ABIM Proposes New MOC Options

The American Board of Internal Medicine (ABIM) recently announced plans to begin offering physicians new Maintenance of Certification (MOC) options. The proposed changes come after months of pushback by the medical community and still may not go far enough in addressing concerns.

ABIM in 2014 announced that that it was changing its MOC process from a 10-year program into one in which physicians had to complete new requirements every 2, 5, and 10 years. The announcement set off a backlash by individual physicians and medical specialty societies. In early 2015, ABIM issued a mea culpa, stating, “[We] clearly got it wrong. We launched programs that weren’t ready,” and announced suspension of the Practice Assessment, Patient Voice, and Patient Safety requirements of its MOC program for at least 2 years.

The concerns spilled over into a series of Newsweek articles that not only questioned the MOC changes but also ABIM’s governance structure and financial operations.

ABIM said the new MOC options will involve shorter assessments, or exams, that physicians may potentially take on their personal or office computer “more often than every 10 years but no more than once a year.” The 10-year exam will also be kept as a “second” option. ABIM said it will provide more details about the alternative assessment options by December 31, 2016. For now, ABIM said in a statement:

The options will provide feedback on important knowledge gap areas so physicians can better plan their learning to stay current in knowledge and practice.

Those who meet a performance standard on shorter assessments will not need to take the 10-year exam again to remain certified.

The proposed MOC assessment options—set to begin in January 2018 for internal medicine and perhaps 1 or 2 subspecialties—address some concerns but raise others.

For example, ABIM said it would continue to consider the possibility of offering open-book exams, but provided no additional clarity on this option, which was popular with almost half of the US nephrologists who are ASN members that the society surveyed in January 2016.

The new options also do not address the concerns of those individuals up for recertification before 2018.

“I am up for recertification in 2017 and among the diplomates caught between an outgoing program and a proposed new program for recertification,” said ASN Councilor Anupam Agarwal, MD, FASN. “Should I be handcuffed to ABIM’s existing program because my exam is before 2018? ABIM’s proposal to consider recertification is perhaps a step in the right direction, but it does not provide reasonable options for those in my situation and I am sure there are several others who are in the same situation as I am.”

In addition to surveying US nephrologist members of ASN for input regarding MOC, the society published “ASN’s Options for Helping Nephrologists Maintain Career Excellence” in the December 2015 Kidney News and co-wrote with 11 other medical specialty organizations a letter to ABIM posing several questions and concerns about how ABIM plans to reengineer MOC to reflect the changing nature of medical practice.

In the December 2015 article, ASN Councilor Mark E. Rosenberg, MD, FASN, and Executive Vice President Tod Ibrahim stated that “changes in the practice environment and the proliferation of institutional quality improvement programs have raised questions about the need for a recertification process.” Noting that the proposed Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 creates a Merit-Based Incentive Payment System (MIPS) that increases the relationship between payment and assessment, the authors stated, “ASN strongly supports the concept that physicians should receive credit for meeting existing requirements, such as the forthcoming MIPS for MOC or vice versa.”

Also, on April 4, 2016, ASN and 11 other organizations (Table 1) sent a letter to ABIM asking it to clarify its vision regarding MOC, additional MOC changes under consideration, as well as the respective roles of the ABIM Board of Directors, Council, specialty boards, and staff in the MOC revision process. In the letter, the organizations noted that spotty communications and lack of shared vision make it difficult and costly to adapt to ABIM’s changes.

/kidneynews/8_6/14a/graphic/14at1.png

In response to concerns relayed in the letter that ABIM’s communications lacked transparency and consistency, ABIM stated that it would provide quarterly updates on progress in implementing the MOC changes. ABIM also promised to provide a “public comment period” before finalizing the details of the “new assessment option.”