Maintenance of Certification

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Maintenance of Certification (MOC) is a process of physician certification maintenance through one of the 24 approved medical specialty boards of the American Board of Medical Specialties (ABMS) and the 18 approved medical specialty boards of the American Osteopathic Association (AOA). [1] Variously implemented between 1990 and 2000 in response to quality concerns in the healthcare system, the MOC process is a voluntary certification process and is controversial within the medical community. [2] [3]

Contents

Starting with Oklahoma in 2016, a growing number of states have passed or are considering passage of legislation prohibiting use of participation in Maintenance of Certification as a reason to exclude a physician from hospital staff appointment or from insurance company physician panels. [4] [5]

Medical community

Some major medical organizations gain profit from and have expressed support for the Maintenance of Certification program including the following:

Some major medical organizations do not gain profit from and do not support the Maintenance of Certification program, including the following:

Competencies

The ABMS Program for MOC involves ongoing measurement of six core competencies defined by ABMS and ACGME: [6]

These competencies, which are the same ones used in the ACGME's Next Accreditation System, are measured in the ABMS Program for MOC within a four-part framework: [7]

Studies and criticism

Some health plans are implementing programs that recognize and reward physicians who are actively participating in Maintenance of Certification activities. [8] ABMS member boards are actively working with other health care organizations to advance quality initiatives and reduce measurement redundancy through recognition of physicians' Maintenance of Certification program participation. A growing number of hospitals and health systems are beginning to use Maintenance of Certification components to engage physicians in quality improvement. Many hospitals are now endorsing and accepting certification from the National Board of Physicians and Surgeons (NBPAS) instead of ABMS board certification.

Studies suggest that board-certified physicians provide improved quality of patient care and better clinical outcomes than those physicians without board certification, [9] including a 15% reduction in mortality rate among heart attack patients treated by board-certified physicians. [10] Considering a recent meta-analysis that shows a decline in physician performance associated with the time elapsed since the physician's initial training, [11] it is essential for physicians to participate in programs such as Maintenance of Certification in order to keep current with medicine's expanding knowledge base and technical advances, and to apply this knowledge to quality improvement in their medical practice. There is, however, no evidence MOC participation has any effect on this alleged age-related decline in performance and no evidence MOC is as good as any other intervention or no intervention. Maintenance of Certification strives to help physicians and other health care stakeholders address the critical need to enhance patient safety and patient care quality. [12] There is no evidence to support any efficacy for maintenance of certification in enhancing patient safety and patient care quality. It is important to recognize the extensive conflicts of interests in studies funded by and performed by ABMS and specialty board employees.

Studies have shown that a physician's ability to independently and accurately self-assess is poor, [13] that more clinical experience does not necessarily lead to better outcomes of care [14] and that fewer than 30% of physicians examine their own performance data and try to improve. [15] The MOC program structure strives to address these concerns with a sound theoretical rationale via the six ACGME competencies framework and a respectable body of scientific evidence, and to address its relationship to patient outcomes, physician performance, validity of the assessment or educational methods utilized and learning or improvement potential. [16] A study presented at the AcademyHealth conference in June 2013 found a correlation between an MOC requirement and reduced cost of care and emergency department visits; this paper is currently under review. There are no data suggesting MOC is in any way superior to a number of self-assessment programs, sponsored by physician specialty societies, that are significantly less expensive than MOC.

See also

References

  1. ↑ "Qualified Maintenance of Certification Program Incentive Entities for 2012" (PDF). Centers for Medicare and Medicaid Services. 2012. Archived from the original (PDF) on 27 September 2012. Retrieved 30 March 2013.
  2. ↑ Puffer, J. C.; Bazemore, A. W.; Newton, W. P.; Makaroff, L.; Xierali, I. M.; Green, L. A. (2011-09-01). "Engagement of Family Physicians Seven Years Into Maintenance of Certification" (PDF). The Journal of the American Board of Family Medicine. 24 (5): 483–484. doi: 10.3122/jabfm.2011.05.110170 . ISSN   1557-2625. PMID   21900427 . Retrieved 2025-03-30.
  3. ↑ Levinson, Wendy; Holmboe, Eric (2011). "Maintenance of Certification: 20 Years Later". The American Journal of Medicine. 124 (2): 180–185. doi:10.1016/j.amjmed.2010.09.019.
  4. ↑ "An Act" (PDF). Retrieved 7 July 2024.
  5. ↑ "HB 2304 - Missouri 2016 Regular Session". Open States.
  6. ↑ "Based on Core Competencies - American Board of Medical Specialties". www.abms.org.
  7. ↑ "Four-Part Assessment - American Board of Medical Specialties". www.abms.org.
  8. ↑ Four National Health Care Organizations to Use American Board of Internal Medicine (ABIM) Board Certification Tools in Their Physician Recognition Programs. American Board of Internal Medicine press release, August 7, 2007.
  9. ↑ Chen J, Rathore SS, Wang Y, Radford MJ, Krumholz HM (2006). "Physician board certification and the care and outcomes of elderly patients with acute myocardial infarction". J Gen Intern Med. 21 (3): 238–44. doi:10.1111/j.1525-1497.2006.00326.x. PMC   1828098 . PMID   16637823. However Close examination of this article discloses that the difference is minor, the type of data used is of poor validity and indeed, cardiologist care was much better than any internist group.
  10. ↑ The Certification Status of Generalist Physicians and the Mortality of Their Patients After Acute Myocardial Infarction. Academic Medicine 2001 October; 76(10) Supplement:S21-S23.
  11. ↑ Choudhry NK (February 2005). "The Relationship between Clinical Experience and Quality of Health Care". Annals of Internal Medicine . 142 (4): 260–273. doi:10.7326/0003-4819-142-4-200502150-00008. PMID   15710959. S2CID   15129824.
  12. ↑ The Role of Physician Specialty Board Certification Status in the Quality Movement Archived 2007-09-28 at the Wayback Machine . Journal of the American Medical Association (JAMA). 2004 September; 292(9):1038–1043.
  13. ↑ Davis DA, Mazmanian PE, Fordis M, Van Harrison R, Thorpe KE, Perrier L (2006). "Accuracy of physician self-assessment compared with observed measures of competence: A systematic review". JAMA. 296 (9): 1094–1102. doi:10.1001/jama.296.9.1094. PMID   16954489. S2CID   2637137.
  14. ↑ Eva KW, Regehr G (2008). ""I'll never play professional football" and other fallacies of self-assessment". J Contin Educ Health Prof. 28 (28): 14–19. doi:10.1002/chp.150. PMID   18366120.
  15. ↑ Choudhry NK, Fletcher RH, Soumerai SB (2005). "Systematic review: The relationship between clinical experience and quality of health care". Ann Intern Med. 142 (4): 260–273. doi:10.7326/0003-4819-142-4-200502150-00008. PMID   15710959. S2CID   15129824.
  16. ↑ Audet AM, Doty MM, Shamasdin J, Schoenbaum SC (2005). "Measure, learn, and improve: Physicians' involvement in quality improvement". Health Aff (Millwood). 24 (3): 843–853. doi:10.1377/hlthaff.24.3.843. PMID   15886180.
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