MOC: Debate intensifies as Medicare penalties loom
If you want to spark a debate, just ask a physician about maintenance of certification (MOC) requirements. The reaction often is visceral. The rules are designed to create a culture of continuous improvement in practice, but they can be confusing, costly, and time-consuming. In 2015, Medicare penalties are on the way for not participating in the Physician Quality Reporting System (PQRS). MOC is included in PQRS.
Today, many physicians are fighting the requirements, with one medical group going so far as to file a federal lawsuit (see sidebar: Maintenance of Certification spurs federal lawsuit), while many others are trying to make the best of it, looking for ways to make the experience easier and more valuable to them. Medical Economics recently asked a variety of experts on the subject for their advice on how physicians can make that goal a reality.
Working with your medical society, partnering with colleagues when appropriate, looking for ways to piggyback data collection onto projects you are already doing, and taking the time to really understand the requirements associated with MOC were among the top suggestions.
Strength in numbers
Eric Holmboe, MD, chief medical officer for the American Board of Internal Medicine (ABIM), suggests that in addition to availing themselves of the many ABIM online modules, physicians take advantage of the numerous opportunities offered by their medical societies to complete Part II assessments. Organizations such as the American College of Physicians and the American College of Cardiology are incorporating modules that meet Part II requirements at their annual meetings.
“Physicians can often complete questions online right after attending one of these sessions,” he says.
Some societies present the ABIM modules in a setting in which a group goes over the materials with an expert and they discuss the questions together, then go on the ABIM portal to enter them, he says. Similarly, the members of a group practice can work on the modules together, he adds.
Robert Phillips, MD, MSPH, vice president of research and policy at the American Board of Family Medicine (ABFM), says ABFM is working closely with state family medicine chapters, supporting their efforts to help members work together on self-assessment modules and quality improvement measures, at annual meetings and throughout the year.
“Physicians in these pilot programs have enjoyed it a lot more and do not feel so alone,” he says. “This also draws more attendees to the state meetings, which is an added bonus.”
Study up on the exam
For Part III, the exam, Holmboe suggests physicians avail themselves of the board preparation materials that makes the most sense for their learning style and needs.
He also recommends that physicians review the “blueprints” of the exams that are posted on the ABIM Web site for each specialty. These blueprints show how much of each content area is represented on the exam. Having this information may help a physician decide where to focus his or her studying efforts.
Make it a team effort
For Part IV, practice performance assessments, Holmboe says the principle of working with others applies here as well when using the ABIM’s Web-based practice improvement modules (PIMs).
“There is no reason a physician has to enter all of the data,” he says. “Staff members can do it too. Most questions collect primary data, such as blood pressure readings, so it is not too complicated to enter much of the data into the PIMs, but it does take time.”
He also recommends working with colleagues if you are in a group practice. “This makes it easier for the practice to incorporate the practice improvements that are discussed,” Holmboe says. “Quality improvement really is a team sport.”
Doing the performance improvement modules as a group also cuts down on the number of charts required per physician, he adds.
Interpreting data received from the module can be overwhelming at first, Holmboe says. Again, working with an experienced peer who can coach you through the process can be a big help.
Mark Malangoni, MD, associate executive director of the American Board of Surgery, agrees.
“If patient care activities are provided by a team, it may make sense to look at outcomes as a group,” he says. “It is not about assigning blame, but about finding ways to improve patient care.”
Don’t be repetitive
Holmboe notes that Part IV isn’t limited to practice improvement modules. If your practice already receives performance data from a health plan or other validated source, it can be used to meet MOC requirements and trigger a quality improvement metric as well.
“If you have already gathered data like this in the past 2 years, you can leverage it to complete your project more efficiently,” Holmboe says.
Accepted Quality Improvement Pathways are another option. If your institution has submitted an approved project, a physician can attest that he or she was involved in it and get MOC credit. This is most commonly seen in a large practice or hospital setting, he says.
Many societies also offer registries that physicians can join to make the process easier, Holmboe says.
“Our goal is to align activities and reduce redundancy and let physicians do things that are meaningful and relevant to their practice,” he says.
