MedicalResearch.com Interview with:
Bradley M. Gray, PhD
American Board of Internal Medicine
Medical Research: What is the background for this study? What are the main findings?
Dr. Gray: The American Board of Internal Medicine (ABIM) is committed to evaluating the impact its physician certification programs, including Maintenance of Certification (MOC). That motivated us to investigate the relationship between the MOC requirement and the practice patterns of internists subject to it.
We looked to see whether the original MOC requirement was associated with health care costs and measures of hospitalizations drawn from Medicare claims. Our primary measure of hospitalizations was Prevention Quality Indicators, which were developed by the Agency for Health Care Research and Quality to measure impacts of primary care. These include such things as hospitalizations for an amputation due to diabetic complications. Our health care cost measure included outpatient and inpatient costs.
To examine these associations, we took advantage of a natural experiment that occurred when one group of general internists who originally certified in 1991 were subject to the MOC requirement by 2001, while another group of internists, who originally certified just two years earlier in 1989, were grandfathered out of this requirement.
In essence we can think of the 1991 required group of internists as a group treated by the effects of MOC and the 1989 grandfathered group as a control group in a natural experiment.
We estimated associations with this requirement by comparing outcomes among Medicare beneficiaries treated by the required group of internists before and after the requirement took effect in 2001.
Also before and after the 2001 requirement, we compared this difference to a similar difference in outcomes for a control group of beneficiaries treated by the grandfathered group of internists. At base line before 2001, these beneficiaries had almost identical characteristics and co-morbidities as the beneficiaries treated by the required group of internists.
We did this to account for the natural increase in hospitalizations and health care costs that occur as beneficiaries age, as well as other important factors that might have been coincident with the MOC requirement.