Council Meeting Honolulu, Hawaii May 4, 2008

1. Council MeetingHonolulu, HawaiiMay 4, 2008

2. Welcome New Members • Bruce A Boston, MD – Endocrinology • Mary Beth Fasano, MD - Allergy and Immunology • Robert Spicer, MD – Cardiology • Christine Barron, MD - Child Abuse

3. Maintenance of Certification – PediatricsExecutive Overview Setting standards of excellence in knowledge and performance.

4. Today’s Presentation Review the Maintenance of Certification process and our efforts to reduce redundancy and accelerate improvement Preview how collaboration among the Primary Care Boards and with AAP adds value

5. Why Maintenance of Certification – Pediatrics? All Boards are adopting MOC ABMS-wide action plan for quality Meets IOM imperative to improve quality of care MOC leads to better care MOC is a commitment to quality MOC helps pediatricians perform more effectively Helps you meet payer, regulatory and consumer demands for quality Greater efficiencies; Improved process; Better care for children

6. Designed BY and FOR Pediatricians MOC Committee designed a flexible program Easily tailored to your practice Evolving into a more continuous process

8. Part 1 – Professionalism in Practice • Valid, unrestricted medical license • Disciplinary Action Notification System • DANS notifies ABP of egregious actions resulting in loss or restriction • ABP can revoke certification

9. Part 2 – Lifelong Learning & Self-Assessment Benefits Options Online access CME credit

10. Part 3- Cognitive Expertise has evolved 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)

11. Part 4 Menu of Options (example) Example *Developed and administered by the AAP; requires payment directly to AAP for access. **ABP-approved on-going quality improvement initiatives.

12. Committed to Reducing Redundancy Joint Commission – MOC as a surrogate for quality requirements Payers – Working with 20+ payers to encourage pay-for-improvement Medicaid/CMS – Recognize MOC with financial incentives/reimbursement Federation of State Medical Boards – Remove duplicate requirements; demonstrate how MOC meets 6 core competencies Malpractice Carriers – Reduce malpractice premiums (the “Doctors Company” in CA) Role ofBoardCertification Goal: Align to reduce redundancy and accelerate improvement

13. Collaborating to Bring More Value Primary Care Boards share resources, knowledge to: jointly develop tools for MOC present a united front to payers/health plans, regulators, and accrediting bodies advocate for meaningful recognition/pay-for-improvement programs Long-time AAP and ABP relationship produces results: Jointly developed self-assessments eQIPP modules for improvement approved by the Board CME credit for participation in MOC starts in early 2008

14. Get Started Now: The Physician Portfolio Secure personal Web account abp.org

15. Questions? For Information: Jim Stockman, MD President/CEO Jim.Stockman@abpeds.org MOC Committee Myles B. Abbott, MD Julian L. Allen, MD Laura M. Brooks, MD H. James Brown, MD Christopher A. Cunha, MD Aaron L. Friedman, MD Hazen P. Ham, PhD Kevin B. Johnson, MD Sarah S. Long, MD Thomas K. McInerny, MD Paul V. Miles, MD Robert H. Perelman, MD Julie K. Stamos, MD David K. Stevenson, MD James A. Stockman III, MD Michele J. Wall, MA

16. Financial Report • At our inception in September of 2006, we received agreements for 2-3 years of support at $25,000/year from both AMSPDC and APPD (total of $50,000/yr). • First official financial and activity reports were made to AMSPDC and APPD in the first quarter of this calendar year, approximately 15 months into this arrangement.

18. Financial Report • Costs of activities are expected to increase as our activities broaden. We must work to minimize these costs to Council while moving forward with our agenda. • In these reports, I outlined a number of potential mechanisms for CoPS to enhance its own support, including the initiation of a dues structure. • Also outlined a philosophy of partnership with organizations of FOPO while maintaining independence to act as needed to represent subspecialty pediatric needs.

23. Commitment

24. Task Force Reports • Fellowship Application Process • Fellowship Core Curriculum • Advocacy • Communications • Relationships with Regulatory Agencies • Pipeline/Reimbursement

25. Fellowship Application Task Force:CoPS Hawaii May 4, 2008

26. The Charge and The Members • Task Force Charge: • Respond to the recommendations of FOPO • Consider delaying the start of fellowship application process • Proposed date: Fall of the 3rd year of Residency • Co-Chairs: • Tom Abshire (Hematology-Oncology) • Sharon Oberfield (Endocrinology) • Members: • Judy Aschner (Neonatology) • Chris Kennedy (Emergency Medicine) • Josef Neu (Neonatology) • Steven Wassner (Nephrology)

27. Task Force Recommendations • Current ERAS participants • Dec date: GI, Heme Onc, Rheum, Nephrology, Neonatal • July date: ER • Current Match participants • Spring match dates: Rheum, Heme Onc, Cardiology, GI • Fall match date: Neonatal, Critical Care, ER • Encourage the use of ERAS for July 2009 academic year (2010 ERAS cycle) • Consider two match dates to coincide with ERAS: • 3rd week in May of 2nd yr of residency • 1st week of December of 3rd yr of residency • Offer date coincides with one of two match dates • Evaluate yearly

