The ACC and other members of the internal medicine community recently received a letter from the American Board of Internal Medicine (ABIM) Board of Directors responding to a number of the concerns previously outlined by ACC and other professional organizations regarding the revised requirements for the ABIM Maintenance of Certification (MOC) Program. (For a summary of the concerns, including the ones I outlined at the July 15 summit convened by the ABIM, go here.)

The letter acknowledges the dramatic changes and pressures being faced by the internal medicine physicians, including implementation of the Affordable Care Act, Meaningful Use requirements, payment changes, aggressive institutional compliance policies, increasing emphasis on the roles of systems, teams and technology, and more. “Given these mounting pressures, the timing for releasing the changes in our MOC program was hardly propitious,” the ABIM Board members write. “Indeed, in our ongoing commitment to ‘reduce redundancy’ and decrease the reporting burden on physicians, we linked our credential to many of these other efforts. That has clearly been a double-edged sword, engendering confusion instead of good will.”

As such, the letter specifically addresses two of the biggest concerns: the 10 year secure exam and satisfying the requirements for Part IV (practice  improvement). The ABIM Board members agree that the secure exam must evolve with time and “that any future changes related to content, format, delivery vehicle, feedback, etc. will need to support the use of the exam as a summative assessment tool that signifies competence in the disciplines of internal medicine.” They note that a committee is being convened to explore how to move this forward and that formal mechanisms for society input will be developed. In terms of Part IV requirements, the ABIM board members note that this topic has generated some of the most intense negative feedback, and as a result is “the area of the MOC program that will change most dramatically in the next 12-24 months.” Finally, the letter clarifies that ABIM does not believe that MOC should be required for maintenance of licensing. In states where licensure includes required continuing medical education, MOC should count for those and any other knowledge or quality improvement requirements.

The letter also includes two appendices, the first outlining ABIM’s commitments to changes in the MOC process, and the second providing detailed responses to specific issues raised by the internal medicine community. Among the highlights:

• ABIM will streamline the process for recognizing products produced by specialty societies and other organizations for medical knowledge (Part 2) credit. This will allow ACC to expand its library of Part II offerings.
• ABIM will explore pricing options whereby diplomats, over their 10-year exam cycle, can opt in/out of access to ABIM products and, if they opt out, get a discount on their MOC fee.
• Any diplomat who takes an exam before his/her examination is due and fails, will get an additional year to pass before being reported as “Not Certified” or “Not Meeting MOC Requirements.” In addition, first-time MOC retake fees will be reduced from $775 to $400 starting in 2015.
• The ABIM Board of Directors will discuss website language for “meeting MOC requirements” at its upcoming August meeting.
• The Council will charge each specialty board with addressing the question of whether underlying certifications are required in each tertiary specialty and conjoint boards; decisions are expected by 2015 for the Boards which ABIM administers. These considerations will pertain to our members who now must pass the general cardiology exam before sitting for their interventional, electrophysiology, or heart failure exam.
• A newly formed committee, established at the June ABIM Board of Directors meeting, will examine expanding MOC options for clinically inactive (and less clinically active) physicians, including researchers, academics and administrators.
• A formal strategy for society/specialty board communication will be developed, in consultation with the specialty societies, with discussions beginning this fall.
• ABIM welcomes the opportunity to partner with other professional organizations on research to assess the efficacy of MOC.
• ABIM will work with professional societies to further understand the burden imposed by MOC.
• ABIM has begun the process of revising the criteria for the patient survey (patient voice) module. It is anticipated that there will be four different pathways to meet these requirements by 2018.

The ACC will continue to work with the broader internal medicine community and the ABIM as these efforts are implemented and further discussions take place. These early responses are encouraging, but we recognize that much further work needs to be done. We will provide updates as efforts continue to move forward.

Learn more about the MOC changes and ACC resources at CardioSource.org/MOC.

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