Final ‘Vision’ report addresses MOC woes

Whatever you do, change the name.

That was key among the final recommendations the Vision Initiative Commission submitted to the American Board of Medical Specialties on how to improve the maintenance of certification process.

“A new term that communicates the concept, intent, and expectations of continuing certification programs should be adopted by the ABMS in order to reengage disaffected diplomates and assure the public and other stakeholders that the certificate has enduring meaning and value,” according to the final report. A new term was not suggested.

The commission recommended a continuing certification system with four aims:

• Become a meaningful, contemporary, and relevant professional development activity for diplomates that ensures they remain up-to-date in their specialty.
• Demonstrate a commitment to professional self-regulation to both diplomates and the public.
• Align with international and national standards for certification programs.
• Provide a specialty-based credential that would be of value to diplomates and to multiple stakeholders, including patients, families, the public, and health care institutions.

Testing methods and situations must be simplified and updated, according to the report, which was submitted to ABMS on Feb. 12. Continuing certification “must change to incorporate longitudinal and other innovative formative assessment strategies that support learning, identify knowledge and skills gaps, and help diplomates stay current. The ABMS Boards must offer an alternative to burdensome highly secure, point-in-time examinations of knowledge.” In addition, the boards “must no longer use a single point-in-time examination or a series of single point-in-time assessments as the sole method to determine certification status.”

 

Instead, the commission recommends that ABMS “move quickly to formative assessment formats that are not characterized by high-stakes summative outcomes (pass/fail), specified time frames for high-stakes assessment, or require burdensome testing formats (such as testing centers or remote proctoring) that are inconsistent with the desired goals for continuing certification – support learning; identify knowledge and skills gaps; and help diplomates stay current.”

The commission also defined how the certification process should be used by other stakeholders.

“ABMS must demonstrate and communicate that continuing certification has value, meaning, and purpose in the health care environment,” the report states. “Hospitals, health systems, payers, and other health care organizations can independently decide what factors are used in credentialing and privileging decisions. ABMS must inform these organizations that continuing certification should not be the only criterion used in these decisions, and these organizations should use a wide portfolio of criteria in these decisions. ABMS must encourage hospitals, health systems, payers, and other health care organizations to not deny credentialing or privileging to a physician solely on the basis of certification status.”

Additionally, the commission report states that “ABMS and the ABMS Boards should collaborate with specialty societies, the [continuing medical education/continuing professional development] community, and other expert stakeholders to develop the infrastructure to support learning activities that produce data-driven advances in clinical practice. The ABMS Boards must ensure that their continuing certification programs recognize and document participation in a wide range of quality assessment activities in which diplomates already engage.”

The report adds that the boards “should readily accept existing activities that diplomates are doing to advance their clinical practice and to provide credit for performing low-resource, high-impact activities as part of their daily practice routine.”

 

The commission’s final report incorporates a number of changes that physicians offered based on a draft version of the report.

The American College of Physicians commented that it “objects to the use of data regarding quality measures for individual diplomate certification status, because physician-level measures of quality are flawed, and because physician-level data inevitably leads to physician-level documentation burden. Flawed performance measures also often inadequately adjust for patient comorbidities and socioeconomic status, which leads to assessments that do not reflect the actual quality of care.”

Similarly, the American Society of Hematology noted in a statement that it “disagrees with the commission’s recommendation to retain the reporting of practice improvement activities as part of continuous certification due to direct and indirect costs needed to fulfill this requirement on top of requirements for engagement in quality improvement mandated by insurers, institutions, and health systems.”

While the draft report recommended that specialty boards provide aggregated feedback to medical societies, a more individualized dissemination on the gaps in knowledge would be more helpful, according to Doug Henley, MD, CEO of the American Academy of Family Physicians, who said that a more individualized approach would help his organization better provide CME to its members to help fill in the knowledge gaps.

“If we can identify these and use other processes and then target at the individual level to seek improvement, I think that will be a better outcome rather than just x learners don’t do well in diabetic care,” he said in an interview. “That doesn’t really help me in terms of who needs the real education in diabetic care versus who needs it for heart failure.”

The final recommendation notes that ABMS member boards “must collaborate with professional and/or CME/CPD organizations to share data and information to guide and support diplomate engagement in continuing certification.”

