News & Announcements

The American Board of Preventive Medicine Announces Requirements for Diplomates to Maintain Certification during the Transition to the New, Continuing Certification Program

Chicago, IL, December 10, 2019: The American Board of Preventive Medicine (ABPM) today announced the requirements for its Diplomates to maintain ABPM Certification during the transitional period from the current Maintenance of Certification (MOC) program to a new and innovative Continuing Certification Program (CCP).  The transitional period will begin February 1, 2020 and continue through December 31, 2022 (Transitional Period).

The objective of ABPM’s Transition Plan is to provide Diplomates with a thoughtful, simple, well-organized and orderly transition from the current MOC requirements to the more flexible and relevant requirements of the new CCP.

During the Transitional Period, the requirements to maintain ABPM Certification will be as follows:

  • ABPM will continue to require its Diplomates to maintain a full, valid, and unrestricted medical license in all states, territories or jurisdictions in which they are licensed to practice medicine.
  • For each calendar year 2020, 2021 and 2022, Diplomates will be required to attest to the completion of twenty-five (25) AMA PRA Category 1TM continuing medical education (CME) credits (or the equivalent). The required attestation will be available to Diplomates via ABPM’s Diplomate portal and will no longer require Diplomates to submit proof of completion. Instead, Diplomates will simply electronically sign the attestation confirming completion of the required CME courses.
  • Diplomates whose ABPM Certificates expire between January 1, 2020 and January 31, 2023, will be required to take and pass the MOC exam in each Specialty or Subspecialty for which recertification is being sought.
  • ABPM’s current requirements for MOC Part IV Improvement in Medical Practice (IMP) will remain unchanged. However, in addition to receiving current credit for IMP activities completed during the Transitional Period, the Diplomate will also receive credit for the first IMP (or its equivalent) that will be required by ABPM’s CCP. During the Transitional Period, ABPM will not require Diplomates to submit proof of completion by Diplomates of IMP activities during their current Certification Cycle. Instead, Diplomates who complete an IMP activity in their Specialty/Subspecialty during the Transitional Period will simply log on to ABPM’s Diplomate portal and submit an attestation of completion.
  • Prior to February 1, 2023, Diplomates must attest to completion of a one-hour patient safety course (PSC) by using ABPM’s Diplomate portal. This requirement can be fulfilled in one of two ways: (1) Successful completion of an ACGME-accredited residency or fellowship in 2012 or later, or; (2) Successful completion of an ABPM-approved PSC.

Consistent with its current MOC program, throughout the Transitional Period ABPM will continue to audit up to five percent (5%) of the Diplomates with respect to fulfillment of their MOC requirements. These audits will require Diplomates to submit to ABPM proof of completion of CME activities including the IMP activity.

“Although the updated ABMS Standards for CCP may not be finalized for another year, we are already engaged in the planning process for our CCP which will be developed based on recommendations of the Continuing Board Certification: Vision for the Future Commission (Commission), not the least of which will include ABPM moving away from the every 10-year examination to an innovative longitudinal assessment model,” said Hernando “Joe” Ortega, Jr., MD, MPH, ABPM Board Chair. “The annual engagement with Diplomates that is part of the requirements during the Transitional Period is not only consistent with the recommendations of the Commission to engage with Diplomates annually but, equally important, allows Diplomates to become comfortable with the annual engagement before the launch of CCP.”  Dr. Ortega added, “We believe that by retaining the core requirements of our MOC program while increasing flexibility and providing credit toward our future CCP during the Transitional Period, Diplomates will view this change favorably and find it to be a positive first-step toward an increasingly relevant and less burdensome process.”

ABPM Diplomates can find specific requirements for maintaining their Certificate during the Transitional Period by going to the ABPM’s website at https://www.theabpm.org/maintain-certification/transitional-moc-to-continuing-certification-program/.

The American Board of Preventive Medicine (ABPM) is a Member Board of the American Board of Medical Specialties (ABMS). Founded in 1948, ABPM works with the ABMS in the development of standards for the ongoing assessment and certification of over 12,000 physicians certified by the ABPM in the Specialties of Aerospace Medicine, Occupational Medicine, and Public Health and General Preventive Medicine, and in the Subspecialties of Addiction Medicine, Clinical Informatics, Medical Toxicology and Undersea and Hyperbaric Medicine.

