Maintenance of Certification: Then, Now and Looking Ahead

Robert Shor MD, FACCChair Board of Governors ACC

October 2015

MOC

• Where were we?• Where are we now?• Where do we go from here?

MOC: Where were we?

• January 2014 Changes

MOC Jan 2014 Changes• Part 1-the initial certification exam• Part 2-Knowledge based questions• Part 3-the 10 year secure exam• Part 4-PIMS (Practice Improvement

Modules)• Part 5 & 6-to be defined but include patient

satisfaction.

MOCThe January 2014 changes:

–Everyone needs to participate-even those certified before 1990

–Now a 5 year and NOT a 10 year cycle–100 points every 5 years-20 part 2, 20

part 4 and 60 either part 2,3 or 4.

What 2014 Brought…

MOC

• The surveys were instrumental in crafting and influencing ACC policy.

Your ACC Listened …and developed a three-pronged approach focused on –

• Serving as a source of information about the changes for members

• Providing tools and resources to help members more easily meet the new requirements

• Advocating on behalf of members for changes to the MOC process

Cardiology Magazine, January 2015

ACC Actions Included• Letters of opposition and

recommendations to ABIM based on member survey results and feedback

• In-person leadership meetings with ABIM in collaboration with internal medicine community

• Continuous leadership updates via the ACC in Touch Blog, JACC and all-member emails

• Development of MOC Resource Hub on ACC.org

• As a result of the ABIM changes in MOC the ACC convened 2 Task Forces to look at ways to work with ABIM to promote reforms to the MOC process and a second TF to look at alternatives to ABIM to provide MOC.

• As a result of pressure from various constituency groups , and in large part the ACC, the ABIM and Rich Baron sent out the “We got it wrong” letter.

• Changes have been made, but I believe more meaningful changes to the MOC/lifelong learning process using validated metrics is needed.

February 2015

• The ACC convened 2 Task Forces on MOC which over several months developed principles regarding the ACC position on MOC (Maintenance of Certification) and lifelong learning and Maintenance of Competence.

• The Task Forces presented their recommendations to the BOT at the August annual BOT Retreat. What follows is the information from the TF’s and the BOT recommendations.

Maintenance of Certification and Recertification (ACC/F)

Task Force #2

Reviewed discussions with:• ABIM• Alternative Boards: Neurosurgery and

Neurology• Input from Key Stake Holders• “Break away” ABMS Board• Independent Boards such as Nuc,

echo

Maintenance of Certification and Recertification (ACC/F)

Task Force #2

Reviewed discussions with:• NBPAS-Dr. Teirstein• Patient Perspective• Payers• Cost• Certificate of Continuing

cardiovascular Development Program(C3PD)

Summary of Elements that TF #2 feels should be included in

ongoing certification:• The current initial certification

process is felt to be acceptable• Expansion of MOC part II to include

elements from LifeLong Learning Clinical Competency Statement (completed in August 2015)

• Elimination of MOC III/Ten year test, allowing instead, credit for ongoing prescribed education/confirmation of successful completion

Summary of Elements that TF feels should be included in

ongoing certification:• Further exploration (during 2

year ABIM grace period) of options for MOC IV, patient safety and patient voice: TF feels that part IV and patient voice should be integrated into existing ACC, hospital and practice programs in such a way that it is not burdensome to physicians.

Task Force #2-MOC-Unresolved issues

• Cost• Will failure of subspecialist to certify in

general cardiology preclude such practice

• Will failure of subspecialist to certify in general cardiology preclude such practice?

• Any new board will require acceptance by medical staffs (and possibly payers)

Task Force #2-BOT issues

• If recertification elements acceptable to ABIM, recommend not initiating new board

• If elements not accepted by ABIM, present same to ABMS for consideration of new board outside of ABIM

ACC BOT MOC TF MotionsAugust 2015

• #1: The BOT recommends that the 10 year exam be replaced with a new externally validated process for maintenance of competence and the ACC work with ABIM to develop this.  No time line or "drop dead" date for action was given, rather conveying a sense of urgency for response. ABIM subsequently presented its 2020 proposal.

