Cardiologists now have an alternative option to maintain their board certification through a new pathway developed jointly by the American College of Cardiology and the American Board of Internal Medicine.
The new avenue, announced at the ACC’s annual meeting, focuses on assessment of specific study areas over the course of 5 years, rather than a single, broader test every 10 years. The Collaborative Maintenance Pathway (CMP) begins in 2019 with a cardiovascular disease CMP option that includes engagement with the ACC’s Adult Clinical Cardiology Self-Assessment Program as a prerequisite to qualify for a performance assessment later in the year.
The new pathway was developed based on feedback from cardiologists who expressed interest in focusing their study on specific areas, said Timothy W. Attebery, ACC CEO.
“The new CMP leverages the respective expertise of the ACC and ABIM to create a literal ‘pathway’ that meets the ongoing learning needs of cardiologists, while also giving patients, the public, and other stakeholders confidence that the care provided by their physicians is of the highest quality,” Mr. Attebery said in a statement. “We appreciate ABIM working with us on what we believe is a win-win solution for cardiologists and the patients they serve.”
As part of the pathway, new performance assessments will be available annually, with each covering 20% of the field of cardiovascular disease. Ultimately, the breadth of general cardiology will be covered in a span of 5 years, according to a summary of the option. The 2019 performance assessment will focus on arrhythmias, which means physicians planning to enter the CMP option in 2019 can begin studying the arrhythmia section of the education materials now in preparation for the fall 2019 performance assessment. The ACC expects to launch CMPs in clinical cardiac electrophysiology, interventional cardiology and advanced heart failure, and transplant cardiology in 2020. The pathways are being developed in collaboration with the Heart Rhythm Society, the Society for Cardiovascular Angiography and Interventions, and the Heart Failure Society of America.
ABIM’s traditional 10-year maintenance of certification exam and the 2-year knowledge check-in assessment will remain available to diplomates who choose not to participate in the CMP option.
ABIM President Richard J. Baron, MD, said the organization is proud to continue the evolution of its MOC program to better meet the needs of physicians and patients.
“This new offering increases choice, flexibility, and relevance for board-certified cardiologists while also keeping a performance standard that gives patients confidence that their physician possesses the current medical knowledge necessary to deliver high-quality care,” Dr. Baron said in a statement. “We appreciate ACC’s expertise and partnership throughout this journey to co-create an innovative new assessment option for cardiologists.”
A summary of the new pathway and how physicians can apply is provided on the ACC website.
Lawsuit against ABIM continues
Not all cardiologists welcome the change.
The CMP option is nothing different and its development is “one of the most shameful money grabs from U.S. cardiologists and cardiac electrophysiologists imaginable, “ Chicago-based cardiologist Wes Fisher, MD, wrote in his blog.
“More importantly, the ACC leverages (ties) CMP to the threat to a physician’s ABIM board certification status, and therefore their right to work, and I believe represents a restriction of trade and is in violation of U.S. antitrust and racketeering laws,” Dr. Fisher wrote. “It is truly unbelievable that the ACC and the Heart Rhythm Society would do this to their own membership, but then again, given their prolific financial balance sheets, maybe it’s not so unbelievable after all.”
Dr. Fisher declined to comment for this story. He and his fellow physicians with the Practicing Physicians of America (PPA) are funding a lawsuit against ABIM in an effort to invalidate its MOC process.
The legal challenge, filed Dec. 6, 2018, in Pennsylvania district court, claims that ABIM is charging inflated monopoly prices for maintaining certification, that the organization is forcing physicians to purchase MOC, and that ABIM is inducing employers and others to require ABIM certification. The four plaintiff-physicians are asking a judge to find ABIM in violation of federal antitrust law and to bar the board from continuing its MOC process. The suit is filed as a class action on behalf of all internists and subspecialists required by ABIM to purchase MOC to maintain their ABIM certifications. On Jan. 23 of this year the legal challenge was amended to include racketeering and unjust enrichment claims
In a motion filed March 18, attorneys for ABIM asked a judge to dismiss the suit. The plaintiffs fail to prove that board certification – initial certification and continuing certification – are two separate products that ABIM is unlawfully tying, and for that reason, their antitrust the claims are invalid, according to the motion.
“Plaintiffs may disagree with ABIM and members of the medical community on whether ABIM certification provides them value, but their claims have no basis in the law,” Dr. Baron said in a statement. “With advances in medical science and technology occurring constantly, periodic assessments are critical to ensure internists are staying current and continuing to meet high performance standards in their field.”
Two other lawsuits challenging MOC, one against the American Board of Psychiatry and Neurology and another against the American Board of Radiology, are ongoing, More than $200,000 has been raised by doctors and their supporters nationwide through a GoFundMe campaign launched by PPA to pay for the plaintiffs’ legal costs.