- Email: [email protected]
ABIM Maintenance of Certification 2014: Navigating the Challenges to Find Opportunities for Success
MENTORING, EDUCATION, AND TRAINING CORNER John Del Valle, Section Editor
ABIM Maintenance of Certification 2014: Navigating the Challenges to Find Opportunities for Success John F. Kuemmerle Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, Medical College of Virginia Campus, Virginia Commonwealth University, Richmond, Virginia
P
hysicians today are under increased pressures and scrutiny from society, insurers, and governmental agencies to deliver demonstrably highquality, safe patient care and document evidence of their continuing competency as a provider. Certification by the American Board of Internal Medicine (ABIM) is 1 measure of a physician’s competence. In January 2014, the ABIM implemented significant changes to its Maintenance of Certification (MOC) program. The changes were the response of the ABIM and its parent board, the American Board of Medical Specialties (ABMS), to signal their endorsement of the need for more frequent participation in MOC activities by their certified physicians. Before 2014, physicians holding ABIM time-limited certificates needed to recertify every 10 years. ABIM and ABMS, along with other external healthcare organizations and the general public, believe that a more continuous MOC program helps physicians to keep pace with changes in the practice of medicine and assessment of performance. These changes are designed to set standards of clinical competency for internal medicine, internal medicine subspecialties, and subspecialtyspecific added qualifications, and ultimately improve the quality of patient care. As medical knowledge and the practice of medicine change, a more continuous MOC program tells the community that physicians are staying current, have met a standard set by their peers, and are actively assessing and seeking to improve their practice and patient outcomes. This commentary outlines the opportunities available to easily and successfully navigate the murky waters of the current MOC requirements while obtaining added value to your practice, and to successfully pass the secure recertifying board examination on the first attempt.
large group or multispecialty practice or in an academic practice. On the plus side, engaging in practice performance evaluation can also be a financial driver for participation in MOC. As the Patient Safety and Affordable Care Act of 2010 goes into full effect this year, our practices face not only a revaluation of reimbursements, but also movement away from fee-for-service business models to a quality-driven, value-based system. As physicians and practices partner with Accountable Care Organizations or enter into capitated contracts, having the quality data available necessary to obtain these partnerships can be provided, in part, via MOC. Because physicians, practices, and Accountable Care Organizations jointly share risk in these bundled contracts, having established practice efficiencies and ongoing practice performance evaluations are a necessary complement to the process that helps to ensure success. On the negative side, there may be financial consequences for not engaging in MOC or failing a secure recertifying board examination that might inhibit attraction or maintaining of existing commercial contracts. These opposite forces can truly make this a high-stakes process. The Federation of State Boards of Medicine also has a long-term initiative to introduce a Maintenance of Licensure (MOL) system in the United States. MOL is a proposed system of continuous professional development that would require physicians to verify their ongoing involvement in lifelong learning as a condition of license renewal. The MOL framework addresses these concerns by envisioning 3 components (reflective self-assessment, assessment of knowledge and skills, and performance in practice) that would be periodically required of actively licensed physicians in their area of practice as a requirement of license renewal. In this process, the Federation of State Boards of Medicine is working closely with the ABMS, which administers MOC for physician specialty organizations. MOC will not be required as a part of a future MOL system. However, the Federation of State Boards of Medicine is recommending that physicians engaged in MOC be recognized as being in “substantial compliance” with the 3 key MOL components. In fact, physicians in the states of Idaho, Minnesota, North Carolina, Oregon, and West Virginia can be exempt from
Why Maintain Your Certification? Many physicians may have board certification as a component of their professional requirements whether in a Gastroenterology 2014;147:260–263
© 2014 by the AGA Institute 0016-5085/$36.00 http://dx.doi.org/10.1053/j.gastro.2014.06.025
MENTORING, EDUCATION, AND TRAINING CORNER Continuing Medical Education requirements for state licensing by virtue of being enrolled in MOC. Professional requirements aside, in return for the privilege of self-regulation, patients want their doctors to undergo rigorous periodic evaluation.1 An ABMS consumer survey found that 95% of Americans felt it was important for their physicians to participate in a program to maintain their board certification.2 There is a considerable body of evidence that demonstrates the value of MOC to physicians; independent assessment is a key component to the process. Even the most talented clinicians are not necessarily good at evaluating their own weaknesses. Physicians perceive that value derives from participation in the lifelong learning process. Eighty-six percent of physicians felt it enhanced their competence and improved their delivery of patient care.3 Moreover, 75%–91% of physicians completing a Practice Improvement Module (PIM) found the process actually improved their practice.3,4 The ABIM continually uses these research findings to inform and guide their program requirements. “MOC is a constantly evolving program in which we focus on improving the value and relevance of the credential, and we welcome constructive diplomate feedback on how to enhance our assessments.. Our obligation to those diplomates is to provide a program that they find relevant and meaningful, that meets them where they practice, and give them credit for the relevant work they are doing” (Dr Richard Baron, MD, MACP, President and CEO of the ABIM in a statement on April 28, 2014).
