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Is greater participation in maintenance of certification associated with a decrease in malpractice litigation or medical board disciplinary actions?

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Park J, Lipner RS. — American Board of Internal Medicine

Presented: AcademyHealth Annual Research Meeting, June 2012

Research Objective: With much attention focused on medical errors and patient safety issues, as well as spiraling health care costs, Maintenance of Certification (MOC) is recognized as one professional response to the need for public accountability and transparency. Early studies demonstrated the mixed evidence on an association between board MOC status and the quality of a physician's clinical care. There have been few studies that have used information from malpractice claims and medical licensure databases to study its relationship with MOC participation. This study examined whether internal medicine MOC contributes to lowering the number and size of overall malpractice claims, and state medical board disciplinary actions in internal medicine.

Study Design: The analyses were conducted using the American Board of Internal Medicine (ABIM) certification files linked to data from the National Practitioner Data Bank and the Disciplinary Alert Notification System by the Federation of State Medical Boards from 2000 through 2010. MOC rates were aggregated by state and year, and a test was performed to determine whether five years lagged average in MOC rates were related to subsequent state-level malpractice litigation and medical board disciplinary actions. A vector of malpractice litigation was measured by number of malpractice claims and median damage amounts awarded, while medical board disciplinary actions was measured by number of adverse action reports in each state. Analyses controlled for state tort reforms that vary over time at the state level since this correlated with malpractice liability and MOC status. Using physician-level logistic regression models with a state-level fixed effects adjustment, additional analyses were conducted to estimate the effect of completing the MOC program on the likelihood of an internist having any adverse disciplinary action reports.

Population Studied: 56,953 internists whose last initial certificate was granted between 1990 and 1999.

Principal Findings: The main results showed that increases in state-level MOC rates significantly decrease the number of malpractice claims. A one percentage point increase in MOC rates in states was associated with a 3.7 percent decrease in the number of overall malpractice claims (p<0.01). There was no significant difference in the size of malpractice payment amounts and adverse disciplinary actions. However, the results from the physician-level analyses showed that there was a significant lower likelihood of having any adverse disciplinary actions for those who completed the MOC program. For example, an internist who completed the MOC program was 89% less likely to ever get suspended (OR 0.11, 95% CI 0.09 to 0.14), and 95% less likely to ever get revoked (OR 0.05, 95% CI 0.03 to 0.09).

Conclusions: Higher rates of completing the MOC program in a state are associated with lowering the frequency of malpractice claims, but not the severity of liability claims and medical board disciplinary actions.

Implications for Policy, Delivery or Practice: As medical specialty boards try to promote quality of care through MOC for all physicians, an association between board MOC status and physician performance needs to be validated.

For more information about this presentation, please contact Research@abim.org