VBCR - October 2015, Volume 4, No 5 - Value Propositions

The American Board of Internal Medicine (ABIM) has received significant criticism related to the requirements and the increased fees for its maintenance-of-certification (MOC) program. Although the ABIM suspended certain content requirements in February 2015, the increased fees and number of modules were maintained. A recent study by researchers from the University of California San Francisco and Stanford University presents a cost analysis of the MOC program that affects more than 250,000 physicians. The authors noted that their study is a “first attempt” to measure MOC costs so that other researchers can “better evaluate costs and benefits of this large investment in physician education in comparison with alternative strategies for improving healthcare quality.”

Researchers designed a discrete-state Markov model of ABIM-certified internists, hospitalists, and internal medicine subspecialists in the United States and used it to estimate costs for the 2015 MOC program. Results indicate that by 2025 implementing the latest ABIM requirements will cost an estimated $5.7 billion, which is $1.2 billion more than the 2013 MOC. Most of the cost is attributable to physician time rather than fees. The estimated 32.7 million physician hours would cost $5.1 billion, and testing would cost $561 million. Over 10 years, mean total MOC costs would range from $16,725 for general internists to $40,495 for hematologists and oncologists; mean total costs for rheumatologists would be $21,606.

The authors concluded that decreasing the time needed to fulfill MOC requirements and increasing integration with other continuing education activities should be addressed as areas of needed reform. They wrote, “A rigorous evaluation of the program’s effect on clinical and economic outcomes is warranted to better balance potential gains in the quality and efficiency of clinical care against the high costs identified in this study.” In September, the ABIM announced that its Assessment 2020 Task Force recommended that the 10-year MOC exam be replaced with “meaningful, less burdensome” assessments that physicians could complete at home or at the workplace. Sandhu AT, et al. Ann Intern Med. 2015;163(6):401-408. Akresh-Gonzales J. NEJM Knowledge+ website. September 17, 2015.

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Last modified: October 29, 2015
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