MAINTENANCE OF CERTIFICATION

In May 1999, 10-year time-limited Certificates were first granted to new Diplomates by the ABNS.  Roll out of the Maintenance of Certification (MOC) program was begun by the ABNS in January 2006.  Participation is required of all Diplomates holding time-limited Certificates in order to maintain their certification. 

The guiding principle of MOC is to foster excellence in patient care.  Its intention is to encourage, stimulate, and support continuing education in the practice of neurosurgery.  Through MOC the ABNS supports its Diplomates’ dedication to life-long learning.  The program also provides an avenue for compliance with future state, hospital, and third party payors since these are expected to require either participation in an MOC process or periodic re-examination by state medical boards.

Each 10-year MOC cycle consists of three 3-year mini-cycles, plus a 10th year.  A Diplomate must fulfill all the requirements of each mini-cycle in a timely fashion.  The Cognitive Examination may be taken in March during the 3rd, final, mini-cycle or during year 10.

Because the MOC program was not implemented until 2006 and was phased in over three years, Diplomates who were issued time-limited Certificates from 1999 through 2004 have truncated requirements.  These vary depending on the year the Diplomate was certified.

Diplomates with time-limited Certificates who do not successfully and in a timely fashion complete all elements of the MOC program during their 10-year cycle will have their Certificates expire at the end of that cycle.  The only mechanism to obtain a new Certificate and be reinstated to Diplomate status is to complete the requirements for initial certification again.  Both the Primary and Oral Examinations must be successfully re-passed.

Program Participation

To participate in MOC, a neurosurgeon must hold an ABNS Certificate and a currently valid, unrestricted license to practice medicine.  Diplomates enroll in the program by completing an application on-line.  It can be found at MyMOC, www.abns.org.

Holders of non-time-limited Certificates may participate in MOC at any time and are encouraged to do so.  Their Certificates will not expire regardless of participation in MOC.  To enroll, simply email a request to the ABNS office at abns.moc@tmhs.org.

Candidates may petition the Board for exemptions or an extension of time in which to complete particular MOC requirements.  These will be granted only in rare cases under compelling circumstances.

Basic Components

MOC is composed of four components.

Part I – Evidence of Professional Standing

1. Full unrestricted license to practice medicine in all jurisdictions in which the Diplomate practices
2. Verification of unencumbered hospital privileges to practice neurosurgery in the Diplomate’s hospitals; these will be verified in every 3-year mini-cycle
3. Questionnaire completed by the chief of the medical staff or chief of surgery at the Diplomate’s primary hospital; verified every 3-year every mini-cycle.

Part II – Evidence of Commitment to Lifelong Learning and Periodic Self-Assessment

1. Lifelong Learning – In each mini-cycle, the Diplomate must earn at least 150 Continuing Medical Education (CME) credits.  A minimum of 60 credits must be Category I neurosurgery.  The remaining 90 hours may be Category I or II, and 30 of those may be non-neurosurgery.  Verified Categories I credits are tracked for the Board by the AANS.
2. Self-Assessment – In each mini-cycle, the Diplomate must participate in the Self-Assessment in Neurological Surgery (SANS) examination.  Currently, there are three SANS examinations that will fulfill this requirement: regular SANS, Spine, and Pediatric.  This web-based educational tool is developed and updated by the Congress of Neurological Surgeons (CNS) and available free of charge to MOC participants through MyMOC.  Each grants 24 CME credits.  The ABNS also recommends the fourth SANS, which covers compliance and similar pertinent issues.

Part III – Evidence of Cognitive Expertise
Diplomates must demonstrate evidence of cognitive knowledge once during each 10-year MOC cycle by passing a proctored examination.  The ABNS clinically based Cognitive Examination is given in mid-March each year.  In order to be eligible, the individual must be actively involved in MOC or have been successfully reinstated in the process if there was a period of non-participation.  The Examination may be taken in the last 3-year mini-cycle or the 10th year of the Diplomate’s cycle.  Individuals who do not pass may retake it the next year, as long as they are still within their 10-year MOC cycle.  The Board recommends taking the Examination early.  An examination fee must be paid each time the examination is taken.

Part IV – Evidence of Evaluation of Performance in Practice

1. Key Cases – In each mini-cycle, participants must select a Key Case and complete modules on ten consecutive recent patients from their practice with that neurosurgical problem.  As logging is being done, pop-ups give references to the literature about the case.  At the end, graphs give feedback to the Diplomate on his or her outcomes, as well as the aggregate outcome of everyone who used that same Key Case.  The internet based program is available at MyMOC.
2. Communication Assessment Tool – A Communication Assessment Tool using surveys of patients is in development.  Participants’ communication skills will be assessed during each mini-cycle, and a report of the results generated for him or her.
3. As other modules become available, they will be included.  For instance, a Patient Safety module is also under development by the ABMS.

CLASSIFICATION OF DIPLOMATES

With the advent of MOC, ABNS Diplomates are classified into one of four categories:

Currently Certified – Participating in Maintenance of Certification
Diplomates who are actively participating in MOC, for instance have completed an application, paid their annual fees and are in completing the requirements of each 3-year mini-cycle.  These Diplomates are classified on the ABNS website as “Certified – Participating in Maintenance of Certification.”

1. Diplomates who have non-time-limited Certificates (which do not expire) and are not participating in MOC. 
2. Diplomates who have time-limited Certificates that have not yet expired and are not participating in MOC.

An MOC participant who fails to meet the requirements of a 3-year mini-cycle in a timely fashion is subject to the following:

1. A Diplomate who has not participated during the previous 3-year mini-cycle will be notified of his or her non-participation in the six months after the end of that mini-cycle.  To be reinstated, the Diplomate must pay the re-entry fee specified by the Board and fulfill the requirements of the skipped mini-cycle, as well as the current mini-cycle, during the time frame of the current mini-cycle.  This failure to participate in a mini-cycle may occur only once in each 10-year MOC cycle.
2. A Diplomate who has participated in a 3-year mini-cycle but is delinquent in some of its components will be notified of his or her delinquencies in the six months after that mini-cycle.  That Diplomate will have a six month grace period to fulfill of remaining requirements of the previous mini-cycle, while also working on the new mini-cycle.  He or she will not have to pay a re-entry fee.
3. A Diplomate who falls into 1 or 2 above will be classified as Participating in Maintenance of Certification during the entire 3-year mini-cycle and the following 12 months.  Thereafter he or she will be classified as Not Participating in Maintenance of Certification unless the requirements for re-instatement are met.  The new 3-year cycle will begin and end on the same schedule as if the Diplomate had no deficiency.

Certified – Retired From Operative Practice

Diplomates who have retired from operative practice and were certified at the time of retirement fall into this category.  In order to remain certified, they must confirm to the Board that they will no longer perform operative neurosurgical procedures.  Diplomates with time-limited Certificates are not eligible to be listed in this category unless they continue to complete all elements of MOC; however, they may request exemption from certain aspects of MOC, for instance Key Case submission.

Not Certified (Not ABNS Diplomates)

1. Diplomates whose certification have been suspended or revoked,
2. Diplomates whose time-limited Certificates have expired and who have not been awarded new time-limited Certificates due to their failure to complete MOC successfully,
3. Neurosurgeons who have never been certified.

         The ABNS has developed it MOC program to be a fair, effective, and not overburdening method to ensure that Diplomates continue to improve themselves, their practices, and their patient care.  Directors believe it is an important educational process and encourage all Diplomates to participate.