The American Board of Preventive Medicine Announces the Approval of its Longitudinal Assessment Pilot for Clinical Informatics

Chicago, IL, November 25, 2019 – The American Board of Preventive Medicine (ABPM) announced today that the American Board of Medical Specialties’ (ABMS) has formally approved the ABPM’s proposed Longitudinal Assessment Pilot (LAP). The LAP pilot will include all current Diplomates Certified by the ABPM in the Subspecialty of Clinical Informatics.  The LAP pilot is scheduled for launch in the first quarter of 2021 and will run for a consecutive 24-month period.

The LAP pilot is designed as an alternative to the ABPM’s current high-stakes MOC examination which every Diplomate is required to take and pass every ten-years in order to maintain Certification.  In lieu of taking the required MOC examination, all Diplomates Certified by the ABPM in Clinical Informatics will be enrolled in the LAP pilot and, beginning in 2021, LAP participants will answer a total of twenty-four Subspecialty-specific questions, twelve in the first six-months and an additional twelve in the second-six months of each year of the pilot.  The LAP will be offered electronically where Diplomates will be able to answer each question from their own computer at a time and place that is convenient for the Diplomate.  Questions will be open-book and open-resource providing Diplomates with the flexibility to participate in the LAP in a way that is consistent with how Diplomates practice medicine in today’s environment. After each question is answered, the LAP platform will provide the correct answer, references, and a critique so as to provide the Diplomate with a complete learning experience. LAP participants will be able to access their individual performance and their performance as compared to their peers on an on-going basis through ABPM’s physician portal.

“ABPM is committed to moving from its current high-takes MOC examination to a more innovative and simplified assessment methodology. Consistent with the recommendations of the ABMS’ Vision Commission, we’re excited to begin that process with the announcement of the LAP pilot for our Clinical Informaticists,” said Hernando “Joe” Ortega, MD, MPH, ABPM Board Chair. “ABPM Diplomates have made it clear that they desire greater flexibility and more meaningful activities that are designed to confirm their knowledge, judgment and skill, especially when it comes to the high-stakes examination. As a first step toward a complete transition from its current MOC program to a more flexible Continuing Certification Program (CCP), the ABPM actively decided to invest the time and resources required to create a meaningful and relevant LAP experience for our Diplomates.”

Dr. Ortega went on to say “Our current MOC program will have to remain in place for the next 2-3 years but during that period we will continue to evaluate the LAP in order to confirm that, when launched across all of our Specialties and Subspecialties it will not only evaluate knowledge and practice, but provide objective feedback to our Diplomates that they may not receive otherwise. Instead of a periodic high-stakes examination where your Certification status is decided, the LAP will highlight knowledge gaps and will provide resources for Diplomates to seek out educational opportunities that will address those identified areas to maintain a well-rounded specialist.  In this way, the ABPM’s LAP should be assisting Diplomates in maintaining the knowledge, skills and abilities of their chosen specialty.”

Diplomates Certified by the ABPM in Clinical Informatics and participating in the LAP pilot will not be required to take the high-stakes MOC examination but instead, will be deemed to have met this requirement via participation in the LAP pilot.

Upon the conclusion of the LAP pilot, and beginning in the first quarter of 2023, it is anticipated that the ABPM will complete its transition and launch its CCP across all of its Specialties and Subspecialties and which transition will include, but not be limited to implementation of a LAP.

The ABPM is a Member Board of the American Board of Medical Specialties (ABMS). Founded in 1948, ABPM works with the ABMS in the development of standards for the ongoing assessment and certification of over 12,000 physicians certified by the ABPM in the Specialties of Aerospace Medicine, Occupational Medicine, and Public Health and General Preventive Medicine, and in the Subspecialties of Addiction Medicine, Clinical Informatics, Medical Toxicology and Undersea and Hyperbaric Medicine.

ABPM Increases Flexibility for Diplomates by Combining Lifelong Learning and Self-Assessment Requirement into a Single Continuing Medical Education Requirement

Chicago, IL, August 30, 2019 – The American Board of Preventive Medicine (ABPM) announced today that, as a first-step toward a comprehensive overhaul of its Maintenance of Certification (MOC) program, the ABPM Board of Directors has approved a revision to its current MOC Part II requirement by combining MOC Part IIA, Lifelong Learning and Self-Assessment (LLSA) and MOC Part IIB, Continuing Medical Education (CME) into a single, comprehensive MOC Part II requirement.

Specifically, diplomates will no longer be required to complete a minimum number of ABPM-approved LLSA credits in order to complete MOC Part II. Instead, beginning on February 1, 2020 and during each ten-year Certification Cycle, a Diplomate’s total of 250 MOC Part II credits can include any combination of LLSA and AMA PRA Category 1 CME credits (or their equivalent). 

