The NBPAS alternative to MOC
Paul Teirstein, M.D.
Chief of Cardiology
Scripps Clinic
Director Scripps Prebys
Cardiovascular Institute
Scripps Health
Teirstein.paul@scrippshealth.org
858 554 9905
• NBPAS is a new alternative for continuous
physician certification.
• NBPAS relies on ACCME accredited CME for lifelong learning instead of computer modules and
repeat testing.
• Interest in the NBPAS.org alternative is spreading
rapidly.
• This grass roots movement is now in discussions
with hospitals, physician groups and payers to
accept NBPAS continuous certification
Are there data supporting MOC?
ABIM/ABMS argue there are data supporting the
value of MOC. However, close examination of the
reports cited by ABIM/ABMS reveals they support
the opposite conclusion.
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Initial certification Vs. MOC?
• Almost all the studies in the literature evaluate board
certification, not recertification or MOC!
• Initial ABMS certification is earned, for the most part, by
spending several years in an ACGME credentialed training
program.
• The initial certification exam provided by the ABMS is simply
the “final exam” which is obviously a much smaller part of the
educational process.
• Should it be surprising that successfully completing 3 years of
training in an ACGME credentialed cardiology fellowship
makes a doctor better at treating MIs?
• It is absurd to equate the busywork of MOC…clicking on
computer modules for 10-20 hours each year…to the many
years of training required for initial certification
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One of the few studies examining lapsed certification found no
impact on patient outcomes following coronary intervention
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What about the cost?
• Costs (for one specialty) begin at $190 – 256/year
plus module fees.
• Costs increase significantly if you have boards in
multiple specialties
• On top of this are costs for review courses, travel to
review courses
• Time away from practice
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Which brings us to money
• ABIM IRS Form 990 tells the story
• ABIM annual revenue is $55M (that’s per year)
• Directors are very well paid
• We have all had to tighten our belts in medicine
• Patients are NOT demanding MOC…but they ARE
demanding better “value”…better care, lower costs
• Recently, most physicians, have spent an enormous
amount of time cutting costs in their practices and
hospitals
• Physicians are now asking for a better value from
the ABIM.
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www.NBPAS.org
• NBPAS provides and alternative for
maintenance phase of certification
• NBPAS believes CME is the most meaningful
method available for “keeping up.”
• NBPAS replaces computer knowledge
modules and secure exams with accredited,
continuing medical education (CME).
• Acceptable CME must be accredited by the
AACME…independent of commercial
interests.
The 10 year Recertification Exam
• Arguments against testing:
 The exam questions are often not relevant physician’s
practice. Questions often relate to parts of their specialty they
do not practice.
 We have to study for recertification exams. But we only study
what we don’t know…we don’t know what we don’t use, and
after the test we will soon forget
 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 input from colleagues and the internet.
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Detailed 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. Fellows-in-training are exempt.
■ For some specialties (ie interventional cardiology, electrophysiology, surgery), 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).
Abbreviated criteria for NBPAS certification:
■ Previous
certification by an American Board of Medical Specialties member
board. (NBPAS does require a test, just not a repeat test).
■ License to practice medicine in at least one US state.
■ Complete a minimum of 50 hours of ACCME accredited continuing medical
education (CME) within the past 24 months
■ Procedural specialties (ie surgery, interventional cardiology, electrophysiology),
require active privileges to practice that specialty in a licensed US hospital
■ Clinical privileges in your specialty have not been permanently revoked.
NBPAS Fees and Application
• NBPAS is a not for profit 501(c)(3)
organization
• Board members are high profile, thought
leaders representing most ABMS specialties
• Fees are very low, only cover costs
• Physician management and board members
are unpaid
• Governance: transparent, not-for-profit, two
year board terms, COI protections, no
physician pay
www.NBPAS.org
NBPAS Board Members
• NBPAS board members are well respected,
high profile members of the academic
medical community
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
John Anderson, M.D., Past President, Medicine and Science, American Diabetes Association, First Clinic, Nashville, TN
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
NBPAS website
• NBPAS.org
– Website is simple to navigate
– Contains links to NEJM opposing
“Perspectives” on MOC (Teirstein Vs
Irons/Nora) along with the apologetic press
release from ABIM and the NBPAS reaction
– Contains links to explanatory sample letters to
send to hospital administrators and colleagues
– Contains links to downloadable PowerPoint
presentations
Simple
application takes
<15 minutes to
complete
Four common misconceptions
• Board certification was created to provide a
measure of competence over and above the
minimal requirements of state licensing.
NBPAS requirements simply mimic most
state licensing requirements
– NBPAS requires initial ABMS member board
certification which is not required by state boards
– NBPAS only disputes current ABMS MOC
pathways
– NBPAS provides an alternative, more meaningful
pathway for life-long learning
Four common misconceptions
• Supporting an alternative certifying
organization like NBPAS will open the door
to numerous competing boards, standards
will erode and certification will lose meaning
– NBPAS requires initial ABMS certification,
therefore NBPAS actually supports ABMS and
requires a rigorous secure test
– NBPAS disputes ABMS approach to MOC and
provides an alternative only to maintenance of
certification.
Four common misconceptions
• NBPAS requirements are not rigorous
enough. A rigorous certification process is
needed to protect the public from bad
doctors.
