ACC Response to ABIM’s MOC Requirements

As part of the College’s ongoing efforts to address the American Board of Internal Medicine’s (ABIM’s) new Maintenance of Certification (MOC) requirements, the ACC has developed the following response that takes into account member feedback over the last several months and outlines the College’s commitment to improving the process moving forward. This response was unanimously approved by the ACC’s Executive Committee and Board of Trustees. As stated in the document, the ACC’s commitment to its members and their patients remains steadfast. Advocating for our members to assist them in the provision of professional, knowledgeable and compassionate care, coupled with demonstration of ongoing competence, will continue to guide our actions and fulfill our obligations to society.

 ACC Response to the ABIM’s MOC Requirements

The ABIM instituted significant changes to its MOC process on January 1, 2014. The modifications apply to all physicians, including those who received life-time certification prior to 1990 (“grandparents”), and mandate completion of any MOC activity every two years, accumulation of 100 MOC “points” distributed between Part II and Part IV activities within five years, completion of patient survey and patient safety activities, and passing a secure examination every 10 years. The revisions of standards initially established in 2006 have sparked heated discussions across the entire ACC membership and have called into question the validity, relevance, utility, and associated financial and opportunity costs of meeting these revised MOC requirements. ACC members have clearly expressed their frustration and dissatisfaction with the process and have proposed several alternative approaches. This communication is intended to state the ACC’s position on MOC and provide a strategic framework for College initiatives to improve the process.

As background, it is important to share the results of a member survey commissioned by ACC and distributed through our state chapters in the spring of 2014. The survey was completed within four weeks by over 4,400 members (12 percent of the total solicited). Nearly 90 percent of respondents opposed the changes to MOC, citing, among multiple concerns, higher than expected costs. Nearly a third of respondents indicated that the changes will affect their future career plans and will likely accelerate career decisions such as early retirement, part-time work, or transition to non-clinical work. Approximately one-quarter of physicians in practice for 15 years or more specified that early retirement was a probable outcome. Recommended process revisions included reverting to the 2006 standards, removing various MOC parts (II, III, or IV), or having ACC assume certification responsibilities. No single process revision was chosen by more than 50 percent of respondents. A significant majority (68 percent) did recommend that ACC work with ABIM to revise the requirements. There was a strong request for ACC to make more MOC modules available and more easily accessible.

The ACC recognizes that the ABIM’s mission as a standards-setting organization differs from its own mission as an educational organization. The ACC strongly supports the ideals of lifelong learning and continuous professional development. The College and its members are acutely aware of the need to continuously maintain the public trust by transparently demonstrating ongoing competence as guided by the principles of high value patient care. Our membership holds itself to the highest professional standards. The ACC is an educational organization in which the ongoing learning of our members is accorded strategic priority. Educational activities must be designed and delivered in ways that enhance provider performance and improve patient outcomes.

The ABIM-imposed changes in the MOC process have called into question the optimal methodology for achieving the intertwined goals of lifelong learning and high value care.

In response to these changes and our members’ concerns, the ACC commits to the following:

  • Ongoing, discussions with ABIM leadership, in partnership with other cardiovascular professional organizations whose members are similarly affected, to review these issues and to explore changes in MOC requirements that will result in more meaningful outcomes and less onerous burdens for ACC members;
  • Request for ACC representation at ABIM to participate in discussions involving MOC, including its educational and financial aspects;
  • Review of the evidence base underlying current recommendations;
  • Investigation of impact of MOC changes on non-ABIM certified members;
  • In the interim, ACC will support its membership by:
  • Free provision of web-based MOC modules and navigation tools to ACC members;
  • Expansion of Part IV MOC modules through ACC programs, such as the NCDR’s inpatient registries and the PINNACLE Registry;
  • Creation of mechanisms for ACC members by which patient safety and patient survey requirements can be efficiently fulfilled;
  • Bidirectional communication with and engagement of membership through Chapters, Sections and Councils.

In order to begin this process, the ACC President, Chief Executive Officer, and Executive Vice President for Science, Education, and Quality met personally on May 27, 2014 with the Chief Executive Officer of the ABIM in his offices in Philadelphia, PA.