The document further clarifies that the boards should examine “the aggregated results from assessments to identify knowledge, skills, and other competency gaps,” and the aggregated data should be shared with specialty societies, CME/CPD providers, quality improvement professionals, and other health care organizations.

One weakness in the draft noted by Dr. Henley was the lack of a more forceful tone within the recommendations. Even though AMBS is not bound by its recommendations, he said that he would like to see stronger language throughout the document.

 

“We would certainly hope that the ABMS and the member boards will follow the direction of the Vision Commission very directly and succinctly,” he said. “That is why we suggested that some of the recommendations from the Vision Commission should use words like ‘should’ and ‘must’ and not just ‘encourage’ and words like that.”

That recommendation was taken and implemented in the final document.

Societies differed in how often participation in the certification process should occur.

The American College of Rheumatology in its comments challenged a recommendation that certification should be structured to expect participation on an annual basis.

“The ACR supports the importance of ongoing learning,” it stated. “However, no discussion is provided as to how and why the recommendation for annual participation by diplomates was conceived. For some ABMS Boards, an annual requirement will increase physician burden unless continuing certification is modified to a formative pathway. If this recommendation is to be retained, the commission would be encouraged to emphasize that inclusion of annual participation should be part of an overall program structure plan that supports a formative approach to assessment. In addition, the ACR requests that ABMS Boards allow exceptions without penalty to be made to this annual requirement to all for live events.”

The American College of Cardiology took a different point of view with regard to this recommendation.

In its comments, ACC stated that it “concurs with this recommendation. Annual participation is a feature of the ACC’s proposed maintenance of certification solution. The ACC believes that ABMS boards should recognize, and make allowances for, physicians who may, for valid reasons (illness, sabbatical, medical or family issue) may not participate in MOC for a period of a year.” ACC generally concurred with the recommendations in the draft.

The final document presented the commission’s view that the ABMS member boards “need to engage with diplomates on an ongoing basis instead of every 2, 5, or 10 years. The ABMS Boards should develop a diplomate engagement strategy and support the idea that diplomates are committed to learning and continually improving their practice, skills, and competencies. The ABMS Boards should expect that diplomates would engage in some learning, assessment, or advancing practice work annually.”

The American Gastroenterological Association, in its comment letter on the draft, said it was “greatly concerned” about the inclusion of practice improvement data, noting it is “debatable whether it is even within the appropriate domain of the boards to assume responsibility for clinical practice performance and quality assurance.”

The final report states that ABMS “must ensure that their continuing certification programs recognize and document participation in a wide range of quality assessment activities in which diplomates already engage,” and added that “when appropriate, taking advantage of other organizations’ quality improvement and reporting activities should be maximized to avoid additional burdens on diplomates.”

ABMS and its board are not bound to follow any of the recommendations contained within the report, but the commission states that it “expects that the ABMS and the ABMS Boards, in collaboration with professional organizations and other stakeholders, will prioritize these recommendations and develop the necessary strategies and infrastructure to implement them.”

[email protected]

Whatever you do, change the name.

That was key among the final recommendations the Vision Initiative Commission submitted to the American Board of Medical Specialties on how to improve the maintenance of certification process.

“A new term that communicates the concept, intent, and expectations of continuing certification programs should be adopted by the ABMS in order to reengage disaffected diplomates and assure the public and other stakeholders that the certificate has enduring meaning and value,” according to the final report. A new term was not suggested.

The commission recommended a continuing certification system with four aims:

• Become a meaningful, contemporary, and relevant professional development activity for diplomates that ensures they remain up-to-date in their specialty.
• Demonstrate a commitment to professional self-regulation to both diplomates and the public.
• Align with international and national standards for certification programs.
• Provide a specialty-based credential that would be of value to diplomates and to multiple stakeholders, including patients, families, the public, and health care institutions.

Testing methods and situations must be simplified and updated, according to the report, which was submitted to ABMS on Feb. 12. Continuing certification “must change to incorporate longitudinal and other innovative formative assessment strategies that support learning, identify knowledge and skills gaps, and help diplomates stay current. The ABMS Boards must offer an alternative to burdensome highly secure, point-in-time examinations of knowledge.” In addition, the boards “must no longer use a single point-in-time examination or a series of single point-in-time assessments as the sole method to determine certification status.”

