The NBPAS alternative to MOC

Paul Teirstein, M.D.Chief of Cardiology Scripps ClinicDirector Scripps PrebysCardiovascular InstituteScripps Health

Teirstein.paul@scrippshealth.org858 554 9905

• NBPAS is a new alternative for continuous physician certification.

• NBPAS relies on ACCME accredited CME for life-long learning instead of computer modules and repeat testing.

• Interest in the NBPAS.org alternative is spreading rapidly.

• This grass roots movement is now in discussions with hospitals, physician groups and payers to accept NBPAS continuous certification

What’s wrong with MOC?

• The majority of available data indicates MOC has no impact on patient outcomes

• The overwhelming majority of physicians believe the medical knowledge modules and recertifying exams are onerous, and a poor use of their time.

• Even the ABIM now agrees that the patient safety modules and practice improvement modules should be suspended.

• MOC is costly for physicians and has become a money-making enterprise

• Arguments against the 10 year Recertification Exam– The exam questions are often not relevant physician’s practice.

Questions often relate to parts of their specialty they do not practice.

– The questions are often outdated. Most of the studying is done to learn the best answer for the test, which is very often not the current best practice.

– Testing often uses “Guidelines” as gold standard but there is a long history of Guidelines changing and often reversing

– Closed book tests are no longer relevant. We care for patients with our colleague’s input (ie conferences, the Heart Team, curbside consults etc) and we are connected to the internet all day long

– There are no re-certification or MOC programs outside the U.S.

Petition Attracts >22,000 Signatures

• The following slide is a screen shot of the petition to ABIM to recall the MOC with over 22,000 signatures

ABIM Admits they “Got it Wrong”

• The following slide shows an apology offered by the NBPAS for MOC

ABIM is now under fire from many organizations!

SCRIPPS CLINIC

ABIM Apologizes-a good first step

• Part IV is suspended. Very good decision• Other changes, however, are not meaningful: Changing public

reporting language of diplomat status, freezing fees, and promises to consider further changes

• We are still left with parts 2 and 3 that are onerous, time wasting and expensive (self assessment modules and repeat secure testing)

• The self-admitted poor roll-out of MOC by ABIM illustrates the need for alternative certifying organizations.

• Different physicians have different needs. • One size does not fit all. • Applications for NBPAS tripled after there apology. Physicians

are not satisfied

CME Vs MOC for Life-long Learning

• Why ACCME accredited CME is a better approach to lifelong learning. – Organizations providing recognized CME programs are regulated

by a rigorous accreditation body (ACCME) requiring each CME offering provide an educational gap analysis, “needs assessment," speaker conflict of interest, course evaluations and many other performance standards.

– ACCME accredited CME is NOT permitted to be influenced by industry.

– MOC focuses on established knowledge while CME often goes further, offering new and future directions that keep the physician on the "cutting edge."

– CME offerings are highly competitive and provide choice. If physicians do not perceive value in a particular CME offering, they will go elsewhere. This contrasts with the monopoly ABIM has on MOC.

NBPAS Criteria for Certification

• NBPAS supports the initial ABIM certification criteria and secure test

• NBPAS strongly objects to the ABIMS’s requirements for MOC

• NBPAS supports choice. Physicians who believe they benefit from MOC, should participate in MOC

• Life-long learning is not one size fits all. No single program will meet everyone’s needs.

• NBPAS provides physicians with an important alternative.

• The next slide provides the complete NBPAS criteria for continuous certification

■ Candidates must have been previously certified by an American Board of Medical Specialties member board. Currently, NBPAS certifies physicians in non-surgical ABMS specialties.

■ Candidates must have a valid, unrestricted license to practice medicine in at least one US state. Candidates who only hold a license outside of the U.S. must provide evidence of an unrestricted license from a valid non-U.S. licensing body.

■ Candidates must have completed a minimum of 50 hours of continuing medical education (CME) within the past 24 months, provided by a recognized provider of the Accreditation Council for Continuing Medical Education (ACCME). CME must be related to one or more of the specialties in which the candidate is applying. Re-entry for physicians with lapsed certification requires 100 hours of CME with the past 24 months.  Physicians in or within two years of training are exempt.

■ For some specialties (ie interventional cardiology, electrophysiology, critical care), candidates must have active privileges to practice that specialty in at least one US hospital licensed by a nationally recognized credentialing organization with deeming authority from CMS (ie Joint Commission, HFAP, DNV).

■ A candidate who has had their medical staff appointment/membership or clinical privileges in the specialty for which they are seeking certification involuntarily revoked and not reinstated, must have subsequently maintained medical staff appointment/membership or clinical privileges for at least 24 months in another US hospital licensed by a nationally recognized credentialing organization with deeming authority from CMS (ie Joint Commission, HFAP, DNV).

■ Candidates must have been previously certified by an American Board of Medical Specialties member board. Currently, NBPAS certifies physicians in non-surgical ABMS specialties.

■ Candidates must have a valid, unrestricted license to practice medicine in at least one US state. Candidates who only hold a license outside of the U.S. must provide evidence of an unrestricted license from a valid non-U.S. licensing body.

