MOC questions and ABIM answers

(Originally posted 1/1/2016) There appears to have been a great deal of confusion regarding the ABIM's (American Board of Internal Medicine's) MOC (Maintenance of Certification) program. I contacted the ABIM about some of my questions and hope that this information will be helpful to you. If any of you have additional information to share, please feel free to add it to this page yourself or email contact@hemonc.org us to add it for you. —PeterYang
1/2017 update: The ABIM kindly reached out to me a while ago and provided additional information, which I am belatedly incorporating below. Their additional responses are appreciated. They suggested that "It is best to sign in to ABIM.org and reference your personal status page for the most up-to-date information on what is individually required to maintain certification." That is, some of the information below may or may not be applicable to your specific scenario.
==Minimal requirements==
Per the ABIM MOC requirements page, after the February 3, 2015 ABIM post about updates to the MOC program, these are the current requirements which need to be satisfied regarding physicians' participation in the MOC program and their ability to retake their board exams/recertify every 10 years. Despite my efforts, the terminology that they use regarding certifications and MOC still confuses me when looking at some of their documents. I apologize if I inadvertently use the wrong terminology. In their own words:
:"The Maintenance of Certification (MOC) program requires that you earn some MOC points every two years to be reported as participating in MOC. To be reported as certified, you must earn 100 points every five years (the points you earn every two years count towards your 100 points) and pass the MOC exam in your specialty within 10 years of when you last passed it."
So, essentially, you need to just earn some kind of MOC points once every two years, make sure the total number of points earned over a five-year period is at least 100, and take the usual board exam every 10 years.
There previously were additional requirements as part of the MOC program. In the February 3, 2015 ABIM announcement, the ABIM said:
:"We got it wrong and sincerely apologize. We are sorry.... Effective immediately, ABIM is suspending the Practice Assessment, Patient Voice and Patient Safety requirements for at least two years."
According to the MOC website, this moratorium on needing to perform the non-medical knowledge MOC activities in fact extends at least through December 31, 2018.
==How to earn MOC points==
This is ABIM's list of accredited CME activities that will earn points for the have been registered for the American Board of Internal Medicine's (ABIM's) Medical Knowledge Assessment Recognition Program. The most straightforward way in my opinion is to enroll in the actual ABIM MOC modules, which costs a different amount depending on how whether you choose to just activate MOC for internal medicine or other ABIM subspecialties too. As soon as you finish an ABIM MOC medical knowledge module—such as "2015 Update in Internal Medicine"—the MOC points will be recorded in your ABIM account and an update to your requirements will be posted. I am not sure how the MOC points earned with other CME ends up getting registered with ABIM, but likely the accredited program is responsible for conveying the information to ABIM. ABIM clarification: "If a physician completed an activity through an external CME provider, the points earned must be transferred by the CME provider via the Program and Activity Reporting System (PARS)." 
Some educational activities such as MKSAP provide over 100 MOC points in total if all activities are completed—so those would presumably allow one to avoid needing to participate in any ABIM MOC medical knowledge module over a 5-year period—but one would still need to make sure some points are generated once every two years.
Someone participating in any ABIM MOC medical knowledge program is listed in the ABIM website as "participating in MOC" even if they are only signed up for just one field, such as internal medicine or medical oncology, so I am not sure what the benefit of signing up for multiple MOCs in the same calendar year is, in light of the additional responses below, unless you really want access to those question & answer modules.
:ABIM comment: "Although you will be reported as Participating in MOC for all certifications even if you are only maintaining one certification, that is only the public reporting. Individually, if a physician went to his/her personal MOC Status Report, their individual certificates will report whether each certification is currently being maintained; if it is not, the Status Report will show them as Not Participating in MOC for that area of certification."
Nevertheless, the necessity of participating in multiple specialties in a given year seems somewhat limited if:
#the MOC points earned in one specialty can be applied to all specialties
#the main priority is to maintain board certification
#someone doesn't mind if they are privately listed as not participating in MOC for all of one's specialties
==Questions and answers from ABIM (FAQ?)==
These are some answers that I received from the ABIM regarding some questions that I had. Some answers are more clear/specific than others. Some of my questions were better worded than others. Nevertheless, I hope this information is helpful, both to physicians who may have the same questions, but also to the ABIM so they do not need to answer the same question so many times. In my situation, I obtained my board certifications for internal medicine in 2010, hematology in 2013, and medical oncology in 2013. 
===Board certification status revoked due to failure to participate in MOC?===
There previously was an issue where people were listed online as no longer being board certified merely for not participating in MOC, even people who just finished their training and took board exams. The 8/4/2015 update reversed this:
:"Effective immediately, diplomates who are meeting all other programmatic requirements will not lose certification simply for failure to enroll in MOC."
