, they were worried that, as proposed, ABIM’s requirements could be too cumbersome without effectively measuring quality. They would have been required to review old charts and paperwork every five years, collecting data to indicate what they had done in treating relevant diseases, as well as surveying patients about the level of care they received.

Doctors “viewed this as a significant burden – very time-consuming,” said Steven Weinberger, chief executive of the American College of Physicians, and at the same time, “they weren’t really clear that it actually improved the practices of medicine and the care that they gave to patients.”

And such criticism, Wachter said, convinced board members that “the methods we had to assess those things were too imperfect and too onerous to force physicians to do them right now.”

But some have said even the existing process is too expensive – completing the ABIM protocol for maintenance of certification, including the exam, costs about $2,000 every decade. Others have argued the exam doctors must take, for which the content is also being re-evaluated, isn’t always relevant, a qualm that could suggest it is not worth the energy and expense of completing.  For instance, a physician who works only with breast-cancer patients might still be required to demonstrate knowledge about prostate cancer, colon cancer or other forms of the disease.

“How relevant do you need to make the exam?” Weinberger asked. “Does the certificate say that I’m in fact competent in a broader area? It’s a very nuanced question.”

But despite these reservations, finding a way to somehow hold doctors accountable is essential when it comes to patient safety, Binder said.

“We are in an environment where there are so many significant problems in quality and safety in healthcare,” she said. “I hope they will turn around quickly and that the new standards they set will be more appropriate and at the same time tougher.”

The prevalence of organizations assessing doctors actually makes a strong board credential more important, Wachter argued.

“We wanted to create a process that we thought was appropriate and credible for the public” and that others could use as a gold standard for evaluating physicians, Wachter said.

And though continuing medical education (CME) programs  already exist, they aren’t a substitute for being certified, Weinberger said, especially given how relatively unstandardized the courses can be. “When you’ve seen one CME program, you’ve seen one CME program – they’re all very different in terms of what their goals are and how effective their goals are.”

Balancing physician and consumer needs can get tricky, Binder said, but effective and stringent standards are important given the significance doctors hold in patients’ lives.

“Physicians are an elite profession – one that is revered and admired by all of us,” she said. “And in return for that admiration and respect, I think, they should reassure us that they are holding themselves to very high standards.”

MOC: Finally, physicians strike back

Jordan Grumet, M.D., writes about how the “greedy group” of “once doctors” at the American Board of Internal Medicine (ABIM) went too far and “awoke the heart of the lion in the poor bleating body of the lamb” known as physicians.

The ABIM’s efforts “to boost revenues announced new maintenance of certification (MOC) requirements.  These largely unproven, waste of time and money efforts, did something that all the legislation and finger pointing on Capitol Hill had largely avoided”: An angry pushback by overworked doctors already  strangling in red tape.

”Maintenance of certification has become the spark that has finally ignited the beleaguered physician. Faced with a nonsensical healthcare system mired in administrative minutia, we have found a rallying cry that symbolizes all that trampling we have endured over the last few decades.  The hope rings out from city to city, that if we can just conquer MOC, then maybe Meaningful Use will be next. ”

ABIM backs off from parts of MOC program


The American Board of Internal Medicine (ABIM) suspended parts of its maintenance-of-certification program and apologized ”after many internists and internal medicine subspecialists complained that it was a waste of time and money,” Modern Healthcare reported.

Indeed, some physicians have complained that the program is a money-making scheme for the organization and its  very well-compensated leadership.

The ABIM, along with the other 23 members of the American Board of Medical Specialties, ”recently changed its recertification process from one that requires an exam every 10 years to a process requiring continuous education and self-assessment,” the publican noted.

Dr. Westby Fisher, an internist and cardiologist with the NorthShore University HealthSystem,  in Evanston, Ill., denounced the ABIM in a blog post:

“The American Board of Internal Medicine deployed some chaff in an attempt to ward off a flurry of incoming Exocet missiles aimed squarely at its yearslong history of corrupt and coercive financial dealings, gross mismanagement and entirely unproven Maintenance of Certification program by saying simply, ‘We got it wrong and sincerely apologize,’ ”

Physician says it’s past time to jettison MOC

Paul S. Teirstein, M.D.,  taking aim at the American Board of Internal Medicine (ABIM), argues in the New England Journal of Medicine that ”Maintenance of Certification”  (MOC) requirements are bad for both physicians and patients because, he asserts, they waste time and money on ABIM mandates that primarily benefit the ABIM as a business.

He writes: “Although the ABIM argues that there is evidence supporting the value of MOC, high-quality data supporting the efficacy of the program will be very hard, if not impossible, to obtain.”
And he complains that the ABIM has become a big business from fees used, for among other things, to compensate highly paid board members and its chief executive.
“We all support lifelong learning, but an excellent alternative to MOC already exists: continuing medical education (CME).”
“My main recommendation would be to allow 25 annual hours of CME to be substituted for the current MOC requirements that need to be met every 2 years.””Doing so would eliminate, or make optional, the {ABIM} busywork modules that have little practical value, including all medical knowledge, practice-improvement, and patient-safety modules.”


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