 

Instead, the commission recommends that ABMS “move quickly to formative assessment formats that are not characterized by high-stakes summative outcomes (pass/fail), specified time frames for high-stakes assessment, or require burdensome testing formats (such as testing centers or remote proctoring) that are inconsistent with the desired goals for continuing certification – support learning; identify knowledge and skills gaps; and help diplomates stay current.”

The commission also defined how the certification process should be used by other stakeholders.

“ABMS must demonstrate and communicate that continuing certification has value, meaning, and purpose in the health care environment,” the report states. “Hospitals, health systems, payers, and other health care organizations can independently decide what factors are used in credentialing and privileging decisions. ABMS must inform these organizations that continuing certification should not be the only criterion used in these decisions, and these organizations should use a wide portfolio of criteria in these decisions. ABMS must encourage hospitals, health systems, payers, and other health care organizations to not deny credentialing or privileging to a physician solely on the basis of certification status.”

Additionally, the commission report states that “ABMS and the ABMS Boards should collaborate with specialty societies, the [continuing medical education/continuing professional development] community, and other expert stakeholders to develop the infrastructure to support learning activities that produce data-driven advances in clinical practice. The ABMS Boards must ensure that their continuing certification programs recognize and document participation in a wide range of quality assessment activities in which diplomates already engage.”

The report adds that the boards “should readily accept existing activities that diplomates are doing to advance their clinical practice and to provide credit for performing low-resource, high-impact activities as part of their daily practice routine.”

 

The commission’s final report incorporates a number of changes that physicians offered based on a draft version of the report.

The American College of Physicians commented that it “objects to the use of data regarding quality measures for individual diplomate certification status, because physician-level measures of quality are flawed, and because physician-level data inevitably leads to physician-level documentation burden. Flawed performance measures also often inadequately adjust for patient comorbidities and socioeconomic status, which leads to assessments that do not reflect the actual quality of care.”

Similarly, the American Society of Hematology noted in a statement that it “disagrees with the commission’s recommendation to retain the reporting of practice improvement activities as part of continuous certification due to direct and indirect costs needed to fulfill this requirement on top of requirements for engagement in quality improvement mandated by insurers, institutions, and health systems.”

While the draft report recommended that specialty boards provide aggregated feedback to medical societies, a more individualized dissemination on the gaps in knowledge would be more helpful, according to Doug Henley, MD, CEO of the American Academy of Family Physicians, who said that a more individualized approach would help his organization better provide CME to its members to help fill in the knowledge gaps.

“If we can identify these and use other processes and then target at the individual level to seek improvement, I think that will be a better outcome rather than just x learners don’t do well in diabetic care,” he said in an interview. “That doesn’t really help me in terms of who needs the real education in diabetic care versus who needs it for heart failure.”

The final recommendation notes that ABMS member boards “must collaborate with professional and/or CME/CPD organizations to share data and information to guide and support diplomate engagement in continuing certification.”

The document further clarifies that the boards should examine “the aggregated results from assessments to identify knowledge, skills, and other competency gaps,” and the aggregated data should be shared with specialty societies, CME/CPD providers, quality improvement professionals, and other health care organizations.

One weakness in the draft noted by Dr. Henley was the lack of a more forceful tone within the recommendations. Even though AMBS is not bound by its recommendations, he said that he would like to see stronger language throughout the document.

 

“We would certainly hope that the ABMS and the member boards will follow the direction of the Vision Commission very directly and succinctly,” he said. “That is why we suggested that some of the recommendations from the Vision Commission should use words like ‘should’ and ‘must’ and not just ‘encourage’ and words like that.”

That recommendation was taken and implemented in the final document.

Societies differed in how often participation in the certification process should occur.

The American College of Rheumatology in its comments challenged a recommendation that certification should be structured to expect participation on an annual basis.

“The ACR supports the importance of ongoing learning,” it stated. “However, no discussion is provided as to how and why the recommendation for annual participation by diplomates was conceived. For some ABMS Boards, an annual requirement will increase physician burden unless continuing certification is modified to a formative pathway. If this recommendation is to be retained, the commission would be encouraged to emphasize that inclusion of annual participation should be part of an overall program structure plan that supports a formative approach to assessment. In addition, the ACR requests that ABMS Boards allow exceptions without penalty to be made to this annual requirement to all for live events.”

The American College of Cardiology took a different point of view with regard to this recommendation.