People who are board-certified and enrolled in MOC are listed as "Certified, Participating in MOC" and people who are board-certified and not enrolled are listed as "Certified, Not Participating in MOC."
:ABIM update: To elaborate, "meeting all other programmatic requirements" means keeping up to date with milestone deadlines; deadlines are based on when a physician initially earned his/her Internal Medicine certification so not all diplomates will have the same milestone dates. If a physician does not meet the five-year milestone, only then will the certification status be changed to "Not Certified"."
My interpretation is still that as long as people meet their 2 & 5-year MOC point requirements, they will still be listed as certified, regardless of whether they are formally enrolled in an ABIM MOC program in a given year. Participating in MOC merely affects whether someone is listed as "Participating/Not Participating in MOC."
===Do you have to enroll in ABIM's MOC to maintain board certifications?===
:Question: "Must I enroll in at least one ABIM MOC program in order to be eligible to maintain my board certifications in internal medicine, hematology, and medical oncology?"
:Answer: "If you are interested in participating in ABIM's MOC program to renew any of your certifications, you must enroll and select the certifications you wish to maintain." 
Because the every 10-year board examination is part of the MOC process, in retrospect I didn't ask this question well. My intent was to discern whether I needed to sign up for the yearly, annual fee medical knowledge portion of MOC.
:Question: "If I do not need to participate in any ABIM MOC program, what are other options for me to earn the 100 MOC points which are needed to be able to maintain my internal medicine, hematology, and oncology board certifications in the future?" 
:Answer: "You do need to participate to earn MOC points. ABIM accepts hundreds of CME activities that also offer MOC points. To review a list of accepted activities, please visit https://www.accme.org/MOClist."
:Question: "Do I need to participate in the MOC program to recertify for hematology and/or medical oncology in 2023?" 
:Answer: "Yes. While ABIM does accept MOC points from external organizations, you must enroll to sit your Hematology and Medical Oncology MOC examinations which a required to renew your certifications."
So, one could potentially only give fees to ABIM for the once-every-10-years board/MOC examination and earn all of prerequisite MOC points from other organizations.
===Can MOC points/CME earned for one specialty be applied to requirements for all of one's specialties?===
:Question: "If it is required that I participate in some kind of MOC program, would doing modules and earning points for one (internal medicine, hematology, and/or medical oncology) satisfy the MOC points requirement for all three per the reciprocal credit clause (ABIM/ABMS Reciprocal Credit for Dual-Boarded Diplomates)?" 
:Answer: "All points completed will be applied toward all of your certifications that you choose to maintain. Please Note: The ABIM/ABMS Reciprocal Credit is a separate policy that applies to physicians boarded with other ABMS boards. (i.e. American Board of Pediatrics (ABP), American Board of Allergy & Immunology (ABAI))."
===Can doctors enroll in MOC for just internal medicine or one subspecialty rather than paying for multiple specialties?===
:Question: "Could I change which MOC I participate year to year and have the accumulated points count toward the necessary 100 MOC point total? That is, in 2015, could I do internal medicine modules, and in 2016, I could choose to enroll in medical oncology and do those modules, and in 2017 I could do hematology modules, etc.?" 
:Answer: "You can complete MOC points in any area and these points will be applied to your MOC point requirements."
My interpretation is that, yes, there is no absolute requirement to pay a yearly fee for multiple specialties.
===Can doctors just enroll in MOC once every two years?===
:Question: "Since Richard Baron's post said the requirement is to "complete some MOC activity every two years," could I therefore enroll in MOC one year, skip the next, and then enroll the following year, as long as I accumulated enough MOC points?"
:Answer: "If you are participating in MOC, and meet the required milestones every two and five years, your certification status will not change. However, you will need to take and pass the relevant examination by the exam due date to renew your certifications."
:Subsequent ABIM comment: "As mentioned above, if a physician does take this route, he/she will be reported as "Certified, Not Participating in MOC" for the year he/she is not enrolled in the MOC program."
My interpretation was and still is "yes." If it matters to people that they are listed every year as "Certified, Participating in MOC," then they would need to enroll every year.
===Do people need to maintain internal medicine boards to recertify for subspecialty board certifications?===
No.
:"Requesting a refund of the MOC fees paid will not prevent you from maintaining your Hematology and Medical Oncology Certifications in 2023. Also, you are not required to maintain Internal Medicine in the MOC program to maintain your subspecialty certifications." (Confirmed in a subsequent communication too.)
