ACC Impacts on MOC Process: Success But Still a Partial Victory

This post was authored by Kim Allan Williams Sr., MD, FACC, president of the ACC; Richard A. Chazal, MD, FACC, president-elect of the ACC; Mary Norine Walsh, MD, FACC, vice president of the ACC; and Patrick T. O’Gara, MD, MACC, immediate-past president of the ACC.

Over the past year, the American Board of Internal Medicine (ABIM) has made substantial changes to its Maintenance of Certification (MOC) process in response to concerns raised by physicians and specialty organizations like the ACC. Among the changes: reversal of the double jeopardy provision (need to maintain certification in cardiovascular medicine in order to maintain certification in a cardiovascular subspecialty); decoupling of the initial board exam from MOC participation; streamlined ability for practitioners to get both CME and MOC Part II credit; a delay in MOC Part IV; and more. (Check out ACC’s online MOC hub, as well as the ACC in Touch Blog, for complete information on all of the changes, as well as information on frequently asked questions on recertification).

However, it is clear that further progress is needed, particularly regarding the MOC 10-year recertification examination. Drs. Chazal, Walsh and William Oetgen representing the ACC, along with other specialty societies, recently met with ABIM to express ongoing concerns. We clearly communicated the following needs to ABIM in order to make the MOC process useful and effective for cardiologists, as well as for our patients:

  • Replace the 10-year exam with focused assessments or re-evaluations of cognitive skills. ACC’s MOC Task Forces and Board of Trustees strongly favor melding this re-evaluation into verifiable education (i.e. the “SAP” model) and have indicated to ABIM that a proposed option to replace the 10-year recertification exam with standard exams every two years is not a palatable option for us. It is ACC leadership’s belief that all “formal” recertification examinations be eliminated.
  • Move the paradigm from quality assurance to quality improvement, working to help physicians improve.
  • Allow the ACC, other professional societies and qualified entities to put forth standards-based processes that would be certified by the ABIM. Under this model, physicians who successfully complete the ACC process, for example, would then be recertified by ABIM.
  • Enable diplomates to seamlessly receive credit for activities in which they lead and participate in on behalf of hospitals, health care systems, payers and state medical boards.
  • Oppose any proposals or policies requiring specific participation in ABIM practice improvement activities to meet MOC. The College feels strongly that the ABIM, the ACC and other internal medicine societies should be able to facilitate practice improvement activities and these activities should count towards fulfilling MOC point requirements, but specific practice-improvement activities should not be required in the context of MOC.
  • Undertake research, working with the internal medicine community, to test the outcome of MOC activities on the actual improvement in patient care and outcomes. As physician scientists, we seek evidence for the value of MOC.

Heading into 2016 the College will continue to press ahead with efforts to turn these recommendations into reality. ACC leadership will continue to explore all options regarding the MOC process but hope that ABIM will tailor their final plan to be consistent with the College’s opinions and the ultimate goal of finding a solution or solutions that best allow clinicians to maintain and demonstrate competence as it relates to patient outcomes, quality care and cost-effectiveness. This remains an utmost priority for the College and we intend to prevail.

Read more on ACC’s asks of ABIM in a recent letter to ABIM leaders.


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