Maintenance of Certification What does it mean for you?

1. Maintenance of CertificationWhat does it mean for you? John J. Ricotta MD FACS Chair Vascular Surgery Board American Board of Surgery

2. What is Maintenance of Certification? • A program of continuous learning and improvement that goes beyond the 10-year recertification “snapshot” • Documents that diplomates are maintaining the necessary competencies to provide quality care • Created by the ABMS and its 24 member boards in a collaborative effort with other organizations involved in health care quality

3. MOC is supported by: • Federation of State Medical Boards of the U.S. (FSMB) • The Joint Commission • American Hospital Association (AHA) • American Medical Association (AMA) • National Board of Medical Examiners (NBME) • Accreditation Council for Graduate Medical Education (ACGME) • Association of American Medical Colleges (AAMC) • Council of Medical Specialty Societies (CMSS) • Educational Commission for Foreign Medical Graduates (ECFMG)

4. Board Certification and Quality Care • The board movement began in 1917 to set standards for quality care • There is evidence of a need for continued monitoring and promotion of quality … • “To Err is Human,” IOM, 2000 • 44,000-98,000 Americans die yearly due to preventable errors • “Bridging the Quality Chasm,” IOM, 2001 • Health care system fails to translate knowledge into practice • Harvard Medical School Study, Annals of Internal Medicine, Feb. 2005 • Doctors who have been in practice for more years tend to possess less factual knowledge and are less likely to adhere to appropriate standards of care

5. Physician Competencies The ABMS and ACGME have defined six general competencies as the foundation for physicians’ training and practice during their professional lifetime: • Medical Knowledge • Patient Care • Interpersonal and Communication Skills • Professionalism • Practice-based Learning and Improvement • Systems-based Practice

6. Four Components of MOCTo assess physician competencies on a continual basis • Professional Standing • Lifelong Learning and Self-Assessment • Cognitive Expertise • Evaluation of Performance in Practice

7. Transition to MOC • Diplomates are automatically enrolled in MOC once they certify or recertifyin any ABS specialty after July 1, 2005 • Until then, “regular” recertification requirements apply • MOC requirements start for a diplomate as of the July 1 following date of certification or recertification • MOC runs in three-year cycles: At the end of each cycle, diplomates submit information to the ABS regarding their MOC activities • The ABS will individually contact diplomates a year before submission is due for MOC

8. MOC Requirements TimelineMOC Year = July 1 to June 30, starting July 1 following certification or recertificationThree cycles of MOC (nine years) must be completed to recertify

9. Goals of Vascular MOC Process • Make it easy • Make it relevant - Use existing vehicles where possible - Measure things we are already required to report - Define scope in a way that will differentiate Vascular Surgery - Anticipate what we are likely to report in the future (modular concept)

10. Four Components of MOC1. Professional Standing • Full and unrestricted medical license • Verified every three years • Hospital admitting and operating privileges • Must be maintained in the specialty if clinically active • Reference letters from chief of surgery and chair of credentials committee • From the institution where most work is performed • To be submitted every three years • Must refer to Vascular Privileges

11. Four Components of MOC2. Lifelong Learning and Self-Assessment • Continuing medical education (CME): 30 hours Category I, 50 hours overall annually • Documentation of CME completion to be submitted every three years • Over the course of three years, one-third of Category I CME must be a self-assessment activity • 50% of CME in Vascular • Self assessment must be in Vascular

12. Four Components of MOC3. Cognitive Expertise • Secure examination • May be taken starting three years prior to certificate expiration (unchanged) • All MOC requirements must be fulfilled up to that point to be admissible to the examination

13. Four Components of MOC4. Evaluation of Performance in Practice • Participation in a national, regional or local outcomes database or quality assessment program • Verified every three years • Must encompass Vascular specific Practice • Periodic patient communication skills assessment also to be eventually required 2007 Surgery Recertification Examination: 51% of applicants said they were participating in outcomes studies. These individuals also had a lower exam failure rate.

14. Participation in programs such as these would meet this requirement: The ABS is investigating other national, regional, or hospital-specific programs, and is soliciting diplomates’ input atmocpart4@absurgery.org The ABMS is developing an assessment tool for patient communication skills that will likely be used in future Fulfilling the Performance in Practice Requirement

15. MOC Requirements TimelineMOC Year = July 1 to June 30, starting July 1 following certification or recertificationThree cycles of MOC (nine years) must be completed to recertify

16. Requirements for Multiple Certificate Holders • Parts 1, 2 and 4– professional standing, lifelong learning/self-assessment and performance in practice – requirements in Vascular can be credited to Surgery Certificate • Part 3 – cognitive expertise (secure examination) – must be fulfilled in all disciplines for which a diplomate holds a certificate

17. Benefits of MOC for Diplomates • Improved learning and self-assessment opportunities • Relevant measures of practice performance • Documents a diplomate’s commitment to quality care • Will reduce multiple and/or redundant quality assessments • Responds to public’s concerns regarding health care quality and patient safety • Overall improved patient care

18. SVS MOC Committee • Donald Jacobs - Part 2 MOC • David Gillespie – Part 4 MOC • Ashraf Mansour – Michigan experience in Practice Assessment