In announcing this new policy, the ABPM’s Board Chair Hernando “Joe” Ortega, Jr., MD, MPH, said “The ABPM is pleased to offer our Diplomates a simplified and less burdensome MOC Part II requirement.”  Dr. Ortega went on to say that “Since there will be no required minimums for either type of credit, Diplomates will have the flexibility to choose between and amongst the various LLSA and AMA PRA Category 1 CME credits that best fits their practice.  Our doctors can select the CME offerings that will be most effective and impactful in achieving their individual learning goals.  This is a small, but important step on the ABPM’s journey toward a Continuing Certification program that incorporates the recommendations of the ABMS Vision Commission and, more importantly, is responsive to feedback from our Diplomates.”

The process by which Diplomates will be able to obtain MOC Part II credit from the ABPM will remain unchanged.  Diplomates must forward certificates/transcripts for completed LLSA and/or CME credits to the ABPM office at moc@theabpm.org

Any questions about this updated policy can be directed to the ABPM Staff at abpm@theabpm.org

The ABPM is a Member Board of the American Board of Medical Specialties (ABMS). Founded in 1948, ABPM works with the ABMS in the development of standards for the ongoing assessment and certification of over 12,000 physicians certified by the ABPM in the Specialties of Aerospace Medicine, Occupational Medicine, and Public Health and General Preventive Medicine, and in the Subspecialties of Addiction Medicine, Clinical Informatics, Medical Toxicology and Undersea and Hyperbaric Medicine.

UHM Journal publishes second special edition on traumatic brain injury

UHM Journal publishes second special edition on traumatic brain injury

The Undersea and Hyperbaric Medical Society has published a supplemental issue of its member publication, the Undersea and Hyperbaric Medicine Journal, to summarize results in studies on traumatic brain injury (TBI). The issue, consisting of 11 papers plus an executive summary, reports new data from two interventional studies sponsored by the United States Army, as well as from a companion study of normal volunteers, and includes a pooled data analysis of all military-sponsored investigations of hyperbaric oxygen for persistent post-concussive symptoms to date.

This special issue of the UHM Journal is available to the public at www.uhms.org. Cost for the electronic copy is $25. UHMS members have free access to the PDF files. As with all papers that appear in the UHM Journal, these TBI-related texts received peer review.

Drawing on the robust data set from the completed studies, in particular BIMA (Brain injury and mechanisms of action of hyperbaric oxygen for persistent post-concussive symptoms after mild traumatic brain injury) and the normative study, the authors of the papers in this second special issue present new analyses that complement the primary publications and add to the general knowledge about tools for diagnosing and measuring deficits after mild TBI, the safety of hyperbaric oxygen in this population, and the possible role of hyperbaric oxygen in ameliorating post-concussive symptoms and symptoms of post-traumatic stress disorder (PTSD).

“Over the last several years, the scientific community has learned that the long-term consequences of mild TBI occur much more often than previously thought. We’re learning more about how mild TBI disrupts the brain. But we haven’t made huge strides in learning how to help patients who have those long-term consequences become healthy again,” notes Dr. Lindell K. Weaver, study director and lead principal investigator of the BIMA and healthy volunteer studies. “One limiting factor in conducting studies in mild TBI is that we haven’t really known what tools to use to measure improvement. With BIMA and the companion normal study, we hoped to gather good data about outcome measures that are sensitive to change in mild TBI and differentiate from ‘normal’ brain function.”

The studies reported in this special issue are of particular importance to the hyperbaric medicine community. Hyperbaric oxygen has been proposed as a treatment for brain injury, and the studies sponsored by the United States military help to establish a safety profile for hyperbaric oxygen in the mild TBI population. In addition, the information in these papers can guide future research in this area. “While we found significant improvement in post-concussive symptoms with 40 hyperbaric oxygen sessions in BIMA, the effect was not durable to one year and beyond. This might mean that more than 40 sessions are required for long-term improvement, but other research studies will have to answer that question,” says Dr. Weaver.

The special issue also highlights other exciting directions for research. “The improvements we saw after chamber sessions in eye tracking and the possible relationship between oxygen dosing and improved PTSD symptoms are particularly intriguing,” adds Dr. Weaver.

