MOC Part 4

All surgeons who wish to maintain their board certification status must comply with American Board of Surgery (ABS) requirements. Starting in 2007, the ABS began requiring a fourth part to the Maintenance of Certification (MOC Part 4) that requires surgeon involvement in a quality improvement initiative fulfillment. SCOAP is working to certify that participation by surgeons meets the requirements of MOC Part 4 with the following stipulations:

  1. Hospital with which surgeon is affiliated must be a SCOAP participating hospital with current, audited data.
  2. Hospital with which surgeon is affiliated must use the surgeon identifier window on SCOAP data submission form
  3. Surgeon must register for MOC 4 with the Foundation for HealthCare Quality (FHCQ) and provide proof of participation in SCOAP activities. This includes:
    • attendance at the annual SCOAP Retreat or
    • participation in at least one regional or local SCOAP meeting; and
    • participation in at least two hospital meetings where SCOAP data is reviewed
    • participation in a local quality improvement effort related to an opportunity for improvement identified by review of the SCOAP data
  4. Surgeon must read two SCOAP-related articles annually and answer a set of related questions. (See column to the right  )

Surgeons who have met these requirements will receive SCOAP MOC 4 certificates on a yearly basis that they can submit to the ABS as proof of involvement in the program. Please visit our online registration site now to provide your contact information and payment so that we might begin the certification process!


  1. Diplomates are required to participate in MOC once they certify or recertify in any specialty after July 1, 2005.
  2. MOC takes effect for a diplomate as of the July 1 following certification or recertification. MOC years run from July 1 to June 30.
  3. Every three years diplomates report to the ABS about their MOC activities by completing an online form on the ABS website. This form will be available as of January 2009.
  4. Also starting in January, diplomates will be able to log in to the ABS website and view a personalized MOC requirements timeline.
  5. Diplomates who certified or recertified in the fall of 2005 or spring of 2006 will be contacted in January with specific instructions and will have until June 30, 2009 to submit information about their MOC activities.

For more information on MOC Part 4 or other MOC requirements, see:

Registration fees will be required to help fund this certification maintenance. Surgeons who have met these requirements swill receive SCOAP MOC 4 certificates on a yearly basis that they can submit to the ABS as proof of involvement in the program. 

“One of the biggest returns of our SCOAP membership has been the knowledge that SCOAP data will qualify for our MOC information.”

— Steve Cabrales, MD, SCOAP Champion at St. John Medical Center, Longview


Articles to Read (2018)

Alvimopan Use, Outcomes, and Costs: A Report from the Surgical Care and Outcomes Assessment Program-Comparative Effectiveness Research Translation Network Collaborative.

The Colorectal Writing Group for the SCOAP-CERTAIN Collaborative, Ehlers AP, Simianu VV, Bastawrous AL, Billingham RP, Davidson GH, Fichera A, Florence MG, Menon R, Thirlby RC, Flum DR, Farjah F. J Am Coll Surg. 2016 May;222(5):870-7. doi: 10.1016/j.jamcollsurg.2016.01.051. Epub 2016 Feb 5.

Time-of-day and appendicitis: Impact on management and outcomes.

Drake FT, Mottey NE, Castelli AA, Florence MG, Johnson MG, Steele SR, Thirlby RC, Flum DR; Writing Group for SCOAP-CERTAIN. Surgery. 2017 Feb;161(2):405-414. doi: 10.1016/j.surg.2016.06.052. Epub 2016 Aug 31.


Articles to Read (2017)

Thromboembolic Complications and Prophylaxis Patterns in Colorectal Surgery.

Colorectal Writing Group for Surgical Care and Outcomes Assessment Program–Comparative Effectiveness Research Translation Network (SCOAP-CERTAIN) Collaborative, Nelson DW1, Simianu VV2, Bastawrous AL3, Billingham RP2, Fichera A2, Florence MG3, Johnson EK1, Johnson MG4, Thirlby RC5, Flum DR2, Steele SR1.

