ACC Corner | Maintenance of Certification Could Have Brighter Future with Healthcare Reform

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Dr. Harold is Secretary of the ACC and Chair of the ACC Board of Governors and serves on the ABIM Board of Directors

In 1936, the American Medical Association (AMA) and American College of Physicians (ACP) answered a call for the development of uniform high standards for new physicians by forming the American Board of Internal Medicine (ABIM). Since then, the ABIM has fulfilled its mission to enhance the quality of healthcare by certifying internists and subspecialists who demonstrate the knowledge, skills and attitudes essential for excellent patient care. To date, the number of ABIM-certified cardiovascular specialists has grown from 223 in 1941 to nearly 26,000 in 2009.

The ABIM requires physicians who were Board Certified after 1990 to maintain their certification every 10 years. The Maintenance of Certification (MOC) program is based on guidelines established by the American Board of Medical Specialties and includes four components: verification of credentials; a knowledge exam in a physician’s specialty area that assesses diagnostic acumen and clinical judgment; knowledge modules that pose a series of questions for physicians to demonstrate they are keeping up with the latest developments in their field; and a self-evaluation of practice performance through data collection, reporting and assessment.

As debate over healthcare reform legislation heats up in the House and Senate, several proposals are looking at ways to better integrate Medicare accountability and physician certification to ensure greater patient value and high-quality, evidence-based care. One such proposal would expand the Physician Quality Reporting Initiative (PQRI) to allow physicians who voluntarily participate in MOC and who participate in a biennial practice assessment to be eligible for quality bonuses for a period of two years, without necessarily having to report under PQRI in the second year.

These new models could potentially create new reimbursement opportunities for cardiovascular specialists who voluntarily participate in MOC via ABIM, while also providing new collaborative opportunities between the ABIM and the American College of Cardiology around MOC and lifelong education tools and resources. Not to mention, on a broader level, these discussions mean MOC is likely to evolve into a more continuous program—more congruent with what the reporting physicians need to do in other arenas, be it health plans, state licensing or hospital credentials.

Making MOC more continuous could recognize those activities physicians are already engaged in. For example, participation in ACC’s “D2B: Sustain the Gain” initiative—aimed at reducing door-to-balloon times to the guideline-recommended time of 90 minutes or less—can be used to earn Self-Evaluation of Practice Performance Part IV credit.

In addition, continuing medical education (CME) that is being used to meet other requirements, such as state licensure, could potentially meet MOC requirements, reducing the burden of physician reporting. The ABIM will look to societies like the ACC to offer products that will meet “MOC CME” requirements tailored to members’ specific needs.

The ACC and ABIM are working together to make MOC activities more value-added and to enrich the cardiology-specific educational opportunities for ACC membership. Working with the ABIM, the ACC is intensifying its efforts to develop methods and metrics to assess professionalism, communication and interpersonal skills, systems-based practice, patient care competency and practice-based learning and improvement. The college is going to great lengths to consider how MOC can be more relevant to clinical practice, enabling physicians to enhance skills in areas in which they have experience, but in which they may have no formal training.

The ACC and ABIM hope to continue their collaborative efforts, sharing the desire to establish standards for quality care that will begin to move the American healthcare system dramatically forward.