What Are the New Maintenance of Certification Requirements? Fortunately, much of the overall process that makes up MOC requirements is similar to those familiar to physicians from past requirements. The ABIM offers a website to provide information on the new requirements (http:// moc2014.abim.org). To provide additional, more granular information for each diplomate, the ABIM provides a unique personalized Physician Portal that shows exactly what they are required to complete and what resources are available that can help them to meet their personal MOC requirements. All ABIM Board-Certified physicians, including those holding indefinite certifications, need to engage in MOC activities at least every other year to be reported as “Meeting MOC Requirements.” Physicians will remain certified for the time period remaining on their current certifications (provided they hold a valid license). All ABIM Board-Certified physicians holding 1 valid certification were considered “Meeting MOC Requirements” at program launch in 2014, regardless of enrollment status. As of April 30, 2014, all diplomats needed to enroll in MOC to be considered “meeting requirements.”
New Maintenance of Certification Requirements Beginning January 2014 Complete an ABIM MOC program activity to earn MOC points every 2 years, and earn 100 MOC points every 5 years: Points earned every 2 years will count toward the 5year, 100-point requirement. Physicians may complete any certified MOC activity to meet the 2-year requirement. Physicians will also have to complete a patient survey and a patient safety module by December 31, 2018, and every 5 years thereafter. Physicians, including grandfathered physicians, need to pass a secure examination once every 10 years as part of MOC and, beginning in 2014, will earn MOC points for their first MOC examination attempt. Physicians in subspecialty fellowship training who are Board Certified in IM will earn 20 MOC points for each year of training they successfully complete. This allows them to get started on meeting their MOC requirements for maintaining their Internal Medicine Certification without being required to complete other activities. Physicians enrolled in MOC can accrue the required 100 points in 2 categories of activities: Self-Evaluation of Medical Knowledge (Part 2) and Self-Evaluation of Practice Performance (Part 4). To meet the required 100 points, you must obtain a minimum of 20 points in each of the 2 activity categories. The remaining 60 MOC points can be obtained from the required patient survey and patient safety activities, the secure Recertification examination, or additional Medical Knowledge or Practice Performance activities. At present, most physicians opt to obtain 80 MOC points in SelfAssessment of Knowledge and 20 Practice Improvement MOC points. With the new requirement for Patient survey and Patient Safety activities, these additional practice performance requirements will change the approach physicians need to take in meeting the required mixture of activities within the required 100 points. This is an important consideration owing to the time constraints in completing practice performance activities. Self-assessment of medical knowledge modules can be completed rapidly to attain the required points in this category. Practice performance evaluations can take 6 months to complete. Physicians should be wary to not wait until the last minute to complete these requirements. It is important to remember that physicians can claim AMA PRA Category 1 Credits, which are available for completion of many of the required MOC activities. The ABIM offers physicians 2 MOC fee payment options for added convenience. A yearly payment option of $256 and a 10-year full upfront payment option of $2,560 are both available. However, be aware that the yearly fees may increase. The cost of maintaining more than your Internal Medicine certification in addition to GI will be greater, although the same MOC activities and points apply to both certificates.