JAMA Surg. 2015 Aug;150(8):712-20. doi: 10.1001/jamasurg.2015.1057.

Time to appendectomy and risk of perforation in acute appendicitis.

Frederick Thurston Drake, MD, MPH1,2,3; Neli E. Mottey, BS1,2; Ellen T. Farrokhi, MD, MPH2,4; Michael G. Florence, MD5; Morris G. Johnson, MD6; Charles Mock, MD, PhD1,3; Scott R. Steele, MD7; Richard C. Thirlby, MD8; David R. Flum, MD, MPH1,2

JAMA Surg. 2014 Aug;149(8):837-44. doi: 10.1001/jamasurg.2014.77.

Articles to Read (2016)

Addressing the Appropriateness of Elective Colon Resection for Diverticulitis: A Report From the SCOAP CERTAIN Collaborative Vlad V. Simianu, MD,* Amir L. Bastawrous, MD, MBA,† Richard P. Billingham, MD,† Ellen T. Farrokhi, MD, MPH,‡ Alessandro Fichera, MD,* Daniel O. Herzig, MD,§ Eric Johnson, MD,¶ Scott R. Steele, MD,¶ Richard C. Thirlby, MD,‖ and David R. Flum, MD, MPH*

JAMA Surg. 2014 Aug;149(8):837-44. doi: 10.1001/jamasurg.2014.77.

Comparative Effectiveness of Skin Antiseptic Agents in Reducing Surgical Site Infections: A Report from the Washington State Surgical Care and Outcomes Assessment Program

Timo W Hakkarainen, MD, MS, E Patchen Dellinger, MD, FACS, Heather L Evans, MD, MS, FACS, Farhood Farjah, MD, MPH, Ellen Farrokhi, MD, FACS,* Scott R Steele, MD, FACS,+ Richard Thirlby, MD, FACS,# and David R Flum, MD, MPH, FACS, for the Surgical Care and Outcomes Assessment Program Collaborative

J Am Coll Surg. 2014 Mar;218(3):336-44. doi: 10.1016/j.jamcollsurg.2013.11.018. Epub 2013 Nov 27.


Articles to Read (2015)

Nonsteroidal Anti-inflammatory Drugs and the Risk for Anastomotic Failure

TimoW. Hakkarainen, MD, MS; Scott R. Steele, MD; Amir Bastaworous, MD, MBA; E. Patchen Dellinger, MD; Ellen Farrokhi, MD, MPH; Farhood Farjah, MD, MPH; Michael Florence, MD; Scott Helton, MD; Marc Horton, MD; Michael Pietro, MD; Thomas K. Varghese, MD; David R. Flum, MD, MPH

JAMA Surg. 2015;150(3):223-228. doi:10.1001/jamasurg.2014.2239 Published online January 21, 2015. Corrected on April 10, 2015.

Perioperative Hyperglycemia and Risk of Adverse Events Among Patients With and Without Diabetes

Meera Kotagal, MD, Rebecca G. Symons, MPH, Irl B. Hirsch, MD, Guillermo E. Umpierrez, MD, E. Patchen Dellinger, MD, Ellen T. Farrokhi, MD, and David R. Flum, MD, MPH for the SCOAP-CERTAIN Collaborative

Ann Surg. 2015 January ; 261(1): 97–103. doi:10.1097/SLA.0000000000000688.

The impact of delaying elective resection of diverticulitis on laparoscopic conversion rate

The Surgical Care and Outcomes Assessment Program and The Comparative Effectiveness Research Translation Network (SCOAP-CERTAIN) Collaborative: Vlad V. Simianu, M.D., Mika N. Sinanan, M.D., Ph.D. Amir L. Bastawrous, M.D., M.B.A., Richard P. Billingham, M.D., Alessandro Fichera, M.D., Michael G. Florence, M.D., Daniel O. Herzig, M.D, Eric K. Johnson, M.D., Scott R. Steele, M.D., Richard C. Thirlby, M.D., David R. Flum, M.D., M.P.H.


