ABIM is changing MOC and will not require Practice Assessment, Patient Voice, and Patient Safety in its Maintenance of Certification (MOC) program through December 31, 2018. Earlier this year, ABIM announced that they would be suspending these requirements for 2 years, and it was not clear what the future of these requirements would be. ABIM says it will continue to award MOC points to physicians who choose to do approved Practice Assessment activities.
The self-assessment and exam components of the MOC program remain in place: participating physicians need to take and pass an exam every 10 years, earn 100 MOC points every 5 years, and complete some MOC activity every 2 years.
What Led to Changes in MOC Requirements?
At the beginning of 2014, ABIM expanded the MOC requirements for internal medicine physicians. These new requirements were met with increasing and vocal opposition from physicians, including the launch of a petition in March 2014 calling for a rollback of the changes.
Throughout 2014, ABIM worked to respond to internists’ concerns. They released a statement in April in response to the anti-MOC petition; issued an open letter to medical societies on July 10 to further respond to concerns; convened a meeting in mid-July at which representatives from 26 medical societies gathered to share their thoughts regarding MOC; and followed this up with an additional open letter, as a formal response to concerns about MOC requirements that came out of the meeting.
ABIM’s proposed steps toward change and its responses to organized opposition during the past year did little to quiet the storm of objections, which led to their announcement of changes to the Maintenance of Certification program.
The original aim of the ABIM MOC Practice Improvement requirement was to encourage and document physician- and hospital-based efforts to learn from patient data and improve quality. Although many physicians agreed that this type of QI effort was laudable, the requirements for documentation and the oversight by the ABIM were considered onerous. Critics argued that small private practices, academic physicians, and retired doctors should not be regulated as if they were hospitals or large conglomerate practices.
Whether you’re practicing medicine in a hospital or a private practice, you were probably working on QI projects before the ABIM required documentation of practice improvement — and, most likely, you’re continuing your QI efforts now that the ABIM has suspended its requirement. The only thing that has changed is that one overseeing body has stopped requiring the extra step of submitting documentation of these projects (i.e., ABIM practice-improvement modules).
Physicians describe major changes in the medical landscape that are contributing to QI efforts:
- modifications to payment structures — pay for performance, readmission penalties, lack of reimbursement for care of complications — are helping to change the culture of medicine and increase transparency of quality-of-care metrics to the public
- physicians are reducing overuse of services that are either unnecessary or marginally helpful
- patients have better access to information to make choices about where they should seek medical care
Patient Safety was an MOC requirement that was introduced in 2014. ABIM-board-certified physicians needed to complete this requirement every 5 years.
Patient Safety activities for MOC fall either into the realm of self-assessment (question banks and other at-home activities) or practice assessment (reviewing hospital data for infection control, for example). The content areas ABIM includes in its Patient Safety activities are:
- Epidemiology of error
- Culture of safety
- Fundamentals of patient-safety improvement
Physicians voiced their uneasy reaction to all the scorekeeping and credit-counting involved in the patient safety requirement, but in the background, they are trying to continually transform care to the highest standards of safety. They are working hard to improve the safety of patients through technology, methods, and tools, especially in hospitals — but also in group and private practice.
According to the U.S. Department of Health and Human Services, adverse drug events account for over 3.5 million physician office visits, an estimated one million emergency department visits, and approximately 125,000 hospital admissions each year. Hospital-acquired infections as well as procedure-related infections in the office setting are both preventable causes of patient morbidity and mortality.
Software and routines can aid in evaluating events, making informed decisions at the point of care, and preventing harm. For example, something as simple as using a proven method to use patient identifiers appropriately can minimize the risk of administering a mismatched blood product or the wrong medication to a patient.
Managing risk in an environment full of life-and-death decisions is just part of the day-to-day life of every physician. The challenge is to assess the risks accurately and to communicate them transparently. Improving communication and coordinating care among medical team members, including improving the timeliness of critical follow-up, is both a systemic and an individual responsibility.
Physician Input Continues to Change MOC
ABIM has responded to controversy and sought greater transparency, a less burdensome process, and clearer relevance to practice. These changes include
- suspending quality improvement and patient safety requirements
- no longer requiring underlying certifications for MOC
- a new partnership with the Accreditation Council for Continuing Medical Education (ACCME) to accept more forms of continuing medical education (CME) for MOC credit
- a more-detailed blueprint and score report for the internal medicine recertification exam
- its Assessment 2020 Task Force recommending replacing the 10-year MOC exam with “meaningful, less burdensome” assessments that physicians could take at home or at the workplace, as well as new assessments on cognitive and technical skills
Have you made an effort to improve patient safety in your practice, either for MOC or for your own purposes? Have you assessed your practice or surveyed your patients within MOC criteria or outside it? Please share your stories in the comments.