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What is MOC Part IV?

What is Maintenance of Certification Part IV?

Since the inception of the Maintenance of Certification (MOC) principle in 2001, the American Board of Medical Specialties (ABMS) has led and overseen the development of MOC programs for all 24 of its member boards. The development of MOC programs by member boards was not an option and was a prudent decision to ensure the integrity of all medical specialties and, most importantly, make certain the public has confidence they are receiving high-quality medical care from physicians who are well-trained and knowledgeable in the latest advancements, research and technologies in their chosen specialty. For more information on the history and development of MOC, visit the ABMS Website at www.abms.org.

By January 2007, medical boards expect all of their diplomates, including those with lifetime certificates, to participate in MOC. All 24 boards, including the ABNM, have MOC programs that have been approved by the ABMS. To be acceptable to the ABMS, MOC programs must include all four parts of the MOC requirements: 1) Licensure and professional standing, 2) Lifelong learning and self-assessment, 3) Cognitive expertise, and 4) Practice performance assessment.

Part IV of MOC process is practice performance evaluation. In the past, physicians were given a cognitive exam to determine the extent of their knowledge. The goal of Part IV is continuous quality improvement. Now in addition to gaining new knowledge and evaluating whether or not they “know it,” they must now evaluate whether or not they “do it” and determine if it makes a difference in their quality of practice and patient outcomes. This more direct measure of quality of nuclear medicine performance would involve metrics on such topics as over- and underutilization, accuracy of interpretation, appropriateness of therapy, and clarity and timeliness of communication.

A widespread problem in medicine is that physicians do not get feedback on how their performance compares with that of their peers. All physicians want to provide the best care for their patients, but they often lack the necessary tools. With feedback, physicians can identify areas in which performance can be improved. Now with Part IV of MOC, physicians will be expected to participate in quality improvement initiatives.

The basic idea is for physician specialists to gather data about how they are doing, assess the data to identify what things they could be doing better, come up with an improvement plan, implement the improvement plan, and then re-measure to determine if they really improved. The overriding objective of MOC is to improve the quality of health care through diplomate-initiated learning and quality improvement.

ABMS Part IV Requirements
The ABMS has charged the 24 member boards to require evidence of evaluation of performance in practice from their diplomates. Part IV projects should be in any of the following areas of practice:

  • Medical care provided for common/major health problems
  • Physician behaviors, such as communication and professionalism, as they relate to patient care
  • Includes assessment of competencies
    • Patient care
    • Interpersonal and communication skills
    • Professionalism
    • Medical knowledge
    • Practice-based learning and improvement
    • Systems-based practice
  • Evaluation of physician practice performance based on participation in a valid process in which physicians are asked to demonstrate that they can assess the quality of care they provide compared to their peers and national benchmarks
  • Application of the best evidence or consensus recommendations to improve the physician’s practice performance using follow-up assessments

Content Categories
The ABNM and ABR have recommended the following content categories for initiating MOC Part IV programs. These categories are based on the recommendations provided by the ABMS.

  • Patient safety
  • Accuracy of interpretation
  • Practice guidelines and/or technical standards
  • Under- or over-utilization of studies and/or therapy
  • Appropriateness of therapy
  • Report turnaround time
  • Referring physician survey

Types/Levels of Projects
Three levels of performance improvement projects are available for diplomats:

  • Individual – must follow criteria identified by ABNM as individual-centered projects or by ABR as Type 1 projects to pass random audit by ABR or ABNM.
  • Center- or group-based – must follow criteria identified by ABNM as group-centered projects or by ABR as Type 1 projects to pass random audit.
  • Society-based – these projects are pre-approved by the ABNM and ABR (Type 2) so no random audits will be implemented. They can be either individual-based or group-based.

Project Requirements
Project requirements for ABNM and ABR qualification include:

  • Relevant to diplomates’ practice
  • Achievable in a practice setting
  • Produce measurable results suitable for repeated measurements
  • Be able to effect quality improvement
  • Must have predetermined measurable endpoint in which baseline parameters are compared with evidence-based guidelines, consensus statements or peer comparisons
  • Action plan outlining how diplomats will improve performance should be in place with follow-up plan to assess effect of each project on the diplomate’s practice
  • Submission to ABNM and ABR for approval