ABMS MOC Program at 10 Years:
Board Congress Reflects on Successes, Challenges and the Future MOC Program

CHICAGO – Oct. 29, 2010 – The American Board of Medical Specialties celebrated the first decade of its ABMS Maintenance of Certification® (ABMS MOC®) program by gathering representatives of its 24 Member Boards to share best practices of the MOC program, which promotes lifelong learning and self assessment for physician specialists. The second annual ABMS Board Congress, held Sept. 23 in Chicago, featured 10 presentations by representatives of Member Boards and the ABMS, as well as a public member from the ABMS Board of Directors (BOD).  All relayed successes, challenges and plans for the next decade of the ABMS MOC program.

The Board Congress was established in 2009 for the purpose of allowing the ABMS Member Boards to share the MOC program “best practices” with each other. To ensure representation of the varying perspectives that are crucial to the continued progress of the MOC program – including those of the ABMS BOD, Member Board executives and staff – the agenda was planned by Thomas E. Norris, MD, American Board of Family Medicine (ABFM) and vice chair of the ABMS BOD, James A. Stockman III, MD, American Board of Pediatrics (ABP) president and CEO and Terry M. Cullison, RN, MSN, administrator for the American Board of Plastic Surgery (ABPS). 

ABMS Board Certification has evolved since 1933 from a one-time process to the current continual process, the MOC program, in which physicians are measured on six core competencies: Professionalism, Patient Care and Procedural Skills, Medical Knowledge, Practice-based Learning and Improvement, Interpersonal and Communications Skills and Systems-based Practice.  Through the MOC program, these competencies are continually assessed using a variety of tools, depending on the specialty, including patient chart reviews, online modules that test whether the doctor is familiar with the latest treatment recommendations, surveys of patients and colleagues and tests.
During the Board Congress, several recurring themes emerged.

• Many physician specialists concur that their practices have improved based on what they learned by participating in the MOC program.
• Many Member Boards are streamlining their MOC programs and keeping costs for their diplomates down by collaborating with their specialty societies to offer physicians tools and other learning opportunities.
• Online portals and activities have improved the ease and efficiency of the MOC program.
• Member Boards are working to tie the MOC program to pay-for-performance initiatives.
• Challenges often create opportunities for improvement.

Successes and Challenges

The 24 ABMS Member Boards are working hard to make their MOC tools accessible to physicians and beneficial to patients.  For instance, doctors certified by the American Board of Urology (ABU) can go online to complete required practice assessment protocols (PAP) that include reviews of the charts of patients with the same diagnosis, and analyze their treatment of these patients compared to national guidelines.

Initial comments from physicians taking the ABU PAP were frequently negative, often because their specific practice didn’t match guidelines, but in the end concurred that they changed their practice based on what they learned.  Gerald H. Jordan, MD, ABU trustee and member of the ABMS BOD shared an example of a physician who complained to ABU that he didn’t get a top score on the renal lithiasis (kidney stones) PAP because one of the questions asked about documentation of stone dimensions prior to therapy and he’d received only the radiologist’s report, not the CT itself.

“On the flip side, the physician said ‘I learned what I should be documenting and therefore I’ve changed my documentation practices,” Dr. Jordan shared. “What the physician did was go to his radiology department and say ‘I need to get that information,’ they said ‘Fine,’ and problem solved. The physician is happy, and, in fact we did change his practice, which is a positive outcome.”

“We’re starting to see some good reports from our early analysis of data from our MOC program, which is exciting,” concurred Cullison, co-facilitator of the Board Congress. “When the doctors see the benchmarks and the national data, they’ve loved that, and we’ve heard many success stories regarding what they’ve changed and improved in their practice as a result of the MOC program.”  

Programs in Development and on the Horizon

To continue to ensure that doctors meet the health care needs of patients, the ABMS MOC program must continually evolve, and several Member Board representatives discussed their vision of that evolution.
The American Board of Psychiatry and Neurology (ABPN) determined that communicating the benefits of the MOC program is a key goal in order to encourage more physicians to participate.  “We changed the way we described the MOC program, emphasizing ‘lifelong learning’, which is more familiar, concrete, self-directed, positive, and nurturing,” said Larry R. Faulkner, MD, ABPN president and CEO.

The American Board of Pediatrics (ABP) is pushing its MOC program forward by piloting a program that replaces certification end dates with administrative reverification dates. “We’ve always wanted to work toward a continuous program,” said Hazen P. Ham, PhD, ABP vice president of global initiatives. “We wanted to build something flexible, with the ability to easily add new requirements – like creating a chassis that you can take things on and off. So we developed a point system and can flex the amount of points awarded for various activities, enabling us to emphasize or de-emphasize activities based on the need for improvement in specific areas.”

“Physicians care about and are engaged in life-long learning and quality improvement” noted Lynn Langdon, MS, American Board of Internal Medicine (ABIM) senior vice president and chief operating officer.   “As we revise our MOC program to meet the ABMS standards, we will seek to create a framework for physician assessment that reflects what physicians are doing in practice and assures the public that a physician has met the high standards of MOC.”

 ABIM currently has more than75, 000 participating in its MOC program and that number is expected to double by 2015.  To accommodate the challenges of these increasing numbers, ABIM undertook an extensive planning approach for their new program. The process included convening focus groups of physicians, IT, Communications, Psychometric and policy staff as well as engaging the ABIM Board of Directors to design a program that would be rigorous, relevant and reduce redundancy.   
While the ABP’s policy of no certification end dates does not affect other Member Boards, it does align with the MOC’s program emphasis on continuous, life-long learning. But this change has proved challenging to credentialers, who are charged with verifying whether physicians are qualified to practice within a hospital, for instance. They must refer to a doctor’s certification expiration date, and with no date, the process is more complicated.  