261
MENTORING, EDUCATION, AND TRAINING CORNER But Wait! I Am a Grandfathered Physician ABIM diplomates certified before 1989 hold timeunlimited certificates. These “grandfathered” physicians are not required to enroll in the new 2014 MOC program. However, although grandfathered physicians will remain certified, to be considered as “Meeting MOC Requirements,” they must be enrolled in MOC. By December 31, 2015, they will need to complete an MOC activity and earn ABIM MOC points to continue being reported as “Meeting MOC Requirements.” Like physicians holding time-limited certificates, by December 31, 2018, they will also need to earn a total of 100 MOC points with Self-Evaluation of Medical Knowledge and Self-Evaluation of Practice Assessment modules, as well as complete the required patient safety and patient survey requirements. Ultimately, by December 31, 2023, they would need to pass the same secure recertification examination. A grandfathered physician who does not enroll in MOC, although remaining “Certified,” will be listed on their ABIM public information page as “not meeting MOC requirements.”
How Can I Easily and Successfully Maintain My Certification? To be successful in the MOC process, and with the greatest ease, each diplomate should to be familiar with their personal requirements. Planning ahead helps! Avoid waiting until the last minute to begin required elements that may require several months to complete, even under the best of circumstances. Some of the required activities like Practice Performance evaluations are golden opportunities to multitask, where even a “hat-trick” is possible when completing these elements to obtain Physician Quality Reporting System, Physician Recognition, and Part 4 MOC credit simultaneously. On each physician’s personal portal, the ABIM lists their requirements; potential Medical Knowledge and Practice Performance activities to satisfy these requirements can be found on the ABIM website. The ABIM develops and supports their own yearly Medical Knowledge updates in Gastroenterology, which satisfy Part 2 points, and Practice Performance activities, which satisfy Part 4. Physicians can use any ABIM-certified activity to satisfy these requirements. However, a number of GI societies including the American Gastroenterological Association (AGA) offer Self-Assessment modules that are ABIM certified (available at: https://www. abim.org/specialty/gastroenterology.aspx). The AGA also offers several unique Practice Performance activities for physicians to complete. In 2013, the AGA convened a taskforce to investigate the less than optimal pass rates for first-time recertification examination test takers and to develop a structure to guide AGA MOC product development and provide opportunities to physicians to increase their success rates. The AGA remains fully committed to helping physicians navigate the new MOC requirements, and we have developed resources to assist with MOC and with successful 262
passage of the secure certification examination. Visit http://www.gastro.org/education-meetings/maintenanceof-certification to learn more about the AGA’s MOCapproved tools. Despite the program changes, the required components—Parts 2 and 4—remain largely unchanged. We have an ongoing program to provide relevant ABIM-certified options to assist our physicians in lifelong learning, updating and maintaining their medical knowledge, and improving their practice performance. To meet the need for self-evaluation of medical knowledge credits, AGA offers a number of GI Self-Assessment Modules (GI SAM) each providing 10 ABIM MOC points and 10 AMA PRA Category 1 Credits. These modules cover a wide range of topics, including digestive diseases of women; disorders of the stomach, esophagus, and pancreas; GI motility; liver disease; viral hepatitis; GI imaging and endoscopic therapy; functional bowel disorders; and vascular disorders. These topics are based and developed along the content of the GI Core Curriculum. By completion of GI SAM modules, diplomates not only earn selfassessment MOC points, but also reinforce core knowledge in GI and hepatology at the same time as providing practice answering board-style review questions. Each contains case-based questions developed through a rigorous peer review process using ABIM board-style questions. Each multiple choice question has commentary and rationale explaining correct and incorrect responses and provides learners with additional resources to guide their learning. Participants receive immediate feedback on their responses and opportunity to remediate their answers. GI SAM is a fully online platform available to participants from anywhere, at any time. Users can complete modules in multiple sessions if desired logging in and out resuming the test where they left off at a later time. This feature allows complete flexibility for physicians to work within their busy schedules. Physicians can opt to participate in 2 different types of Part 4 Practice Performance activities. The first type of practice performance activity is known as an Approved Quality Improvement activity like the ABIM Colonoscopy PIM. The second type of activity is known as a self-directed PIM, where physicians can develop themselves using a number of approved quality measures from the prepopulated listing through the ABIM. Some of the PM activities can be done as “team sports,” where multiple physicians work together to complete the activity and each obtain credit when finished. The AGA has also created an innovative approach to support members in earning Part 4 Practice Performance MOC points, that is, “the hat trick.” Enrollees in the AGA Digestive Health Recognition Program are eligible for Bridges to Excellence recognition, Centers for Medicare and Medicaid Services Physician Quality Reporting System benefits, and 20 points toward ABIM MOC. Physicians who participate in the Digestive Health Recognition Program are able to use 1 initial set of data entry for all 3 benefits. The practice performance activity provides instruction and resources for participating physicians to use their data to complete the ABIM self-directed PIM. PIMs also assist in