28. Questionnaire to CoPS Representatives • Focus first on ERAS • Should fellowship programs utilize ERAS? If so, what release date? • December 1 (19 mos prior to starting fellowship) • July 15th (11 1/2 mos prior) • Should there be a match (NRMP)? • If so, which date? • Spring of 2nd yr (May, 14 mos prior) • Fall of 3rd yr (November, 8 mos prior)

29. Survey: ERAS Participation • Academic Peds: no - Genetics: no • * Adol Med: no -Heme Onc: yes • Allergy/Immunol: yes - * ID: no • Cardiology: no - Neonatal: yes • Child Abuse: no - Nephrology: yes • Child Psych: no response - Neurology: no • * Critical care: no - Pulmonary: no • Derm: no - Rheumatology: yes • Developmental: no - ER: yes • * Endocrine: no - GI: yes * Subspecialties in bold have interest in ERAS

30. Fellowship Core Curriculum: Current issues B Li, Joe Neu Judith Campbell, Mary-Ann Shafer, Steve Feig CoPS Task Force on Fellowship Core Curriculum

31. Outline • How do we meet the ABP requirements? Do we go beyond it? • Fewer Gen-X fellows want the research path – do we need additional tracks? • How do we document competence? • Questions for the task force

32. Fellows core curriculum – < 5 • Increasing mandated requirements • Less duplication between divisions • More efficient – in light of work hour restrictions • Use best people in department • Provide wider array of topics and skill development – career counseling, administrative and leadership skills

33. ABP Scholarly Requirements – • Biostatistics, research methods, design • Prep for applications to IRB, for funding • Critical literature review, EBM • Ethical principles – in research • Teaching skills – principles of adult learning , teaching, curriculum development, provision of feedback and assessment (in a variety of settings)

34. Patient care Medical knowledge Interpersonal skills (IS) Professionalism (P) Practice-based learning (PBL) Systems-based learning (SBL) Teaching skills Scholarly skills Other Administrative Leadership Career development Career counseling Personal planning ACGME 6 core competencies + …

35. The future – fellowship tracks?

36. How to implement? • Local strategies • Coalesce current institutional offerings • Develop new coordinated core curriculum • Place curriculum on intranet (ANGEL) • National strategies • Develop shared web-based curricula • Increase offerings at PAS

37. How to document competence? • Record attendance • Pass local exam • Develop skill-based criteria • Pass national exam – 7% of ABP sub-specialty exam in 2010 will cover scholarly • Combinations of above

38. Questions • What are the key FCC elements within the 6 core competencies, teaching & scholarly curriculum, as well as outside it? • What is most useful strategy for pediatric departments that don’t have a ‘super’ fellowship core curriculum director? • What is an effective yet practical approach to documenting competence?

39. Example format: 2 hour sessions • Introduction – background, why important • Didactic overview ( 30 min) or panel discussion (1 hr) • Small group exerciseor Q&A (1 hr) • Case-based scenario, exercise, role playing • Presentsolution to entire group (15 min) • Evaluation – identify top 3 points learned • Faculty debriefing

40. Advocacy Task Force

41. Charge Determine ways in which CoPS can be proactive in promoting child health and subspecialty activities

42. Fine Print The term "advocacy" is used broadly here, meaning not just representing ourselves to Congress and state legislatures, or speaking out publicly when necessary, but also to insure our participation with other organizations that make decisions pertinent to our patients and our subspecialties. Developing a standing approach to advocacy would thus permit CoPS to anticipate issues of importance to us and to influence their resolution.

43. Members

44. “Target” Organizations • FOPO organizations • “Adult” subspecialty societies • Government agencies • Local • State • Federal • The Public

45. Issues to Consider • Funding of pediatric research and training grants • GME, especially for fellow training • Federal and state children's health care plans • Pharmaceutical/device industry interactions with academic medicine • Billing/coding/reimbursement • Linking of Quality of Care to reimbursement • Transition between pediatric and adult care: Medical Homes

46. Modus Operandi • Model activities from pediatric subspecialty societies with strong advocacy programs • Collaborate with AAP, which has well-developed advocacy program • Also, work with corresponding “adult” subspecialty societies • Yet seek to find our own “voice” • Develop a list of priorities based upon both our greatest needs and synergy with other organizations

47. Operational Concerns • We need to be comprehensive in our analysis of the issues but focused in our choice of priorities • We also should seek synergy with other pediatric organizations • It has been difficult to elicit a response after several e-mails • We need to select a more permanent task-force chair who is a voting member of CoPS

48. Richard Mink, Chair James Bale Judith Campbell Gail McGuinness Paul Moore Bruce Boston James Perrin David Rubin Bruder Stapleton Donald Vernon Steven Wassner Communications Task Force

49. Committee Charge • to address the core needs of our organization to communicate effectively with ourselves and the memberships of our constituent subspecialties.

50. CoPS Communication Survey • 39 respondents • some incomplete • 36 voting members • 3 non-voting members • 22 (56%) program directors • At least one representative from every subspecialty except Child Psychiatry