Maintenance of Certification Essentials

1. Maintenance of Certification Essentials SCAMPs to the rescue????

2. Credentialing Organizations • Self appointed, generally non-profit organizations that rely on monopoly or external acceptance for validity • ABMS Purpose (1908): To define specialty qualifications, to supervise examinations that test the preparation of those who desire to practice and to issue credentials that would assure the public of the specialist's qualifications

3. Allergy and immunology Anesthesiology Colon and rectal surgery Dermatology Emergency medicine Family medicine Internal medicine Medical genetics Neurosurgery Nuclear medicine OB/GYN Ophthalmology Orthopedic surgery Otolaryngology Pathology Pediatrics Physical med & rehab Plastic surgery Preventive medicine Psychiatry and neurology Radiology Surgery Thoracic surgery Urology American Board of Medical Subspecialties

4. Permanent Certificates On November 30, 2009, James A. Stockman, III, M.D., president of the American Board of Pediatrics admitted under oath at a North Carolina Medical Board hearing that 41% of ABMS boarded physicians are board certified for life, i.e. are not required to be re-certified every several years like its competitors (AOA and ABPS) require

5. Anesthesiology Dermatology Diagnostic Radiology Disaster Medicine Emergency Medicine Family Medicine & Ob Family Practice Geriatric Medicine Hospital Medicine Internal Medicine Obstetrics and GYN Ophthalmology Orthopedic Surgery Psychiatry Radiation Oncology Surgery American Board of Physician Specialists

6. Anesthesiology Dermatology Emergency Medicine Family Physicians Internal Medicine Neurology and Psychiatry Neuromusculoskeletal medicine Nuclear medicine Obstetrics and Gynecology Ophthalmology and Otolaryngology Orthopedic Surgery Pathology Pediatrics Physical Medicine and Rehabilitation Preventive Medicine Proctology Radiology Surgery American Osteopathic Association Bureau of Osteopathic Specialists

7. The “MOC” Rationale • Response to the quality-of-care movement and related concerns of the public • Federation of State Medical Board is developing a process whereby demonstration of ongoing competence is a requirement for licensure renewal (maintenance of licensure) • MOC qualifies for MOL requirements, even for non-board certified physicians

8. Understanding Maintenance of Certification Presented By: The American Board of Pediatrics

9. About the ABP • Sole mission is to the public. • Independent certifying board; • Those certified are known as • diplomates of the Board. • One of the 24 specialty boards of • the American Board of Medical • Specialties (ABMS) • Created in 1933 by the pediatric • community to certify physicians • with specialized education and • clinical expertise in the care of • children • Includes 250 physicians who • volunteer their time to set the • standards of certification The American Board of Pediatrics 111 Silver Cedar Court Chapel Hill, NC 27514

10. The Evolution of Board Certification Permanent Certification Until 1988, certification was done by successfully passing a test of knowledge only once in a career, typically at the end of training. Time-Limited Certification Beginning in 1989, a diplomate was required to successfully pass a similar test of knowledge every 7 years. Maintenance of Certification (MOC) Beginning in 2010, diplomates will maintain certification by continual evaluation of the competencies verified during residency. A secure test of knowledge is one part of this four-part program.

11. The ABP certifies physicians who demonstrate a commitment to lifelong learning and providing the highest quality care. Certification is a self-regulated, professional responsibility.

12. What is Maintenance of Certification? (MOC) • 4-part program that you begin once you have passed your initial certification examination. • Evaluates the same 6 ACGME core competencies measured throughout training. • Competencies are assessed in • 5-year cycles, as defined by Maintenance of Certification.

13. The Purpose of MOC • For The Public: • MOC has been developed to assure the public that diplomates certified by the American Board of Pediatrics have demonstrated: • Professionalism • Commitment to lifelong learning • Specialized knowledge of Pediatrics • Dedication to continuously improving care • For The Pediatrician: • Participation in MOC: • Leads to better care for children • May help you meet payer, regulatory and consumer demands for quality • Represents to the public your commitment to providing quality care • Acknowledges your achievement of the gold standard in pediatric care

14. Measuring the 6 Core Competencies Part 1 – Professional Standing Patient care, Interpersonal & communication skills, Professionalism Part 2 – Knowledge Assessment Patient care, Medical knowledge, Practice-based learning & improvement, Systems-based practice Part 3 – Cognitive Expertise Medical knowledge Part 4 – Performance In Practice Patient care, Practice-based learning & improvement, Interpersonal & communication skills, Professionalism, Systems-based practice

15. Part 1 MOC - Professionalism • Requirement for Part 1 : • All diplomates must hold a valid, unrestricted • medical license.