MENTORING, EDUCATION, AND TRAINING CORNER Table 1.Secure Exam Content Medical Content Category Esophagus Stomach/duodenum Liver Biliary tract Pancreas Small intestine Colon General Total
Relative Percentage 10 15 25 8 10 10 15 7 100
developing and implementing an improvement plan to assess the impact of practice changes through chart remeasurement. This package is available for inflammatory bowel diseases and for hepatitis C virus treatment. To complete each Practice Performance module, a second data entry assesses the impact the activity has had on your practice, and also used to complete the ABIM self-directed PIM module for credit. A complete list of ABIM MOC-approved activities is available by visiting www.abim.org/mk for medical knowledge products and www.abim.org/tool for practice performance products. Physicians can also obtain credit for things they are already doing. MOC credits can be earned by answering questions written for participation in specific sessions at Annual Society meetings such as the AGA Clinical Congress, or by attending specific learning session at DDW, the AASLD or the ACG meetings. Physicians can also obtain MOC credit through the ABIM for quality improvement activities in their home institutions and hospitals.
How Do I Ensure I Pass the Secure Recertification Examination? From November 1996 through November 2012, pass rates for first-time takers of the MOC Examination averages 87%, but has been a high as 90% in 2007 and as low as 84% in 2010. Ultimately, 96% of examination takers pass the secure examination. The Medical Content that is examined spans the core curriculum for GI, hepatology, and nutrition. The relative percentage of the exam content covered by each area is consistent year to year (Table 1). It is important to note that one need not pass every content area to pass the secure examination. Remember that this is a multiple-choice test without a penalty for incorrect responses. You should leave no questions unanswered, even if you are unsure of the correct response. One key attribute of successful, high-stakes examination takers is extensive practice with questions in the examination’s format. It is not sufficient to be knowledgeable about
the content, but to be practiced in your approach to answering these multiple choice questions. Medical educators recommend practicing with answering as many ABIM board examination-style questions as possible in preparation for the secure examination. Many opportunities are available for this purpose. The Digestive Disease SelfEvaluation Program (DDSEP) developed by AGA provides hundreds of questions covering the entire GI Core Curriculum content that are also great question answering practice as well. Although this program does not carry MOC credit, in addition to the knowledge and question answering skills obtained, AMA PRA Category 1 Credits are available for participation.
Summary The ABIM’s mission is to enhance the quality of healthcare. This goal is met by certifying physicians who demonstrate the knowledge, skills, and attitudes needed to deliver safe, quality patient care in the rapidly changing world of medical practice.5 This mission resonates also with that of gastroenterologists and with the AGA, and can be a practical and necessary component of our practice as we move into a value-based health care delivery world. All the partner stakeholders in health care delivery—physicians, ABIM, and the public—seek to ensure the safe care of patients and provide demonstrably high-quality gastroenterology and hepatology care.
References 1.
2.
3.
4.
5.
Brennan TA, Horwitz RI, Duffy FD, et al. The role of physician specialty board certification status in the quality movement. JAMA 2004;292:1038–1043. American Board of Medical Specialties (ABMS). Facts about the ABMS consumer survey: lifelong learning and other qualities in choosing a doctor [PDF]. Chicago: ABMS, 2011. Holmboe ES, Meehan TP, Lynn L, et al. Promoting physicians’ selfassessment and quality care: the ABIM diabetes practice improvement module. J Contin Educ Health Prof 2006;26:109–119. ABIM SEP modules survey results. July 2009– January 2012. http://www.abim.org/pdf/publications/ certification-MOC-what-the-research-shows.pdf. Accessed June 26, 2014. Reid RO. Associations between physician characteristics and quality of care. Arch Intern Med 2010;170: 1442–1449.
Reprint requests John F. Kuemmerle, MD, Professor and Chair, Division of Gastroenterology, Hepatology and Nutrition, Medical College of Virginia Campus, Virginia Commonwealth University, Molecular Medicine Research Building 5-036, 1220 E Broad Street, PO Box 980341, Richmond, Virginia 23298-0341. e-mail: [email protected]. Conflicts of interest The author discloses no conflicts.