Articles to Read (2014)

Adoption of Laparoscopy for Elective Colorectal Resection: A Report from Surgical Care and Outcomes Assessment Program

The Surgical Care and Outcomes Assessment Program (SCOAP) Collaborative: Steve Kwon, MD, MPH, Richard Billingham, MD, FACS, Ellen Farrokhi, MD, FACS, Michael Florence, MD, FACS, Daniel Herzig, MD, FACS, Karen Horvath, MD, FACS, Terry Rogers, MD, Scott Steele, MD, FACS, Rebecca Symons, MPH, Richard Thirlby, MD, FACS, Mark Whiteford, MD, FACS, and David Flum, MD, MPH, FACS

J Am Coll Surg. 2012 Jun; 214(6):909-918.e1. PMID: 22533998.


Importance of Perioperative Glycemic Control in General Surgery A Report From the Surgical Care and Outcomes Assessment Program

Steve Kwon, MD MPH, Rachel Thompson, MD, Patchen Dellinger, MD, David Yanez, PhD, Ellen Farrohki, MD, and David Flum, MD, MPH

Ann Surg. 2013 Jan; 257(1):8-14. PMID: 23235393.


Creating a learning healthcare system in surgery: Washington State’s Surgical Care and Outcomes Assessment Program (SCOAP) at 5 years

The writing group for the SCOAP Collaborative – Steve Kwon, MD, MPH, Michael Florence, MD, Peter Grigas, RN, BHSA, CTQM, CPHQ, Marc Horton, MD, Karen Horvath, MD, Morrie Johnson, MD, Gregory Jurkovich, MD, Wendy Klamp, MHA, Kristin Peterson, JD, Terence Quigley, MD, William Raum, MD, PhD, Terry Rogers, MD, Richard Thirlby, MD, Ellen T. Farrokhi, MD, and David R. Flum, MD, MPH

Surgery 2012 Feb; 151(2):146-52. PMID: 22129638.

Articles to Read (2013)

Beta-Blocker Continuation After Noncardiac Surgery A Report From the Surgical Care and Outcomes Assessment Program

Steve Kwon, MD, MPH; Rachel Thompson, MD; Michael Florence, MD; Ronald Maier, MD; Lisa McIntyre, MD; Terry Rogers, MD; Ellen Farrohki, MD; Mark Whiteford, MD; David R. Flum, MD, MPH; for the Surgical Care and Outcomes Assessment Program (SCOAP) Collaborative


Progress in the Diagnosis of Appendicitis A Report From Washington State’s Surgical Care and Outcomes Assessment Program

The SCOAP Collaborative, Frederick Thurston Drake, MD, Michael G. Florence, MD, Morris G. Johnson, MD, Gregory J. Jurkovich, MD, Steve Kwon, MD, MPH, Zeila Schmidt, MLIS


Routine Leak Testing in Colorectal Surgery in the Surgical Care and Outcomes Assessment Program

Steve Kwon, MD, MPH; Arden Morris, MD, MPH; Richard Billingham, MD; Joseph Frankhouse, MD; Karen Horvath, MD; Morrie Johnson, MD; Shane McNevin, MD; Anthony Simons, MD; Rebecca Symons, MPH; Scott Steele, MD; Richard Thirlby, MD; Mark Whiteford, MD; David R. Flum, MD, MPH; for the Surgical Care and Outcomes Assessment Program (SCOAP) Collaborative

Articles to Read (2012)

Creating a learning healthcare system in surgery: Washington State’s Surgical Care and Outcomes Assessment Program (SCOAP) at 5 years.