■ Candidates must have completed a minimum of 50 hours of continuing medical education (CME) within the past 24 months, provided by a recognized provider of the Accreditation Council for Continuing Medical Education (ACCME). CME must be related to one or more of the specialties in which the candidate is applying. Re-entry for physicians with lapsed certification requires 100 hours of CME with the past 24 months.  Physicians in or within two years of training are exempt.

■ For some specialties (ie interventional cardiology, electrophysiology, critical care), candidates must have active privileges to practice that specialty in at least one US hospital licensed by a nationally recognized credentialing organization with deeming authority from CMS (ie Joint Commission, HFAP, DNV).

■ A candidate who has had their medical staff appointment/membership or clinical privileges in the specialty for which they are seeking certification involuntarily revoked and not reinstated, must have subsequently maintained medical staff appointment/membership or clinical privileges for at least 24 months in another US hospital licensed by a nationally recognized credentialing organization with deeming authority from CMS (ie Joint Commission, HFAP, DNV).

Complete criteria for NBPAS certification:Complete criteria for NBPAS certification:

NBPAS Board Members

• NBPAS board members are high profile members of the academic medical community

• Current NBPAS board members are listed on the next slide

The NBPAS Board Members are physicians who value patient care, research, and life long learning. Board members believe continuous physician education is required for excellence in patient care.

NBPAS Board Members:

Paul Teirstein, M.D., President NBPAS, Chief of Cardiology, Scripps Clinic

David John Driscoll, M.D., Professor of Pediatrics, Mayo Clinic College of Medicine

Daniel Einhorn, M.D., Immediate-Past President, American College of Endocrinology; Past President, American Association of Clinical Endocrinologists

Bernard Gersh, M.D., Professor of Medicine, Mayo Clinic College of Medicine

C. Michael Gibson, M.D., Professor of Medicine, Harvard Medical School

J. Marc Pipas, M.D., Professor of Medicine, Dartmouth School

Jeffrey Popma, M.D., Professor of Medicine, Harvard Medical School

Harry E. Sarles Jr. M.D., FACG, Immediate Past President for the American College of Gastroenterology

Gregg W. Stone, M.D., Professor of Medicine, Columbia University College of Physicians and Surgeons

Eric Topol, M.D., Chief Academic Officer, Scripps Health; Director, Scripps Translational Science Institute

Bonnie Weiner, M.D., Professor of Medicine, University of Massachusetts Medical School

Mathew Williams, M.D., Chief, Division of Adult Cardiac Surgery, New York University Medical Center 

The NBPAS Board Members are physicians who value patient care, research, and life long learning. Board members believe continuous physician education is required for excellence in patient care.

NBPAS Board Members:

Paul Teirstein, M.D., President NBPAS, Chief of Cardiology, Scripps Clinic

David John Driscoll, M.D., Professor of Pediatrics, Mayo Clinic College of Medicine

Daniel Einhorn, M.D., Immediate-Past President, American College of Endocrinology; Past President, American Association of Clinical Endocrinologists

Bernard Gersh, M.D., Professor of Medicine, Mayo Clinic College of Medicine

C. Michael Gibson, M.D., Professor of Medicine, Harvard Medical School

J. Marc Pipas, M.D., Professor of Medicine, Dartmouth School

Jeffrey Popma, M.D., Professor of Medicine, Harvard Medical School

Harry E. Sarles Jr. M.D., FACG, Immediate Past President for the American College of Gastroenterology

Gregg W. Stone, M.D., Professor of Medicine, Columbia University College of Physicians and Surgeons

Eric Topol, M.D., Chief Academic Officer, Scripps Health; Director, Scripps Translational Science Institute

Bonnie Weiner, M.D., Professor of Medicine, University of Massachusetts Medical School

Mathew Williams, M.D., Chief, Division of Adult Cardiac Surgery, New York University Medical Center 

NBPAS website

• NBPAS.org– Website is simple to navigate– Contains links to NEJM opposing “Perspectives” on

MOC (Teirstein Vs ABMS) along with the apologetic press release from ABIM and the NBPAS reaction

– Contains links to sample letters to send to hospital administrators and colleagues

– Contains link to a PowerPoint presentation

• The following slides demonstrate sample NBPAS website pages.

www.NBPAS.org

Simple application takes <15 minutes to complete

Simple application takes <15 minutes to complete

NBPAS Fees and Application

• NBPAS is a not for profit 501(c)3 organization• The fee is $84.50 per year ($169 for two year certification),

irrespective of the number of specialty applications. This one fee covers two years and all specialties desired. Physicians in or within 2 years of training qualify for a reduced rate of $29 for a two year certification ($14.50/year). Fees are used for staff, IT, offices, equipment and marketing. The fee will be adjusted in future years, determined by our expenses.

• The application requires less than 15 minutes to complete.

• NBPAS currently offers certification in most non-surgical specialties

• Go to NBPAS.org to view the website, apply for certification, leave comments and help us educate administrators and the public.

www.NBPAS.org