In its comments, ACC stated that it “concurs with this recommendation. Annual participation is a feature of the ACC’s proposed maintenance of certification solution. The ACC believes that ABMS boards should recognize, and make allowances for, physicians who may, for valid reasons (illness, sabbatical, medical or family issue) may not participate in MOC for a period of a year.” ACC generally concurred with the recommendations in the draft.

The final document presented the commission’s view that the ABMS member boards “need to engage with diplomates on an ongoing basis instead of every 2, 5, or 10 years. The ABMS Boards should develop a diplomate engagement strategy and support the idea that diplomates are committed to learning and continually improving their practice, skills, and competencies. The ABMS Boards should expect that diplomates would engage in some learning, assessment, or advancing practice work annually.”

The American Gastroenterological Association, in its comment letter on the draft, said it was “greatly concerned” about the inclusion of practice improvement data, noting it is “debatable whether it is even within the appropriate domain of the boards to assume responsibility for clinical practice performance and quality assurance.”

The final report states that ABMS “must ensure that their continuing certification programs recognize and document participation in a wide range of quality assessment activities in which diplomates already engage,” and added that “when appropriate, taking advantage of other organizations’ quality improvement and reporting activities should be maximized to avoid additional burdens on diplomates.”

ABMS and its board are not bound to follow any of the recommendations contained within the report, but the commission states that it “expects that the ABMS and the ABMS Boards, in collaboration with professional organizations and other stakeholders, will prioritize these recommendations and develop the necessary strategies and infrastructure to implement them.”

[email protected]

Whatever you do, change the name.

That was key among the final recommendations the Vision Initiative Commission submitted to the American Board of Medical Specialties on how to improve the maintenance of certification process.

“A new term that communicates the concept, intent, and expectations of continuing certification programs should be adopted by the ABMS in order to reengage disaffected diplomates and assure the public and other stakeholders that the certificate has enduring meaning and value,” according to the final report. A new term was not suggested.

The commission recommended a continuing certification system with four aims:

• Become a meaningful, contemporary, and relevant professional development activity for diplomates that ensures they remain up-to-date in their specialty.
• Demonstrate a commitment to professional self-regulation to both diplomates and the public.
• Align with international and national standards for certification programs.
• Provide a specialty-based credential that would be of value to diplomates and to multiple stakeholders, including patients, families, the public, and health care institutions.

Testing methods and situations must be simplified and updated, according to the report, which was submitted to ABMS on Feb. 12. Continuing certification “must change to incorporate longitudinal and other innovative formative assessment strategies that support learning, identify knowledge and skills gaps, and help diplomates stay current. The ABMS Boards must offer an alternative to burdensome highly secure, point-in-time examinations of knowledge.” In addition, the boards “must no longer use a single point-in-time examination or a series of single point-in-time assessments as the sole method to determine certification status.”

 

Instead, the commission recommends that ABMS “move quickly to formative assessment formats that are not characterized by high-stakes summative outcomes (pass/fail), specified time frames for high-stakes assessment, or require burdensome testing formats (such as testing centers or remote proctoring) that are inconsistent with the desired goals for continuing certification – support learning; identify knowledge and skills gaps; and help diplomates stay current.”

The commission also defined how the certification process should be used by other stakeholders.

“ABMS must demonstrate and communicate that continuing certification has value, meaning, and purpose in the health care environment,” the report states. “Hospitals, health systems, payers, and other health care organizations can independently decide what factors are used in credentialing and privileging decisions. ABMS must inform these organizations that continuing certification should not be the only criterion used in these decisions, and these organizations should use a wide portfolio of criteria in these decisions. ABMS must encourage hospitals, health systems, payers, and other health care organizations to not deny credentialing or privileging to a physician solely on the basis of certification status.”

Additionally, the commission report states that “ABMS and the ABMS Boards should collaborate with specialty societies, the [continuing medical education/continuing professional development] community, and other expert stakeholders to develop the infrastructure to support learning activities that produce data-driven advances in clinical practice. The ABMS Boards must ensure that their continuing certification programs recognize and document participation in a wide range of quality assessment activities in which diplomates already engage.”

The report adds that the boards “should readily accept existing activities that diplomates are doing to advance their clinical practice and to provide credit for performing low-resource, high-impact activities as part of their daily practice routine.”

 

The commission’s final report incorporates a number of changes that physicians offered based on a draft version of the report.

