Interventional Cardiologists Take Another Stand Against Maintenance of Certification

Interventional cardiology leaders are calling for an end to procedural volume reporting requirements for maintenance of certification (MOC), arguing that they are an unnecessary burden causing unintended consequences.

This week, the Society for Cardiovascular Angiography & Interventions (SCAI) released a draft position statement recommending that the American Board of Internal Medicine (ABIM) do away with the current requirement of 100 percutaneous coronary intervention (PCI) or equivalent procedures over 2 years, as well as the low-volume alternative of 25 consecutive primary operator procedures with explicit outcomes reporting.

It is recognized that volume requirements are particularly hard to meet for the increasing population of low-volume operators. In large rural areas of the U.S., this could risk limiting patient access to emergent PCI, warned SCAI President J. Dawn Abbott, MD, of Brown University Health in Providence, Rhode Island, during a virtual town hall meeting with SCAI members.

SCAI President-Elect Joaquin Cigarroa, MD, of Oregon Health & Science University in Portland, noted that “our community of interventional cardiology is overwhelmingly questioning the value of reporting volume and using this as a surrogate for quality in our ongoing maintenance of certification, and believe it is no longer relevant.”

No other specialty is subject to procedural volume requirements for MOC under the ABIM, SCAI argued, and the idea that interventional cardiology should be singled out as a field where volume thresholds would translate to better patient outcomes is questionable to begin with.

“Evidence does not support the use of an operator volume threshold that reliably discriminates between operators with adequate and inadequate competence or risk-adjusted outcomes outside the normal distribution. Additionally, procedural volume requirements are misaligned with modern competency frameworks that emphasize outcomes, appropriateness, and performance within systems of care,” noted the SCAI draft statement, now open for public comment until September 18.

A major partner society, the American College of Cardiology (ACC), appears to be on board with this proposal.

“The American College of Cardiology agrees that procedure volume is not the most accurate measure of competency and supports it being removed as a condition of maintaining interventional cardiology certification,” ACC President Roxana Mehran, MD, of Mount Sinai Medical Center in New York City, said in a statement to MedPage Today.

“The College has long been a proponent of certification programs that emphasize continuous learning and competency-based assessment that are aligned with real-world practice,” she said. “Ultimately, the goal of certification should be ensuring that patients are receiving the highest quality care based on a clinician’s performance, not on their meeting a numerical procedure threshold.”

SCAI stressed that once these volume requirements are out, they’re out — ABIM should not substitute new performance, credentialing, or quality metrics for procedural volume reporting, because competency in interventional cardiology is already well assessed through outcomes, peer review, credentialing, and quality systems.

Of note, SCAI’s demands represent the latest of many challenges to MOC under ABIM. Previously, SCAI had joined the ACC and other professional societies in trying to establish an independent American Board of Cardiovascular Medicine (ABCVM), partly due to cardiologists’ wishes to escape the burdensome testing requirements for board certification maintenance under the ABIM. The ABCVM application was ultimately rejected last year by the American Board of Medical Specialties.

Outside cardiology, there are also several ongoing physician-led lawsuits over ABIM’s perceived monopoly on MOC; plaintiffs allege these requirements force physicians into costly and time-consuming cycles that do not assure clinical competence, but rather an income for ABIM.