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Associations Between American Board of Internal Medicine Maintenance of Certification Status and Performance on a Set
Bradley Gray1, Jonathan Vandergrift1, Bruce Landon2
1American Board of Internal Medicine, Philadelphia, Pennsylvania (B.G., J.V., R.L.).
Background:
The value of the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program has been questioned as a marker of physician quality.
Objective:
To assess whether physician MOC status is associated with performance on selected Healthcare Effectiveness Data and Information Set (HEDIS) process measures.
Design:
Annual comparisons of HEDIS process measures among physicians who did or did not maintain certification 20 years after initial certification.
Setting:
Fee-for-service Medicare.
Participants:
1260 general internists who were initially certified in 1991 and provided care for 85 931 Medicare patients between 2009 and 2012.
Measurements:
Annual percentage of a physician's Medicare patients meeting each of 5 HEDIS annual or biennial standards and a composite indicating meeting all 3 HEDIS diabetes standards.
Results:
Among the 1260 physicians, 786 maintained their certification from 1991 to 2012 and 474 did not. The mean annual percentage of HEDIS-eligible diabetic patients who completed semiannual hemoglobin A1c testing was 58.4% among physicians who maintained certification and 54.4% among those who did not (regression-adjusted difference, 4.2 percentage points [95% CI, 2.0 to 6.5 percentage points]; P < 0.001). Diabetic patients of physicians who maintained certification more frequently met the annual standard for low-density lipoprotein (LDL) cholesterol measurement (83.1% vs. 80.5%; regression-adjusted difference, 2.3 percentage points [CI, 0.6 to 4.1 percentage points]; P = 0.008) and all 3 diabetic standards (46.0% vs. 41.6%; regression-adjusted difference, 3.1 percentage points [CI, 0.5 to 5.7 percentage points]; P = 0.019). The regression-adjusted difference in biennial eye examinations was statistically insignificant (P = 0.112). Measures for LDL cholesterol testing in patients with coronary heart disease and biennial mammography were also met more frequently among physicians who maintained certification (79.4% vs. 77.4% and 72.0% vs. 67.8%, respectively), with regression-adjusted differences of 1.7 percentage points (CI, 0.2 to 3.3 percentage points; P = 0.032) and 4.6 percentage points (CI, 2.9 to 6.3 percentage points; P < 0.001), respectively.
Limitation:
Potential confounding by unobserved patient, physician, and practice characteristics; inability to determine clinical significance of observed differences.
Conclusion:
Maintaining certification was positively associated with physician performance scores on a set of HEDIS process measures.
Primary Funding Source:
American Board of Internal Medicine.
Insights
Physician Maintenance of Certification (MOC) positively impacts quality care. Doctors maintaining MOC certification showed better performance on Healthcare Effectiveness Data and Information Set (HEDIS) measures, including diabetes care and cholesterol management.
Area of Science:
- Internal Medicine
- Healthcare Quality
- Physician Performance Metrics
Background:
- The value of the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program as a marker of physician quality has been debated.
- Assessing the association between MOC status and adherence to established quality metrics is crucial for understanding its impact.
Purpose of the Study:
- To determine if physician MOC status correlates with performance on specific Healthcare Effectiveness Data and Information Set (HEDIS) process measures.
- To evaluate the long-term association between maintaining certification and quality of care provided.
Main Methods:
- A comparative analysis was conducted on HEDIS process measures.
- Physicians were grouped based on whether they maintained ABIM certification for 20 years post-initial certification.
- Data from fee-for-service Medicare beneficiaries provided by 1260 general internists between 2009-2012 were analyzed.
Main Results:
- Physicians maintaining MOC certification demonstrated higher rates of adherence to HEDIS measures.
- Specifically, patients of MOC-certified physicians were more likely to receive timely hemoglobin A1c testing (58.4% vs 54.4%) and LDL cholesterol measurement (83.1% vs 80.5%).
- Higher performance was also observed in mammography screening (72.0% vs 67.8%) and meeting all diabetes care standards (46.0% vs 41.6%).
Conclusions:
- Maintaining ABIM certification is positively associated with physician performance on key HEDIS process measures.
- The findings suggest that MOC participation may serve as an indicator of quality in internal medicine practice.
- Further research is needed to explore the clinical significance and potential confounding factors.
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