Here’s a listing of papers and authors in this issue:

  • Executive summary: Secondary analyses of DoD-sponsored studies examining hyperbaric oxygen for persistent post-concussive symptoms after mild traumatic brain injury
    BB Hart, LK Weaver, SH Wilson, AS Lindblad, S Churchill, K Deru
  • Reference ranges and stability of auditory and vestibular measures in a comprehensive assessment battery for traumatic brain injury
    A Meehan, A Lewandowski, K Deru , D Hebert, LK Weaver
  • Quantitative analysis tool for clinical functional MRI in mild traumatic brain injury
    PE Cartwright, TG Perkins, P Santhanam, LK Weaver, K Deru, WW Orrison
  • Hidden hearing deficits in military service members with persistent post concussive symptoms
    A Meehan, D Hebert, K Deru, LK Weaver
  • Central auditory processing disorders after mild traumatic brain injury
    P Santhanam, A Meehan, WW Orrison, SH Wilson, TR Oakes, LK Weaver
  • Prospective study of anxiety, post-traumatic stress and depression on postural control, gait, otolith and visuospatial function in military service members with persistent post-concussive symptoms
    A Meehan, A Lewandowski, LK Weaver, D Hebert, K Deru
  • Analysis of magnetic resonance spectroscopy relative metabolite ratios in mild traumatic brain injury and normative controls
    PE Cartwright, TG Perkins, SH Wilson, LK Weaver, WW Orrison
  • Eye tracker outcomes in a randomized trial of 40 sessions of hyperbaric oxygen or sham in participants with persistent post concussive symptoms
    PA Wetzel, AS Lindblad, C Mulatya, MA Kannan, Z Villamar, GT Gitchel, LK Weaver
  • Extended follow-up in a randomized trial of hyperbaric oxygen for persistent post-concussive symptoms
    BB Hart, SH Wilson, S Churchill, K Deru, LK Weaver, M Minnakanti, AS Lindblad
  • Adverse events and blinding in two randomized trials of hyperbaric oxygen for persistent post-concussive symptoms
    S Churchill, K Deru, LK Weaver, SH Wilson, D Hebert, RS Miller, AS Lindblad
  • A composite outcome for mild traumatic brain injury in trials of hyperbaric oxygen
    LK Weaver, S Churchill, SH Wilson, D Hebert, K Deru, AS Lindblad
  • Hyperbaric oxygen for mTBI-associated PCS and PTSD: Pooled analysis of results from Department of Defense and other published studies
    BB Hart, LK Weaver, A Gupta, SH Wilson, A Vijayarangan, K Deru, D Hebert

For more information, email uhms@uhms.org.

~ Kayla Deru, LDS Hospital, Salt Lake City, Utah

UHMS member alerts the Society on problems with CMS coverage of radiation proctitis

The Case of the Disappearing Indication

Thomas M. Bozzuto, DO, FACEP, FFACHM, UHM

            On May 15, 2018, Palmetto GBA conducted an “Ask the Contractor Teleconference” (ACT) with Dr. Leland Garrett, Medical Director of Palmetto GBA of Columbia, South Carolina. On a side note, several times it appeared that Dr. Garrett did not know the difference between transcutaneous oxygen measurements and topical oxygen therapy – commenting several times that TCOM was not covered under the national coverage determination (NCD). A clarification update had to be issued on July 6, 2018, stating that Dr. Garrett “misunderstood the question” and that TCOM is covered.

            Later in that teleconference, he made the statement that radiation proctitis was not covered. When asked what providers could do about it, he said that the only provider option would be the Appeal Process. I sent an email to Dr. Garrett on August 21, 201,8 asking how Palmetto could deny payment for an indication listed in the NCD. He stated that “radiation proctitis is not covered per our instructions from CMS.”

            A week later on August 27 I sent an email to Drs. Susan Miller and James Rollins from the Coverage and Policy Group of CMS regarding coverage of radiation proctitis. They invited me to a conference call to discuss. The teleconference took place on October 9 between Drs. Miller, Rollins and me, with Dr. Garrett listening in.

I was informed that this decision is an “interpretation” of the NCD, NOT a revision. By doing this, they bypassed the required publication in the Federal Register and the 45-day public comment period. I send Drs. Miller and Rollins the article from the Association of Colon and Rectal Surgeons on the Clinical Practice Guidelines for the Treatment of Radiation Proctitis 1 along with the chapter in the UHMS indications manual and Dr. Feldmeier’s article on delayed radiation injury.

            Dr. Miller said that their definition of soft tissue was: “tissue (such as tendon, muscle, skin, fat and fascia) that typically connects, supports, or surrounds bone and internal organs and that not all collagen-containing tissues are included. I pointed out to her that the National Cancer Institute definition of soft tissue: “Refers to muscle, fat, fibrous tissue, blood vessels, or other supporting tissue of the body” and that the bowel wall contains blood vessels, muscle and fat. I thought it was appropriate to use the NCI definition because the reason for the radiation treatment was cancer.

