1. The NBPAS alternative to MOC
Paul Teirstein, M.D.
Chief of Cardiology
Scripps Clinic
Director Scripps Prebys
Cardiovascular Institute
Scripps Health

2. 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

4. Are there data supporting MOC?
ABIM/ABMS argue there are data supporting the value of MOC. However, close examination of the reports cited by ABIM/ABMS reveals they support the opposite conclusion.

7. Initial certification Vs. MOC?
Almost all the studies in the literature evaluate board certification, not recertification or MOC!
Initial ABMS certification is earned, for the most part, by spending several years in an ACGME credentialed training program.
The initial certification exam provided by the ABMS is simply the “final exam” which is obviously a much smaller part of the educational process.
Should it be surprising that successfully completing 3 years of training in an ACGME credentialed cardiology fellowship makes a doctor better at treating MIs?
It is absurd to equate the busywork of MOC…clicking on computer modules for hours each year…to the many years of training required for initial certification

8. One of the few studies examining lapsed certification found no impact on patient outcomes following coronary intervention

14. What about the cost?
Costs (for one specialty) begin at $190 – 256/year plus module fees.
Costs increase significantly if you have boards in multiple specialties
On top of this are costs for review courses, travel to review courses
Time away from practice

16. Which brings us to money
ABIM IRS Form 990 tells the story
ABIM annual revenue is $55M (that’s per year)
Directors are very well paid
We have all had to tighten our belts in medicine
Patients are NOT demanding MOC…but they ARE demanding better “value”…better care, lower costs
Recently, most physicians, have spent an enormous amount of time cutting costs in their practices and hospitals
Physicians are now asking for a better value from the ABIM.

20. NBPAS provides and alternative for maintenance phase of certification
NBPAS believes CME is the most meaningful method available for “keeping up.”
NBPAS replaces computer knowledge modules and secure exams with accredited, continuing medical education (CME).
Acceptable CME must be accredited by the AACME…independent of commercial interests.

21. The 10 year Recertification Exam
Arguments against testing:
The exam questions are often not relevant physician’s practice. Questions often relate to parts of their specialty they do not practice.
We have to study for recertification exams. But we only study what we don’t know…we don’t know what we don’t use, and after the test we will soon forget
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 input from colleagues and the internet.

22. Detailed criteria for NBPAS 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.  Fellows-in-training are exempt.
■ For some specialties (ie interventional cardiology, electrophysiology, surgery), 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).

23. ■ License to practice medicine in at least one US state.
Abbreviated criteria for NBPAS certification:
■ Previous certification by an American Board of Medical Specialties member board. (NBPAS does require a test, just not a repeat test).
■ License to practice medicine in at least one US state.
■ Complete a minimum of 50 hours of ACCME accredited continuing medical education (CME) within the past 24 months
■ Procedural specialties (ie surgery, interventional cardiology, electrophysiology), require active privileges to practice that specialty in a licensed US hospital
■ Clinical privileges in your specialty have not been permanently revoked.

24. NBPAS Fees and Application
NBPAS is a not for profit 501(c)(3) organization
Board members are high profile, thought leaders representing most ABMS specialties
Fees are very low, only cover costs
Physician management and board members are unpaid
Governance: transparent, not-for-profit, two year board terms, COI protections, no physician pay

25. NBPAS Board Members
NBPAS board members are well respected, high profile members of the academic medical community

26. C. Michael Gibson, M.D., Professor of Medicine, Harvard Medical School
The NBPAS Advisory Board Members are physicians who value patient care, research, and life long learning. Board members (all unpaid) 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
John Anderson, M.D., Past President, Medicine and Science, American Diabetes Association, First Clinic, Nashville, TN
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
Paul G. Mathew, M.D., FAHS, Director of Continuing Medical Education, Brigham & Women's Hospital/Harvard Medical School, Department of Neurology
Jordan Metcalf, M.D., Professor and Research Director, Pulm. Crit. Care,  Oklahoma University Health Sciences Center
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
Hal Scherz, M.D., Chief of Urology- Scottish Rite Children's Hospital, Assoc Clinical Professor of Urology Emory University
Karen S. Sibert, M.D., Associate Professor of Anesthesiology, Cedars-Sinai Medical Center, Secretary, California Society of Anesthesiologists
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

27. NBPAS website NBPAS.org Website is simple to navigate
Contains links to NEJM opposing “Perspectives” on MOC (Teirstein Vs Irons/Nora) along with the apologetic press release from ABIM and the NBPAS reaction
Contains links to explanatory sample letters to send to hospital administrators and colleagues
Contains links to downloadable PowerPoint presentations

