Physician time a main driver of MOC costs, analysis indicates
General internists were estimated to have the lowest 10-year costs for Maintenance of Certification, while hematologists/oncologists were estimated to have the highest costs.
Physician time may be the biggest driver of costs associated with the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program, according to a new study.
To examine the costs involved with MOC and help inform further potential updates to the program, researchers used a decision analytic model to estimate the total costs of 2015 MOC and its incremental costs compared with the 2013 version (MOC fee increases were instituted in 2014). The study focused on a 10-year period, from 2015 to 2024, and targeted all U.S. physicians (internists, hospitalists, and internal medicine subspecialists) certified by ABIM. Outcome measures were testing costs (ABIM annual fees as well as retesting fees for physicians who failed a first exam attempt) and time costs (the market value of physician time spent on MOC activities). The study results were published online July 28 by Annals of Internal Medicine.
The authors assumed that physicians would spend 12.5 hours annually completing modules to earn 20 MOC points plus another 1.5 hours annually completing related documentation. In years in which physicians took a recertification examination, it was assumed that the time spent would triple. According to the base-case analysis, at the current 2015 rates, internists stood to incur an average of $23,607 in MOC costs over 10 years. General internists were estimated to have the lowest 10-year costs while hematologists/oncologists were estimated to have the highest costs ($16,725 vs. $40,495). The researchers estimated that 90% of costs could be accounted for by physician time. The cumulative 10-year costs for 2015 MOC were estimated at $5.7 billion, $1.2 billion more than 2013 MOC, with the $5.7 billion figure comprising $5.1 billion in time costs and $561 million in testing costs.
The authors acknowledged that the figures used for physician time spent were estimates and that they did not consider the possibility that MOC changes would affect physicians' career decisions by, for example, leading some to retire early or elect not to renew one of multiple certifications. They also noted that they believe the changes to MOC content requirements made in February 2015 “are a step in the right direction” and pointed out that the study focused only on the costs of MOC and not the potential benefits, such as improvements in quality or efficiency of physician care. However, they concluded that the current ABIM MOC program will result in “considerable” costs, mostly due to investment of physician time in the recertification process.
“Reform of MOC should focus on decreasing the time required to fulfill MOC requirements and increasing integration with existing continuing education activities,” the authors wrote. “A rigorous evaluation of the program's effect on clinical and economic outcomes is warranted to better balance potential gains in the quality and efficiency of clinical care against the high costs identified in this study.”