ABIM Rolls Back MOC Changes

Richard J. Baron, MD

The American Board of Internal Medicine (ABIM) is making substantial changes to its Maintenance of Certification Program (MOC) for internists and subspecialists following strong objections to an MOC revision made last year designed to ensure doctors were at the top of their game.

“This change generated legitimate criticism among internists and medical specialty societies,” ABIM President and CEO Richard J. Baron, MD, said in an open email to the internal medicine community. “Some believe ABIM has turned a deaf ear to practicing physicians and has not adequately developed a relevant, meaningful program for them as they strive to keep up to date in their fields.”

The ABIM, whose changes a year ago made continuous assessment a feature of the MOC rather than once-in-10-years requalification, said it would immediately suspend MOC requirements for “practice assessment,” “patient voice,” and “patient safety” for at least 2 years.

“This means that no internist will have his or her certification status changed for not having completed activities in these areas for at least the next two years,” the email said.

The ABIM said those holding diplomas who are currently not certified but who have satisfied all requirements for MOC except for practice assessment will be issued new certificates this year.

Another change promised is to refer to diplomates’ MOC status as “participating in MOC” rather than “meeting MOC requirements.” This becomes effective within 6 months.

In addition, ABIM will update the internal medicine MOC exam to make it “more reflective of what physicians in practice are doing.” Those changes will be implemented in the fall of this year, with similar exam changes for subspecialties to follow.

MOC enrollment fees will remain at or below 2014 levels through at least 2017, the email said.

The ABIM also promised to develop new ways that internists could demonstrate medical knowledge by recognizing most forms of training approved by the Accreditation Council for Continuing Medical Education (ACCME).

The announced changes drew praise from the American Society of Hematology (ASH), which described them—particularly the suspension of the Practice Assessment requirement and the freeze on MOC enrollment fees¬–as “needed” and “a critical first step.”

The changes “follow years of criticism from ASH and mounting concerns voiced by ASH and other medical societies on the MOC requirements launched in 2014,” the ASH statement said.

The group, which is the largest professional society of hematologists, called for additional changes by ABIM to move the MOC away from “a closed-book examination delivered in a secure location to an examination experience that reflects current access to medical information.”

ABIM was founded nearly 80 years ago to create uniform standards for internists.

The practice assessment option for earning points toward MOC enables physicians to qualify based on participation in activities that improve the quality of patient care in their own practices. Physicians must implement changes and measure the impact of them.

The patient voice option for earning MOC points measures physicians on how well they incorporate the values and preferences of patients and their families when medical decisions are made. Completing patient surveys is one form patient voice measurement may take.

For patient safety, physicians may earn MOC credits by demonstrating foundational knowledge of current safety standards in the practice of medicine, prevention of adverse events and teamwork and care coordination.

While issuing an apology for the disruption it had caused with last year’s change, the ABIM stuck to its belief that more frequent MOC requirements would be beneficial. “While ABIM’s board believes that a more continuous certification helps all of us keep up with the rapidly changing nature of modern medical practice, it is clear that parts of the new program are not meeting the needs of physicians,” Baron said in the statement.

The ABIM promised to involve physician communities in planning for revisions to the MOC requirements. “The goal is to co-create an MOC program that reflects the medical communities’ shared values about the practice of medicine today and provides a professionally created and publicly recognizable framework for keeping up in our discipline,” the statement said.