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ABIM Maintenance of Certification 2014: Navigating the Challenges to Find Opportunities for Success John F. Kuemmerle Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, Medical College of Virginia Campus, Virginia Commonwealth University, Richmond, Virginia
P
hysicians today are under increased pressures and scrutiny from society, insurers, and governmental agencies to deliver demonstrably highquality, safe patient care and document evidence of their continuing competency as a provider. Certification by the American Board of Internal Medicine (ABIM) is 1 measure of a physician’s competence. In January 2014, the ABIM implemented significant changes to its Maintenance of Certification (MOC) program. The changes were the response of the ABIM and its parent board, the American Board of Medical Specialties (ABMS), to signal their endorsement of the need for more frequent participation in MOC activities by their certified physicians. Before 2014, physicians holding ABIM time-limited certificates needed to recertify every 10 years. ABIM and ABMS, along with other external healthcare organizations and the general public, believe that a more continuous MOC program helps physicians to keep pace with changes in the practice of medicine and assessment of performance. These changes are designed to set standards of clinical competency for internal medicine, internal medicine subspecialties, and subspecialtyspecific added qualifications, and ultimately improve the quality of patient care. As medical knowledge and the practice of medicine change, a more continuous MOC program tells the community that physicians are staying current, have met a standard set by their peers, and are actively assessing and seeking to improve their practice and patient outcomes. This commentary outlines the opportunities available to easily and successfully navigate the murky waters of the current MOC requirements while obtaining added value to your practice, and to successfully pass the secure recertifying board examination on the first attempt.
large group or multispecialty practice or in an academic practice. On the plus side, engaging in practice performance evaluation can also be a financial driver for participation in MOC. As the Patient Safety and Affordable Care Act of 2010 goes into full effect this year, our practices face not only a revaluation of reimbursements, but also movement away from fee-for-service business models to a quality-driven, value-based system. As physicians and practices partner with Accountable Care Organizations or enter into capitated contracts, having the quality data available necessary to obtain these partnerships can be provided, in part, via MOC. Because physicians, practices, and Accountable Care Organizations jointly share risk in these bundled contracts, having established practice efficiencies and ongoing practice performance evaluations are a necessary complement to the process that helps to ensure success. On the negative side, there may be financial consequences for not engaging in MOC or failing a secure recertifying board examination that might inhibit attraction or maintaining of existing commercial contracts. These opposite forces can truly make this a high-stakes process. The Federation of State Boards of Medicine also has a long-term initiative to introduce a Maintenance of Licensure (MOL) system in the United States. MOL is a proposed system of continuous professional development that would require physicians to verify their ongoing involvement in lifelong learning as a condition of license renewal. The MOL framework addresses these concerns by envisioning 3 components (reflective self-assessment, assessment of knowledge and skills, and performance in practice) that would be periodically required of actively licensed physicians in their area of practice as a requirement of license renewal. In this process, the Federation of State Boards of Medicine is working closely with the ABMS, which administers MOC for physician specialty organizations. MOC will not be required as a part of a future MOL system. However, the Federation of State Boards of Medicine is recommending that physicians engaged in MOC be recognized as being in “substantial compliance” with the 3 key MOL components. In fact, physicians in the states of Idaho, Minnesota, North Carolina, Oregon, and West Virginia can be exempt from
Why Maintain Your Certification? Many physicians may have board certification as a component of their professional requirements whether in a Gastroenterology 2014;147:260–263
© 2014 by the AGA Institute 0016-5085/$36.00 http://dx.doi.org/10.1053/j.gastro.2014.06.025
MENTORING, EDUCATION, AND TRAINING CORNER Continuing Medical Education requirements for state licensing by virtue of being enrolled in MOC. Professional requirements aside, in return for the privilege of self-regulation, patients want their doctors to undergo rigorous periodic evaluation.1 An ABMS consumer survey found that 95% of Americans felt it was important for their physicians to participate in a program to maintain their board certification.2 There is a considerable body of evidence that demonstrates the value of MOC to physicians; independent assessment is a key component to the process. Even the most talented clinicians are not necessarily good at evaluating their own weaknesses. Physicians perceive that value derives from participation in the lifelong learning process. Eighty-six percent of physicians felt it enhanced their competence and improved their delivery of patient care.3 Moreover, 75%–91% of physicians completing a Practice Improvement Module (PIM) found the process actually improved their practice.3,4 The ABIM continually uses these research findings to inform and guide their program requirements. “MOC is a constantly evolving program in which we focus on improving the value and relevance of the credential, and we welcome constructive diplomate feedback on how to enhance our assessments.. Our obligation to those diplomates is to provide a program that they find relevant and meaningful, that meets them where they practice, and give them credit for the relevant work they are doing” (Dr Richard Baron, MD, MACP, President and CEO of the ABIM in a statement on April 28, 2014).
