HELP DESK Experts address relevant and topical questions in the field | Edited by Gladwyn Leiman, MBBCh, FIAC, FRCPath
Diane Davis Davey, MD Diane Davis Davey, MD, is a Professor and Assistant Dean of Graduate Medical Education at the University of Central Florida College of Medicine in Orlando, Florida. She is a pathologist at the Orlando Veterans Affairs Medical Center. She is currently a Trustee and Past President of the American Board of Pathology (ABP) and has also served on American Board of Medical Specialties committees. She is Past President of the American Society of Cytopathology. She is board certified in Anatomic and Clinical Pathology, Cytopathology, and Hematology, and is participating in the ABP Maintenance of Certification Program. Prior to moving to Florida, she directed the cytopathology fellowship program and laboratory at the University of Kentucky.
Maintenance of Certification: How Does It Affect Cytopathologists? All certificates issued by the American Board of Pathology (ABP) are now time-limited, and diplomates must participate in Maintenance of Certification (MOC) to remain board-certified. The voluntary recertification program administered by the ABP has stopped taking applications, but pathologists with ABP lifetime certificates can now enroll voluntarily in MOC. How does this affect you as a practicing cytopathologist? The ABP is one of 24 member boards of the American Board of Medical Specialties (ABMS), and all ABMS boards now have MOC programs with similar general standards and sections. MOC programs allow physicians to demonstrate their commitment to lifelong learning and competence, and MOC fulfills public expectations for enhanced patient safety and quality clinical outcomes. MOC is different from previous recertification programs in that the program is continuous and involves more than an examination: if certain reporting deadlines are missed, the board certificate may expire before the end of the 10-year cycle. The MOC program has 4 parts, which will be described briefly below; additional information is available on the ABP Web site and in recent publications.1,2 Part 1: Professional standing includes demonstration of a full and unrestricted license to practice medicine in the United States, Canada, or the local jurisdiction where they practice, if outside either the United States or Canada. Information regarding medical staff privileges or a description of practice setting must also be provided. Part 2: Life-long learning and self-assessment includes Continuing Medical Education (CME) and Self-Assessment Modules (SAMs). Each MOC participant must obtain a minimum of 70 American Medical Association Category 1 CME credits over each 2-year period, and at least 20 of the 70 credits must include successful completion of SAMs. The way SAMs differ from CME is that participants must pass a self-assessment test at the end of the educational activity and receive feedback. All SAMs count as CME, but the reverse is not true. A patient safety module approved by the ABP and ABMS must be taken once during every 10-year cycle. Part 3: Cognitive expertise is the mandatory proctored computerized examination which must be taken between years 7 and 10 of each cycle. Each general or subspecialty examination is 150 questions and can be
completed in a half day. The anatomic and clinical pathology MOC examination is considered one exam and consists of a required 50-question module plus 4 modules of 25 questions that are selected by the diplomate. The required module contains general anatomic and clinical pathology questions and noninterpretive topics such as laboratory management, test validation, safety, compliance, and quality assurance. The diplomate will be able to select at least 3 cytopathology modules including general, gynecologic, and nongynecologic (includes aspiration topics). The general examinations are graded together so one does not need to pass each module. The cytopathology subspecialty examination is also 150 questions but is not modular; it will encompass gynecologic, nongynecologic, and fine-needle aspiration topics plus laboratory management. A practicing cytopathologist can take the MOC anatomic and clinical pathology examination in the morning and the cytopathology exam in the afternoon and pay a single-day cost of $500. An individual who decides to relinquish his clinical pathology certificate saves no money and still takes a 150-question examination in the morning; the only difference is that the 50-question required module has no clinical pathology questions. Part 4: Evaluation of performance in practice includes laboratory accreditation, laboratory and individual performance improvement, quality assurance activities, and peer evaluations/attestations. A cytopathologist will fulfill Part 4 activities easily through laboratory accreditation, participation in government-mandated cytology proficiency testing, and laboratory participation in cytopathology interlaboratory comparison programs sponsored by professional organizations. Many programs can be used to satisfy both Part 2 and Part 4 requirements, and the ABP Web site provides a listing of qualifying programs.1 Pathologists participating in MOC may choose to maintain all general and subspecialty certificates or be selective, depending on their practice setting. However, because practice circumstances may change, and it is much easier to maintain certificates instead of passing the primary certification examination again, maintaining as many certificates as feasible may be the safest course. Cytopathologists participating in MOC need to submit reports to the ABP every 2 years for Parts 2 and 4 activities, and report licensure and peer attestation references at the end of the fourth and eighth years. Note that 81
HELP DESK an accredited cytopathology fellowship program fulfills both Part 2 and Part 4 requirements for one 2-year cycle. The ABP and the ABMS are working together to enhance the value of MOC to participating pathologists, and also to align MOC programs with other types of physician assessment programs.2 By working through the ABMS, the ABP received approval from the Centers for Medicare and Medicaid Services (CMS) to participate in the MOC: Physician Quality Reporting System (PQRS) Additional Incentive Program. The field of pathology currently has 5 PQRS quality measures mainly related to cancer resection reporting, and these may be reported through Medicare Part B claims or other mechanisms. For 2013 and 2014, PQRS provides an incentive payment of 0.5% of Medicare Part B allowed charges, and those who do not participate in reporting the quality measures incur a 1.5% penalty beginning in 2015.2 If 2 physicians in a group are reporting quality measures using a registry, the entire group of physicians with the same tax identification number qualifies for the incentive payment. The MOC:PQRS program offers an additional incentive of 0.5% to those pathologists who have submitted quality measures data and are participating in the ABP MOC programs “more frequently” than required. Pathologists with lifetime certificates need only enroll and participate in MOC to meet the “more frequently” requirement, whereas those with time-limited certificates need to complete extra Part 2 or Part 4 activities or pass the Part 3 examination earlier than year 10 of the cycle. More information is available on the ABP and ABMS Web sites.1,3
MOC participation is voluntary for those with lifetime certificates, and a decision not to participate will not jeopardize the physician’s original certificate. However, the future may bring additional incentives to participate. The ABMS has served as a resource to both the public and other health care constituencies seeking information about physician qualifications for 80 years.4 In the future, the ABMS Web site will publically disclose which pathologists are participating in MOC programs. Pathologists participating in MOC will be recognized as being in substantial compliance with maintenance of licensure requirements adopted by the Federation of State Medical Boards.2 There is ongoing discussion between the ABMS and The Joint Commission on how MOC can be used to meet ongoing professional practice evaluation physician privileging standards. For all these reasons, cytopathologists are encouraged to determine the benefits and costs of participation, and make an informed decision.
American Board of Pathology. Maintenance of Certification (MOC). http://www.abpath.org/MOCGenInfo.htm. Accessed September 6, 2013.
R Johnson RL. The American Board of Pathology’s Maintenance of CertificationV update. Arch Pathol Lab Med. (in press).
American Board of Medical Specialties. MOC Matters. https://mocmatters.abms.org/ default.aspx. Accessed September 6, 2013.
American Board of Medical Specialties. http://www.abms.org. Accessed September 10, 2013. DOI: 10.1002/cncy.21357
Cytopathology Help Desk represents the opinions and views of the author and does not reflect any policy or opinion of the American Cancer Society, Cancer Cytopathology, or Wiley unless this is clearly specified.