The Changing Maintenance of Certification Landscape
John F. Kuemmerle, MD, AGAF
Professor of Medicine, and Physiology and Biophysics, Interim Chair, Gastroenterology, Hepatology and Nutrition, Medical College of Virginia Campus, Virginia Commonwealth University
The American Board of Internal Medicine (ABIM) will be implementing changes to its Maintenance of Certification (MOC) program beginning January 2014. The American Board of Medical Specialties (ABMS) of which ABIM is a member, endorse the need for more frequent participation in MOC activities of board-certified physicians than the current every-10-year requirement. ABIM and ABMS, along with other external health organizations and the general public, believe that a more continuous MOC program helps physicians keep pace with the changes in the science and practice of medicine.
In January 2014, ABIM will provide a unique personalized Physician Portal for each diplomate that will show exactly what he or she is required to complete to meet MOC requirements, as well as suggest from the available resources choices to meet those MOC requirements. ABIM will offer physicians two MOC fee payment options for added convenience, an annual and a 10-year option. Here is what members need to know about their certification status beginning in January of 2014:
- All ABIM board-certified physicians, including those holding certifications that are valid indefinitely, will need to engage in MOC activities more frequently starting in 2014 to be reported as “meeting MOC requirements” on the ABIM website.
- 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 at least one valid certification will be considered “meeting MOC requirements” at program launch in 2014, regardless of enrollment status. If you are not enrolled in MOC you will need to activate your MOC program by March 31, 2014, and pay either the annual or a 10-year MOC program fee at that time.
New MOC requirements beginning January 2014:
Complete an ABIM MOC program activity to earn MOC points every two years, and earn 100 MOC points every five years. Items to note:
- Points earned every two years will count toward the five-year, 100-point requirement.
- Physicians may complete any certified MOC activity to meet the two-year requirement.
- Physicians will also have to complete a patient survey and a patient safety module by Dec. 31, 2018, and every five years thereafter.
- Physicians will be required to pass a secure exam once every 10 years and, beginning in 2014, will earn 20 MOC points for their first MOC exam attempt.
- Physicians in fellowship training who are board certified in internal medicine will earn 20 MOC points for each year of training they successfully complete.
Despite the program changes, the required components, part 2 (self-assessment of medical knowledge) and part 4 (self-assessment of practice performance), will remain largely unchanged. Passing the ABIM secure examination is still a requirement for both board certification and recertification. ABIM diplomates who participate in MOC must pass the exam every 10 years to maintain their time-limited board certification. Two effective strategies for successful exam preparation are securing a strong base of basic medical knowledge and having extensive practice answering board-style multiple choice questions. AGA has created a new board review item bank, free to members, to assist trainees and members not only in expanding their medical knowledge and highlighting areas of relative weakness, but also in gaining extensive practice answering board-style questions. The newly released DDSEP® 7 includes 850 board-style questions and board exam preparation hints.
Over the last several years physician performance on the gastroenterology board recertification exam has declined. ABIM documented that the 2010 pass rate of 84 percent for gastroenterologists was the lowest since 2006. The pass rate was higher among first-time test takers (94 percent of first-time test takers passed the certification exam compared to 85 percent of recertification exam takers). The AGA Governing Board formed an ABIM MOC Task Force to determine how to help AGA members prepare for the certification and recertification exams. Based on member survey findings and review of AGA and non-AGA board review materials, the task force concluded that it would be beneficial to offer additional board-style review questions for trainees and members to use for board review preparation.
ABIM diplomates who participate in MOC must accrue 100 MOC points every five years. A key component of this process is accruing at least 20 points in self-evaluation of medical knowledge and 20 points in self-evaluation of practice performance; the remaining 60 can be from either category. To meet the need for self-evaluation of medical knowledge credits, AGA offers six GI Self-Assessment Modules (GI SAM®) totaling 60 ABIM MOC points, with two additional 10-point modules in development. In addition, upon completion of each GI SAM module participants earn up to 10 AMA PRA Category 1 Credits™.
Current GI SAM topics covered include digestive diseases of women, disorders of the stomach, esophagus, pancreas, GI motility, liver disease, viral hepatitis, GI imaging and endoscopic therapy, and functional bowel disorders. New modules covering vascular disorders and geriatric GI are forthcoming in 2013. Case-based questions are developed through a rigorous peer-review process using ABIM question writing guidelines. 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 the opportunity to remediate their answers. Each module has a total of 25 to 30 questions.
AGA has created an innovative approach to support members in earning Part 4 Self-Assessment of Practice Performance (Practice Improvement Modules (PIM)) MOC points. Enrollees in the AGA Digestive Health Recognition Program are eligible for Bridges to Excellence (BTE), the CMS Physician Quality Reporting System (PQRS), and up to 20 points towards ABIM MOC. Physicians who participate in AGA’s recognition program are able to use one set of data entry for all three benefits. The self-directed PIM component incorporates valid performance measures and gives physicians a means of conducting a structured, data-driven evaluation of a specific area of practice. PIMs also assist in developing and implementing an improvement plan to assess the impact of practice changes through chart re-measurement. This package is available for IBD, and AGA is currently working on a similar product for HCV.
AGA is committed to helping members navigate the new MOC requirements and provide information on products and resources we have developed to assist with maintaining members’ certificates. Visit www.gastro.org/education-meetings/maintenance-of-certification to learn more about AGA’s MOC-approved products.
Dr. Kuemmerle receives research support from NIH, UCB S.A., Pfizer Inc., Sanofi-Aventis U.S. LLC., Merck & Co., Inc., and Coronado Biosciences.
1. Boland CR, Lynch HT. The History of Lynch Syndrome. Fam Cancer 2013.