The ABPN Maintenance of Certification (MOC) Program is provided as a service to Diplomates of the American Board of Psychiatry and Neurology. The program includes examination format options, tracking options, online examination registration, and a structure that will assist Diplomates in remaining up-to-date in their respective fields. It is the expectation of the Board that Diplomates will use the tools provided to keep themselves abreast of improvements in their individual fields and thus maintain their certification.
The ABPN has developed a program for our Diplomates that strikes a balance between what will likely be required by organizations that license, credential, and pay physicians, and what is reasonable and straightforward enough to be accomplished by busy physicians. Many of our Diplomates are already participating in various components of MOC through institutional quality improvement programs and the MOC program will attempt to recognize those efforts. ABPN has tried to develop a clear MOC program that will enable Diplomates to demonstrate their competence throughout a certificate cycle.
The Board is committed to supporting its Diplomates throughout their careers by its mission of advancing the clinical practices of psychiatry and neurology and by promoting the highest evidence-based guidelines and standards. The goal of the MOC program is to ensure excellence of patient care and encourage and support practice improvement.
The MOC program requires Diplomates to participate in sanctioned self-assessment performance measures, identify possible weaknesses in their knowledge, pursue learning activities tailored to individual areas that need to be strengthened, and develop quality improvement programs based on their clinical practice. The goal for Diplomates is to reflect on their personal knowledge and performance, commit to a process of improvement and reevaluation over specified time frames, and continually improve care for their patients.
History of Recertification and MOC
Physicians certified in psychiatry, child and adolescent psychiatry, neurology, or neurology with special qualification in child neurology prior to October 1, 1994 were granted lifetime certificates.
Between October 1, 1994 and December 31, 2011 all individuals achieving specialty Board certification by the ABPN were issued time-limited certificates that expired December 31, ten years after they were issued. Certificates issued in all subspecialties except child and adolescent psychiatry have always been time-limited. Time-limited certificates for child and adolescent psychiatry began in 1995. Beginning January 1, 2012, all certificates are dependent upon continuous maintenance of certification based on a three-year cycle of requirements with certificates being valid as long as they are maintained. The examination cycle remains at ten years.
Due to a mandate of the American Board of Medical Specialties (ABMS), the recertification program transitioned to Maintenance of Certification in 2007. Prior to 2007, Diplomates could recertify simply by taking the recertification examination. Beginning in 2007, admission to the recertification (now called Maintenance of Certification or Cognitive) examination required prerequisites. The change from recertification to maintenance of certification strengthened the program and guaranteed that physicians were current in ways not immediately available for testing.
General Conditions of Maintenance of Certification
Diplomates’ certification and maintenance of certification status is public information. This information is reported by the ABPN to the public in the ABPN verifyCERT® system and annually to the American Board of Medical Specialties.
Specialty certification certificates (psychiatry, neurology, neurology with special qualification in child neurology) and all subspecialty certificates must be renewed periodically in order to remain valid. Certificates that are not renewed are no longer valid and the physician is no longer certified in that specialty and/or subspecialty.
Certifications in most subspecialties are dependent upon the primary specialty. Diplomates with certificates in any subspecialty other than child and adolescent psychiatry must also maintain certification in their specialty in order to maintain certification in the area of subspecialization. Diplomates in neurodevelopmental disabilities must maintain certification in neurology with special qualification in child neurology. If certification in the primary specialty lapses, certification in any subspecialty except child and adolescent psychiatry is no longer valid.
Diplomates in child and adolescent psychiatry do not need to maintain current certification in general psychiatry for their subspecialty certification to remain valid and to recertify in child and adolescent psychiatry.
If a certificate lapses, there is no time limit on regaining certification status through MOC.
MOC program participation includes meeting all MOC requirements, (Continuing Medical Education credits (CME), Self-Assessment (SA), Performance in Practice (PIP)) as well as passing the MOC cognitive examination. MOC requirements must be completed prior to submitting an application for the cognitive examination.
The cognitive expertise component of the MOC program is the maintenance of certification (previously recertification) examination. A passing score on the cognitive examination automatically enrolls the Diplomate into the Continuous Maintenance of Certification (C-MOC) Program.