 “The ABP’s move to continuous MOC means we must provide a great deal of education to credentialers, assuring them that the doctor met requirements for the MOC program,” said Barb Rosenthal, ABMS director of products and business development.   “It has created a lot of opportunities for clarification.” For instance, ABMS and ABP leadership have given a joint presentation at the National Association Medical Staff Services (NAMSS) Annual Conference & Exhibition in October.

The pilot program includes a “reverification date” of February 15th and ABMS and ABP recommend credentialers verify a physician’s certification status on or after that date every year. This will ensure the status of a physician’s MOC participation every year.

Strengthening Board Operations

The MOC program requires significant commitment on the part of the ABMS Member Boards, who have had to assess how to prioritize their other planned projects.  Last year the American Board of Radiology (ABR) staff undertook an extensive exercise to help develop a five-year plan.  The process involved assigning points, or dollars, to the 100 top planned projects according to the resources those projects would need, including staff time, travel, capital expenditures, etc.  They then compared the needs to the actual resources and determined what must be done, what could wait and what could be eliminated. 
 “Our challenges are to stick to our priorities and ‘prevent priority creep,’” said Jennifer Hutson, MBA, director of board affairs at ABR.   “As we continuously note in committee meetings, we can do everything, but we can’t do it all right now.” 

The American Board of Obstetrics and Gynecology (ABOG) staff realized one way to be more efficient was to partner with their specialty society, the American Congress of Obstetrics and Gynecology (ACOG), which provided MOC Part IV self-assessment modules at no cost and conducted seminars at its annual meeting. The two groups also combined their patient safety committees to develop Part II safety requirements.  “The success of the MOC program is due to our collaboration with ACOG,” said Larry Gilstrap, MD, ABOG executive director.  “Working together was the only way to get it up and running.”

Another way ABOG found to be efficient was to develop a Web-based MOC program. While ABOG requires annual, active participation of its physicians, like other ABMS Member Boards it recognizes that the process must be made as easy and streamlined as possible. “The program is user-friendly and totally Web-based except for the exam,” said Dr. Gilstrap. “All tracking of their MOC progress is online, and at anytime they can go see where they are at in the process.”

Evidence of the Benefits

“It’s important we encourage evidence-based medicine, but evidence-based policy is equally important,” said Dr. Norris, co-facilitator of the Board Congress. With its seven-year transition to the MOC program complete, the ABFM undertook the latter challenge by analyzing data from 68,000 ABFM Board Certified physicians who participated in the program.

“The good news is participation in the MOC program is robust. We were concerned there could  be a problem with rural physician participation, but we found there was no difference in the uptake of their involvement,” said James C. Puffer, MD, ABFM president and chief executive officer. “But we were concerned that physicians from poverty areas as well as those in physician-shortage areas were more likely to miss MOC program milestones. We will continue to research why these differences exist and how we can help them overcome obstacles to participation.”

Communicating the Benefits

Lloyd Morgan, a public member of the ABMS Board of Directors, commended the progress of the MOC program, and noted the next task is to communicate to the public the excellent progress that is being made on behalf of the entire ABMS Board Enterprise.

“We need to convince patients and consumers about what I know you are doing, which is providing a better physician profession with emphasis on safety and quality,” said Morgan. “In putting yourself 10 years into the future…I fully expect ABMS information to be attached to every physician’s name wherever it’s carried.”

 Physicians also need a better understanding of the benefits of the MOC program, which is why emphasizing the lifelong learning aspect is important, notes ABPN’s Dr. Faulkner. “The core of the matter is about changing behavior and lifelong learning occurs by speaking to people’s feelings, not their minds” he said. “Lifelong learning appeals to doctors’ pride and professionalism.”

About ABMS
For more than 75 years, American Board of Medical Specialties has been the medical organization overseeing physician certification in the United States. It assists its 24 Member Boards in their efforts to develop and implement educational and professional standards for the evaluation and certification of physician specialists. ABMS Member Boards provide physician certification information to ABMS for its certification verification service programs. ABMS is recognized by the key health care credentialing accreditation entities as a primary equivalent source of board certification data for medical specialists. Patients can visit www.abms.org or call toll-free 1-866-ASK-ABMS to see if their physician is board certified by an ABMS Member Board. For more information about ABMS visit www.abms.org or call (312) 436-2600.

The 24 Member Boards that make up the ABMS Board Enterprise covers over 145 medical specialties and subspecialties include: American Board of Allergy and Immunology, American Board of Anesthesiology, American Board of Colon and Rectal Surgery, American Board of Dermatology, American Board of Emergency Medicine, American Board of Family Medicine, American Board of Internal Medicine, American Board of Medical Genetics, American Board of Neurological Surgery, American Board of Nuclear Medicine, American Board of Obstetrics and Gynecology, American Board of Ophthalmology, American Board of Orthopaedic Surgery, American Board of Otolaryngology, American Board of Pathology, American Board of Pediatrics American Board of Physical Medicine and Rehabilitation, American Board of Plastic Surgery, American Board of Preventive Medicine, American Board of Psychiatry and Neurology, American Board of Radiology, American Board of Surgery, American Board of Thoracic Surgery, and American Board of Urology.