disclosures member, board of directors of the american board of medical specialties

Disclosures

Member, Board of Directors of the American Board of

Medical Specialties

What Does the ABR Currently Expect from PQI Projects?

RSNA 2010, Chicago, IL November 30, 2010Gary J. Becker, M.D

David Laszakovits, M.B.A.

Really 3 questions: What does the ABR expect PQI to deliver?

What are ABR’s expectations of diplomates in meeting MOC Part IV requirements?

What changes in Part IV can be expected in the near future?

Mission“… to serve patients, the public, and the medical profession by certifying that

its diplomates have acquired, demonstrated, and maintained a requisite standard of knowledge, skill and understanding essential to …practice…”

1) What does the ABR expect PQI to deliver?

“…acquired, demonstrated, and maintained …”

…used to be simply a knowledge assessment (examination), but…

…now it is evolving into assessment of performance in practice.

To earn the public’s trust and maintain a portion of our privilege to self-regulate, we will have to…

…deliver quality, affordable care…engage in physician performance assessment and improvement…demonstrate outcomes through public reporting

To accomplish all of this, the Boards must move from…

…measuring what candidates/diplomates know

“…a culture of pedigree”

to…

…measuring what they know and do.

“…a culture of improvement”1

1Norman Kahn, CMSS, NQF-ABMS meeting, April 29, 2009

Demonstrate to the public that diplomates of the ABMS Member Boards—including the ABR-- maintain the competencies necessary to provide quality patient care, and thereby:

Improve the quality & safety of U.S. healthcare

Purposes of MOC (in a nutshell)

National Priorities

Drivers of Healthcare Transformation Performance Measurement Public Reporting Payment Systems Research and Knowledge Dissemination Education and Certification

MOC Part IV (PQI): Evidence of evaluation and improvement of performance in practice…

…is where the rubber meets the road.

Pati

ents

Best Practice

Low Quality

Minimal shiftin overall qualityMinimal shiftin overall quality

IdentifyoutliersIdentifyoutliers

Goal: an overallQuality shiftGoal: an overallQuality shift

Quality Healthcare

2) What are ABR’s expectations of diplomates endeavoring to meet Part IV requirements?

Participate in MOC Prepare to improve

– Learn standard, accepted quality improvement methods– Identify quality leader for your practice/dept/institution– Start establishing culture of improvement, eliminating

culture of blame Plan: what to work on; think 6 IOM quality aims PDSA or DMAIC PDB: Attest to what you have done each year

5 Ps

Calls for fundamental change in aims, with delivery of healthcare that is:

SafeEffectivePatient-centeredTimelyEfficientEquitable

INSTITUTE OF MEDICINE

2001

Healthcare Quality AimsQuality Aim Problem to AddressPeople get the care they need Underuse

People need the care they get Overuse

Provided safely Error, harm

Timely Delays

Patient-centered Unresponsive

Delivered efficiently Waste

Delivered equitably Disparities IOM, Crossing the Quality Chasm (2001)

ImprovementOpportunities

MOC Part IV: Evidence of Evaluation and Improvement of Performance in Practice (PQI)

3 PQI projects/10-yr cycle Each project must meet criteria Maintain source data for audit Complete attestation on PDB

Relevant to patient care Relevant to diplomate’s practice [Set performance target] Include baseline performance measurement Comparative peer data, consensus-based standards, evidence-based guidelines

MOC Part IV: PQI Project Essentials

Data analysis Improvement plan Intervention (implement the plan) Re-measurement [Self-reflection] Attestation on your PDB

MOC Part IV: PQI Project Essentials

www.theabr.org

Detailed MOC Information

Practice Quality Improvement (PQI)

Approved Projects and Templates

2003-2013 MOC Timeline

2008-2018 MOC Timeline

Personal Database (PDB)

PDB Home Screen

Welcome back Dr. Jane Doe!You last signed in on 2010-10-13 13:30:12:67

Dr. Jane Doe (ABR ID 99999)

PQI Attestation: Certificates Expiring < 2017

PQI Attestation: Certificates Expiring > 2018

Dr. Jane Doe (ABR ID 99999)Dr. Jane Doe (ABR ID 99999)

Attestation Questions

3) What changes in Part IV can be expected in the near future?

Expect changes that will make MOC increasingly relevant to all stakeholders.

StakeholdersStakeholder What MOC should deliverPatients Competent physician; safe, quality careDiplomates Streamline requirements, $$Credentialiers Delineation of privilegesLicensing Boards MOC as Proxy for MOLHealth Plans Cost of careincentives, recognitionCMS Incentives / penalties, P4QConsumer Groups Patient-centered objectivesBusiness Coalitions Value: $$ cost/healthcare outcomes

ABR, All ABMS Boards: 2009MOC standards

MOC begins to address quality, safety aimsContinue high-stakes testing, but:

ABR, All ABMS Boards: 2010What diplomates KNOW What diplomates DO;

MOC in Patient Protection and Affordable Healthcare ActMOC enters “federal accountability framework”

Boards work to make MOC deliver for all stakeholdersFSMB House of Delegates adopts MOL framework

ABR, All ABMS Boards: 2010 & Beyond Payment reform; focus shifts to outcomes

Boards become positioned in measures developmentRegistry participation: P4Q and MOC requirements

Additional P4Q (value-based) federal rules include MOC

Public reporting of MOC participation (August, 2011)MOC as proxy for MOL

Credentialing, accrediting bodies require MOCInstitutional recognition of MOC widely adopted

Health plans embrace MOC in incentive programsMOC regarded as gold-standard marker of quality

Aligning, streamlining: Simultaneously: OPPE, Part II and IV credit Group practice model Institutional Sponsor Recognition

Qualify for CMS incentives (carrot), avoid future penalties (stick): MOC PQRI ABR crafting measures that matter:

ABMS-ABR/PCPI Pilot: radiation dose optimization

ABR and ABMS Making MOC Better

Value of certification and MOC Starting to work with health plans to gather data

MOC as proxy for MOL FSMB MOL Principles 4/2010 FSMB MOL Implementation Team report 11/2010

Innovation Pathways in MOC Focused Practice Recognition in brachytherapy Focused Practice Recognition in cardiac CT

ABR and ABMS Making MOC Better

All must grasp Part IV in quality-driven environment

Fulfilling part IV requirements as part of workflow

Requirements still evolving in COMMOC: pace, frequency of change

Finding opportunities to innovate

Boards must demonstrate, and communicate the value of certification and MOC

Challenges

ABR Booth @ RSNALakeside Hall E

Northwest side of the hall next to the digital poster area

Thank You!

MOC Support Hotline(520) 519-2152

abrmocp@theabr.org