What Are the New Maintenance of Certification Requirements? Fortunately, much of the overall process that makes up MOC requirements is similar to those familiar to physicians from past requirements. The ABIM offers a website to provide information on the new requirements (http:// moc2014.abim.org). To provide additional, more granular information for each diplomate, the ABIM provides a unique personalized Physician Portal that shows exactly what they are required to complete and what resources are available that can help them to meet their personal MOC requirements. All ABIM Board-Certified physicians, including those holding indefinite certifications, need to engage in MOC activities at least every other year to be reported as “Meeting MOC Requirements.” Physicians will remain certified for the time period remaining on their current certifications (provided they hold a valid license). All ABIM Board-Certified physicians holding 1 valid certification were considered “Meeting MOC Requirements” at program launch in 2014, regardless of enrollment status. As of April 30, 2014, all diplomats needed to enroll in MOC to be considered “meeting requirements.”
New Maintenance of Certification Requirements Beginning January 2014 Complete an ABIM MOC program activity to earn MOC points every 2 years, and earn 100 MOC points every 5 years: Points earned every 2 years will count toward the 5year, 100-point requirement. Physicians may complete any certified MOC activity to meet the 2-year requirement. Physicians will also have to complete a patient survey and a patient safety module by December 31, 2018, and every 5 years thereafter. Physicians, including grandfathered physicians, need to pass a secure examination once every 10 years as part of MOC and, beginning in 2014, will earn MOC points for their first MOC examination attempt. Physicians in subspecialty fellowship training who are Board Certified in IM will earn 20 MOC points for each year of training they successfully complete. This allows them to get started on meeting their MOC requirements for maintaining their Internal Medicine Certification without being required to complete other activities. Physicians enrolled in MOC can accrue the required 100 points in 2 categories of activities: Self-Evaluation of Medical Knowledge (Part 2) and Self-Evaluation of Practice Performance (Part 4). To meet the required 100 points, you must obtain a minimum of 20 points in each of the 2 activity categories. The remaining 60 MOC points can be obtained from the required patient survey and patient safety activities, the secure Recertification examination, or additional Medical Knowledge or Practice Performance activities. At present, most physicians opt to obtain 80 MOC points in SelfAssessment of Knowledge and 20 Practice Improvement MOC points. With the new requirement for Patient survey and Patient Safety activities, these additional practice performance requirements will change the approach physicians need to take in meeting the required mixture of activities within the required 100 points. This is an important consideration owing to the time constraints in completing practice performance activities. Self-assessment of medical knowledge modules can be completed rapidly to attain the required points in this category. Practice performance evaluations can take 6 months to complete. Physicians should be wary to not wait until the last minute to complete these requirements. It is important to remember that physicians can claim AMA PRA Category 1 Credits, which are available for completion of many of the required MOC activities. The ABIM offers physicians 2 MOC fee payment options for added convenience. A yearly payment option of $256 and a 10-year full upfront payment option of $2,560 are both available. However, be aware that the yearly fees may increase. The cost of maintaining more than your Internal Medicine certification in addition to GI will be greater, although the same MOC activities and points apply to both certificates.
