ABIM has added new requirements for Maintenance of
Certification (MOC). Comparing with what used to be a every-10-year
recertification test plus yearly CME credits, the workload is
now more than doubled, not to mention the expense. Many physicians, as
well as subspecialty societies such as AACE, ACC, AGA, AASM,
etc. have expressed concerns about this significant change in the
accreditation rules. However, the American Society of Nephrology (ASN) has not
made any public statement on this important issue.
On Nov 15, 2014 a special session on
MOC was held during ASN kidney week in Philadelphia. The meeting was
based on requests by several of ASN members who are deeply concerned
about this abrupt change in accreditation policy. Unfortunately, the
session was not included in the formal conference program guide or
the conference app, thus the attendance was extremely low. As one of
the three who attended the session, I want to let you know what
happened, and what might be our next steps in restoring some sanity to the
whole MOC debacle.
The Meeting
Participants:
- ABIM panel: Drs. R Baron (CEO of ABIM), S Linas
(Nephrologist and treasurer of ABIM Board of Directors)
- ASN education committee panel: Drs. J Berns, E Lederer,
S Linas, M Rosenburg, S Wartnick
- ASN staff, including Mr. P Kokemueller, Chief Learning
Officer
- ASN members: Drs. M Azar, L Huber, E O’Shaughnessy
Concerns/comments presented by ASN
members:
1. There is insufficient
evidence to support the benefit of MOC.
- After 20 years of implementing re-certification, there
has been no study showing the benefit of re-certification, such as
comparing outcomes of “grandfathered-in” physicians vs. physicians who
take re-certification every 10 years.
- Note: new studies were published after this meeting. JAMA will
host a discussion on these new data on 12/17/2014, Wed at 12N.
Please attend if you could.
- No study has compared the MOC requirements with other
methods of keeping up-to-date, such as self-directed education, attending
conferences, preparing presentations.
- No study has shown that the current system (every
10-year re-certification + yearly CME) failed. Many countries using initial certification
ONLY + yearly CME WITHOUT any re-certification are having superior patient outcomes.
2. Personal experiences from ASN
members have proved that the MOC process is onerous, expensive, redundant and
irrelevant
- It requires a major time commitment, detracting
significantly from patient care.
- The every 2-year, every 5-year scheme is arbitrary,
lacks scientific evidence and is impractical.
- Many MOC modules are irrelevant.
- Although new, some MOC content might not have
sufficient time to be validated, and testing based on these new studies
might be premature.
- It is a significant financial burden.
- The PIM (performance improvement module) and patient
survey are potentially associated with selection bias.
- Most hospitals conduct patient surveys regularly. If
being done at the local level, there is no need for ABIM oversight.
3. Mandatory MOC will affect
the future of medicine and physicians unfavorably
- The ABIM is a proprietary organization in the business
of credentialing. They should not speak for our scientific or clinical
societies. The legitimacy of ABIM promoting more credentialing process
such as MOC is questionable and raises significant financial conflict.
- Constantly implementing unproven new regulations adds
distrust towards our profession.
- Many physicians have to surrender their hard-earned
multiple board certifications due to the egregious time and financial burdens
imposed by the new MOC requirements mandated for each board certification.
This is contrary to the goal of life-long learning.
- Mandating these radical changes in MOC requirements
without input from practicing physicians sends a negative message to all
hard working physicians and trainees. Furthermore, the ABIM
continues to not address concerns raised by petitions from several groups
and an ongoing lawsuit.
Comments by Dr. Baron/ABIM
- CMS PQRS (Physician Quality Reporting System) showed
that the quality of care is inconsistently provided. More regulations may
come from other sources if we do not police ourselves. ABIM is trying to
help all physicians.
- The fee for MOC is justified because of the high
expenses related to preparing the test questions, setting up tests, staff,
etc.
- Increased revenue of ABIM is all from membership fee
and is transparent.
- If physicians decide not to maintain some of their
board certifications, it is their choice.
- There is a lawsuit initiated by AAPS (Association of
American Physicians and Surgeons), and the recent hearing was postponed.
Everyone is free to support any group. However, the AAPS is a radical
group with views not shared by the mainstream medical community.
- ABIM cannot set the criteria for hospital
credentialing, CMS requirements or insurance company mandates.
Post-meeting Assessment:
1.
Tremendous amount of work will be needed to completely recall these
MOC requirements. A more practical goal may be to modify it so it can be more
manageable.
2. There
is the possibility that the ASN could take a position about MOC if we can align
the membership toward a goal for the members and the organization. Several ASN
panel members sympathized with our plight, and expressed some willingness to
help. They stated that ASN will work to avoid regulations from other
organizations while trying to simplify the MOC requirements.