– This debate is about how to best pursue life-long
learning, not initial certification. The is no
evidence (or even general belief) that current
ABMS MOC programs protect the public from bad
doctors.
– Most, if not all of the recent scandals in medicine
involved board certified physicians.
Four common misconceptions
• We have to do something to be accountable
to the public. MOC is quick, easy,
inexpensive and we learn something.
– This response almost always comes from a
surgeon who is a diplomate of a board that does
not require the kind of MOC mandated by most
other boards. For example, cardiac surgeons have
a very reasonable and easy MOC process. It is
nothing like the MOC required by internal
medicine specialties, family practice,
anesthesiology etc.
• In just a few months of operation with
only word of mouth and social media:
 Over 3,300 physicians are now certified by
the NBPAS
 A growing number of hospitals have
changed their bylaws to allow NBPAS as
an alternative certification for maintaining
hospital privileges
Hospitals accepting NBPAS as alternative certification for hospital privileges
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Capital Region Medical Center – Jefferson City, MO (affiliated w/ Univ. of Missouri)
Brandon Regional Hospital – Tampa, FL
Shawnee Mission Medical Center – Kansas City, MO
Mendocino Coast District Hospital – Fort Bragg, CA
Florida Hospital Heartland Division – Sebring, FL
Baylor St. Luke’s Medical Center/Texas Heart Institute – Houston, TX
Sibley Memorial Hospital, Sibley Memorial, Johns Hopkins Medical System, Washington, DC.
Southeast Missouri Hospital, Cape Girardeau, MO
Columbia Basin Hospital, Ephrata, WA
St. Mary Medical Center, Langhorne, PA
St Luke’s Hospital, Cedar Rapids, IA
Mercy Medical Center, Cedar Rapids, IA
Hoag Hospital, Newport CA in process - MEC approval
Texas Health Presbyterian Rockwall, TX
Arkansas Heart Hospital, Little Rock, AR
Lawrence & Memorial Hospital, New London, CT
Providence Little Company of Mary, Torrance, CA
Holmes Regional Medical Center, Melbourne, FL
Palm Bay Hospital, Palm Bay Florida
Wuesthoff Hospital, Melbourne. Florida
Virginia Gay Hospital, Vinton, IA
Frederick Memorial Hospital, Frederick, MD
Oklahoma Heart Hospital, Oklahoma City, OK
University of Pittsburgh Medical Center Hamot, Erie, PA
Davita Dialysis Center, Sparta, TN
Miller County Hospital Colquitt, GA
*Note: Some of the above hospitals have changed their bylaws to allow alternatives to ABMS
certification that include NBPAS without specifically naming NBPAS
• Organizations accepting or
considering criteria for acceptance of
alternative board certification
organizations
–
–
–
–
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California ACC
National ACC
American Collage of Physicians (ACP)
Washington State Medical Association
California Medical Association (two resolutions under consideration this
week)
– Other physician societies, ie The American Association of Clinical Endocrinologists (AACE)
– Others
From: "Steven Weinberger, MD, FACP" <resources@acpresources.org>
Date: October 2, 2015 at 8:00:00 PM EDT
To: tomrifai@gmail.com
Subject: ACP Update about ABIM's MOC Program
Finally, we’d like to reiterate our position that ACP does not support
making participation in MOC an absolute prerequisite for state licensure,
hospital credentialing, or health plan (insurer) credentialing. Instead,
decisions about licensure and credentialing should be based on the
physician’s performance in his or her practice setting and a broader set of
criteria for assessing competence, professionalism, commitment to
continuous professional development, and quality of care provided.
ABMS and ABIM are currently under fire in the lay and scientific press!
10 days after
launching the
NBPAS,
ABIM
apologizes
hundreds of
thousands of
its diplomates
ABIM Apologizes-a good first step
February 2015
• 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)
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ABIM --- additional changes
announced – summer 2015
• Streamlining recertification for tertiary subspecialists, which
previously required interventional cardiologists and other
subspecialists to re-take and pass multiple examinations…but
beware of unintended consequences
• Eliminating punitive labels from the ABIM website, such as
“not meeting MOC requirements.”
• Accepting different types of traditional CME as counting for
MOC requirements.
Awaiting the specifics of how ABIM will partner with AACME and how CME
will “count” towards MOC.
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Given recent announcements, do
we still need alternative boards?
• The self-admitted poor roll-out of MOC by ABIM
illustrates the need for alternative certifying
organizations.
• We do not know how the changes will be executed.
Will “take home” exams be meaningful or just more wasted
time
Will costs come down?
Will part IV requirements return after the two year hold.
Will there slippage back to onerous requirements
• Some physicians will prefer a less complicated, less
expensive approach.
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Visit NBPAS.org
• Physicians, go to NBPAS.org and apply for board
certification.
• Use the resources on NBPAS.org
– Downloadable PowerPoints and Sample letters
• Spread the word
• Lobby your hospital to accept NBPAS as an
alternative board certification
www.NBPAS.org
Vol.CLV18. .No. 34,682
NEW YORK. November 6th, 2010
Breaking News:
Physicians Finally Extract Heads From Sand
Docs came close to ceding
control of entire profession
• This has been a sentinel event for many physicians
• Busy physicians often focus on the urgent and not the important
• Many initially reacted with jaded pessimism, saying "Its too late. The
new requirements are 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
Its time for practicing physicians to take back the leadership of
medicine