MOC Part IV Self Directed PIM: Your Guide To Making It Happen

1. MOC Part IV Self Directed PIM: Your Guide To Making It Happen Joseph P. Drozda Jr., MD, FACC Mercy Health Richard J. Kovacs, MD, FACC KrannertInstitute of Cardiology Charles R. McKay, MD, FACC Harbor-UCLA Medical Center Paul D. Varosy, MD, FACC, FHRS University of Colorado, Denver VA Eastern Colorado Health Care System

2. Joseph P. Drozda Jr., MD, FACC

3. Overview • History & Role of the ABIM • ABIM’s Maintenance of Certification Process • MOC Part IV PIM Options • What, Why, Who, When, Where and How of ABIM’s Self-Directed PIM • Part A – Orientation • Part B – Measures and Data • Part C – Action Plan • Part D – Re-Measurement • Part E – Completion and Credits

4. History & Role of the ABIM ABIM Mission Statement To enhance the quality of health care by certifying internists and subspecialists who demonstrate the knowledge, skills and attitudes essential for excellent patient care “Of the Profession, For the Public”

5. History & Role of the ABIM • Founded in 1936 • Physician-led, not-for-profit, independent of professional societies and government • Sets the standards for certifying internists and subspecialists • Accountable to both to the profession of medicine and to the public • Certifies 1 out of 4 practicing physicians in the U.S. (>200,000 ABIM Board Certified physicians)

6. History & Role of the ABIM Most relevant certifications: • Internal Medicine (1936) • Cardiovascular Diseases (1941) • Clinical Cardiac Electrophysiology (1992) • Interventional Cardiology (1999) • Advanced Heart Failure & Transplant Cardiology (2010) • Adult Congenital Heart Disease (proposed)

7. History & Role of the ABIMDevelopment of Certification Process

8. Certification Certification Pre- 1990 • Secure exam after completing fellowship • Lifetime certification with no end date

9. Recertification Recertification 1990- 2006 • Secure exam after completing fellowship • Time-limited certification with an end date • Recertification exam every 10 years

10. Maintenance of Certification (MOC) Maintenance of Certification 2006- • Secure exam after completing fellowship • Time-limited certification with an end date • Maintenance of Certification exam every 10 years • MOC includes completion of Parts I, II, III and IV

11. Maintenance of Certification – Four Parts

12. Maintenance of Certification – 100 Points 100 Points Every 10 years

13. Completing MOC Part IV Self Evaluation of Practice Performance • Goal: • To improve some aspect of your practice • Tasks: • Measure practice using 3 performance measures • Analyze data and select one measure with potential for improvement • Develop and implement an action plan for improvement • Re-measure practice using same 3 measures

14. Performance Improvement Modules (PIMs) • Allow physicians to report on their quality-improvement work using a standardized web-based platform • Structured tools that guide physicians through a review of patient data and support the implementation of and/or reporting on a performance improvement project in their practice

15. MOC Part IV PIM Options • Condition/topic-specific PI modules • From ABIM, e.g. • Preventive Cardiology PIM • Communication with Referring Physicians PIM • From medical specialty societies or academic medical centers (Approved QI Pathway PIMs) • Generic PI modules • From ABIM • Self-Directed PIM (If you are beginning a new QI project) • Completed Project PIM (If you are reporting on QI activities that have already taken place)

16. Richard J. Kovacs, MD, FACC

17. What, Why, Who, When, Where and How of PIMs • What is ABIM’s Self-Directed PIM? • Why is completing a PIM necessary for me? • Who can participate in a PIM project? • When should I complete a PIM? • Where can I find ABIM’s Self-Directed PIM? • How do I complete a Self-Directed PIM?

18. What Is ABIM’s Self-Directed PIM? • Generic PI module that allows physicians to report on quality/performance improvement activities being implemented in any specialty or sub-specialty

19. Why Is Completing A PIM Necessary For Me? • ABIM require physicians to complete one of these projects to maintain board certification • Physicians not needing or wishing to maintain board certification need not complete a PIM

20. Who Can Participate In A PIM Project? • Can be completed by hospitalists and other physicians working in an in-patient or out-patient setting • ABIM encourages completion as a multi-disciplinary team • All physicians in the team can claim MOC Part IV credit

21. Who Can Participate In A PIM Project? ABIM/ABMS Reciprocal Credit for Dual-Boarded Diplomates • ABIM-certified physicians who are dual-boarded by one or more of the American Board of Medical Specialties’ (ABMS) 24 member boards (e.g. the American Board of Pediatrics) are eligible to receive self-evaluation credit in ABIM's MOC program • To receive credit, ABIM diplomates will need to attest that they are current and participating in the other board's MOC program

22. Who Can Participate In A PIM Project? • Doctors of Osteopathy must certify with the American Osteopathic Board of Internal Medicine (AOBIM) which introduced new Osteopathic Continuous Certification (OCC) January 1, 2013

