Eyeworld

8 January 2018 EW ASCRS NEWS not so simple as ABO doing away with it completely. As a member board of the ABMS, ABO, like the other member boards, "are expected to meet all the Standards of MOC," ABMS leadership said in a statement in 2015, noting that it does not, however, dictate how these stan- dards are implemented by member boards. "Each Board determines its own way to deliver on certification's core values," the statement contin- ued later. Dr. DeStafeno, reiterating that the overall complexity of the situ- ation with states taking legislative action, questions remaining about the correct way to assess compe- tency and the appropriate cost and requirements for maintaining it, and the situation with payers and hospi- tals, said his colleagues should know "ABO is listening." Alternative certification Dr. Teirstein's frustration with MOC came to a head several years ago, and he decided to start an online petition against its requirements, garnering tens of thousands of signatures. Dr. Teirstein published his perspective "Boarded to death— why maintenance of certification is bad for doctors and patients" in the New England Journal of Medicine, voicing his sentiments against MOC and supporting continuing medical education (CME) as a method for keeping physicians current. 4 In this article, Dr. Teirstein wrote about the efficacy—or what he perceives as a lack thereof—of the traditional MOC process: Although the ABIM argues that there is evidence supporting the value of MOC, high-quality data supporting the efficacy of the program will be very hard, if not impossible, to obtain. In fact, close examination of the reports cited by the ABIM reveals that the data are ambiguous at best: in a meta-analysis of 33 studies, 16 described a significant association between certification status and positive clinical outcomes, 14 found no association, and 3 found a negative association. Moreover, the authors of the meta-analysis concluded that the research meth- ods of most published studies on this topic are inadequate. 5 Almost all published studies evaluate initial board certification, not recertification or MOC, 6 and the rigorous requirements for initial certification should not be equated with the busywork required for the MOC every 2 years. One of the few studies examining lapsed certification showed no effect of physicians' certification status on patient outcomes after coronary intervention. 7 Two very recent stud- ies found no association between recertification and performance or quality measures; one, conducted by ABIM members, found a minor reduction in cost of care. 8 No study provided level A data, and these findings relate only to recertifi- cation, not the controversial new MOC requirements. Dr. Teirstein described CME as "an excellent alternative to MOC [that] already exists." CME, he not- ed, is regulated by the Accreditation Council for Continuing Medical Education to meet certain stan- dards, and such content is available through various sources, giving phy- sicians the opportunity to find and support what they consider to be the most valuable CME programming. "What physicians need to do is be current, and certification is a way of quantifying or codifying it," said Warren Hill, MD, East Valley Ophthalmology, Mesa, Arizona, and member at large, ASCRS Governing Board. But, he added, "we all stay current in different ways. … As a teacher, when I look at how to keep people current in my small area of ophthalmology, it's CME." Best practices in IOL power calculations, as Dr. Hill's area of expertise for example, undergo "tremendous transformations every year," he said. Once a question for MOC because the ABMS requires MOC, and the founder and CEO of the NCQA is a board member of the ABMS. What holds this village of fiddlers together? Is it tradition? No, it's tuition; it's money. Who are they fiddling with? Physicians." In his presentation, Dr. Teirstein, using the American Board of Internal Medicine (ABIM), an ABMS member board, as an ex- ample, showed ABIM's tax form, which revealed that certification testing brought in $30 million to the organization in 2016 and MOC fees contributed $24 million in the same timeframe. There are also questions as to whether it's legal for payers or employers to require MOC for licensure, insurance, or hospital privileges. Seven states, the first being Oklahoma in 2016, have passed legislation to bar a MOC re- quirement, and several others have introduced similar legislation. 3 "ABO is listening" Evidence that ABO is listening to its diplomats' discontent over the MOC process, Dr. DeStafeno said, in- clude its elimination of the 10-year examination requirement starting in 2019. It will be replaced with quar- terly questions and journal article review instead. While perhaps only a Band-Aid, Dr. DeStafeno said time will tell if this is a positive change or not. Overall, Dr. DeStafeno noted that reforming the MOC process is Taking continued from page 3 " There is a disconnect between what we do every single day and the maintenance of certification and a written exam. Written exam vs. an expert in the field telling you what current best practices are? The difference is like day and night as far as I'm concerned. " —Warren Hill, MD Like us on Facebook: facebook.com/CorneaSocietyUniversity Find us on social media CORNEA SOCIETY UNIVERSITY (CSU) is the newest online educational initiative geared toward cornea fellows and young physicians.

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