The College’s commitment to its membership and their patients remains steadfast. Advocating for our members to assist them in the provision of professional, knowledgeable and compassionate care, coupled with demonstration of ongoing competence, will continue to guide our actions and fulfill our obligations to society.

 

49 thoughts on “ACC Response to ABIM’s MOC Requirements

  1. Please stop the ABIM racketeering scheme! Taking the boards every ten years and CME for the rest of our careers after 14 years of training should be more than enough. Stop this madness.

  2. Very well done
    We must continue to press Abim for more realistic and manageable expectations which take into account busy practice and research commitments. The acc must continue to press Abim to allow us to aid in the rehaul of the entire program which was I’ll conceived from the get go.

  3. Once again and despite an overwhelming mandate from the membership our leadership chooses appeasement over principled action. Our leaders should lead, not play politics with our profession. Tougher tactics are required to protect our integrity, which must never be on any table. My advice is to simply say NO. The sum of our individual decisions will triumph de facto if not de jure.

  4. All is needed is an exam every ten years. Patient surveys and such is a waste of our time. Annual CMEs are already required for licensing

  5. I liked the changes suggested by ACC. Sooner they are
    accepted and applied will be better for busy cardiologists.

  6. Now is the time….
    Repeat out loud after me: I’m mad as hell and I’m not going to take it anymore!
    Leadership ignores membership.

  7. I believe the SAP modules and questions are good for maintenance of certification and can be done on line. I believe the practice improvement points can be done in a better way looking at processes in the hospital with cardiologist improving patient care such as shorter door to balloon times or emergency room bypass for acute myocardial infarction. I believe the secured test, if required ,can be done on line with appropriate validation of identification. The expenses involved with current recommended MOC process are too expensive and onerous for a busy physician. Simplification of on line testing with immediate feedback would decrease the cost and improve the compliance of those of us who are interested in recertification . I appreciate the ACCs efforts in this regard Matthew Glover MD FACC

  8. The board certification and recertifcation process has not only become financially burdensome, but difficult to manage, esp. in the current healthcare environment, where more is expected from physicians for less. I have several concerns:
    1. Who authorized ABIM to institute and later unilaterally change the certification rules?
    2. Who get’s nominated/elected to the board? Is there a democratic process involving physicians or their representatives?
    3. The entire process reeks of a moneymaking scheme!
    4. A fair process to ensure continuing education of all physicians must be found.

    I suggest, if annual MOC completion is required, include it in CME activities in form of post-test questionaires AND eliminate recertification exams.
    Make MOC/recertification voluntary, but reward physicians with higher reimbursement for participation in MOC//recertification. The difference in reimbursement must be significant and may be achieved through a combination of lower reimbursement to nonparticipants and higher reimbursement to participants.

  9. Completion of a fellowship program should be enough to practice cardiology. Requiring Board Certification on top of that implies that our training programs are not trusted to produce good cardiologists. In addition passing or failing a multiple choice exam does not reflect how good or bad a practitioner is. In the real world, If a cardiologist is not good he will not have a good practice and hospitals will not let him practice in the hospital.

  10. I’d like to thank the ACC for listening to its members. We have chosen the profession that requires lifelong commitment to learning. In our daily work, we interact with each other, depending on the ACC educational opportunities to help us stay abreast with changes and deliver the best care possible. I am anxiously awaiting the final outcome of continued cooperation between the ACC and the ABIM in this very important matter.

  11. Basically this is a highly unpopular program which casts great concern on the previous attempts at recertification. I am totally unaware of any peer reviewed data that can scientifically suggest that this is anything close to being worth the cost. The idea of continuing education is certainly a primary goal of the ACC and has been for it’s entire existence (long before recertification). My sense is that we need to do something more drastic such as withdrawing entirely from their organization. I suspect we are not the only subspecialty that feels this way. I do not see a future in negotiating with them. Most of their support I am positive is based on relatively bright people not believing in what is being done but simply agreeing in order to avoid any conflict or any economic hardship. Basically show some controlled data that shows that even the previous system of recertification results in better physicians or Cardiologists.