One does not need to maintain board certification in internal medicine to be eligible to maintain board certifications for subspecialties such as hematology and medical oncology. This post further defined how "underlying board certifications" would not need to be maintained for some other subspecialties.
==Finding your MOC requirements==
By logging into your ABIM account, you can access some information about your MOC status. If you are not currently participating in MOC, there will be a link which says, "Enroll in MOC Program." If you are enrolled, then you have access to my MOC Status, which lists a timeline of your requirements. For the benefit of people who do not have access, I am providing an example so you can see what it's like. Since I earned some MOC points in 2015 and in consideration of my board certification listed above, my requirements were listed as:
By 12/31/2017:
*Complete any MOC activity
By 12/31/2018:
*Complete X points of which 20.00 must be practice assessment points (Where X = 100 - (the number of MOC points you've earned already). I added strikethroughs for emphasis)
:Practice Assessment Currently Under Review, See Details
*Complete a patient voice activity 
:Currently Under Review, See Details
*Complete a patient safety activity 
:Currently Under Review, See Details
By 12/31/2019:
*Complete any MOC activity between 1/1/18 and 12/31/19
By 12/31/2020:
*Pass the Internal Medicine MOC examination
:Your first MOC exam attempt, per certificate, earns 20 MOC points.
Because I requested a refund for 2015's hematology and medical oncology MOC fees, nothing was listed for them, but I presume that it would have otherwise said that by 12/31/2023 I need to pass those MOC examinations as well. I was puzzled why, just if someone is not participating in the ABIM MOC medical knowledge in a particular year, the ABIM would cut off someone's access to see what their future requirements are. However, this appears to be intentional per the 8/4/2015 ABIM announcement: 
:"Please note that if ABIM provides a refund, MOC enrollment will be canceled, the physician’s status will be reported on abim.org and to the American Board of Medical Specialties (ABMS) as “Certified, Not Participating in MOC”, and the physician will no longer have access to ABIM activities or their MOC Status Report, which gives them their specific requirements and deadlines (refund requests must be in by October 31, 2015)."
The listed requirements on the MOC site indeed matched what the anticipated requirements would be based on the responses I received from ABIM.
==New option: every 2 year testing rather than every 10 year testing!==
On 12/14/2016, the ABIM announced: 
:"Physicians will be able to choose to take assessments every two years or every 10 years.
:Beginning in 2018, physicians certified in Internal Medicine can choose to take shorter “knowledge check-ins”—at the location they choose—every two years. ABIM will share updates on availability of these options for subspecialties in the coming months."
Additional details that physicians may be pleased about:
*The assessments can also be done on personal or work computers rather than only at testing centers.
*One does not need a passing score on every 2-year assessment. Failing twice in a row will require additional actions to maintain certification, including taking the long-form exam.
*More dates available for testing.
Additional information is available at the ABIM Changes to MOC Assessment FAQ.
==Old, obsolete information==
===Refund of MOC fees for people who finished training in 2013 or later===
No longer relevant since all physicians who were eligible for refunds were contacted in 2015.
The 8/4/2015 ABIM announcement said that, "Diplomates who earned initial certification since 2013 or renewed certification since 2014 who no longer wish to be enrolled in MOC this year as a result of this policy change may be eligible for a refund of their 2015 MOC enrollment fee(s)."
:Question: "According to the 8/4/2015 update, Acting on Diplomate Feedback: MOC Enrollment and Certification Status, my understanding is that at the very least I no longer need to be enrolled in MOC for hematology and medical oncology, I may request a refund of those annual fees that I paid, and not being enrolled in the hematology and medical oncology MOC will not affect my ability to be able to take and maintain my certifications in hematology and medical oncology in 2023. Is that correct?"
:Answer: "As stated in ABIM’s policy change announcement on August 4th, refunds only apply to enrollment fees paid in 2015 for initial certifications earned since 2013 and re-certifications earned through 2014. The Internal Medicine certification was earned in 2010 so it is not eligible for a refund.
:Please Note: You do not need to maintain Internal Medicine in the MOC program to recertify in 2020.
:If you no longer wish to be enrolled in MOC this year for Hematology or Medical Oncology, you can reply directly to this email." 
I requested a refund by email on 10/28/2015. They replied: "In reviewing your enrollment history, your MOC enrollment is eligible for a refund. Please allow for an estimated 8 to 10 weeks for refunds to be processed. If you paid by credit card, the refund will be issued to the card ABIM has on file. You will receive a confirmation letter from ABIM once your refund has been processed." I subsequently received a refund to my credit card on 12/22/2015.
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