The ACC has continued to engage the American Board of Internal Medicine (ABIM) in advocating for modifications to the revised requirements for Maintenance of Certification (MOC). Recently ABIM President Richard Baron, MD, shared with the ACC and other professional societies the following preliminary process changes adopted by the ABIM Board during its June retreat:

• Provide increased flexibility on deadlines; a one year grace period will be granted for those who have attempted but failed to pass the secure exam. The cost of the first exam retake will be reduced significantly.
• Ensure transparency of information; ABIM will continue to update its governance and financial information on its website.
• Ensure a broader range of continuing medical education (CME) options for medical knowledge/skills self-assessment (Part II); this will reduce redundancy and provide physicians with credit for relevant activities in which they are already engaged. ABIM will align its knowledge assessment standards with existing standards for certain types of CME products and providers. ABIM will also shorten the approval process for CME activities that include an assessment of the learner.
• Provide more actionable feedback regarding individual test scores.
• Evolve the "patient survey" requirement to a "patient voice" requirement and increase the number of ways this requirement can be met, particularly by using tools already in use (shared decision-making, active participation in patient/family advisory panels, training programs in patient communication, etc.). ABIM recognizes that their initial statements regarding this requirement were vague and will work to roll out new processes over the next two years.
• Reduce the data collection burden for the practice assessment requirement; utilize practice improvement activities already in place and minimize the time and complexity of data input.
• Investigate changes to the secure exam to increase relevance with specific attention to exploring applications for practice focus areas ("modular exams") and open book exams.

The College was also invited by ABIM to attend an Internal Medicine Summit in Philadelphia on July 15 to share member feedback in an open forum with 25 other professional societies affected by the MOC process. Patrick T. O'Gara, MD, FACC, president of the ACC, William J. Oetgen, MD, MBA, FACC, executive vice president of Science, Education and Quality of the ACC, and Debra Ness, MS, member of the ACC Board of Trustees, represented the ACC. During the time allotted, O'Gara made the following recommendations for ABIM's consideration:

1. Creation of dual pathways for recertification, one involving a 10-year secure exam with annual completion of CME activities as currently required for licensing/credentialing; and the other consisting of completing MOC Part II activities for 10 years. This recommendation has been strongly endorsed by the ACC's Board of Governors.
2. Harmonization of CME with MOC credits;
3. Recognition of ongoing, hospital-based quality improvement and patient surveys as qualifying for MOC accreditation;
4. Elimination of the "double jeopardy" faced by interventional, electrophysiology and heart failure colleagues who currently have to pass both the general cardiology and sub-specialty boards;
5. Reduction of fees;
6. Improvement in the ease with which accurate and understandable information can be retrieved from the ABIM web site;
7. Research into the value of MOC, as measured by physician competency and patient outcomes.

O'Gara further emphasized the urgency of the situation and the need for action. Many of these points were shared by the other participants and additional recommendations were made concerning enhanced communication, partnerships, ways to improve self-assessment products/modules, and formative feedback from the secure exam. There was further discussion about the desirability of changing the manner in which some diplomats are listed on the ABIM website as "not meeting MOC requirements."

More MOC information and resources are available at CardioSource.org/MOC.

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