Associations Between American Board of Internal Medicine Maintenance of Certification Status and Performance on a Set of Healthcare Effectiveness Data and Information Set Process Measures

Publisher: Annals of Internal Medicine, vol. 169, issue 2 (subscription required)
Jul 17, 2018
Bradley Gray, Jonathan Vandergrift, Bruce Landon, James Reschovsky, and Rebecca Lipner

Background. The value of the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program has been questioned as a marker of physician quality.

Objective. To assess whether physician MOC status is associated with performance on selected Healthcare Effectiveness Data and Information Set (HEDIS) process measures.

Design. Annual comparisons of HEDIS process measures among physicians who did or did not maintain certification 20 years after initial certification.

Setting. Fee-for-service Medicare.

Participants. 1260 general internists who were initially certified in 1991 and provided care for 85,931 Medicare patients between 2009 and 2012.

Measurements. Annual percentage of a physician's Medicare patients meeting each of 5 HEDIS annual or biennial standards and a composite indicating meeting all 3 HEDIS diabetes standards.

Results. Among the 1260 physicians, 786 maintained their certification from 1991 to 2012 and 474 did not. The mean annual percentage of HEDIS-eligible diabetic patients who completed semiannual hemoglobin A1c testing was 58.4% among physicians who maintained certification and 54.4% among those who did not (regression-adjusted difference, 4.2 percentage points [95% CI, 2.0 to 6.5 percentage points]; P < 0.001). Diabetic patients of physicians who maintained certification more frequently met the annual standard for low-density lipoprotein (LDL) cholesterol measurement (83.1% vs. 80.5%; regression-adjusted difference, 2.3 percentage points [CI, 0.6 to 4.1 percentage points]; P = 0.008) and all 3 diabetic standards (46.0% vs. 41.6%; regression-adjusted difference, 3.1 percentage points [CI, 0.5 to 5.7 percentage points]; P = 0.019). The regression-adjusted difference in biennial eye examinations was statistically insignificant (P = 0.112). Measures for LDL cholesterol testing in patients with coronary heart disease and biennial mammography were also met more frequently among physicians who maintained certification (79.4% vs. 77.4% and 72.0% vs. 67.8%, respectively), with regression-adjusted differences of 1.7 percentage points (CI, 0.2 to 3.3 percentage points; P = 0.032) and 4.6 percentage points (CI, 2.9 to 6.3 percentage points; P < 0.001), respectively.

Limitation. Potential confounding by unobserved patient, physician, and practice characteristics; inability to determine clinical significance of observed differences.

Conclusion. Maintaining certification was positively associated with physician performance scores on a set of HEDIS process measures.

Primary Funding Source. American Board of Internal Medicine.