Any CME, SA, or PIP activities completed will apply to all specialties/subspecialties in which a physician is certified. Combined (formerly modular) examination formats are available for physicians who wish to maintain certification in more than one area.
The ABPN recognizes that many physicians already participate in quality improvement (QI) efforts in their local institutions. The Multi-Specialty MOC Portfolio Approval Program (Portfolio Program) sponsored by the ABMS is an alternative pathway for healthcare organizations that support physician involvement in quality improvement and MOC to have their quality improvement efforts be approved for MOC Part IV credit. ABPN Diplomates who successfully complete an approved QI program receive credit for one PIP clinical module. If the approved QI effort includes a patient or peer survey, ABPN Diplomates may also receive credit for one PIP feedback module.
ABPN recognizes that all ABMS Member Boards have built their MOC programs based on the same guidelines issued by ABMS. Therefore, Diplomates of any ABMS Board, who are also ABPN Diplomates, will be able to receive CME, SA, and PIP credit as long as they are currently meeting the other Board’s MOC requirements. Physicians receiving such credit must still pass the ABPN cognitive examination in order to maintain their ABPN certification.
Participation in the MOC program
The ABPN currently has two active Maintenance of Certification programs: The Ten-Year MOC (10-Year MOC) Program for Diplomates with time-limited certificates granted prior to 2012 and the Continuous Maintenance of Certification (C-MOC) Program for Diplomates certified or recertified in 2012 or later. Diplomates who do not maintain their certification according to the requirements of the MOC program in which they are enrolled are no longer certified. A description of the requirements of each program is found in this booklet.
The 10-Year MOC program will sunset December 31, 2021. Following that date, all Diplomates other than those with lifetime certificates, will be enrolled in the C-MOC program.
Maintenance of Certification for Lifetime Certificate Holders
Physicians certified in psychiatry, child and adolescent psychiatry, neurology, or neurology with special qualification in child neurology prior to October 1, 1994 were granted lifetime certificates.
Participation in the MOC program is not required for Diplomates with lifetime certificates; however, credentialing requirements for hospitals, practice groups, and third-party payers may require evidence of continuous certification efforts. In addition, some states are considering the implementation of Maintenance of Licensure Programs, similar to the MOC program.
Lifetime certificate holders may voluntarily participate in the MOC program. Lifetime certificate holders who voluntarily participate in the MOC program and do not pass the cognitive examination, will not lose their lifetime certificate. Lifetime certificate holders who do not participate in MOC will be reported to the ABMS and on the ABPN website as, “Certified-not meeting MOC requirements and not required to do so.”
Responsibilities of Diplomates including Record Keeping and Attestation
• It is the responsibility of Diplomates to understand and follow current requirements for maintenance of certification and to submit application materials for maintenance of certification examinations by the appropriate deadlines.
• Diplomates are responsible for keeping their medical license information up-to-date.
• Diplomates are responsible for keeping their mailing and email address up-to-date.
• Diplomates are required to maintain records of their SA, CME, and PIP efforts.
• Diplomates are responsible for choosing their own MOC activities. Physicians may choose the self-assessment, continuing medical education, and practice improvement plans that will best address their own needs, expand their expertise, and enhance the effectiveness and efficiency of their practice. Category 1 CME activities that are relevant to their practice will be acceptable. Self-assessment and Performance in Practice activities must come from the ABPN approved products list beginning January 2014.
• Physicians must complete the cognitive examination in all specialties/subspecialties in which they are certified in order to retain certification in that specialty/subspecialty.
• Diplomates must provide their signature attesting to completion of the required activities on their applications for the MOC cognitive examinations.
Responsibilities of the ABPN
• The ABPN will provide online services for the convenience of Diplomates through ABPN Physician Folios. ABPN Physician Folios includes mechanisms for tracking Diplomates’ SA, CME, and PIP activities, and an online application service for applying for examinations.
• The ABPN will provide regular reminders to Diplomates regarding requirements, updates to the MOC program, and other information of interest to Diplomates. This information will generally be provided by email or via the website (www.abpn.com)
• ABPN will make available a current examination schedule on our website, www.abpn.com. This examination sched- ule will include examination date choices and application deadlines. Applications are made through ABPN Physician Folios and are available three months prior to the initial deadline. Applications received after the initial deadline will incur a late fee.