261
MENTORING, EDUCATION, AND TRAINING CORNER But Wait! I Am a Grandfathered Physician ABIM diplomates certified before 1989 hold timeunlimited certificates. These “grandfathered” physicians are not required to enroll in the new 2014 MOC program. However, although grandfathered physicians will remain certified, to be considered as “Meeting MOC Requirements,” they must be enrolled in MOC. By December 31, 2015, they will need to complete an MOC activity and earn ABIM MOC points to continue being reported as “Meeting MOC Requirements.” Like physicians holding time-limited certificates, by December 31, 2018, they will also need to earn a total of 100 MOC points with Self-Evaluation of Medical Knowledge and Self-Evaluation of Practice Assessment modules, as well as complete the required patient safety and patient survey requirements. Ultimately, by December 31, 2023, they would need to pass the same secure recertification examination. A grandfathered physician who does not enroll in MOC, although remaining “Certified,” will be listed on their ABIM public information page as “not meeting MOC requirements.”
How Can I Easily and Successfully Maintain My Certification? To be successful in the MOC process, and with the greatest ease, each diplomate should to be familiar with their personal requirements. Planning ahead helps! Avoid waiting until the last minute to begin required elements that may require several months to complete, even under the best of circumstances. Some of the required activities like Practice Performance evaluations are golden opportunities to multitask, where even a “hat-trick” is possible when completing these elements to obtain Physician Quality Reporting System, Physician Recognition, and Part 4 MOC credit simultaneously. On each physician’s personal portal, the ABIM lists their requirements; potential Medical Knowledge and Practice Performance activities to satisfy these requirements can be found on the ABIM website. The ABIM develops and supports their own yearly Medical Knowledge updates in Gastroenterology, which satisfy Part 2 points, and Practice Performance activities, which satisfy Part 4. Physicians can use any ABIM-certified activity to satisfy these requirements. However, a number of GI societies including the American Gastroenterological Association (AGA) offer Self-Assessment modules that are ABIM certified (available at: https://www. abim.org/specialty/gastroenterology.aspx). The AGA also offers several unique Practice Performance activities for physicians to complete. In 2013, the AGA convened a taskforce to investigate the less than optimal pass rates for first-time recertification examination test takers and to develop a structure to guide AGA MOC product development and provide opportunities to physicians to increase their success rates. The AGA remains fully committed to helping physicians navigate the new MOC requirements, and we have developed resources to assist with MOC and with successful 262
passage of the secure certification examination. Visit http://www.gastro.org/education-meetings/maintenanceof-certification to learn more about the AGA’s MOCapproved tools. Despite the program changes, the required components—Parts 2 and 4—remain largely unchanged. We have an ongoing program to provide relevant ABIM-certified options to assist our physicians in lifelong learning, updating and maintaining their medical knowledge, and improving their practice performance. To meet the need for self-evaluation of medical knowledge credits, AGA offers a number of GI Self-Assessment Modules (GI SAM) each providing 10 ABIM MOC points and 10 AMA PRA Category 1 Credits. These modules cover a wide range of topics, including digestive diseases of women; disorders of the stomach, esophagus, and pancreas; GI motility; liver disease; viral hepatitis; GI imaging and endoscopic therapy; functional bowel disorders; and vascular disorders. These topics are based and developed along the content of the GI Core Curriculum. By completion of GI SAM modules, diplomates not only earn selfassessment MOC points, but also reinforce core knowledge in GI and hepatology at the same time as providing practice answering board-style review questions. Each contains case-based questions developed through a rigorous peer review process using ABIM board-style questions. Each multiple choice question has commentary and rationale explaining correct and incorrect responses and provides learners with additional resources to guide their learning. Participants receive immediate feedback on their responses and opportunity to remediate their answers. GI SAM is a fully online platform available to participants from anywhere, at any time. Users can complete modules in multiple sessions if desired logging in and out resuming the test where they left off at a later time. This feature allows complete flexibility for physicians to work within their busy schedules. Physicians can opt to participate in 2 different types of Part 4 Practice Performance activities. The first type of practice performance activity is known as an Approved Quality Improvement activity like the ABIM Colonoscopy PIM. The second type of activity is known as a self-directed PIM, where physicians can develop themselves using a number of approved quality measures from the prepopulated listing through the ABIM. Some of the PM activities can be done as “team sports,” where multiple physicians work together to complete the activity and each obtain credit when finished. The AGA has also created an innovative approach to support members in earning Part 4 Practice Performance MOC points, that is, “the hat trick.” Enrollees in the AGA Digestive Health Recognition Program are eligible for Bridges to Excellence recognition, Centers for Medicare and Medicaid Services Physician Quality Reporting System benefits, and 20 points toward ABIM MOC. Physicians who participate in the Digestive Health Recognition Program are able to use 1 initial set of data entry for all 3 benefits. The practice performance activity provides instruction and resources for participating physicians to use their data to complete the ABIM self-directed PIM. PIMs also assist in
MENTORING, EDUCATION, AND TRAINING CORNER Table 1.Secure Exam Content Medical Content Category Esophagus Stomach/duodenum Liver Biliary tract Pancreas Small intestine Colon General Total
Relative Percentage 10 15 25 8 10 10 15 7 100
developing and implementing an improvement plan to assess the impact of practice changes through chart remeasurement. This package is available for inflammatory bowel diseases and for hepatitis C virus treatment. To complete each Practice Performance module, a second data entry assesses the impact the activity has had on your practice, and also used to complete the ABIM self-directed PIM module for credit. A complete list of ABIM MOC-approved activities is available by visiting www.abim.org/mk for medical knowledge products and www.abim.org/tool for practice performance products. Physicians can also obtain credit for things they are already doing. MOC credits can be earned by answering questions written for participation in specific sessions at Annual Society meetings such as the AGA Clinical Congress, or by attending specific learning session at DDW, the AASLD or the ACG meetings. Physicians can also obtain MOC credit through the ABIM for quality improvement activities in their home institutions and hospitals.