ACC BOT MOC TF MotionsAugust 2015

• #2: The BOT decided that the ACC will continue its work toward an alternative Board pending ongoing discussions with ABIM.  This is the purview of Task Force #2.  Task Force #1 will be rolled in to TF#2.

ACC BOT MOC TF MotionsAugust 2015

• #3: The BOT appoints Patrick T. O'Gara MD,MACC and William J Oetgen MD, MBA, FACC to serve as liaisons for ABIM continued communications.  Both have worked closely and well with the ABIM leadership.

ACC BOT MOC TF MotionsAugust 2015

• #4: Will work with ABIM to research into best practices for maintenance and demonstration of competence with eventual link to patient outcomes, cost and cost effectiveness.  We wish to define what actually makes sense for our members and improves outcomes.

ACC BOT MOC TF MotionsAugust 2015

• #5: Recognizing that elements of Part IV and patient experience are federally mandated, these should be integrated into existing ACC hospital and practice programs.  Elements are apparently imbedded in MACRA and we are trying to recognize and get credit for  the work we all do regularly and integrate this in to our normal workflow.

•  

• Where are we now?

ACC Input to ABIM Has Created Change:

• Reversal of the double jeopardy provision

• Decoupling of the initial board exam from MOC participation

• Streamlining the ability for practitioners to get both CME and MOC Part II credit

• Delaying MOC Part IV

Most Recent ABIM Actions• April 2015: ABIM announces plans to provide increased

opportunities for physicians to earn MOC through self-assessment activities previously categorized as CME credits.

• July 2015: Requirement for underlying certification discontinued

• August 2015: ABIM announces official collaboration with ACCME to expand options for MOC credit by enabling CME providers to offer more lifelong learning CME-MOC options

• August 2015: ABIM announces no loss of certification for failure to enroll in MOC (if other requirements, including 5 and 10 year milestones met)

ACC’s Education Team will continue to work with ABIM to clarify the changes.

ABIM’s Assessment 2020 Task Force Report Developed to:

• Develop a vision for future of assessment

• Stimulate discussion among stakeholders

In line with many of the ACC’s recommendations!

My take on the ABIM 2020 Task Force Proposal

• *more frequent lower stakes exams AND secure exams of some sort.

• *Uncertain cost, but can't imagine it would be cheaper -TBD

• *replaces MOC Part 2

My take on the ABIM 2020 Task Force Proposal

• *The recommendations seem far more expansive and intrusive on initial review, but much of the detail remains unclear.

• *I'm not sure Parts IV, V and VI have been abandoned or rather shelved till alternative methods of measurement can be determined.

Summary of MOC ChangesOctober 2015

The prior changes from the ABIM:– MOC Parts 4,5 and 6 are on hold for 2

years– You still need 100 points in 5 years.– You CAN use PIMs (Part 4) to obtain these

points fairly painlessly– You will be listed as “participating in

MOC”, NOT “In Compliance with MOC”.

The Most Recent Changes to MOC

• Reversal of the double jeopardy provision

• Decoupling of the initial board exam from MOC participation

• Streamlining the ability for practitioners to get both CME and MOC Part II credit

The Most Recent Changes to MOC

• Reduce fees

• Possible suspension of the 10 year secure exam (Part III): the New 2020 Task Force report

What is your ACC Doing at this point?

• We continue to reiterate and emphasize to ABIM our previously stated positions regarding meaningful, simplified, less expensive Maintenance of Competence and Lifelong learning.

• We continue to work with ABIM to forward our goals on behalf of our patients and members.

What is your ACC Doing at this point?

• We continue to have dialogue with other Medical Societies.

• We continue to keep open the option of establishing a separate and new Board recognizing the costs and potential issues.

• We recognize the efforts ABIM has made so far.