• The ABPN will make available online Information for Applicants publications for each examination three months prior to the application deadline. These publications will provide detailed information about the requirements for admission, and the administration of each MOC examination and will remain available for reference until the subsequent publication.
• A blueprint describing the content of each examination will be available on the website.
• The ABPN will collaborate with professional organizations to ensure the availability of adequate numbers of SA and PIP MOC products.
• ABPN staff will be available by phone and email during regular business hours to answer questions about requirements and examinations, and offer ABPN Physician Folios support.
Examinations and Applications for Examination
Maintenance of Certification Examinations for each specialty are offered annually. MOC examinations for subspecialties are offered annually beginning in the ninth year the subspecialty exists.
All MOC examinations are administered at more than 200 Pearson-VUE computer-testing centers located throughout the United States. MOC examinations are currently administered early in the calendar year (except pain medicine). Other than pain medicine, application deadlines for MOC examinations are currently in the year prior to the examination.
Combined (formerly modular) MOC examinations are available for physicians who wish to recertify in more than one specialty and/or subspecialty at the same time. Combined examinations consist of 100 questions from each specialty or subspecialty area. Any MOC examinations administered by ABPN are available to be combined into this examination format. Examinations administered by other Boards (i.e., sleep medicine, pain medicine, etc.) are not available to be combined.
Applications and current Information for Applicants publications for each examination are available three months prior to the deadline indicated on the examination schedule. Applications are made through ABPN Physician Folios (www.abpn.com/folios). Information for Applicants publications and the current examination schedule are found at www.abpn.com.
The ABPN will audit approximately five percent of the applications submitted for the cognitive examination. Candidates whose applications are audited will receive a letter or email detailing the documentation required as evidence of completion of required components (SA, CME, and PIP activities). Failure to return this documentation may result in the denial of the application for the MOC cognitive examination.
The Two Maintenance of Certification Programs
The ABPN currently has two active Maintenance of Certification programs: The Ten-Year MOC (10-Year MOC) Program for Diplomates with time-limited certificates granted prior to 2012 and the Continuous MOC (C-MOC) Program for Diplomates certified or recertified in 2012 or later.
Specific requirements exist for both the 10-Year MOC program and the C-MOC program. The specific requirements for each program are covered later in this booklet. The 10-Year MOC program description includes a schedule for physicians recertifying between 2014 and 2021 that describes when certain common requirements must be met. The schedule is slightly different for physicians in the C-MOC program.
Common Requirements: Maintenance of Certification for all Diplomates
As mandated by the American Board of Medical Specialties, the Board has developed Maintenance of Certification programs that include four components:
1. Professional Standing
2. Self-Assessment (SA) and Continuing Medical Education (CME)
3. Cognitive expertise
4. Performance in Practice (PIP)
Any CME, SA, or PIP activities completed will apply to all specialties/subspecialties in which a physician is certified. Combined examination formats are available for physicians who wish to maintain certification in more than one area.
1. Professional Standing
To show evidence of professional standing, all Diplomates must continually hold an active, full, and unrestricted allopathic and/or osteopathic license to practice medicine in at least one state, commonwealth, territory, or possession of the United States, or province of Canada. All licenses held by a physician must be unrestricted. An active, full, unrestricted license must be maintained even if the physician is out of the country for extended periods of time. Full details of licensure requirements are found in any Information for Applicants publication.
2. Self-Assessment and Continuing Medical Education
A. Self-Assessment (SA)
Diplomates of the ABPN are required to participate in broad-based self-assessment activities. Self-assessment activities may come from multiple self-assessment programs. Each self-assessment activity must cover new knowledge and/or current best practices in one or more of the competency areas, and provide feedback that can be used by the Diplomate as the basis for focused CME, lifelong learning, and/or career development. That feedback must include the correct answer and recommended literature resources for each question, and comparative performance to peers.
|• At least 8 CME credits per year (averaged over 3 years) should involve self-assessment.
• Feedback must include comparative performance to peers.