Steve Kwon, MD, MPH,a Michael Florence, MD,b Peter Grigas, RN, BHSA, CTQM, CPHQ,c Marc Horton, MD,b Karen Horvath, MD,a Morrie Johnson, MD,d Gregory Jurkovich, MD,e Wendy Klamp, MHA,a Kristin Peterson, JD,f Terence Quigley, MD,g William Raum, MD, PhD,h Terry Rogers, MD,i Richard Thirlby, MD,j Ellen T. Farrokhi, MD,k and David R. Flum, MD, MPH. Surgery. 2012 Feb;151(2):146-152.


Cost per day of patency: Understanding the impact of patency and reintervention in a sustainable model of healthcare.

Michael C. Stoner, MD, Dorian J. deFreitas, MD, Mark M. Manwaring, MD, Jacqueline J. Carter, MD, Frank M. Parker, DO, and C. Steven Powell, MD. Journal of Vascular Surgery. 2008 Dec;48(6):1489-1496. Epub 2008 Jul 10.


The Quality of Health Care Delivered to Adults in the United States.

Elizabeth A. McGlynn, Ph.D., Steven M. Asch, M.D., M.P.H., John Adams, Ph.D., Joan Keesey, B.A., Jennifer Hicks, M.P.H., Ph.D., Alison DeCristofaro, M.P.H., and Eve A. Kerr, M.D., M.P.H.. N Engl J Med. 2003 Jun 26;348(26):2635-2645. Epub 2011 Nov 9.

Articles to Read (2011)

Jonah J. Stulberg; Conor P. Delaney; Duncan V. Neuhauser; et al. Adherence to Surgical Care Improvement Project Measures and the Association With Postoperative Infections . JAMA. 2010;303(24):2479-2485. doi: 10.1001/jama.2010.841

Smedley F, Bowling T, James M, et al. Randomized clinical trial of the effects of preoperative and postoperative oral nutritional supplements on clinical course and cost of careBr J Surg. 2004; 91:983-990

Williams, Trevor M.; Harken, Alden H. Statins for Surgical Patients. Annals of Surgery – January 2008 (Vol. 247, Issue 1, Pages 30-37)

Articles to Read (2010)

Theodor Asgeirsson, Khaled I. El-Badawi, Ali Mahmood, Jeffrey Barletta, Martin Luchtefeld, Anthony J. Senagore. Postoperative Ileus: It Costs More Than You Expect. Journal of the American College of Surgeons – February 2010 (Vol. 210, Issue 2, Pages 228-231, DOI: 10.1016/j.jamcollsurg.2009.09.028)

Martindale RG, Maerz LL. Management of perioperative nutrition supportCurr Opin Crit Care. 2006 Aug;12(4):290-4. Oregon Health and Science University, Portland, OR 97239.

NICE-SUGAR Study Investigators, Finfer S, Chittock DR, Su SY, Blair D, Foster D, Dhingra V, Bellomo R, Cook D, Dodek P, Henderson WR, Hébert PC, Heritier S, Heyland DK, McArthur C, McDonald E, Mitchell I, Myburgh JA, Norton R, Potter J, Robinson BG, Ronco JJ. Intensive versus conventional glucose control in critically ill patients. N Engl J Med. 2009 Mar 26;360(13):1283-97. Epub 2009 Mar 24.

Articles to Read (2009)

Bangalore S, Wetterslev J, Shruthi P, Sawhney S, Gluud C, Messerli F. Perioperative β blockers in patients having non-cardiac surgery: a meta-analysis. Lancet. 2008 Dec 6;372(9654):1962-76.

Ramos M, Khalpey Z, Lipsitz S, Steinberg J, Panizales MT, Zinner M, Rogers SO. Relationship of perioperative hyperglycemia and postoperative infections in patients who undergo general and vascular surgery. Ann Surg. 2008 Oct;248(4):585-91.

Wong SL, Ji H, Hollenbeck BK, Morris AM, Baser O, Birkmeyer JD. Hospital lymph node examination rates and survival after resection for colon cancer. JAMA. 2007 Nov 14;298(18):2149-54.