  12. It’s uplifiting to learn that the ACC has heard loud and clear the concern of its members. Every cardiologist and ABIM certified non-cardiologist I’ve spoken to are outraged by the ABIM’s decision. Continuous MOC added to an exam feels like institutionalized extortion enforced by shame by a private, for profit entity that hasn’t done anything to justify its requirements. This is not mention the hypocrisy of ABIM execs who argue recertification is neither expensive nor time consuming, yet have not chosen to go thru the expense and aggravation themselves. The ABIM is unaware of the multiple board certifications that many cardiologists maintain, from IM to nuclear, ECHO, interventional, EP, and HTN. I for one, hope that the ABIM takes the message from the ACC seriously, and if not, it is perhaps the duty of the ACC to herd its members under its own umbrella via a separate certification pathway. Worse than the expense and inconvenience of certification is the lack of confidence and trust I’ve felt for the ABIM. Thanks for all your help. Good luck and keep up the good fight,
    Mike

    • The ACC has not heard any of the complains like you seem to think. They are just going to present the same requirements with different labels, and they will strike a deal with the ABIM to share some of the money with them, so the physicians get screwed any way, and ACC and ABIM will continue their multi-million dollar industry anwyay..

  13. 1) ABIM MOC system was created to charge physicians extra fees. I have 3 boards, that means I have to pay $480 a year to use ABIM site for one hour every year to read couple of questions (MOC).
    2) The amount of material available for free is limited, if you want to use MOC from ACC you have to pay extra!
    3) They should take the re certification exam out. It does not make sense to keep the re certification exams with MOC. either-or.

  14. The arrogance of the ACC and ABIM is nauseating. All the ACC is going to do is leverage the survey’s 90% dissatisfaction rate to get their piece of the pie.
    They will strike a deal with the ABIM and sell ACC members down the river like they did with OBAMACARE. Thats worked out great for ACC members so far,huh!!!! They did so well with that problem we’re certainly going to trust the ACC to handle this problem…..only looking out for the members not themselves.
    A power grab by bureauocrats to see which group can control us and take our money to pad their own pockets is all this is. Get out of the way and let us practice medicine. This is not the time to mess with the practicing physician.
    Leave us the hell alone.

    • The arrogance of the ACC and ABIM is nauseating. All the ACC is going to do is leverage the survey’s 90% dissatisfaction rate to get their piece of the pie. They will strike a deal with the ABIM and sell ACC members down the river like they did with OBAMACARE. Thats worked out great for ACC members so far,huh!!!! They did so well with that problem we’re certainly going to trust the ACC to handle this problem…..only looking out for the members not themselves. A power grab by bureauocrats to see which group can control us and take our money to pad their own pockets is all this is. Get out of the way and let us practice medicine. This is not the time to mess with the practicing physician. Leave us the living heck alone.

  15. The arrogance of the ACC and ABIM is nauseating. All the ACC is going to do is leverage the survey’s 90% dissatisfaction rate to get their piece of the pie. They will strike a deal with the ABIM and sell ACC members down the river like they did with OBAMACARE. Thats worked out great for ACC members so far,huh!!!! They did so well with that problem we’re certainly going to trust the ACC to handle this problem…..only looking out for the members not themselves. A power grab by bureauocrats to see which group can control us and take our money to pad their own pockets is all this is. Get out of the way and let us practice medicine. This is not the time to mess with the practicing physician. Leave us the heck alone.

  16. I oppose the changes the ABIM has imposed. There has been no demonstrated value in terms of quality of patient care by MOC. We all pursue updates in our education by journal reading, meetings, grand rounds, journal clubs and CME for ongoing accreditation of nuclear labs and echo labs. We already do much more than most professions. We are all highly motivated to deliver quality care for our patients.

  17. Acc commitment is not to patients, it’s to make money. Clear and open black mail by a rogue administration. Lets have the ACC admin staff take yearly MOC to show their commitment to the US people. What a sham!

