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Disclosures

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, 2010 Gary J. Becker, M.D David Laszakovits, M.B.A . Really 3 questions:.

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Disclosures

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  1. Disclosures Member, Board of Directors of the American Board of Medical Specialties

  2. What Does the ABR Currently Expect from PQI Projects? RSNA 2010, Chicago, IL November 30, 2010 Gary J. Becker, M.D David Laszakovits, M.B.A.

  3. 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?

  4. 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?

  5. “…acquired, demonstrated, and maintained …” …used to be simply a knowledge assessment (examination), but… …now it is evolving into assessment of performance in practice.

  6. 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

  7. To accomplish all of this, the Boards must move from… to… …measuring what candidates/diplomates know “…a culture of pedigree” …measuring what they know and do. “…a culture of improvement”1 1Norman Kahn, CMSS, NQF-ABMS meeting, April 29, 2009

  8. Purposes of MOC (in a nutshell) • 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 &safetyof U.S. healthcare

  9. National Priorities Drivers of Healthcare Transformation • Performance Measurement • Public Reporting • Payment Systems • Research and Knowledge Dissemination • Education and Certification

  10. MOC Part IV (PQI): Evidence of evaluation and improvement of performance in practice… • …is where the rubber meets the road.

  11. Quality Healthcare Goal: an overall Quality shift Minimal shift in overall quality Patients Identify outliers Best Practice Low Quality

  12. 2) What are ABR’s expectations of diplomates endeavoring to meet Part IV requirements? 5 Ps • 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

  13. Calls for fundamental change in aims, with delivery of healthcare that is: Safe Effective Patient-centered Timely Efficient Equitable INSTITUTE OF MEDICINE 2001

  14. Healthcare Quality Aims Quality AimProblem to Address People 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 Improvement Opportunities IOM, Crossing the Quality Chasm (2001)

  15. 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

  16. MOC Part IV: PQI Project Essentials • 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

  17. MOC Part IV: PQI Project Essentials • Data analysis • Improvement plan • Intervention (implement the plan) • Re-measurement • [Self-reflection] • Attestation on your PDB

  18. www.theabr.org

  19. Detailed MOC Information

  20. Practice Quality Improvement (PQI)

  21. Approved Projects and Templates

  22. 2003-2013 MOC Timeline

  23. 2008-2018 MOC Timeline

  24. Personal Database (PDB)

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

  26. Dr. Jane Doe (ABR ID 99999)

  27. PQI Attestation: Certificates Expiring < 2017

  28. PQI Attestation: Certificates Expiring > 2018 Dr. Jane Doe (ABR ID 99999) Dr. Jane Doe (ABR ID 99999)

  29. Attestation Questions

  30. 3) What changes in Part IV can be expected in the near future? Expect changes that will make MOC increasingly relevant to all stakeholders.

  31. Stakeholders

  32. ABR, All ABMS Boards: 2009 MOC standards MOC begins to address quality, safety aims Continue high-stakes testing, but: ABR, All ABMS Boards: 2010 What diplomates KNOW What diplomates DO; MOC in Patient Protection and Affordable Healthcare Act MOC enters “federal accountability framework” Boards work to make MOC deliver for all stakeholders FSMB House of Delegates adopts MOL framework

  33. ABR, All ABMS Boards: 2010 & Beyond Payment reform; focus shifts to outcomes Boards become positioned in measures development Registry 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 MOC Institutional recognition of MOC widely adopted Health plans embrace MOC in incentive programs MOC regarded as gold-standard marker of quality

  34. ABR and ABMS Making MOC Better • 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

  35. 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

  36. Challenges • All must grasp Part IV in quality-driven environment • Fulfilling part IV requirements as part of workflow • Requirements still evolving in COMMOC: pace, frequency ofchange • Finding opportunities to innovate • Boards must demonstrate, and communicate the value of certification and MOC

  37. ABR Booth @ RSNA Lakeside Hall E Northwest side of the hall next to the digital poster area

  38. Thank You! • MOC Support Hotline • (520) 519-2152 • abrmocp@theabr.org

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