ABIM Announces Latest MOC Change in Response to Internal Medicine Community ACC Leaders Issue Recommendations Charting College’s MOC Path Forward In a major reversal, the American Board of Internal Medicine (ABIM) announced it is reversing its policy requiring physicians who have passed the initial Certification exam in 2014 or later to have enrolled in the Maintenance of Certification (MOC) process in order to be listed as board certified. Effective immediately, physicians who are meeting all other programmatic requirements will not lose certification simply for failure to enroll in MOC. “By tying together board certification and enrollment in Maintenance of Certification, the ABIM set different standards for recently certified physicians compared to those certified in previous years. The ABIM should be commended for recognizing the negative impact of this policy on current and future employment opportunities, particularly for those in the early stages of their careers, and taking the steps necessary to reverse it,” said ACC President Kim Allan Williams Sr., MD, FACC. ACC and MOC: An Important Update All of us continue to be troubled by the complex situation presented by the changes in re-certification by the American Board of Internal Medicine (ABIM) over the past year. We have heard clearly that our members are unhappy, and many are dissatisfied with ACC’s actions to date. Our approach to the issue has been careful and deliberate, perhaps leading to the assumption that the ACC is not adequately addressing the problem. The current ACC approach is as follows: • We respect the intelligence of our members in analyzing the best path for continuing education/certification individually and realize that it may not be the same for each of us; we are not wedded to one solution for all. • An ACC Task Force led by ACC Immediate Past President Patrick T. O’Gara, MD, MACC, is focused on continuing to provide input to ABIM to see if proposed temporary changes become permanent and to see if their processes can further improve to the extent that they are helpful and acceptable to members. • A second ACC Task Force led by ACC President-Elect Richard A. Chazal, MD, FACC, is aggressively exploring whether an alternative board should/could be developed by ACC for our members. Potential possibilities could include: new board(s); working with already established alternate boards and/or other organizations; working within or without American Board of Medical Specialties’ framework; and other solutions. While working as rapidly as possible, we want to be cautious, realizing the great complexity of the situation. In the interim, all of us as members have alternatives. These include joining a new board, waiting to see a final ABIM proposal, and waiting to see if an alternate ACC Board is feasible and/or needed. Recent ABIM suspension of Maintenance of Certification (MOC) Part IV/ patient modules and expansion of much Continuing Medical Education to MOC II gives some potential breathing room (we are watching to see what actions will be permanent, what will be done with 10-year exams, and how to approach multiple certifications … among other problems). Our position is to look for the best ways to help our members and their patients in proceeding forward. Sincerely, ACC President Kim Allan Williams, Sr., MD, FACC ACC President-Elect Richard A. Chazal, MD, FACC ACC Vice President Mary Norine Walsh, MD, FACC ACC Immediate Past President Patrick T. O’Gara, MD, MACC ACC Treasurer Robert Guyton, MD, FACC ACC Board of Governors Chair Robert Shor, MD, FACC ACC BOG Chair-Elect Matthew Phillips, MD, FACC ACC Immediate Past BOG Chair Michael Mansour, MD, FACC *Look for MOC updates on the ACC in Touch Blog at blog.acc.org. “The ABIM should be commended for recognizing the negative impact of this policy… and taking the steps necessary to reverse it. “ ACC President Kim Allan Williams Sr., MD, FACC Under the new policy, physicians who lost certification solely on the basis of failure to enroll in MOC or to pay MOC fees have had their certification status updated to “Certified” on the ABIM’s website. However, those wishing to be reported as “Participating in MOC” must be enrolled in the MOC program, be current with their payments and be meeting ongoing program requirements. Physicians who earned initial certification since 2013 or renewed certification since 2014 and who no longer wish to be enrolled in MOC in 2015 as a result of this policy change may be eligible for a refund of their 2015 MOC enrollment fee(s). Those receiving a refund will be reported as “Certified, Not Participating in MOC.” Finally, physicians must still meet five- and 10-year MOC program milestones to maintain their certification. This recent ABIM decision follows several other major changes to MOC over the last year that have occurred as a result of continued advocacy by the ACC, other cardiology specialty societies and internal medicine stakeholders on behalf of their members. “The ACC and its members are being heard and this will no doubt continue,” said Williams. Moving forward, the ACC’s Board of Trustees approved the following five motions at its August meeting based on recommendations from the two task forces charged with identifying how best to work with the ABIM and exploring alternatives to ABIM MOC certification, respectively: • ACC Immediate Past President Patrick T. O’Gara, MD, MACC, and ACC Executive Vice