American Board of Surgery Maintenance of Certification: Practice Performance Improvement

1. MAINTENANCE OF CERTIFICATIONPart IV Practice Performance and Improvement David L. Gillespie MD, FACS Professor of Surgery University of Rochester School of Medicine and Dentistry Rochester, NY

2. Maintenance of Certification • ongoing process • continuous improvement • Surgeons must demonstrate a program of • ongoing learning • professional assessment • self improvement • Facilitates maintaining expertise within specialty The American Board of Surgery

3. Maintenance of Certification • patient centered initiative • demonstrate high degree of professionalism • improve patient care • address concerns of public about quality • will strengthen the value of Board certification   The American Board of Surgery

4. Maintenance of Certification (“MOC”):      • 1) Demonstration of Current Professional Standing • every 3 years, unrestricted License, privileges to practice, letter of attestation • 2) Demonstration of Lifelong Learning and Self Assessment • 50 CME credits per year, demonstrate self assessment • 3) Demonstration of Cognitive Expertise • recertification examination, once every TEN (10) years. • 4) Evaluation and Improvement of Performance in Practice The American Board of Surgery

5. Maintenance of Certification (“MOC”):      • 1) Demonstration of Current Professional Standing • every 3 years, unrestricted License, privileges to practice, letter of attestation • 2) Demonstration of Lifelong Learning and Self Assessment • 50 CME credits per year, demonstrate self assessment • 3) Demonstration of Cognitive Expertise • recertification examination, once every TEN (10) years. • 4) Evaluation and Improvement of Performance in Practice The American Board of Surgery

6. Maintenance of Certification (“MOC”):      • 1) Demonstration of Current Professional Standing • every 3 years, unrestricted License, privileges to practice, letter of attestation • 2) Demonstration of Lifelong Learning and Self Assessment • 50 CME credits per year, demonstrate self assessment • 3) Demonstration of Cognitive Expertise • recertification examination, once every TEN (10) years. • 4) Evaluation and Improvement of Performance in Practice The American Board of Surgery

7. Maintenance of Certification (“MOC”):      • 1) Demonstration of Current Professional Standing • every 3 years, unrestricted License, privileges to practice, letter of attestation • 2) Demonstration of Lifelong Learning and Self Assessment • 50 CME credits per year, demonstrate self assessment • 3) Demonstration of Cognitive Expertise • recertification examination, once every TEN (10) years. • 4) Evaluation / Improvement of PracticePerformance The American Board of Surgery

8. Part IV MOCPractice Performance and Improvement • Verification required every three (3) years • involved in one or more assessment programs • focus on analysis of practice performance • quantitative assessment • Use info gained for performance improvement The American Board of Surgery

9. Part IV MOCPractice Performance and Improvement • Requirements are subject of active discussion • by the ABS, ACS, SVS, SCVS • unclear what programs will qualify • To show Performance Evaluation/Improvement • will be more than participation in M&M The American Board of Surgery

10. Part IV MOC- Practice Performance and Improvement – • Some examples which might apply include • participation in Quality Outcome projects such as • National Surgical Quality Improvement Project (NSQIP), • Surgical Care Improvement Project (SCIP) • practice databases such as those being developed through • the ACS web portal • the SVS carotid database The American Board of Surgery

11. Part IV MOC- Practice Performance and Improvement – • Participation in NSQIP (National Surgery Quality Improvement Program) The American Board of Surgery

12. Part IV MOC- Practice Performance and Improvement – • NSQIP (National Surgery Quality Improvement Program) • Grew out of the National VA Surgical Risk Study 1991 • now offered to all interested hospitals • 2004 ACS began enrolling • new private sector hospitals into the ACS NSQIP The American Board of Surgery

13. Part IV MOC- Practice Performance and Improvement – • NSQIP (National Surgery Quality Improvement Program) • The ACS NSQIP is available to all private sector hospitals that • meet the minimum participation requirements, • complete a hospital agreement, • pay an annual fee of $35,000. • Many benefits by participating • most importantly reduction of surgical morbidity and mortality • VA NSQIP will continue in parallel system • will compare its results against the ACS NSQIP private sector data The American Board of Surgery

14. Part IV MOC- Practice Performance and Improvement – • Participation in SCIP (Surgical Care Improvement Project) The American Board of Surgery

15. Part IV MOC- Practice Performance and Improvement – • SCIP (Surgical Care Improvement Project) • A national quality partnership of organizations • improving surgical care by reducing surgical complications • Steering committee ACS, CMS, AHA, ASA, AORN, CDC, AHRQ • Goal: reduce preventable surgical M&M by 25 % by the 2010 • Hospitals can join SCIP to collect and submit data • Hospitals that wish to sign up to participate in SCIP • complete Hospital Letter of Participation and fax it The American Board of Surgery

16. Part IV MOC- Practice Performance and Improvement – • SCIP has four modules • Infection • 7 Infection Prevention Process Measures • Venous Thromboembolus (VTE) • 2 VTE Prevention Process Measures • Cardiac Prevention Module • 1 Cardiovascular Prevention Measure • Respiratory • Delayed implementation to use these measure in expanding the ICU Core Measure Set The American Board of Surgery

17. Part IV MOC- Practice Performance and Improvement – • Some examples which might apply include • participation in Quality Outcome projects such as • National Surgical Quality Improvement Project (NSQIP), • Surgical Care Improvement Project (SCIP) • practice databases such as those being developed through • the ACS web portal • the SVS carotid database. The American Board of Surgery

18. Part IV MOC- Practice Performance and Improvement – • ACS Practice Based Learning System (case log system) The American Board of Surgery

19. Part IV MOC- Practice Performance and Improvement – • ACS case log system • allows surgeons to track their cases and outcomes • convenient easy-to-use. • Can compare personal outcomes to others confidentially • opportunities for training from learning modules The American Board of Surgery

20. Part IV MOC- Practice Performance and Improvement – • ACS case log system • The American Board of Surgery has • identified Practice Based Learning and Improvement as a core competency. • in the future the case logging system could support • submission of case logs for maintenance of certification (MOC). • open only to members of the American College of Surgeons. • To register for the system you will need to log in to the ACS Web site. The American Board of Surgery

21. Part IV MOC- Practice Performance and Improvement – • SVS carotid database The American Board of Surgery

22. Part IV MOC- Practice Performance and Improvement – • SVS carotid database • ensures eligibility for CAS reimbursement. • CMSrequire data collection on CAS for reimbursement • offers confidential benchmarking reports • Site-specific CEA vs. CAS baseline risk factors and complications • over time in your facility. • to other institutions • by individual provider • "Real time" access to all your data for analysis. The American Board of Surgery

23. Part IV MOC- Practice Performance and Improvement – • SVS carotid database • Facility benefits • available now • easy-to-use • cost-effective way to meet CMS regulations for CAS • downloadable database • Collection of ongoing follow-up • Collects both stenting and open repair data for comparison. • Real-time comparative reports. • one-time enrollment fee of $1,000 • annual subscription fee of $3,000 The American Board of Surgery

24. Part IV MOC- Practice Performance and Improvement – • The ABS is investigating other data systems • Personal • national, • regional, • hospital-specific • and is soliciting input • e-mail at mocpart4@absurgery.org The American Board of Surgery

25. Thank you The American Board of Surgery