What Is Maintenance of Certification and How Does It Impact You?
Many of you have expressed both concern and confusion about the new plans for Maintenance of Certification (MOC). It is not as complicated or demanding as many of us think. In fact, many of you are already meeting some of the requirements involved, particularly if you participate in a self-assessment or institutional performance quality improvement program.
MOC is an initiative mandated by the American Board of Medical Specialties (ABMS) to ensure that physician specialists offer quality patient care through an ongoing process of self-improvement and performance improvement.
MOC is not an initiative specific to APA but was put in place in 2006, when ABMS's 24 member boards adopted a standard for recertification for all specialties. The ABMS determines the basic MOC requirements for the American Board of Psychiatry and Neurology (ABPN) and other member boards. Additionally, many state-licensing boards are developing similar requirements for Maintenance of Licensure.
These are among the principles of the ABPN MOC program: it must follow ABMS guidelines, address the competencies set forth by the ABMS and the Accreditation Council for Graduate Medical Education, fulfill federal-government requirements, and fulfill the requirements of Maintenance of Licensure.
In compliance with the ABMS's mandate, the ABPN has developed an MOC program for all diplomates with time-limited certificates. To maintain certification, diplomates must show evidence that they have met or exceeded requirements in each of four components over the 10-year cycle. Here are the four components:
| •. | Diplomates must possess an unrestricted medical license in at least one state, commonwealth, territory, or possession of the United States or a province of Canada. This has always been a requirement for ABPN certification. | ||||
| •. | Diplomates must participate in self-assessment activities that award CME credit, and an average of at least 8 CME credits a year must come from self-assessment activities. Such activities have already been developed by professional organizations and approved by the ABPN as meeting this requirement; information is linked to the ABPN Web site at <www.abpn.com>. | ||||
Some examples include the Psychiatrist in Practice Examination (PIPE), the Focus Annual Self-Assessment Examination, educational modules by the American Academy of Child and Adolescent Psychiatry, and the Geriatric Psychiatry Self-Assessment Program. The phase-in of this requirement has already begun. Other CME activities are already required by some states for Maintenance of Licensure.
| •. | The cognitive-expertise portion mandates that diplomates pass a recertification examination prior to the expiration date of their certificates. A passing score on the cognitive examinations extends the renewal date of time-limited certificates to December 31 after the 10th year of the examination. | ||||
| •. | The Performance in Practice (PIP) aspect of MOC has probably generated the most controversy. The phase-in of this requirement is scheduled to begin in 2013. The PIP component is a quality-improvement program to evaluate whether a physician has shown practice improvement over the 10-year MOC cycle. | ||||
Diplomates must complete three PIP units, each consisting of a clinical module and a feedback module. The clinical module must assess at least five cases in a specific category (for example, diagnosis, type of treatment, treatment setting) from the diplomate's clinical practice over the previous three years. All data from clinical modules are kept by the diplomate and not sent to the ABPN.
The feedback modules must be based on feedback from at least five patients and five peers over the previous three years. Diplomates will select their own peers and patients, and all data are, again, kept by the diplomates and not sent to the ABPN. Diplomates must attest to the ABPN that peer and patient feedback modules have been completed. The ABPN will randomly audit a sample of diplomates who will be required to explain further and document what they have done for MOC. However, even in these cases, no specific patient data will be sent to the ABPN.
To help APA members fulfill MOC requirements, APA is developing programs for self-assessment and PIP. APA's PIP modules are guided practice-improvement programs created for the general psychiatrist. In 2011, APA will introduce its clinical chart review modules. Sample modules for major depression and PTSD are available now, each offering 5 hours of CME credit.
APA already offers FOCUS: The Journal of Lifelong Learning and the FOCUS Self-Assessment Program. The FOCUS Self-Assessment is a yearly 100-question, multiple-choice examination on topics consistent with those listed by the ABPN in its content outline for recertification. The self-assessment exam must be completed before the MOC cognitive exam, but the CME requirement for self-assessment will not be enforced until 2013. In 2011 APA will launch the APA Annual Meeting Self-Assessment in Psychiatry, a 100-question examination that will provide additional opportunities to obtain CME credit at the annual meeting.
Information about ABPN's requirements for MOC is posted at <www.abpn.com>. APA has posted information about lifelong learning at <www.psych.org/MainMenu/EducationCareerDevelopment/LifelongLearning.aspx> and resources for MOC at <www.psych.org/moc>.
APA will continue to work closely with our members to ensure that MOC requirements are appropriate and not unnecessarily burdensome. Nevertheless, we must recognize the patient-advocacy movement's support for patient feedback on the quality of our work and not advocate for some type of special status different from the rest of medicine. As physicians, we must continue to remain current with advances and new knowledge in our field and work collaboratively with our patients to ensure the highest quality outcomes in our treatments. 