The American College of Physicians commented that it “objects to the use of data regarding quality measures for individual diplomate certification status, because physician-level measures of quality are flawed, and because physician-level data inevitably leads to physician-level documentation burden. Flawed performance measures also often inadequately adjust for patient comorbidities and socioeconomic status, which leads to assessments that do not reflect the actual quality of care.”

Similarly, the American Society of Hematology noted in a statement that it “disagrees with the commission’s recommendation to retain the reporting of practice improvement activities as part of continuous certification due to direct and indirect costs needed to fulfill this requirement on top of requirements for engagement in quality improvement mandated by insurers, institutions, and health systems.”

While the draft report recommended that specialty boards provide aggregated feedback to medical societies, a more individualized dissemination on the gaps in knowledge would be more helpful, according to Doug Henley, MD, CEO of the American Academy of Family Physicians, who said that a more individualized approach would help his organization better provide CME to its members to help fill in the knowledge gaps.

“If we can identify these and use other processes and then target at the individual level to seek improvement, I think that will be a better outcome rather than just x learners don’t do well in diabetic care,” he said in an interview. “That doesn’t really help me in terms of who needs the real education in diabetic care versus who needs it for heart failure.”

The final recommendation notes that ABMS member boards “must collaborate with professional and/or CME/CPD organizations to share data and information to guide and support diplomate engagement in continuing certification.”

The document further clarifies that the boards should examine “the aggregated results from assessments to identify knowledge, skills, and other competency gaps,” and the aggregated data should be shared with specialty societies, CME/CPD providers, quality improvement professionals, and other health care organizations.

One weakness in the draft noted by Dr. Henley was the lack of a more forceful tone within the recommendations. Even though AMBS is not bound by its recommendations, he said that he would like to see stronger language throughout the document.

 

“We would certainly hope that the ABMS and the member boards will follow the direction of the Vision Commission very directly and succinctly,” he said. “That is why we suggested that some of the recommendations from the Vision Commission should use words like ‘should’ and ‘must’ and not just ‘encourage’ and words like that.”

That recommendation was taken and implemented in the final document.

Societies differed in how often participation in the certification process should occur.

The American College of Rheumatology in its comments challenged a recommendation that certification should be structured to expect participation on an annual basis.

“The ACR supports the importance of ongoing learning,” it stated. “However, no discussion is provided as to how and why the recommendation for annual participation by diplomates was conceived. For some ABMS Boards, an annual requirement will increase physician burden unless continuing certification is modified to a formative pathway. If this recommendation is to be retained, the commission would be encouraged to emphasize that inclusion of annual participation should be part of an overall program structure plan that supports a formative approach to assessment. In addition, the ACR requests that ABMS Boards allow exceptions without penalty to be made to this annual requirement to all for live events.”

The American College of Cardiology took a different point of view with regard to this recommendation.

In its comments, ACC stated that it “concurs with this recommendation. Annual participation is a feature of the ACC’s proposed maintenance of certification solution. The ACC believes that ABMS boards should recognize, and make allowances for, physicians who may, for valid reasons (illness, sabbatical, medical or family issue) may not participate in MOC for a period of a year.” ACC generally concurred with the recommendations in the draft.

The final document presented the commission’s view that the ABMS member boards “need to engage with diplomates on an ongoing basis instead of every 2, 5, or 10 years. The ABMS Boards should develop a diplomate engagement strategy and support the idea that diplomates are committed to learning and continually improving their practice, skills, and competencies. The ABMS Boards should expect that diplomates would engage in some learning, assessment, or advancing practice work annually.”

The American Gastroenterological Association, in its comment letter on the draft, said it was “greatly concerned” about the inclusion of practice improvement data, noting it is “debatable whether it is even within the appropriate domain of the boards to assume responsibility for clinical practice performance and quality assurance.”

The final report states that ABMS “must ensure that their continuing certification programs recognize and document participation in a wide range of quality assessment activities in which diplomates already engage,” and added that “when appropriate, taking advantage of other organizations’ quality improvement and reporting activities should be maximized to avoid additional burdens on diplomates.”

ABMS and its board are not bound to follow any of the recommendations contained within the report, but the commission states that it “expects that the ABMS and the ABMS Boards, in collaboration with professional organizations and other stakeholders, will prioritize these recommendations and develop the necessary strategies and infrastructure to implement them.”

[email protected]