  18. I applaud the ACC for its statement. As a Fellow, I look to ACC for leadership in my continuing education. The MOC requirements are onerous and as alluded to in the ACC recommendations, may not have any evidence to support this drastic change. Without a definitive indication that those “grandfathers” are not maintaining and improving with CME that they are required to do for license requirements, I see this as a way to extract money from physicians. The patient safety and quality aspects are also redundant with many activities required of hospitals and larger practices. Documentation of those ongoing activities is justifiable, as opposed to starting these de novo for an organization without any authority for clinical quality, such as CMS. One suggestion I have is that taking any sub sub specialty boards since original certification be a criteria for exemption from MOC. If you have sat for Echo, EP, Nuclear or HF Boards or have gotten re-certified in any of these areas (through ABIM), that should be sufficient. The fees for those exams alone should meet the apparent financial needs of ABIM.

  19. This entire process is confusing, burdensome, and expensive. The draconian way the ABIM set forth new requirements demonstrates a lack of insight into the time burdens that physicians find themselves. The lack of communication congruence between ACC and ABIM has lead to much confusion. The websites are disorganized and do not present a clear and concise list of requirements. They do not show what has already been achieved. For those of us with mutiple board certifications, the burden is magnified exponentially by the disorganized and opaque websites, multiple communications and warnings from both ACC and ABIM. Frankly, it looks like something a typical government agency put together…

  20. Woefully inadequate response to the position of those of us who achieved ” lifetime ” certification prior to 1990 ! The ACC leadership’s position on this issue is analogous to the Congressional leadership’s position on ” guaranteed ” lifetime retirement and healthcare benefits for military retirees.More precisely, take the politically correct position rather than the morally and honorably correct position! You have lowered the BAR of excellence set and maintained by the COLLEGE since its inception!

  21. We are pushed to the limit in time. The EMR/EHR now imposed has doubled to tripled our patient time on hospital rounds. Hospitals are pushing educational expenses back toward us, incomes are declining and our aging bodies now longer can spring back after a “brutal” night on call. I appreciate education and excellence like no other but some of these exercises in practice improvement, etc. do not improve us as practicing physicians and simply cannot be accomodated within the chaos of our lives. I’m 60 years old. I love the practice of EP but can no longer exist “viably” under the extreme demands of my professional life. I feel that I am near the top of my intellectual and procedural skills but, unfortunately, am being crushed to surviving to the weekend (if I’m not on call). I’m reducing my workload to “60%” next month with plans of exiting in 3 years or less.

  22. I studied the ACCSAP 8 fully. I worked very hard with a busy practice. I took the rectification exam by the ABIM.
    I felt the ACCSAP 8 did not prepare me for the examination.

  23. The stress and strain of an already-challenging specialty, interventional cardiology, has been more than doubled by ACC/ABIM/MOC, and the pathetic destruction of medical practice by “guidelines” forcing electronic medical records between my patients and myself. Even with nurse practitioners and other extenders hired by us, hospital rounds now compete with visiting the drivers license office for sheer frustration and nonsense. Communication and pleasing encounters have never been more difficult. The drop in reimbursement rates is only a minor irritant.
    My wife and children actually thank you for accelerating my journey towards retirement. Thank you.

  24. recertification should involve a minimum amount of CME and board exam. Academicians seem clueless in the struggles private practioners go through to simply maintain a viable practice and keep hospital privileges

  25. This seems to be another way for the ABIM to extort money from older practitioners. If they are really serious about their mission to maintain competence, there should be no (or minimum) cost for those of us who are doing largely charity work.

  26. A laudable baby step by ACC which took a long time coming. It would be nice to begin the discussion by acknowledging the ABIM proposal for what it is in plain terms. It is a business model designed to generate profit through the expedient and trusted means of coercion and monopoly. It needs to be rejected. Our efforts are directed towards maintaining competence through education. This goal is best achieved by keeping the process simple. The 10 year recertification exam achieves this objective in large measure. It can be supplemented by requiring a certain number of CMEs every 2 years in designated specialty specific subjects. Access to these CMEs should be available to practitioners from the widest possible variety of sources. This would coincidentally dovetail nicely with most state board licensing requirements. The choice of CME source material and consequently its expense must devolve to the individual physician’s discretion. Competition in the marketplace would then play a role in keeping prices in check. ABIM is welcome to compete as a participant in this market but not as the sole proprietor of the only store in town. The process outlined would be simple, accessible, and importantly, would achieve the objectives that all responsible physicians aspire to in our professional lives.