President of Science, Quality and Education William J. Oetgen, MD, MBA, FACC, were appointed as liaisons for continued communications with ABIM. • The ACC will work with ABIM to develop a new externally validated process for maintenance of competence to replace the 10-year exam. • The ACC will work with ABIM to research best practices for maintenance and demonstration of competence with eventual linkages to patient outcomes, cost and cost-effectiveness. • The ACC will support efforts to integrate federally mandated elements related to Part IV and patient experience into existing hospital and practice programs. • The ACC will continue its work toward an alternative board pending ongoing discussions with ABIM. Details of the MOC changes can be read on the ACC in Touch Blog and can be found on ACC’s online MOC hub at ACC.org/MOC. ACC.org Clinical Topic Collections Feature Personalized Content The Clinical Topic Collections on ACC.org are designed to deliver more personalized content. Led by expert editorial teams, the 20 Clinical Topic Collections house a variety of learning formats to meet ongoing educational needs: expert analysis articles, article reviews, patient case quizzes and clinical images. Clinical Topic Collection editorial teams identify the most relevant topics in their areas, and have recently included responses to updated data surrounding PCSK9 inhibitors, transparency and public reporting in congenital pediatric cardiac surgery, anticoagulation and chronic kidney disease, and more. These collections also use advanced technology to pull in the latest in cardiology – journal scans, clinical trial summaries and news stories – as well as certified educational activities and meetings. These Collections also provide links to related Member Section pages, for users who are logged in as an ACC member. Visit ACC.org/Clinical-Topics to see a full listing of available topical areas. ACC members should log in to ACC.org to sign up for email notifications when new content is posted. Click on the “Notify Me” button in the upper righthand corner of a given Clinical Topic Collection to sign up for immediate, daily or weekly notifications. Martha Gulati, MD, MS, FACC, Named New CardioSmart Editor Martha Gulati, MD, MS, FACC, has been named editor-in-chief of CardioSmart.org, ACC’s patient education and empowerment initiative to help individuals prevent, treat and manage cardiovascular disease. Gulati is an associate professor of medicine and clinical public health in the division of cardiology at The Ohio State University. In addition, she serves as the Sarah Ross Soter chair in women’s cardiovascular health and the section director for women’s cardiovascular health and preventive cardiology at The Ohio State University. She has received numerous honors in the cardiovascular field, including ACC’s first CREDO (Coalition to Reduce Racial and Ethnic Disparities in Cardiovascular Outcomes) award and the National Red Dress Award for her efforts in raising awareness of cardiovascular disease in women and advancing research in this field. “I am honored to have the opportunity to head an initiative with such an important mission,” Gulati said. “Patient education is key to early recognition and prevention of heart disease, and as physicians, it is our duty to provide our patients with the tools they need to keep their hearts healthy. CardioSmart provides the platform for just that.” Download the ACC’s New Statin Intolerance App The ACC recently launched the Statin Intolerance mobile app to guide clinicians through the process of managing and treating patients who report muscle symptoms while on statin therapy. Clinicians can use the app to evaluate possible intolerance in a patient’s current statin prescription, follow steps to manage and treat patients who report muscle symptoms while taking statins, and compare statin characteristics and drug interactions to inform management of LDL-related risk. Information in the app is derived from the 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults and best practices. Download the Statin Intolerance mobile app from the iTunes or Google Play stores today. Learn more about the app at ACC.org/StatinIntoleranceApp, and find out more about ACC’s suite of mobile apps at ACC.org/Apps. WHAT’S NEW IN CLINICAL DOCUMENTS New Recommendations For LAA Occlusion Devices Released The ACC, along with the Heart Rhythm Society (HRS) and Society for Cardiovascular Angiography and Interventions (SCAI), have published a new overview on the implantation of left atrial appendage (LAA) occlusion devices. The document, published in the Journal of the American College of Cardiology, is the first in a series from the ACC, HRS and SCAI that will address the integration of new technologies into the care of patients with atrial fibrillation (AFib). Studies have shown that LAA occlusion devices may lower the risk of stroke in patients with Afib and can be an alternative for those unable or unwilling to adhere to long-term oral anticoagulation therapy. As these new devices are developed and approved, it is expected that the use of LAA occlusion technologies in clinical practice will expand. However, the writing committee cautions that the new technology should be disseminated thoughtfully, with emphasis on team-based care and the collection of the necessary data in longitudinal registries to determine ideal patient selection, effectiveness and safety. They