Maintenance of Certification (MOC) Part 4 is a board certification requirement for physicians. It is designed to assess and improve the quality of patient care and patient outcomes.
Visit your board's website for more information on board certification.

The ABMS Portfolio Program works through a national network of Program Sponsors to help physicians and physician assistants submit their QI work for continuing certification credit (MOC Part 4) from an ABMS Member Board or the National Commission on Certification of Physician Assistants (NCCPA). 

As a ABMS Program Sponsor, Stanford CME will  handle essential tasks including activity submissions, attestation approvals, and sending confirmation of activity completion to the ABMS Portfolio Program.

The program contributes to organizational goals by encouraging and supporting physician and physician assistant engagement in practice-level activities that make improvement happen and allows QI participants, coaches and trainers, and leaders to receive credit for work they are already doing in areas such as:

• Prevention and public health issues – COVID-19, opioid abuse, health disparities, mental health
• Specific diseases – cardiovascular disease, diabetes, cancer
• Patient safety – sepsis, medication interactions, falls, immunizations
• Resource stewardship – low back pain imaging, Choosing Wisely topics
• Systems issues – transitions of care, reducing readmissions, message management
   

For more information please visit the ABMS website at https://www.abms.org/quality-improvement-support/

QI Projects must:

1. Be affiliated with Stanford Medicine.
2. Be a team-based internal QI/PI and/or patient safety activity that addresses many facets of the health care continuum, including but not limited to: 
   • Processes (e.g., access to care, discharge planning, advanced directives)
   • Clinical care (e.g., cardiovascular disease, depression, opioid treatment)
   • Administration/systems (e.g., efficiency, resource allocation, EMR use)
   • Population health (e.g., childhood obesity, food safety, motor vehicle injury)
3. Include an oversight process that ensures adherence to meaningful participation criteria.
4. Have measurable, relevant, and time-appropriate aims for improvement.
5. Incorporate appropriate, relevant and (when available) evidence-based measures and interventions.
   Examples:
   • Redesign of subprocesses in a clinical process
   • Alerts and reminders in an EHR system
   • Checklist(s) guiding healthcare professionals’ practice (may also be a component of an EHR modification)
   • Utilization of phone calls/reminders/posters and other sources of patient education and compliance information
   • Implementation of standing orders for evidence-based intervention(s)
   • Education of team members addressing practice-changing evidence
   • Kaizen events or similar team-based quality improvement or patient safety events
6. Document data collection pre- and post-intervention.
7. Incorporate appropriate, relevant, and evidence-based performance measures.
   Examples:
   • Practice-level metrics
   • System-level metrics
   • Employer-gathered information or outcomes
   • Survey-generated information
   • ACO- required metrics
   • EHR-produced reports
8. Fulfill the following meaningful participation requirements:
   • Identify and/or acknowledges a gap(s) in outcomes or in care delivery.
   • Identify and/or review data related to the gap(s).
   • Identify or acknowledge appropriate intervention(s) designed to improve the gap(s), OR participate in the planning and selection of intervention(s) designed to improve the gap(s).
   • Implement intervention(s) for a timeframe appropriate to addressing the gap(s), OR monitor and manage implementation of intervention(s) for a timeframe appropriate to addressing the gap(s).
   • Review post-intervention data related to the gap(s).
   • Reflect on outcomes to determine whether the intervention(s) resulted in improvement. If no improvement occurs after an intervention, participants must reflect on why no improvement occurred.
   • Attestation to meeting the above requirements post activity.
     *The attestation must be signed by the participant and the project leader, or a person in an oversight position.

Project Leads Must:

1. Ensure that the project design meets above QI project requirements.
2. Complete and submit an application form to CME Office.
3. Track and monitor physician and/or physician assistant participation to ensure that the meaningful participation standards are met for each participant.
4. Ensure that participants have access to data reports on a regular basis.
5. Send physician completion data to CME office.
6. Upon completion of the project, attest for participants by signing Meaningful Participation Attestation Form(s).
7. Provide project documentation to CME office, including methods, results, and physician participation, if requested.

To apply for MOC 4 credit for your QI project:

1. Identify a QI project in your department.
2. Request QI Project Consultation.
3. Review QI project requirements above.
4. Submit Your QI Project Application. (Accepting applications for participation from January 2022 to October 2023).
   *Note: QI Activities for which Physicians or Physician Assistants seeking credit for this calendar year must be submitted by the last Friday in October.
5. The Stanford CME team ensures QI project requirements have been met and submits the project to ABMS for approval. 
6. Attest to meeting meaningful participation requirements post activity. (Participant & QI project leader signatures required).
   *Note: Physicians and PAs seeking credit for this calendar year must be submitted by the last Friday in November.

