New Quality Indicator: MOC promotes better care, ABOto director says

“I think you can see the more educated patients may wonder about a doctor that doesn’t participate in MOC,” he said.

Hospital privileges may eventually require MOC, he added. “I don’t know of any that currently require MOC but I think this is something coming down the line,” he said.

Also, state licensing boards are requiring doctors to do “something similar to MOC” to meet state licensing requirements, he said.

Mark Wax, MD, professor of otolaryngology-head and neck surgery at Oregon Health and Science University, who was part of the same session, said that doctors who are not grandfathered still need to take MOC seriously, even though that may not have been his view at first.

“I thought, ‘Great, I won’t ever have to do this, it won’t affect me,’” Dr. Wax said. “I think we’re all wrong in that. I think the states are going to mandate that we’re going to have to do something to keep our license through them.”

To underline his point on the importance of MOC, Dr. Miller showed a curve of physician quality as it exists today, with a thin tail on the left for “bad” doctors and a thin tail on the right for “excellent” doctors, and the crest of the curve at the “good” line in the middle.

“The purpose of MOC is to shift the curve to the right,” he said. “Most otolaryngologists practice good medicine on most patients most of the time. Why not all of the patients all of the time?”

Maintenance of Certification: Its Four Parts

Part I: Professional Standing

• Must have certificate from the American Board of Otolaryngology
• Must have an unrestricted medical license
• Must maintain privileges at hospital/ambulatory surgery center

Part II: Continuing Education and Self-Assessment

• Part of a lifelong learning program
• 25 CME units per year
• Completion of self-assessment program that is clinically oriented, is specialty-specific and is aided by online modules
• It is a non-punitive assessment

Part III: Cognitive Examination

• Secure, closed-book exam administered at testing centers around the country
• Totally clinical, no basic science
• 80 questions: 12 on fundamentals, and the other 68 on a selected practice area
• Focuses on specific practice, with clinical fundamentals and one specialty module
• Cannot be used to imply subcertification, except for neurotology and sleep medicine

Part IV: Performance in Practice (Still being developed)

• Possibly the most important part of MOC but the most difficult to develop
• Based on a quality improvement approach
• Will look at doctor-patient interaction and outcomes
• Has to be meaningful but minimally intrusive
• Has resulted in reduced malpractice rates
• ’Enhanced’ Part IV being developed that will meet Physician Quality Reporting Initiative requirement