28. Simple application takes <15 minutes to complete

29. Four common misconceptions
Board certification was created to provide a measure of competence over and above the minimal requirements of state licensing. NBPAS requirements simply mimic most state licensing requirements
NBPAS requires initial ABMS member board certification which is not required by state boards
NBPAS only disputes current ABMS MOC pathways
NBPAS provides an alternative, more meaningful pathway for life-long learning

30. Four common misconceptions
Supporting an alternative certifying organization like NBPAS will open the door to numerous competing boards, standards will erode and certification will lose meaning
NBPAS requires initial ABMS certification, therefore NBPAS actually supports ABMS and requires a rigorous secure test
NBPAS disputes ABMS approach to MOC and provides an alternative only to maintenance of certification.

31. Four common misconceptions
NBPAS requirements are not rigorous enough. A rigorous certification process is needed to protect the public from bad doctors.
This debate is about how to best pursue life-long learning, not initial certification. The is no evidence (or even general belief) that current ABMS MOC programs protect the public from bad doctors.
Most, if not all of the recent scandals in medicine involved board certified physicians.

32. Four common misconceptions
We have to do something to be accountable to the public. MOC is quick, easy, inexpensive and we learn something.
This response almost always comes from a surgeon who is a diplomate of a board that does not require the kind of MOC mandated by most other boards. For example, cardiac surgeons have a very reasonable and easy MOC process. It is nothing like the MOC required by internal medicine specialties, family practice, anesthesiology etc.

33. In just a few months of operation with only word of mouth and social media:
Over 3,300 physicians are now certified by the NBPAS
A growing number of hospitals have changed their bylaws to allow NBPAS as an alternative certification for maintaining hospital privileges

34. Hospitals accepting NBPAS as alternative certification for hospital privileges

35. Organizations accepting or considering criteria for acceptance of alternative board certification organizations
California ACC
National ACC
American Collage of Physicians (ACP)
Washington State Medical Association
California Medical Association (two resolutions under consideration this week)
Other physician societies, ie The American Association of Clinical Endocrinologists (AACE)
Others

36. From: "Steven Weinberger, MD, FACP" <resources@acpresources.org>
Date: October 2, 2015 at 8:00:00 PM EDT
To:
Subject: ACP Update about ABIM's MOC Program
Finally, we’d like to reiterate our position that ACP does not support making participation in MOC an absolute prerequisite for state licensure, hospital credentialing, or health plan (insurer) credentialing. Instead, decisions about licensure and credentialing should be based on the physician’s performance in his or her practice setting and a broader set of criteria for assessing competence, professionalism, commitment to continuous professional development, and quality of care provided.

38. ABMS and ABIM are currently under fire in the lay and scientific press!

39. 10 days after launching the NBPAS,
ABIM apologizes hundreds of thousands of its diplomates

40. ABIM Apologizes-a good first step February 2015
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)

41. ABIM --- additional changes announced – summer 2015
Streamlining recertification for tertiary subspecialists, which previously required interventional cardiologists and other subspecialists to re-take and pass multiple examinations…but beware of unintended consequences
Eliminating punitive labels from the ABIM website, such as “not meeting MOC requirements.”
Accepting different types of traditional CME as counting for MOC requirements.
Awaiting the specifics of how ABIM will partner with AACME and how CME will “count” towards MOC.

44. Given recent announcements, do we still need alternative boards?
The self-admitted poor roll-out of MOC by ABIM illustrates the need for alternative certifying organizations.
We do not know how the changes will be executed.
Will “take home” exams be meaningful or just more wasted time
Will costs come down?
Will part IV requirements return after the two year hold.
Will there slippage back to onerous requirements
Some physicians will prefer a less complicated, less expensive approach.

45. www.NBPAS.org Visit NBPAS.org
Physicians, go to NBPAS.org and apply for board certification.
Use the resources on NBPAS.org
Downloadable PowerPoints and Sample letters
Spread the word
Lobby your hospital to accept NBPAS as an alternative board certification

46. Physicians Finally Extract Heads From Sand
Vol.CLV18. .No. 34, NEW YORK. November 6th, 2010
Breaking News:
Physicians Finally Extract Heads From Sand
Docs came close to ceding
control of entire profession
This has been a sentinel event for many physicians
Busy physicians often focus on the urgent and not the important
Many initially reacted with jaded pessimism, saying "Its too late. The new requirements are here to stay. The horse is out of the barn."
But ABIM is making changes and alternatives have appeared
We CAN put the horse back into the barn
Its time for practicing physicians to take back the leadership of medicine