note that it will also be necessary to develop and implement new guidelines, expert consensus statements, requirements for training, operator credentialing and institutional policies. COUNCIL PERSPECTIVES FROM ACC’S MEMBER SECTIONS ACC’s Prevention Section Assesses Cardiac Rehab in HfrEF Patients Prevention of Cardiovascular Disease MEMBER SECTION Although the U.S. Centers for Medicare Services has extended cardiac rehabilitation (rehab) coverage to patients with heart failure with reduced ejection fraction (HFrEF), enrolling these patients in cardiac rehab may prove difficult, according to a Council Perspective published June 15 in the Journal of the American College of Cardiology. In the article, members from ACC’s Prevention of Cardiovascular Disease Section assess the challenges and opportunities that cardiac rehab presents for HfrEF patients. ACC’s Early Career Section Analyzes Effect of Cardio-Oncology Services on Patient Care Early Career MEMBER SECTION While the impact of cancer treatments on cardiovascular health is an important consideration when treating cancer patients, only 35 percent of centers in a nationwide survey included cardio-oncology services managed by general cardiology, according to a Council Perspective published June 22 in the Journal of the American College of Cardiology. The nationwide survey of cardiology division chiefs and cardiovascular fellowship program training directors, conducted by ACC’s Early Career Section, evaluates the current state of cardio-oncology services, practices and opinions. Of the 106 respondents, 65 percent thought that access to consultants with specialized training would provide an advantage in caring for cancer patients suffering from cardiovascular complications. However, only 27 percent of centers had an established, specialized cardio-oncology service with multiple clinicians. ACC’s Interventional Section Addresses Cardiac Arrest in Non-STEMI Patients Interventional MEMBER SECTION A new algorithm may be a way to identify proper treatment for resuscitated comatose patients after cardiac arrest, according to a Council Perspective published June 29 in the Journal of the American College of Cardiology. The algorithm is one of the recommendations proposed by members of ACC’s Interventional Member Section in response to the lack of guidelines for performing immediate angiography and percutaneous coronary intervention in non-STEMI patients. The authors explain that “there is concern in the interventional community that this may lead to risk-adverse behavior, resulting in suboptimal care by not providing early cardiac catheterization to appropriate patients.” NOTABLE NEWS William T. Mahle, MD, FACC, Assumes Role as Chief of Children’s Healthcare of Atlanta Sibley Heart Center William T. Mahle, MD, FACC, assumed the role of chief of Children’s Healthcare of Atlanta Sibley Heart Center on May 1. Mahle has served on the Children’s Sibley Heart Center leadership team since 2005, and has achieved national recognition for his leadership in pediatric cardiology. As chief, Mahle will oversee the treatment of the more than 35,000 children annually who come to Children’s Sibley Heart Center. He will also aid in continuing to provide comprehensive cardiac services for congenital and acquired heart disease from infancy through young adulthood. In Memoriam: ACC Past President Borys Surawicz, MD, MACC ACC Past President Borys Surawicz, MD, MACC, a pioneer in electrocardiography and a significant contributor to the cardiovascular academic community, has passed away. Surawicz was a true innovator, and his passion for academia shone throughout his involvement in the ACC. In 1978, when the Federated Council for Internal Medicine urged the modification and limitation of subspecialty training slots, Surawicz fought for recognition of the importance of subspecialties, saying, “The public can best be served under an educational system which maximizes the freedom of individuals to choose and develop their career interests and opportunities … This applies to both the selection of medicine as a career and the choice in specialty.” Surawicz dedicated an admirable amount of time, effort and energy into the ACC, serving as vice president from 1977-1978 and president-elect from 1978-1979, in addition to his time as ACC president from 1979-1980. The great impact left by Surawicz’s dedication to the ACC and the field of cardiovascular medicine is sincerely appreciated by all who are touched by his work. In Memoriam: John H.K. Vogel, MD, MACC John H.K. Vogel, MD, MACC, passed away on June 1 from heart failure. Vogel was the first in Santa Barbara, CA to perform cardiac interventions such as thrombolytic therapy, coronary balloon angioplasty, laser atherectomy and placement of coronary artery stents. He became a Master of the American College of Cardiology in 1998, was recognized by the American Heart Association with the Master Teachers award, and received the Service Award from The Society for Cardiac Angiography and Interventions in 2009. Vogel viewed the practice of medicine as a team effort, and it was this mindset that allowed him to reach the heights that he did. His extraordinary achievements will not be forgotten by his loving family, colleagues, friends, and all those who had the pleasure of knowing him throughout his lifetime. In Memoriam: Jerry Luck, MD, FACC Jerry C. Luck, Jr., MD, FACC, passed away on May 17 in a tragic biking accident. Luck was a member of the ACC for 32 years and was an outstanding electrophysiologist and leader in cardiology. After graduating from the Medical School of Temple University and becoming board certified in internal medicine and cardiology, he worked in academia and private practice for 42 years. Colleagues regarded him as a ‘jack of all trades.’ Many saw him as a true role model and mentor. Because of his skillset and charisma, the cardiology fellows in training selected Luck as the Teacher of the Year at Penn State Hershey Heart & Vascular Institute for the 2014-2015 year. It was not only his colleagues and students who recognized his greatness, as patients would comment on his impeccable bedside manner, and Luck would often take time to visit hospitalized patients. He will be remembered by family, friends, colleagues and patients as a remarkable innovator in the landscape of cardiology. In Memoriam: Floyd Loop, MD Floyd Loop, MD, passed away on June 11 from sarcoma. Before retiring in 1999, Loop had operated on kings, presidents, and chief executives, in addition to his usual patients. He had performed more than 12,000 cardiac surgeries, was the author of 350 papers on cardiovascular surgery, refined arterial grafting, improved re-operative techniques, and helped establish the world’s first computerized registry of cardiac surgery outcome. These extraordinary accomplishments all contributed to him receiving the American Heart Association Citation for International Service, the ACC Cummings Humanitarian Award, and the Cleveland Clinic Lerner Humanitarian Award. Loop will be remembered for not just his exceptional talent, but also for his ability to lead and inspire those around him. Texas Children’s Hospital Opens Pediatric HF ICU Texas Children’s Hospital on July 6 opened a pediatric heart failure (HF) intensive care unit (ICU). The unit is the first of its kind, with 12 beds available for children who require specialized care, such as those undergoing heart transplants. Paul Checchia, MD, FACC, medical director of the Cardiovascular Intensive Care Unit at Texas Children’s Hospital and professor of pediatrics-critical care and cardiology at Baylor College of Medicine, noted that because of the new HF ICU, “patient outcomes will only continue to improve as we treat their unique needs in this new setting.” In Memoriam: William C. Little, MD, FACC The cardiovascular community lost a master clinician, educator, advocate, researcher and mentor with the unexpected passing of William C. Little, MD, FACC. According to ACC President Kim Allan Williams Sr., MD, FACC, “Bill was an internationally renowned cardiologist with research interest in ventricular function. He is credited for research leading to a shift in thinking about atherosclerosis as a systemic process and the ensuing use of aspirin or statins. One of his major research accomplishments was the finding that acute cardiac events often occurred at sites of minimal stenosis… There is no doubt that Bill’s legacy will live on through his many colleagues and former trainees, as well as through his wife, Connie, his children and grandchildren.” ACC’s NCDR Celebrates Important Milestones ACC’s NCDR is currently celebrating a number of important milestones: The ACTION Registry-GWTG recently surpassed 1,000 participating sites. With 12,785 patient records and participation from 209 facilities, the PVI Registry is celebrating the one-year anniversary of its expansion from the CARE Registry. The PINNACLE Registry database now contains more than five million unique patients, reflecting more than 20 million office visits. Each of these milestones represents important strides for participating practices and hospitals, the ACC and the cardiovascular community as a whole. The steady increase in patient data held within ACC registries drives improvements in care by enhancing national benchmarking reflected in monthly and quarterly reports – and by building the body of evidence needed to support clinical insights and answer questions about approaches to care and patient outcomes. Correction The Spring 2015 issue of Cardiology (page 23) inaccurately captioned a photo of Daniel B. Mark, MD, MPH, FACC, who addressed the economic implications of the PROMISE trial at ACC.15. Cardiology regrets the error. ACC in Touch Follow @ACCinTouch on Twitter for breaking news from all of the top cardiovascular meetings this fall, including #ESCCongress, #TCT2015 and #AHA15. Use the hashtag #ACCLegConf during the ACC’s 2015 Legislative Conference from Oct. 18-20. Interested in receiving immediate updates from the ACC? ‘Like’ the ACC’s Facebook page to gain access to news, meeting coverage, special promotions, and more. Recent posts on the ACC in Touch Blog include a blog by Robert Shor, MD, FACC, chair of the Board of Governors, who comments on the challenges electronic health records present in improving patient care. Others topics include a post authored by John Vyselaar, MD, member of the ACC’s Sports and Exercise Cardiology Section, on how to integrate sports cardiology into your practice; and a post authored by Robert H. Beekman, III, MD, FACC, chair of the ACC’s Adult Congenital and Pediatric Cardiology Section and Leadership Council, on transparency and patient autonomy. Check out the ACC in Touch Blog for more insights on the latest in cardiology at blog.acc.org.
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