  27. Prior to leaving clinical practice I completed 100 MOC points several years ago. I continue to work part time but in a different capacity and have no patient contact of any kind. As I understand it patient surveys and patient safety modules continue to be part of the MOC. Without a clinical practice these mandatory parts of the MOC don’t work for semi-retired physicians like myself who no longer have a practice or care for patients in any capacity. On a second point, I am grandfathered in general cardiology and have never retaken the exam. But about 6 years ago I successfully passed the Nuclear Cardiology boards and 3 years ago I passed the Coronary CT boards. These boards will need to retaken at their appropriate time. Under the new terms of the MOC requirements I will now have to re-certify in general cardiology as well. This is a lot for any Cardiologist who works full or part time and especially someone no longer caring for patients in any capacity. There should be a special pathway for physicians like myself.

  28. I’m 54 years old and just finished recert in November. I will continue to obtain at least 20 hrs of cme yearly as required by my state for license renewal. The abim can kiss my butt if they think I’m going to do all the crap they’ve mandated and take another big test in 10 yrs. This is nothing more than a money grab and I refuse to participate!!

  29. I am a strong supporter of ACC, its commitments, its mission and its values. Thank you ACC for your efforts over the years to provide ongoing/lifelong learning to your members and to maintain your members’ education at the highest professional standards for the sake of patients’ safety and best medical care.

  30. Thank you for taking some action in our favor.
    Late last year I sent an email to ABIM ( with the approval of all my 8 partners ) complaining about the inadequacy of the MOC program in maintaining and updating cardiovascular knowledge when compared with learning from the experts. I believe that CME system either live or on line is far superior than the MOC system. I learned how, when, and in which instance to do angioplasties from Gruntzig. MOC programs will never teach you how to improve your skills and knowledge.

  31. Its unfortunate that only 12 percent of the total solicited members completed the survey. Does it mean that other members simply do not care or they do not believe that ACC can influence ABIM to revise the MOC requirements.

  32. MOC changes are ridiculous sub specialists will be certifying all year every year ABIM needs to find other ways to make money btw when we originally worked and paid for “lifelong” certification this is what we were promised by the ABIM why is this not a breach of contract??

  33. Thank you ACC, for your efforts.
    Ongoing professional education is important for all, especially those that are ‘gradfathered’.
    However, 10 MOC points per year are plenty.
    = 50 every five years = 100 points every decade
    Also, simplify the non-medical knowledge portion of the requirements by using emr and hospital data. It must be an efficient & less time consuming
    Taking Recertification General Cardiology boards in segments;
    Example, if a member took an MOC segment in HF, EP & valves over a 5 year period, let them take that portion of the exam at 5 years; prorate the cost of the exam.
    Advantage: members will be able to read in more depth, gain more updated knowledge and see the relevence of MOC immediately.
    However, cost to member should not increase.

  34. The ABIM has unfortunately transformed itself into an opaque quasi-regulatory organization whose recent sloppy decision to subject physicians to odious “recertification” burdens, at a time when the profession is already under massive amounts of redundant oversight, has provoked a violent reaction from physicians across the nation. There is no reason why we, as cardiologists, need to be subjugated by the ABIM. I would suggest that the ACC, HRS, TCT organizations, who have all had a strong track record supporting clinical activity and clinical physicians, lead the effort to offer our own recertification process totally independent of the ABIM. Why do ACC members need ABIM certification when the Steering Committees for the Cardiology Exams are all ACC members anyway? The ACC has the resources, the background and the talent to construct our own Board Certification process that is more economical, more relevant, less onerous, more common sense filled, and most importantly more respectful of our sub speciality. I find it oxymoronic that the ABIM leadership relies on overpaid, aloof non-clinicians to adjudicate what makes a competent cardiologist, interventional cardiologist, cardiac electrophysiologist and transplant cardiologist. I would like to appeal to my colleagues, peers and friends to lobby the ACC to construct an independent Board Certification process that is not reliant on the ABIM.