            She told me that the only way we could get it put back into the NCD was to request a reopening of the NCD from CMS. They would consider the medical literature and make a determination. This is a double-edged sword. If we request reopening we could ask them to include central retinal artery occlusion and idiopathic sudden sensorineural hearing loss, BUT they could also review the other indications. If so, we risk a change in their coverage as well as the potential to see them determine that other indications have less-than-optimal evidence and we might lose others.

            On February 25 I send them an abstract of a study done at our facility2 comparing medical treatment, argon plasma coagulation therapy, and hyperbaric oxygen therapy, the results showed that, on average, proctitis resolved at 12 months with medicinal use, 6 months after APC, and 4.5 months after HBO2 therapy. This clearly shows that radiation proctitis resolves faster with HBO2 therapy – and with decreased costs. The reply I received from Dr. Miller was “Thank you.”

            On March 7, 2019, I received a letter from Dr. Kate Goodrich, Director, Center for Clinical Standards and Quality and Chief Medical Officer of CMS. She thanked me for my conversations with Drs. Miller and Rollins. Dr. Goodrich stated: “While it is true that the bowel wall contains muscle, blood vessels and nerves just as many anatomic structures do, that does not qualify the bowel itself, a hollow organ with distinctive absorption and excretory functions as soft tissue.”

            I have written letters to several people pointing out this arbitrary and capricious decision by CMS, including Alex Azar, Secretary of Health and Human Services, Senator Pat Toomey (R-PA), Chairman of the Senate Subcommittee on Health Care, and my local senator. To date I have received no replies.

            I suggest that everyone take time to write these individuals to express your displeasure in CMS’s arbitrary decision.

Alex Azar, II                                                                          
Secretary, Health and Human Services
200 Independence Avenue, SW
Washington, DC, 20201
Email: secretary@hhs.gov

Senator Pat Toomey
Chairman, Senate Subcommittee on Health
248 Russell Senate Office Building
Washington, DC 20510

If anyone would like a copy of the letter I sent to Mr. Azar or a copy of our abstract please email me at tbozzuto@phoebehealth.com

You can also contact your local senators and representatives.

References

  1. Paquette IM, Vogel JD, Maher AA, Feingold, DL, Steele SR: Clinical Practice Guidelines for the Treatment of Radiation Proctitis. Diseases of the Colon and Rectum 2018;61:1135-1140.
  2. Rao A, Bonner MR, Myers S, Morris CG, Bozzuto TM, et al. Incidence and course if Grade 2 proctitis treated with the use of modern IRMT and brachytherapy for localized prostate cancer in a community cancer center. Abstract.

Non-Emergent Hyperbaric Oxygen (HBO) Therapy Reason Codes and Statements (Updated 7/3/17)

ABEM Subspecialists No Longer Required to Maintain EM Certification

ABEM Subspecialists No Longer Required to Maintain EM Certification

Physicians certified in EM by ABEM who also hold an ABEM-issued subspecialty certificate are no longer required to maintain their Primary Emergency Medicine (EM) certification as long as they are participating in ABEM-accepted MOC programs.

Acceptable MOC Programs are:

  • The ABEM EM MOC
  • An ABEM subspecialty specific MOC program
  • An MOC program of another ABMS Member Board (e.g. ABPM for UHM certificate holders)

Physicians with questions are encouraged to contact ABEM at 517-332-4800, ext. 387 or subspecialties@abem.org

Summary: 2019 Medicare Physician Fee Schedule and Quality Payment Program Final Rule

On Nov. 1, 2018, the Centers for Medicare and Medicaid Services (CMS) released the 2019 Physician Fee Schedule (PFS) and Quality Payment Program (QPP) final rule, which will be published in the Federal Register on Nov. 23, 2018. This is the first year CMS combined the Medicare PFS and QPP rules. CMS published several fact sheets on the final rule including a fact sheet on the QPP changes and a fact sheet on the PFS changes for 2019.

One week later, CMS released a snapshot of physician performance during the first year of the QPP, 2017. These data indicate that 93% of clinicians who were MIPS-eligible in 2017 will get a positive MIPS incentive payment in 2019.

AMA is continuing to review the rule and will work with its colleagues in the Federation to further analyze these policies in the coming weeks. Below is a summary of the key policies included in the final regulation and the QPP performance results.

Read the full summary here:

pdfPFS_QPP_final_rule_summary_11-8_003.pdf

Medicare Physician Fee Schedule for CY 2019 (CMS-1693-P) Draft letter 8-28-18