• Feedback must include correct answers and recommended literature resources for each question.
• Self-assessment programs must include no fewer than 25 questions and 2 CME credits per activity.
• The self-assessment examination must take place before any subsequent CME educational activity.
Beginning January 1, 2014, Diplomates are required to use only ABPN-approved products for self-assessment activities. The Board will approve additional programs over time and reserves the right to approve or reject any course or guideline submitted for approval. ABPN-approved products are found on the ABPN website.
B. Continuing Medical Education (CME)
Diplomates of the ABPN are required to complete an average of 30 specialty or subspecialty CME credits per year averaged over three years. CME must be relevant to the specialty in which the Diplomate practices. Acceptable CME credits are Cate- gory 1 CME accredited by Accreditation Council for Continuing Medical Education (ACCME), Category 1A CME accred- ited by American Osteopathic Association (AOA), or Category 1 CME accredited by the Royal College of Physicians and Surgeons of Canada. Diplomates certified in more than one area only need to accrue an average of 30 CME credits per year, as the same CME credits can be used to satisfy the MOC requirements for multiple specialties and subspecialties. This requirement was phased in beginning in 2006 for those applying for 2007 MOC examinations.
|• Diplomates must accrue an average of 30 Category 1 CME credits per year (averaged over 3 years)
• CME must be relevant to the specialty/subspecialty in which the Diplomate practices
• At least an average of 8 of the CME credits per year (averaged over 3 years) should involve self-assessment.
3. Cognitive Expertise (MOC examination)
Passing the MOC examination at least once every 10 years fulfills the cognitive expertise component of the program. To sit for a cognitive examination, all current MOC requirements must be satisfied at the time one applies for the MOC application. The Board will audit 5% of applicants for the cognitive examination. Audited applicants must provide documentation of SA, CME, and PIP activities.
Practice-relevant, clinically oriented, multiple-choice, computer-administered examinations are delivered in over 200 Pearson VUE testing centers throughout the country.
To prepare for the MOC cognitive examinations, Diplomates should keep current with research and developments in their field, review specialty-specific journals and practice guidelines, and attend relevant CME programs.
|• Diplomates must pass the MOC examination at least once every 10 years.
• MOC program participation includes meeting all MOC requirements, including passing the MOC cognitive examination. All MOC components must be met at the time of application for examination.
• MOC examinations are currently administered early in the calendar year (except pain medicine). Other than pain medicine, application deadlines for MOC examinations are currently in the year prior to the examination.
• Combined (formerly modular) MOC examinations are available for physicians who wish to recertify in more than one specialty and/or subspecialty at the same time.
4. Performance in Practice (PIP)
There are two components to a PIP unit, a clinical module and a feedback module. Each component must be done twice to complete the unit. Performance in Practice is designed for “clinically active” physicians (see definitions below) to promote practice improvement activities through both chart review and second-party external review. One PIP unit should be completed every three years.
If a Diplomate participates in an institutional quality improvement program approved by the Multi-Specialty MOC Portfolio Approval Program that institutional participation will fulfill the clinical module. If a Diplomate participates in Portfolio Program approved peer review in a clinical setting, that institutional activity will also fulfill the PIP feedback module criteria.
Standard peer review processes will generally not meet ABMS or ABPN Performance in Practice requirements. Physicians participating in quality improvement programs not approved by the Portfolio Approval Program must get preapproval by the ABPN in order for the program to fulfill the clinical or feedback portions of PIP and should request a QI program review form from the ABPN office.
A. Clinical Module (Chart Review)
|• Diplomates are required to collect data from at least five patient cases in a specific Category (e.g., diagnosis, type of treatment, treatment setting) obtained from the Diplomate’s personal practice over the previous 3-year period.
• Diplomates must then compare data from the five patient cases with published best practices, or practice guide lines, or peer-based standards of care (e.g., hospital quality improvement programs, standard practice guideline published by specialty societies), and develop and carry out a plan to improve effectiveness or efficiency of indi- vidual clinical activities.
• A minimum of 4 quality measures must be collected for each clinical module.
• Re-measurement: Within 24 months, Diplomates must collect the same data from at least another five clinical cases in the same specific category and review that data to see if improvements in practice have occurred.
