(continued from page 19)
sion of knowledge and the impact on individual patients—requiring
a great deal of knowledge on the part of the general internist. He
pointed to the number of times that internists diagnose esoteric
diseases because of constant educational reinforcement of knowledge
of a wide range of diseases. As Dr. Baron pointed out this depth
and breadth of knowledge clearly separates the internist from the
mid-level practitioners. The MOC process both reinforces that and
proves to the public that level of physician knowledge.
Dr. Cutler’s comments then turned to presentations of alleged past
excesses by the American Board of Internal Medicine. He described
salaries he characterized as much higher than would be expected,
a two million dollar condominium on Washington Square, a paid
Board of Trustees (when other boards have voluntary trustees),
and the use of the Ritz-Carlton to house ABIM Board members for
meetings….this at a time when internists are complaining about the
cost of Maintenance of Certification. Dr. Baron has tightened the
controls and eliminated these extravagancies—but the images still
rankled many of the internists in the PCMS audience.
The first time pass rate for the internal medicine boards has fallen from more than 90 percent to 84 percent over the past decade.
(http://www.abim.org/pdf/pass-rates/cert.pdf) There has been some
variation year over year, but the trends have been down. This has
raised fears in practicing internists that the trend will be repeated
among those currently in clinical practice who enroll in Maintenance of Certification. What would happen to insurance contracts,
hospital privileges or public reporting if the internist were to not
pass knowledge based MOC? And what happens to the physician
who voluntarily does not participate in MOC? Is that physician
penalized for not being part of the MOC process? The ACP has
recently issued a strong statement that MOC should not impact
the status of the internist with other entities but should be used
solely for self-education:
“ACP encourages participation in the American Board of Internal
Medicine’s Maintenance of Certification program. Participation
in MOC provides evidence of quality and commitment to continuous professional development, but it is not the only way to
demonstrate these qualities. Consequently, ACP does not support
using participation in MOC as an absolute prerequisite for state
licensure, hospital credentialing, or insurer credentialing. Instead,
decisions about licensure and credentialing should be based on
the physician’s performance in his or her practice setting and a
broader set of criteria for assessing competence, professionalism,
commitment to continuous professional development, and quality
of care provided.”
Dr. Baron reminded the audience that physicians already are being
rated and judged through CMS Physician Compare, by insurance
companies, by community organizations, and by web-based groups
like Health Grades, Zagat, and Angie’s List. The Boards represent
the only physician managed organizations involved in evaluations
of doctors. He urged support of ABIM and other ABMS member
boards.
Maintenance of Certification is in reality a much more complex
concern than a set of examinations, continuing education, and
self-improvement processes. It represents both an academic process for self-assessment and improvement; and a vehicle for public
reporting. Physicians are very familiar with testing knowledge and
are willing to move into the newer directions of using data from the
population within the practice to develop a clinical improvement
process. But physicians are not comfortable with public reporting.
When those reports are generated by other entities, it is easy to
become a victim of such reporting or to just ignore them altogether.
However, if the reporting is based upon knowledge-based exams
without regard to past clinical experience then there is a greater
level of concern. Physicians in organized medical societies are
now questioning the content of MOC and how the results may be
used. The solutions may come from developing new processes of
measuring individual physician care and doctor engagement in
the team approach to population management. Clearly there are
complexities in maintaining skill levels and in helping patients
make proper choices in selecting the right doctor for themselves.
ABMS Statement on Maintenance of Certification:
Assessed Through a Four-Part Framework
The framework for ABMS MOC embodies the core
competencies. The four part process reflects evidence-based
guidelines, national clinical and quality standards, and
specialty best practices.
The ABMS boards and their related societies have evolved
educational and self-assessment instruments that are linked
to many components of the ABMS MOC program. These
tools offer guidance for utilizing efficient practices, using
data more effectively, integrating technology, and cultivating
communication and professionalism skills.
The four-part MOC process includes:
Part I: Professionalism and Professional Standing
• Behave in a professional manner
• Act in the patients’ best interest
• Hold a valid, unrestricted medical license
Part II: Lifelong Learning and Self-Assessment
• Participate in high quality, unbiased educational and
self-assessment activities determined by each Member
Board
Part III: Assessment of Knowledge, Judgment, and Skills
• Pass a written examination and other evaluations
Part IV: Improvement in Medical Practice
• Engage in ongoing assessment and improvement
activities to improve patient outcomes
• Demonstrate use of evidence and best practices
compared to peers and national benchmarks
Source: http://www.abms.org/board-certification/a-trustedcredential/assessed-through-a-four-part-framework/
Note: Dr. James is the Corporate Medical Director of Clinical Policy
at The AmeriHealth Caritas Family of Companies in Philadelphia.
He has a part-time practice within Main Line Healthcare in
Philadelphia.
FEBRUARY 2015
21