Update on MOC: Recalibrating the Process

This post was authored by Patrick T. O’Gara, MD, FACC, president of the ACC, and William J. Oetgen, MD, MBA, FACC, executive vice president of Science, Education and Quality of the ACC.

The ACC has continued to engage the American Board of Internal Medicine (ABIM) in advocating for modifications to the revised requirements for Maintenance of Certification (MOC).  Since our last ACC member communication, ABIM President Richard Baron, MD, has shared with the ACC and other professional societies the following preliminary process changes adopted by the ABIM Board during their June retreat:

  • Provide increased flexibility on deadlines; a one year grace period will be granted for those who have attempted but failed to pass the secure exam. The cost of the first exam retake will be reduced significantly.
  • Ensure transparency of information; ABIM will continue to update its governance and financial information on its website.
  • Ensure a broader range of continuing medical education (CME) options for medical knowledge/skills self-assessment (Part II); this will reduce redundancy and provide physicians with credit for relevant activities in which they are already engaged. ABIM will align its knowledge assessment standards with existing standards for certain types of CME products and providers. ABIM will also shorten the approval process for CME activities that include an assessment of the learner.
  • Provide more actionable feedback regarding individual test scores.
  • Evolve the “patient survey” requirement to a “patient voice” requirement and increase the number of ways this requirement can be met, particularly by using tools already in use (shared decision-making, active participation in patient/family advisory panels, training programs in patient communication, etc.). ABIM recognizes that their initial statements regarding this requirement were vague and will work to roll out new processes over the next two years.
  • Reduce the data collection burden for the practice assessment requirement; utilize practice improvement activities already in place and minimize the time and complexity of data input.
  • Investigate changes to the secure exam to increase relevance with specific attention to exploring applications for practice focus areas (“modular exams”) and open book exams.

The College was also invited by ABIM to attend an Internal Medicine Summit in Philadelphia on July 15 to share member feedback in an open forum with 25 other professional societies affected by the MOC process. We attended with Debra Ness, MS, a lay member of both the ACC and ABIM Boards. While there, we had an opportunity to interact with our interventional (SCAI), electrophysiology (HRS), heart failure (HFSA) and echo (ASE, separately boarded) colleagues, and to learn more about ABIM decision-making from Richard Shannon, MD, a cardiologist and executive vice president of Heath Affairs at the University of Virginia who is also an ABIM Board member. During the time allotted, Dr. O’Gara made the following recommendations for ABIM’s consideration:

  1. Creation of dual pathways for recertification, one involving a 10-year secure exam with annual completion of CME activities as currently required for licensing/credentialing; and the other consisting of completing MOC Part II activities for 10 years. This recommendation has been strongly endorsed by the ACC’s Board of Governors.
  2. Harmonization of CME with MOC credits;
  3. Recognition of ongoing, hospital-based quality improvement and patient surveys as qualifying for MOC accreditation;
  4. Elimination of the “double jeopardy” faced by interventional, electrophysiology and heart failure colleagues who currently have to pass both the general cardiology and sub-specialty boards;
  5. Reduction of fees;
  6. Improvement in the ease with which accurate and understandable information can be retrieved from the ABIM web site;
  7. Research into the value of MOC, as measured by physician competency and patient outcomes.

Dr. O’Gara further emphasized the urgency of the situation and the need for action. Many of these points were shared by the other participants and additional recommendations were made concerning enhanced communication, partnerships, ways to improve self-assessment products/modules, and formative feedback from the secure exam. There was further discussion about the desirability of changing the manner in which some diplomats are listed on the ABIM website as “not meeting MOC requirements.”

We were impressed by the ABIM’s openness and earnest attempt to learn the extent to which our members have been affected by the process – and how it might be recalibrated. There is no doubt that the message has been delivered and received. The ABIM Board will meet again in early August to discuss the themes and recommendations that arose from the Philadelphia Internal Medicine Summit and to deliberate next steps in this dynamic process, which continues to unfold. We think that there will be several opportunities for new collaborations with ABIM and other societies. As always, we will remain engaged at the highest levels.

Learn more about the MOC changes and ACC resources at CardioSource.org/MOC.

5 thoughts on “Update on MOC: Recalibrating the Process

  1. I appreciate the earnest efforts of both societies to challenge us as practitioners to implement guidelines and to pursue adequacy, if not excellence, in our daily deliberations and care.

  2. At some point mandatory demands and associated paperwork for physicians, including certification, reimbursements, EMR requirements, etc etc, as noble as their objectives, must be capped. Very few, if any, of these new time-consuming burdens have been proven to improve disease outcomes, which is the sole reason for our profession.

  3. I think that the open book testing part is fine. The “practice improvement ” part is bogus and should be eliminated. Ridiculous b

  4. ABIM should have joint committees with major professional organizations e.g. ACP, ACC etc. These joint committees should be the only decision maker for any future decisions/ changes about MOC activities. Less than that there will definitely be a resentment among physicians who are involved in patient care.

  5. In an era where there is contemplation of CME “on the fly”(point of service)- where the most relevancy exists to support evidenced based decision making- this formalized framework retrenches to an anachronistic model of information transfer. As Tip O’Neill stated “All politics are local”, so goes CPD- “All cognitive/performance improvement(and, health care) is local” driven by the patients we serve and the cohort with whom we practice.

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