How Do I Ensure I Pass the Secure Recertification Examination? From November 1996 through November 2012, pass rates for first-time takers of the MOC Examination averages 87%, but has been a high as 90% in 2007 and as low as 84% in 2010. Ultimately, 96% of examination takers pass the secure examination. The Medical Content that is examined spans the core curriculum for GI, hepatology, and nutrition. The relative percentage of the exam content covered by each area is consistent year to year (Table 1). It is important to note that one need not pass every content area to pass the secure examination. Remember that this is a multiple-choice test without a penalty for incorrect responses. You should leave no questions unanswered, even if you are unsure of the correct response. One key attribute of successful, high-stakes examination takers is extensive practice with questions in the examination’s format. It is not sufficient to be knowledgeable about
the content, but to be practiced in your approach to answering these multiple choice questions. Medical educators recommend practicing with answering as many ABIM board examination-style questions as possible in preparation for the secure examination. Many opportunities are available for this purpose. The Digestive Disease SelfEvaluation Program (DDSEP) developed by AGA provides hundreds of questions covering the entire GI Core Curriculum content that are also great question answering practice as well. Although this program does not carry MOC credit, in addition to the knowledge and question answering skills obtained, AMA PRA Category 1 Credits are available for participation.
Summary The ABIM’s mission is to enhance the quality of healthcare. This goal is met by certifying physicians who demonstrate the knowledge, skills, and attitudes needed to deliver safe, quality patient care in the rapidly changing world of medical practice.5 This mission resonates also with that of gastroenterologists and with the AGA, and can be a practical and necessary component of our practice as we move into a value-based health care delivery world. All the partner stakeholders in health care delivery—physicians, ABIM, and the public—seek to ensure the safe care of patients and provide demonstrably high-quality gastroenterology and hepatology care.
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Brennan TA, Horwitz RI, Duffy FD, et al. The role of physician specialty board certification status in the quality movement. JAMA 2004;292:1038–1043. American Board of Medical Specialties (ABMS). Facts about the ABMS consumer survey: lifelong learning and other qualities in choosing a doctor [PDF]. Chicago: ABMS, 2011. Holmboe ES, Meehan TP, Lynn L, et al. Promoting physicians’ selfassessment and quality care: the ABIM diabetes practice improvement module. J Contin Educ Health Prof 2006;26:109–119. ABIM SEP modules survey results. July 2009– January 2012. http://www.abim.org/pdf/publications/ certification-MOC-what-the-research-shows.pdf. Accessed June 26, 2014. Reid RO. Associations between physician characteristics and quality of care. Arch Intern Med 2010;170: 1442–1449.
Reprint requests John F. Kuemmerle, MD, Professor and Chair, Division of Gastroenterology, Hepatology and Nutrition, Medical College of Virginia Campus, Virginia Commonwealth University, Molecular Medicine Research Building 5-036, 1220 E Broad Street, PO Box 980341, Richmond, Virginia 23298-0341. e-mail: [email protected]. Conflicts of interest The author discloses no conflicts.
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