ABIM study finds MOC status associated with higher HEDIS process measures

Healthcare Effectiveness Data and Information Set (HEDIS) process measures were slightly higher among physicians pursuing Maintenance of Certification in five categories, but were still low overall in some of the areas.

Maintenance of Certification (MOC) was positively associated with physician performance scores on a set of Healthcare Effectiveness Data and Information Set (HEDIS) process measures, a recent study found.

To assess whether MOC status was associated with performance on selected HEDIS process measures, the American Board of Internal Medicine (ABIM) funded a study comparing HEDIS process measures among physicians practicing in fee-for-service Medicare settings.

ABIM looked at 1,260 general internists who were initially board certified in 1991 and who provided care for 85,931 Medicare patients between 2009 and 2012. Researchers measured the percentage of each physician's Medicare patients that met five HEDIS annual or biennial standards and a composite of all three HEDIS diabetes standards. Results were published by Annals of Internal Medicine on June 12.

Seven hundred eighty-six physicians maintained their certification from 1991 to 2012, and 474 did not. The mean annual percentage of HEDIS-eligible diabetic patients who completed semiannual HbA1c 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; 95% CI, 0.6 to 4.1 percentage points; P=0.008) and the composite of all three diabetic standards (46.0% vs. 41.6%; regression-adjusted difference, 3.1 percentage points; 95% CI, 0.5 to 5.7 percentage points; P=0.019), although 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 by the patients of 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 (95% 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.

An editorial noted that even physicians who maintained certification had low HEDIS scores in some areas, adding that compliance rates with HEDIS standards in the 50th percentile range warrant a grade of “F”.

“The medical profession would be better off if certifying bodies, with their enormous prestige and moral stature, focused on how the recertification process can add the most true value to the public and their physician constituencies, rather than on trying to prove that physicians who ran the gauntlet of their initial unpopular and often burdensome dictums were statistically associated with unimpressive differences in medical practice,” the editorial stated. “The recertification glass is not entirely empty, but we all wish it were more full.”