23. When Should I Complete A PIM? • Takes a minimum of 3 months • Recommend starting at least 6 months prior to expiration of certification

24. Where Can I Find ABIM’S Self-Directed PIM? • Information on the Self-Directed PIM and a link to order it is at: http://www.abim.org/moc/earning-points/productinfo-demo-ordering.aspx • The Self-Directed PIM tutorial is at: http://www.abim.org/moc/earning-points/productinfo-demo-ordering.aspx?self-directed#58A

25. How Do I Complete A Self-Directed PIM? • This session will familiarize attendees with the module and describe key steps involved in using data from ACC’s NCDR registry • Can use a variety of data sources to complete • Step-by-step directions are being developed by ACC to help our members navigate the module. These will be available after March 23, 2013 at: www.CardioSource.org/MOCPartIV

26. Charles R. McKay, MD, FACC

27. Part A – Orientation

28. Part B – Measures and Data

29. Part B – Measures and Data Three sections of Part B • Tell us about your care setting • Select care setting (IP or OP) • Describe your data • Reporting period • Where did baseline data come from? • Enter baseline data

30. Part B – Measures And DataSection 2 – Describe Your Data Where Did Baseline Data Come From? • If NCDR - check “Medical Society Registry” box • Executive Summary and full Outcome Report from hospital RSMs or practice QI lead • Outcome Reports also available by logging on to www.ncdr.com

31. Where Do I Find The Outcome Report? • On NCDR.com • Via secure log-in • Registry specific • Under the Dashboard tab

32. Executive Summary Review • Rolling 4 quarters (R4Q) • Most significant measures/metrics included in the Executive Summary • Measures and Metrics are organized by • Performance Measures • NQF endorsed • ACC/AHA performance measures • Process of Care Metrics • Utilization metrics • Patient Outcome Metrics • Adverse Events • Mortality

33. Outcome ReportingExecutive Summary And Detail Section Executive Summary Detail Section

34. Where Is The Data Value And Sample Size?

35. A Closer Look At The Details . . . Detail line 1018

36. NCDR’s 4-Part Data Quality Program • Training and Clinical Support Team • Orientation webinars • Online FAQs • Live customer support • Email • Monthly webinars • Annual meeting with case reviews, etc. • Data Entry Integrity • Software value checks • Field level range parameters • Parent:Child fields • Data Completeness • Sites receive completeness reports to resubmit with missing fields completed • predetermined levels of completeness and consistency required for data to be included in national and comparison group averages • Data Accuracy • Upto 650 records are audited annually.

37. Part B – Measures And DataSection 2 – Describe Your Data • Other data sources: • National reporting database (e.g. PQRS, Bridges to Excellence) • Regional database (e.g. State QIO) • Local registries (e.g. Facility based) • Health plan data • Report from EMR/EHR • Manual abstraction (Chart Reviews) • Other (Crimson Continuum of Care; Quality Advisor)

38. Part B – Measures And DataSection 3 – Enter Baseline Data ABIM’s Measures Library • Choose a measure set OR • Submit alternative measures for approval

39. Part B – Measures And DataABIM’s Measures Library

40. Part B – Measures And DataSection 3 – Enter Baseline Data • Guidelines for choosing measures • Choose at least three measures • Minimum of 25 patients in the data sample

41. Part B – Measures And DataChoosing Your Measures

42. Part B – Measures And DataSelecting Alternative Measures For Approval • Find “Submit alternative measures for approval” at bottom of page • Click on link for form • Complete and submit form • Approval time is usually around 5 working days

43. Submitting Alternative Measures For Approval

44. Enter Baseline Performance Data For Your Measures

45. Richard J. Kovacs, MD, FACC

46. Part C – Action PlanDownload And Complete An Action Plan • The Action Plan contains: • Recommended tools • Exercises to be completed • Blank spaces for questions to be answered

48. Part C – Action PlanPreparation • Organize a Team • Target a Measure for Improvement

49. Part C – Action PlanPreparation: 1. Organize A Team • Common roles in your care setting • Identify individuals and groups involved in care, interested in results and will be implementing the solution(s) to the selected measure • List possible members, e.g., hospital leadership, QI consultant and RSM • Identify by titles or roles rather than names • Select team leader (?you) and facilitator

50. CV Service National Data Registries • NCDR Cath/PCI Registry • Robin Zwinski, RN; Cindy Humphrey, RN; Elisabeth Von der Lohe, MD • Society of Thoracic Surgeons (STS) Larissa Berty, RN and Arthur Coffey, MD • ACTION / GWTG • Tricia Helms, RN and Richard Kovacs, MD • PINNACLE • Rachel Nation & Richard Kovacs, MD • ICD Registry • Miriam Lowe and William Groh, MD • TAVR Registry • Colin Terry; AnjanSinha, MD and Arthur Coffey, MD • SVS Registry • Shelby Markey and Michael Dalsing MD Coordinator paired with Physician “Champion” for each database