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The NBPAS alternative to MOC

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

3 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

4 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 The questions are often outdated.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.

5 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


7 ABIM Admits they “Got it Wrong”
The following slide shows an apology offered by the NBPAS for MOC

8 ABIM is now under fire from many organizations!

9 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

10 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.

11 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

12 Complete 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.  Physicians in or within two years of training are exempt. ■ For some specialties (ie interventional cardiology, electrophysiology, surgical specialties), 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).

13 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

14 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 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

15 NBPAS website
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.



18 Simple application takes <15 minutes to complete

19 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 to view the website, apply for certification, leave comments and help us educate administrators and the public.

20 Conclusions: The need for an alternative
Irrespective of how the MOC issue is resolved by ABIM, the process of evaluating MOC has shed enormous light on how medicine is regulated in the United States In the past, ABMS/ABIM has made contributions to patient care by providing initial physician certification exam. But it is also clear that ABIM is a private, self appointed credentialing organization. ABIM has grown into a big >$55M business, unfettered by competition, with zealous economic goals, selling proprietary, copyrighted products It is time for other organizations to compete with ABIM and offer alternative credentialing options.

21 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 Sentinel event for many physicians Physicians are waking up to the fact that their profession is controlled by individuals who are not involved with the day to day care of patients When confronted with the inequities of MOC, many initially reacted with jaded pessimism, saying "Its too late. MOC is 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 It is time for practicing physicians to take back the leadership of medicine

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