SCAI asks ABIM to rethink policy on PCI volume reporting requirements
The Society of Cardiovascular Angiography and Interventions (SCAI) is raising concerns about interventional cardiologists being told to use procedural volume reporting requirements to maintain their certification. The society held a town hall meeting with its members on this topic last week. This week, it asked members for comments on a proposed position statement calling for an end to the practice.
This move was precipitated by the results of an August 2026 SCAI survey of its interventional cardiology members. Clinicians taking the survey wanted to see an end to this measure by an overwhelming margin. They also pushed for their work to be evaluated in more relevant ways. SCAI is now gathering additional comments and feedback on its proposed position statement, with a deadline of Friday, Sept. 18.
"SCAI shares the American Board of Internal Medicine (ABIM) and the American Board of Medical Specialties (ABMS) goal of promoting continuous professional development, valid assessment of medical knowledge, and a culture of quality improvement through continuing certification," the society wrote in the proposed position statement. "However, SCAI opposes continued use of procedural volume reporting or thresholds in any form as a condition of maintaining interventional cardiology certification ... Procedural volume requirements are misaligned with modern competency frameworks that emphasize outcomes, appropriateness, and performance within systems of care."
SCAI said evidence does not support the use of an operator volume threshold that reliably discriminates between operators with adequate and inadequate competence or risk-adjusted outcomes outside the normal distribution. Instead, the society in its statement said procedural competence and performance evaluation are best assessed locally through established hospital privileging, ongoing professional practice evaluation (OPPE) and focused professional practice evaluation (FPPE) processes, peer review, morbidity and mortality conferences, and registry-enabled, risk-adjusted benchmarking. The group said this would be more consistent with approaches already used across comparable procedural fields.
"We feel these competency assessments are better served by other mechanisms than ABIM monitoring," said SCAI President Dawn Abbott, MD, during the group's the town hall meeting. She is a professor of medicine, associate chief of faculty development and academic advancement, division of cardiology, and director of interventional cardiology cath labs at Brown University Health Cardiovascular Institute.
Among ABIM subspecialties, only interventional cardiology is required to submit procedural volume reporting as a condition of continuing certification. But Abbott said comparable internal medicine procedural subspecialties, including clinical cardiac electrophysiology and other endovascular subspecialties, are not required to do so. She added that SCAI is petitioning ABIM to remove the procedural threshold requirement and use other metrics already being used in the field instead of replacing it with something new.
"If procedural volume is not required across comparable ABIM certified procedural fields, it should not remain a singular certification gatekeeper for interventional cardiology," SCAI said in its proposed position statement.
SCAI survey shows low confidence in PCI volume metric
The 2026 SCAI survey on ABIM procedural volume requirements included 327 responses, and 73.4% of respondents did not believe the ABIM procedural volume requirements are necessary to ensure patient safety. Also, 57.5% said procedural volume alone is “not very meaningful” or “not meaningful at all” as a valid measure of procedural competence. More than 90% had concerns about the current procedural volume requirement and the time involved in documenting their procedure logs.
The survey respondents also had a strong concern about the unintended consequences of this measure on patient access in low-volume practice environments, especially in rural or under-served areas.
Clinical evidence shows volume is not the same as quality
SCAI Vice President John Messenger, MD, clinical director of the Heart and Vascular Center at University of Colorado Hospital, spoke at the town hall meeting and outlined why procedural volume is not the best metric to use. Early on in the 1990s, Messenger said most operators were not participating in quality registries so the volume of procedures was used as a surrogate for operator experience and assumed quality. However, data from the American College of Cardiology (ACC) NCDR now shows that as percutaneous coronary intervention (PCI) became more mature, more centers opened cath labs that added large numbers of new operators. This resulted in procedural volumes declining for all operators.
He pointed to a 2019 study of NCDR data with 723,644 PCIs performed by a wide array of operators.[1] It showed that between 2009 and 2014, lower-volume operators had no difference in overall major adverse cardiovascular event rates compared to operators who perfumed more than 50, or even more than 100 PCIs per year.
"Importantly, volume has not borne out to be a surrogate. When we went and really looked at whether procedural volume was associated with differences in outcomes, we were a little bit surprised," Messenger explained. "When you looked at STEMI, there clearly was no difference. Unstable angina and stable angina really did not have significant differences. Essentially there is not a tight relationship with volume outcomes."
He also cited a 2020 study of 34,498 patients who underwent PCI at 60 hospitals in New York State.[2] After risk adjusting, researchers found there really was no specific number where volume had a major impact of outcomes.
Messenger said the hospitals involved in these data registries included close to 90% of the U.S. operators, and neither showed a practical cut point based on volume.
"There is an absence of a defensible threshold, we couldn't find any volume threshold that reliably discriminates when looking at risk adjusted outcomes," Messenger said. "Obviously, as PCI volumes continue to decline, more and more operators are going to have to fall into this low-volume group."
SCAI wants to use more local data measures to assess intervention cardiologists
SCAI President-elect Joaquin Cigarroa, MD, division head and professor of medicine within the division of cardiovascular medicine at Oregon Health and Science University, also spoke at the town hall on SCAI's position and the road ahead. He said the 2013 ACCF/AHA/ACC competence statement specifically cautions the emphasis on volume metrics because of limited evidence showing it is a meaningful metric.
Cigarroa said current ABIM volume-based reporting does not attach competence measures, so it is not useful.
"There is in fact no direct assessment of clinical outcomes, and therefore this provides a narrow, incomplete view of the work that we do, and of the quality of our clinical work," he said.
Instead, he thinks ABIM should be using measures set by cardiologists in the ACC/AHA/SCAI 2023 Advanced Training Statement on Interventional Cardiology competency model, which outlines measures to look at the full-spectrum of practice, including clinical judgement, technical proficiency, outcomes and how an operator works in modern team-based systems of care that have been shown to improve outcomes.
Additionally, he said locally evaluated measures from hospital credentialing and privileging should be used rather than volume. Data-driven annual reviews using OPPE, and case-based reviews and remediation using FPPE also offer better insights into physician performance.
"Our community of interventional cardiology is overwhelmingly questioning the value of reporting volume and using this as a surrogate for quality in our ongoing maintenance of certification and believe it is no longer relevant," Cigarroa explained.
The history of volume reporting for interventional cardiology
Historically, when the number of PCI operators were still low and volumes were high in the late 1990s, the initial eligibility requirement for interventional cardiology certification from ABIM was 250 procedures in an ACGME training program. Physicians in practice needed 150 procedures within a two-year period.
In 2009, PCI volumes were dropping as more operators entered the field, but most were by then participating in the NCDR registry. Data also started showing the high numbers were not needed and did not correspond to outcomes, Abbott explained. She added that a low-volume procedural pathway was created in 2009, lowering the threshold to a case log of at least 25 procedures, but that was abolished in 2013.
In 2013, the ACCF/AHA/SCAI updated clinical competence statement was released. And in 2016, SCAI petitioned ABIM to lower the procedure threshold. ABIM did lower the threshold to 50 per year. However, according to Messenger, even operators below 50 procedures a year do not have a drop in outcomes.
"While volume requirements were necessary at the birth of a nascent field, interventional cardiology has evolved into one of the most studied and self-policing procedural disciplines, with a wealth of information available to affirm local proficiency," SCAI wrote in its proposed statement.
Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: [email protected]