Help is coming
Holmboe notes that in 2014 the ABIM is changing its MOC program to make it easier for physicians to know what they need to do to be current at any time. Starting in January, each physician will have a customized Web portal available that clearly explains his or her status.
“This portal will know you and will lead you to ways to complete MOC in your discipline,” he says.
Phillips says ABFM is working to align MOC requirements with other programs so that physicians face less repetition in reporting.
“ABMS (the American Board of Medical Specialties) is a Physician Quality Reporting System (PQRS)-certified registry, and we are trying to let MOC efforts qualify physicians for the PQRS bonus payments. This means reviewing 30 charts instead of 10, because Medicare requires 30 and the Board requires 10 for the quality improvement (Part IV) MOC requirement. This helps physicians meet both reporting needs with one effort and makes quality improvement easier,” he says.
Assistance with achieving Meaningful Use
Phillips also says ABFM is trying to help members achieve meaningful use by identifying ways to gather the data they need from their electronic health records (EHRs) so that they do not need to extract and report it multiple ways, multiple times, for multiple reasons. ABFM has set aside $2 million to build and find tools to help physicians turn their EHR data into information that helps them improve patient care and can reduce their quality reporting burdens.
“We are working to give them a way to identify the patients they need to work with,” he says. “It’s not just about giving data to the board or Medicare; it is about helping unlock their EHR data for their use. Even meaningful-use certified EHRs don’t always have the tools to do this. We are trying to find a way to help the doctors that will be low or no cost to them.”
Think of the money and outcomes
Malangoni encourages physicians to view MOC as a fact of life, especially as it has become increasingly tied to financial incentives, he says. The Centers for Medicare and Medicaid Services (CMS) is paying bonuses to physicians who participate in MOC in 2013. Those reverse and become penalties for failure to participate in 2015.
“This makes participation exceedingly important,” he says. “It is affecting multiple disciplines, from MDs to DOs, as well as podiatrists.”
He adds that physicians who are board-certified perform better in practice and are less likely to be involved in a malpractice lawsuit. MOC is simply changing certification from being a “snapshot in time” to being an ongoing process, he says.
“Physicians now need to document in four areas that they have stayed involved in learning activities between examinations,” Malangoni says. “All you are doing is documenting that you have met your board requirements for lifelong learning and practice performance improvement, nothing more.”
Know the specifics of what’s required
Malangoni encourages physicians who are feeling overwhelmed about MOC to thoroughly educate themselves about their boards’ requirements. “Much of the anxiety about this relates to misinformation and confusion. Familiarizing yourself with the specifics is one of the most important things you can do,” he says.
“Often when we are frustrated, we spend a lot of time and energy figuring out how to get out of doing what we will end up having to do anyway. Don’t risk letting your certification lapse. Learn the requirements. Ask your colleagues what they do,” he says.
All of the boards have help available, via phone or email, or on their Web sites, as do many specialty organizations, he adds.
Each board has its own approach to the Part IV requirements (practice performance improvement), he says. For example, many surgical boards have registries into which physicians can enter their data and get comparative results back.
“The idea isn’t just to enter information. It is to get this information back and analyze ways to improve your practice, make changes, and re-analyze the updated data,” Malangoni says. “It becomes a continuous quality improvement loop that is extremely important.
“The real principle is that by doing these types of activities, physicians will better stay abreast of changes in care that can be slow to reach them. It also links lifelong learning to practice improvement,” he says.
It is important to customize your MOC experiences, he says, particularly continuing medical education attendance, to match what you do in your practice. Don’t waste your time at classes that cover an area in which you do not practice, he says.
American Board of Medical Specialties
Licensure and Professional Standings
Medical specialists must hold a valid, unrestricted medical license in at least one state or jurisdiction in the United States, its territories, or Canada.
Lifelong learning and self assessments
Physicians participate in educational and self-assessment programs that meet specialty-specific standards that are set by their member board.
Physicians demonstrate, through formalized examination, that they have the fundamental, practice-related and practice environment-related knowledge to provide quality care in their specialty.
Practice Performance Assessment
Physicians are evaluated in their clinical practice according to specialty-specific standards for patient care. They are asked to demonstrate that they can assess the quality of care they provide compared to peers and national benchmarks and then apply the best evidence or consensus recommendations to improve that care using follow-up assessments.