Physicians and Physician Assistants are eligible to receive credit if the QI poster meets the following requirements:

1. The physician or physician assistant seeking credit must be affiliated with Stanford Medicine.
2. Poster must include an adequate and appropriate SMART-Aim Statement/Goal. (SMART Goals are Specific, Measurable, Achievable, Relevant, and Time-bound).
3. Poster must include adequate and appropriate measures that are aligned to determine if change occurs and relate directly to the Aim Statement/SMART Goal. 
4. Poster must include adequate and appropriate interventions that have been aligned to impact the measures and were implemented into practice.
5. Poster must have been presented at a conference, symposium, or other organizational event.
6. The Poster must reflect clinical quality improvement work and not research.
7. The physician or physician assistant seeking credit with a Poster must be listed as an “author” on the poster.
8. At least some of the work shared on the poster must have been done within the previous 12 months.
9. The poster cannot reflect work that was already submitted for MOC Part IV credit.

To apply MOC 4 credit for your poster:

1. Ensure that your poster meets the above requirements.
2. Submit your QI poster form and upload a copy of the poster.
   (Accepting applications for participation from January 2022 to October 2023).
   *Note: QI Activities for which Physicians or Physician Assistants seeking credit for this calendar year must be submitted by the last Friday in October.

Anesthesiologists who submitted a QI project or poster are eligible to earn an additional 5 MOCA 2.0 credits if they have a QI training or organizational role(s) in one or more of the following:

1. Organizational Quality Improvement/Patient Safety Officer
2. Quality Improvement or Patient Safety Coach/Trainer (or training to become one)
3. Department/Section/Unit Chair for Quality or Patient Safety 
4. Resident/Student Quality or Patient Safety Advisor 
5. Quality or Patient Safety Committee Chair or Vice Chair
   *Note: if you are in a role other than one listed above, please reach out to our office.

To apply for MOC 4 credit for your QI/PS leadership role:

1. Ensure you are in one of the QI/PS roles listed above.

2. Submit QI/PS Leadership Role form.
   (Accepting applications for participation from January 2022 to October 2023).
   *Note: QI Leadership Role forms for which Physicians or Physician Assistants seeking credit for this calendar year must be submitted by the last Friday in November. 
   
   Credits may be applied for annually.

Best Practices for Facilitating a QI Project

Institute of Healthcare Improvement

SMART-AIM Statement/Goal

A SMART -AIM statement is a explicit statement which describes what a successful project is expected to achieve. SMART Goals are Specific, Measurable, Achievable, Relevant, and Time-bound.

Example: We will [improve, increase, decrease] the [number, amount, percent] of [the process/outcome] from [baseline measure] to [goal measure] by [date].

QI Project Examples from ABMS Portfolio Program Sponsors

Boston University School of Medicine/Boston Medical Center

Marshfield Clinic Health System

Gundersen Health System

St. Jude Children’s Research Hospital

University of Utah Health

What is ABMS?

The American Board of Medical Specialties (ABMS) is a medical specialty certification organization.

Since 1933, ABMS has earned the public’s trust by setting a higher standard of professionalism and care for physicians and specialists. They represent 24 certifying boards and nearly one million active board certified physicians and specialists in 40 specialties and 88 subspecialties. 

Nearly one million individuals hold an active board certification from an ABMS Member Board. Together, we help drive research and innovation, encourage high-quality patient care, promote a quality and safety culture, ease health care disparities, shape future leaders, and support professional development.

What is Maintenance of Certification/Continuous Certification (MOC/CC)?

Each ABMS Member Board’s continuing certification program is developed by practicing physicians and specialists according to the standards set through ABMS. Activities and requirements must be met in the four main components (referred to as MOC or CC) to ensure physicians keep current in their specialties. 
Contact your board to learn more.

The MOC/CC programs of all 24 specialty boards have the same four general requirements:

Part 1: Professionalism
(Adhere to your board’s principles of professionalism and hold a current, valid, and unrestricted license to practice medicine)

Part 2: Lifelong Learning and Self-Assessment
(Participate in self-assessment, Continuing Medical Education (CME), and other practice relevant activities throughout your career)

Part 3: Assessment
(Meet the performance standard on a continuous cycle set by your board)

Part 4: Improvement in Medical Practice
(Design an intervention for improvement, and apply it to improve care or the process of care delivery)

Do all specially boards have the same MOC/CC requirements?

No, specific requirements of individual boards do vary. For more information visit your individual boards website.

How do I find my board MOC/CC requirements? 

For more information on MOC/CC requirements visit your individual boards website.

Is MOC part 4 credit available for existing QI Projects?

Yes, calendar year submission deadlines will apply. If you meaningfully participate in a QI project, boards will award credit based on the end date of participation.

What is the role of a QI project lead?

1. Ensure that the project design meets above QI project requirements.
2. Complete and submit an application form to CME Office.
3. Track and monitor physician and/or physician assistant participation to ensure that the meaningful participation standards are met for each participant.
4. Ensure that participants have access to data reports on a regular basis.
5. Send physician completion data to CME office.
6. Upon completion of the project, attest for participants by signing Meaningful Participation Attestation Form(s).
7. Provide project documentation to CME office, including methods, results, and physician participation, if requested.

Can I be awarded MOC 4 credit for a QI poster presentation?

Yes, please see above for credit eligibility and submission process.