• The same or different patients may be assessed in the original and follow-up data.
B. Feedback Module (Patient and Peer Review)
|• Diplomates must solicit personal performance feedback from at least five peers and five of their own patients concerning the Diplomate’s clinical activity over the previous three years.
• Diplomates must then identify opportunities for improvement in the effectiveness and/or efficiency in their practice as related to the core competencies and take steps to implement improvements as needed.
• Re-measurement: Within 24 months, Diplomates must collect the same data from at least another five peers and another five patients and review the data to see if improvements in practice have occurred.
• The same or different patients and peers may offer feedback.
The ABPN recommends that Diplomates allow 24 months to complete each PIP unit.
• Peers may include other professional healthcare staff such as, psychologists, social workers, physicians, counselors, and nurses
• Patients may include those for which the Diplomate supervises the care of another provider (e.g., resident).
• Approved peer and patient feedback forms are available on the Forms page of the ABPN website (www.abpn.com/forms).
• ABPN will not collect patient or peer data. If audited, ABPN will require that Diplomates submit a description of their PIP activities.
Beginning January 1, 2014, Diplomates are required to use only ABPN-approved products for Performance in Practice Activities. The Board will approve additional programs over time and reserves the right to approve or reject any course or guideline submitted for approval. Please review the ABPN website periodically for updates (www.abpn.com/moc-products).
The American Board of Medical Specialties (ABMS) has issued definitions of “Clinically Active” and “Clinically Inactive” and requires that all Diplomates self-report their status once every 24 months in each area of certification. This information will be available to the public.
1. “Clinically Active”: Any amount of direct and/or consultative patient care has been provided in the preceding 24 months. This includes the supervision of residents.
A. Engaged in direct and/or consultative care sufficient to complete Performance in Practice (PIP) Units
B. Engaged in direct and/or consultative care not sufficient to complete PIP Units
2. “Clinically Inactive”: No direct and or/consultative patient care has been provided in the past 24 months.
3. “Status Unknown”: No information available on the clinical activity of this Diplomate.
• Diplomates who are in Category 1.A. above are required to complete all components of the MOC program includ- ing PIP Units.
• Diplomates who are in categories 1.B. or 2. above are required to complete all components of the MOC program except PIP Units.
• A change in Diplomate status from 1.B. or 2. to 1.A. requires the completion of at least one PIP Unit.
The ABPN urges all Diplomates to update their Clinical Activity Status as needed through ABPN Physician Folios at www.abpn.com/folios.
Specific Requirements: Ten-Year MOC Program
(10-year MOC) for Physicians certified prior to 2012
Diplomates in the 10-Year MOC program who are not recertified before their certificates expire are no longer Board certified in that area of certification. Once a former Diplomate completes all MOC requirements and passes the MOC cognitive examination, he or she will regain certification status. The ABPN recommends that diplomates sit for the cognitive examination the year in which the Diplomate’s certificate is due to expire so that there is no lapse in certification status. [more]
Specific Requirements: Continuous Maintenance of Certification (C-MOC)
Program for Physicians certified or recertified beginning in 2012
Beginning in 2012, Diplomates who certify or recertify are enrolled into the Continuous Maintenance of Certification (C-MOC) Program. Other Diplomates certified prior to 2012, including lifetime certificate holders, may elect to participate in the program through their Physician Folio.
The ABMS requires that the ABPN report the following annually on every Diplomate:
• Is the Diplomate still certified?
• Is the Diplomate actively maintaining certification?
The C-MOC program will assist Diplomates in complying with MOC requirements and timeframes. The program will also facilitate the required annual recording of progress required of Diplomates and reporting of Diplomate participation to the ABMS. [more]
The ABPN has made every effort to create a maintenance of certification program that will meet the requirements of our Diplomates well into the future. The program is modified periodically to adjust to changes in the needs of our Diplomates and to meet new requirements of the American Board of Medical Specialties.
It is the desire of the Board to continue to provide services that will enhance our Diplomates’ practice. To that end, the Board welcomes the comments and ideas of our Diplomates, and encourages them to contact the Board office with any questions or concerns.