16. Part 2 MOC – Knowledge Self Assessment 40-point minimum per 5-year MOC cycle • Requirements for Part 2 : • All approved Part 2 activities are assigned a point value by the ABP. • Diplomates must complete activities provided by either the ABP or approved outside providers. • You must have at least 40 points of Part 2 activities per 5-year MOC cycle. Example *Developed and administered by the AAP; requires payment directly to the AAP for access

17. 1993 - 2002 1969ABMS introduces Recertification 1980-1991Closed Book(voluntary) 1993-2002Open Book Exam(every 7 years) 2003-presentSecure Exam(every 7 years) 2010+Secure Exam(every 10 years) Part 3 MOC – Cognitive Expertise Although the MOC cycle is 5 years, a secure test of knowledge is only required every 10 years. • Requirement for Part 3 : • Successfully pass a secure test of knowledge • every 10 years in each area of certification.

18. Because examinations are only required every 10 years, it’s important to note that the exam does not necessarily coincide with the beginning or end of your 5-year MOC cycle. NOTE!

19. Part 4 MOC – Performance in Practice 40-point minimum per 5-year MOC cycle • Requirements for Part 4 : • Option 1: The Part 4 MOC requirement for Performance In Practice can be • met by completing web-based Quality Improvement activities. • Option 2: Participate in an ongoing ABP-approved collaborative Quality • Improvement project.

20. Part 4 MOC – Menu of Options Example 2 options for completion Point values not yet finalized by the ABP.

21. Part 4 MOC – Performance In Practice Examples of Option 1 (Web-based QI Project) AAP Web-based Modules Patient Safety Improvement Program ABP Performance Improvement Module for ADHD

22. Part 4 MOC – Performance In Practice Example of Option 2 (Collaborative QI Project) 29 children’s hospital PICUs are collaborating to reduce catheter-related bloodstream infections. This project has been approved by the ABP for Part 4 credit and points.

23. Long Term Goal = 95% Results: 44% hospital admissions 22% urgent care/ED visits 30% missed school days Part 4 MOC – Performance In Practice Another Example of Option 2 (Collaborative QI Project) Perfect Care for Asthma (Cumulative %) 160 practicing pediatricians decided to work together to improve care for their children with asthma. They set an ambitious goal – that all 44 participating practices would achieve “perfect care.” Together, the physicians created the infrastructure necessary to measure improvement, created data collection and patient tracking procedures and trained coaches to help. Within 2 years, the network moved from a 4 percent compliance rate in applying “perfect care” to an 88 percent rate.

24. Parts 2 and 4 – How It All Adds Up! A total of 100 points is required per 5-year MOC cycle. 40 points – Part 2 activities + 40 points – Part 4 activities + 20 points – Your choice (Part 2 or 4 activities) 100 required points per 5-year MOC cycle

25. Enrollment, Fees and Tracking • If you do not currently have one, simply register online for your personal physician portfolio. • When you begin your MOC cycle, your portfolio will contain: • A list of your completed requirements • A list of outstanding requirements in your current MOC cycle • The timeframe in which you must complete your next required MOC examination.

26. MOC At-A-Glance • Part 1: Valid, unrestricted license • Part 2: Earn at least 40 points from approved • activities* • Part 3: Pass a secure exam every 10 years • Part 4: Earn at least 40 points from approved • activities* • *Choose activities from either Part 2 or 4 to earn the • additional 20 points you need to fulfill your 100 point • requirement. Need 100 points total

27. Questions? • Visit the ABP website at www.abp.org • Contact the ABP: • Initial Certification: gpcert@abpeds.org • Subspecialty Certification: sscert@abpeds.org • Maintenance of Certification: moc@abpeds.org • By phone: (919) 929-0461

28. Physician QI and MOC • “Meaningful participation” • Deliver direct patient care as part of QI project • Implement the changes designed to improve care • Collect, submit and review data for QI activity • Collaborate actively (at least 4 project meetings) • Length of participation • Variable, but generally about 1 year • Completion date must be within MOC cycle

29. ABP QI Project Requirements • Impact one or more IOM dimensions (safety, effectiveness, timeliness, equity, efficiency, and patient-centeredness) • One or more well-defined project aims • Use of standard QI methods • Training on QI methods • Adequate project structure (sponsor, leadership, infrastructure) • History and results of the project • Documentation (design, process, policies, results) • HIPAA compliance

30. Structure • Project must have: • Sponsoring organization: identified permanent entity that is responsible and accountable • Institutional governance approval • Documented organizational structure • Designated physician project leader

31. Options • Organizations running QI projects can apply to the ABP to gain approval as a MOC activity • Organizations can apply to the ABP to be a Portfolio Sponsor Organization • Sponsor applies to ABP ($10,000 - $30,000!) • If approved, the sponsor manages its own QI projects including deciding which qualify for MOC • Management includes tracking physician participation and granting MOC points

32. Proposal • Boston Children’s Hospital to act as Portfolio Sponsor Organization • Each SCAMP would be designed to qualify as MOC-eligible QI activity • Physician participation for at least one year in 2 different SCAMPS would meet MOC requirements for the 5 year MOC-cycle

33. Advice • Part 2 activity can be done over the course of the 5 year cycle. Attempting to achieve all 40 points the night before due date is unlikely to succeed • Part 4 activity requires at least one year of participation prior to due date – plan ahead • The ABP website maintains a page for each diplomate with requirements, due dates, etc.

34. Aurora Borealis – April 2009