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A Cost Analysis of the American Board of Internal Medicine's Maintenance-of-Certification Program
Background:
In 2014, the American Board of Internal Medicine (ABIM) substantially increased the requirements and fees for its maintenance-of-certification (MOC) program. Faced with mounting criticism, the ABIM suspended certain content requirements in February 2015 but retained the increased fees and number of modules. An objective appraisal of the cost of MOC would help inform upcoming consultations about MOC reform.
Objective:
To estimate the total cost of the 2015 version of the MOC program ("2015 MOC") and the incremental cost relative to the 2013 version ("2013 MOC").
Design:
Decision analytic model.
Data Sources:
Published literature.
Target Population:
All ABIM-certified U.S. physicians.
Time Horizon:
10 years (2015 to 2024).
Perspective:
Societal.
Intervention:
2015 MOC.
Outcome Measures:
Testing costs (ABIM fees) and time costs (monetary value of physician time).
Results Of Base-Case Analysis:
Internists will incur an average of $23 607 (95% CI, $5380 to $66 383) in MOC costs over 10 years, ranging from $16 725 for general internists to $40 495 for hematologists-oncologists. Time costs account for 90% of MOC costs. Cumulatively, 2015 MOC will cost $5.7 billion over 10 years, $1.2 billion more than 2013 MOC. This includes $5.1 billion in time costs (resulting from 32.7 million physician-hours spent on MOC) and $561 million in testing costs.
Results Of Sensitivity Analysis:
Costs are sensitive to time spent on MOC and MOC credits obtainable from current continuing education activities.
Limitation:
Precise estimates of time required for MOC are not available.
Conclusion:
The ABIM MOC program will generate considerable costs, predominantly due to demands on physician time. A rigorous evaluation of its effect on clinical and economic outcomes is warranted to balance potential gains in health care quality and efficiency against the high costs identified in this study.
Primary Funding Source:
University of California, San Francisco, and the U.S. Department of Veterans Affairs.
Insights
The American Board of Internal Medicine (ABIM) Maintenance-of-Certification (MOC) program costs physicians over $23,000 on average, with time costs comprising 90%. This study estimates the significant financial burden of the MOC program on physicians.
Area of Science:
- Medical Education
- Health Economics
- Physician Workforce Studies
Background:
- The American Board of Internal Medicine (ABIM) increased Maintenance-of-Certification (MOC) program requirements and fees in 2014.
- Criticism led to suspension of some content requirements in 2015, but fees and module numbers remained.
- An objective cost appraisal is needed to inform MOC reform discussions.
Purpose of the Study:
- To estimate the total cost of the 2015 ABIM MOC program.
- To calculate the incremental cost compared to the 2013 MOC program.
- To analyze the societal economic impact of MOC.
Main Methods:
- A decision analytic model was employed.
- Data were sourced from published literature.
- The target population included all U.S. ABIM-certified physicians over a 10-year time horizon (2015-2024).
Main Results:
- Internists face average MOC costs of $23,607 over 10 years, varying by specialty.
- Physician time costs constitute 90% of total MOC expenses.
- The 2015 MOC program is projected to cost $5.7 billion cumulatively, $1.2 billion more than the 2013 version.
Conclusions:
- The ABIM MOC program imposes substantial costs, primarily driven by physician time commitments.
- Precise data on time required for MOC activities are currently unavailable.
- Further evaluation is needed to balance MOC's potential quality benefits against its significant economic costs.
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