3. ABIM
so far does not acknowledge the burden MOC imposes on physicians.
4. ABIM
is not addressing the issues raised by different voices; rather it is focusing
on discrediting the opponent.
5. While
Dr. Baron was stating that ABIM cannot set the criteria for hospital
credentialing or insurance company mandates, ABIM has put on an online bonus payment program template for insurance
companies to give incentives for enrolling in MOC.
6. While Dr. Baron was stating that ABIM cannot set the criteria
for hospital credentialing or insurance company mandates, ABIM has already
ruled that “you will be board certified contingent upon "Meeting MOC
Requirements" each year”.
7. While
Dr. Baron was stating that ABIM cannot set the criteria for hospital
credentialing or insurance company mandates, ABIM has already ruled that “Fall
behind in payments, your certification status may change."
Proposals to ASN:
1. Without
any clear evidence, any promotion of MOC is unjustified. ASN should take a
stand, as other subspecialty societies to minimize the burden of
unnecessary regulations.
2. Any
change that will be applied to thousands of physicians needs to be tested first in pilot studies with meaningful and measurable outcomes.
3. Any change that will be applied widely should be voted
on by members.
4. The ABIM board members should be more representative
of the demographics of our physicians.
5. In addition
to meeting the ABIM goal, the ASN should take the opinions of the membership
into account regarding the recertification process. A first step would be to
survey members on their view of the new MOC requirements.
6. ABIM
should develop a process to allow subspecialty societies, including the ASN, to
create specialty-specific MOC products without the need to have each vetted by
ABIM.
7. Nephrology
is a subspecialty with its quality assessment highly monitored and deeply
regulated by both CMS and industry. Practice improvement and reporting is also
being performed regularly at the local level. There is no need to involve the
ABIM. The current practice assessment components of MOC are unnecessary and
need to be reconsidered.
8. If
the ultimate goal of MOC is to satisfy the quality requirement of CMS, it
should only be mandatory for providers who do not meet the quality
standard. For providers who consistently meet the standard, every 10-year
recertification plus yearly CME should be sufficient.
9. Recertification
should NOT be universally contingent on MOC.
Proposals to everyone:
1. For
everyone whose re-certification is due after
2015, let’s stop enrolling in further MOC programs until our requests are
answered and concerns are addressed.
2. Please
encourage every Nephrologist you know to join the fight. Enough on just voicing
your concerns. Nothing will change without action! From the low attendance of
this session, it is obvious that either the importance of this issue is not
realized, or it was assumed that someone else was going to be there. Again,
nothing will change without action from everyone!
3. It
will be helpful to have some prominent figure in Nephrology to join us. If you
know someone, please spread the words and ask for help!
4. Ideas
are needed on how to pressure ABIM to reconsider these requirements before it
is too late. You can tweet to #ABIMMOC or leave message here to share your
thoughts!
Board Certified is PAST TENSE, was designed to detect completion of training and attainment of consultant status. It has been artificially changed and increasingly time limited to PROFIT the boards. WHy not just use Angier's or Craig's listings to detect patient satisfaction. The certification industry has become a "monkey on the back" of american economy sucking down money without any value to anyone. The ABIM concieved time limits on certification to impose this WHOLE NEW burden of MOC-something NEVER proven to amount to a hill of beans. Physicians know what they need to read and update and do NOT need bureaucrats and psychometric analysts to conceive some arbitrary mechanism of extortion to prove competence-with failure rates as high as 33% for competent physicians only detects the fallicy of the testing itself!
ReplyDeleteABMS/ABIM basically is the one wrote MOC into ACA. I put into this post: http://nephtangles.blogspot.com/2015/01/stop-talking-and-start-taking-action-on.html. This is so disheartening for physicians. Basically, there is no need to argue with them on the risk/benefit of MOC. Even a lawsuit won't solve the problem. We are hijacked in the name of lifelong learning and patient care. What do you think will be the most effective way of fighting it off?
DeleteDr. Baron, Why bow to CMS & PQRS, third party medicine is the problem not the solution. Physicians can just say no to the supremacy of Gov. controlled medicine and refocus to patient-directed care. That is the only way to improve care while controlling costs. Kenneth A. Fisher, M. D.
ReplyDeleteThey are not bowing to CMS/PQRS. They shook hand and worked together! http://nephtangles.blogspot.com/2015/01/stop-talking-and-start-taking-action-on.html. We have to pay to report our own PQRS, otherwise there are 2% cut. But then, we pay again to meet PQRA/MOC requirements.
DeleteDear NephTangle -- Thank you for this valuable post. I will urge all my colleagues to visit and read. The ridiculousness of MOC must be addressed and changed. Your blog is the sharp end of the spear, and we should all be grateful.
ReplyDelete