  35. The IRS Form 990 for the ABIM is public domain data and examination of the financial abuses at the ABIM is really disappointing and galling.

    http://www.propublica.org/article/payments-to-ceo-raise-new-conflicts-at-top-health-quality-group

    https://bulk.resource.org/irs.gov/eo/2012_03_EO/23-2585181_990_201106.pdf

    There should be no distinction between the ABIMs “standard setting” mission and the ACCs “educational” mission. Quite frankly, the ACC’s adjudication of what is clinically relevant is the major component for what is “standard” of care in our nation. The ABIM is a broker to disseminate examinations based on the ACC standards and statements. Why do we need the ABIM as the middleman? Why is the ABIM imposing layers of regulatory burden when the ABIM’s own leaders refused to be re-certified themselves with their own processes for years and years?

    I find it disappointing that the ABIM CEO’s salary is higher than the average neurosurgeon or cardiothoracic surgeon.

  36. As a solo cardiologist with more than 25 years of clinical experience, I find the changes of certification requirements to be an unnecessary,odious burden which has been laid upon us. We have had so many difficulties with the overall hostil landscape that we all deal with,that it becomes even more resentful when our own parent organizations place even more weight on our shoulders. I applaude the efforts of the ACC in trying to help remove these most recent changes imposed by the ABIM.

  37. I appreciate ACC leader ship showing ,interest in trying to solve the hardships re: MOC
    how much more should we be doing
    Iam already complying with state boards, every 2 years CME requirement
    every 10 years, of primary boards,interventional cardiology ,nuclear medicine , echo boards , ekg geriatrics and critical care medicine,un known hours of daily journal reading
    If this much education is enough for ABIM to care for the patients,adding moc requirement is going to do it

  38. On the street, those who did not care to respond to the survey are the ones who have no intention of participating in MOC or recertifying. Your results are thus skewed in a much more positive light , and perhaps not an accurate snapshot of our current situation.
    As such, I recommend that you monitor the true percentage of ACA members enrolled in MOC. If enrollment is less than what is predicted, please pay attention and demand that ABIM rectify this process. Thank you. -B Floyd

  39. I am 63 yrs old. I am recertified third time in cardiovascular board exam. I am board recertified until 2012. You want me to take exam again near 201or 2019 if I want to continue to be recertified. It is not acceptable . I think I should be grandfathered now that I should be recertified forever since I am maintaining the certification.After certain age, you should give us break. I do not mind doing modules to keep in touch with topics and updates. you should not force us to continue taking recertification exam every 10 yrs and patient satisfactory survey etc. Thank you for giving me an oppertunity to express my opinion.

  40. Very poor response by ACC. I expected so much more from my specialty organization than to play second fiddle to ABIM. Their game is to give us the same crap the ABIM is dishing out, but just labelled differently. Obviously the money that ABIM is making from this business is being shared by those in ACC. The only respectable organization so far has been the AACE (Endocrinology) which has stood by its members. I dont think I want to support ACC anymore, I dont think I should pay their stupid $1000 a year and also get this no-support crap from them, I dont need their FACC either. This is the worst specialty organization and so called leaders I have seen.

  41. This response demonstrates the sorry state of the ACC today and its unwillingness to fight the status quo for the benefit of its members. As we were thrown under the bus with Obamacare, we are being thrown under the bus again to the benefit of no-one but the ABMS/ABIM. The ACC hopes to make MORE money off of us by selling modules they should be fighting against. I am disgusted by the self-serving executives of the various societies who have given up on ethics and serving in the interests of patients and doctors.

    We need a national movement of physicians who will rebel against this money grab. I dropped out of the AMA years ago because of this kind of disingenuous posturing, and the I am afraid the ACC is next.

  42. I have certified and rerecertified in both cardiology and interventional cardiology twice. I think that plus my initial internal medicine certification is plenty of funds for the ABIM and MOC . Regarding , maintaining my skills and knowledge base , I am required to have 80 hours of CME every two years which is plenty . If none of us sign up the MOC process the certification becomes meaningless and this all ends. We have sat by a watch our profression be degraded by governmental EMR mandates, insurance companies requirements all while reimbursements and available time for patient care is washed away. If I had wanted to spend my time with EMR data entry, arguing with insurance companies for approvals to preform service that are for the patients I serve , I would have gone in to computer technology or law. Now is the time to stand up !! If now then when.?

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