Massachusetts Board of Registration in Medicine 2019 MAMSS Meeting

1. Massachusetts Board of Registration in Medicine 2019 MAMSS Meeting

2. Mission The fundamental mission of the Board of Medicine is public protection. Mission Statement The Boardof Registration in Medicine’s mission is to ensure that only qualified and competent physicians of good moral character are licensed to practice in the Commonwealth of Massachusetts and that those physicians and health care institutions in which they practice provide to their patients a high standard of care, and support an environment that maximizes the high quality of health care in Massachusetts.

3. Today’s Presentation Today’s Presentation will cover: • A review of the Licensing Division’s Current Initiatives • An update on the Online License Application Project • A discussion of Recent Updates in the Law

5. Licensing Division REview Over the past five months, the Licensing Division conducted a thorough examination of its workflow with the objective to find ways to reduce the average time to process applications and to make recommendations to improve communications with physicians without compromising the Board’s fundamental mission. Based on 2018, the review found that, for full license applications: -the median processing time from January to July (busy licensing season) was 88 days. -the median processing time from August to December was 57 days. -93% of initial full license applications submitted to the Board are incomplete

6. Licensing Division REVIEW The overall determination of the review was that, the application workflow is thorough and includes appropriate redundancies to prevent errors. Specifically, the review found that: - Licensing Analysts are detailed oriented and mission driven; - The licensing process is well documented; - Multiple rounds of supervision and review minimize the risk of approving unqualified physicians; and - Licensing Division staff are continuously looking for ways to improve the process.

7. Licensing Division REVIEWAreas for Improvement Current technology reduces the Licensing Division’s efficiency and hinders performance management. • Licensing Division staff must currently use six different tools to process applications. For the most part, these tools do not speak to each other, forcing staff to set up redundant tracking systems. • The disjointed nature of the current technology makes it difficult for staff to understand the current status of any given application and relay that information to inquiring physicians. • The lack of connectivity across tools also prevents staff from having a comprehensive view of where applications are in the queue and how efficiently BORIM is processing applications. Based on the review, the Licensing Division is implementing a series of initiatives to improve its efficiency and service to physicians.

8. Licensing Division Initiatives The Licensing Division is moving ahead with several initiatives to address areas for improvement. • Redesign of the Initial Full License Application. • Development of Online License Application. • Improved Communication with Physician Applicant.

9. Redesign of the Initial Full License Application Full License Application Checklist was reorganized into the following 3 categories: 1) Information required from physician applicant: Application fee; Full License Application; CORI Acknowledgement form; Liability Carrier Report Form; and CV 2) Documents required from third parties: Examination Scores; Supervisory Evaluation Forms; Certificate of Moral and Professional Character; Medical Education Verification; Postgraduate Training Verification; AMA or AOA Physician Profile; NPDB; Liability Carrier Claims History Reports; and License Verifications 3) Information required from IMG applicants only: ECFMG Certification; Medical School Transcript; Medical School Diploma; Translation of Medical School Transcript and Diploma if these documents are not in English; and Substantial Equivalency of Medical Education (if applicable).

10. Redesign of the Initial Full License Application (cont’d) Application - Full License Application Kit reduced from 63 to 31 pages. - Instructionsembedded into the checklist and the application. - Supplement pages reorganized to come after appropriate section. - Created a statutory and regulatory requirements page. - Removed the following forms: 90-Day; Authorization; and EHR form and included information within the body of the application. This redesigned application will used in the development of the Board’s online licensing system.

11. Online Initial License applications The Licensing Division Review determined that the Licensing Division’s current technology makes it difficult for Licensing Analysts to be transparent with physicians about their application status. The Board is currently seeking proposals from vendors on an online licensing applicationsystem for both initial full and limited license applications. The Board anticipates that a vendor will be chosen and this project will be launched in the Fall of 2019. Target date for completion is 2020.

12. Improved communication with Physician Applicant The Licensing Division will be hiring an additional staff member to assist with keeping applicants up-to-date on the status of his/her application prior to the implementation of the online license system. As part of the online license application process, the Board’s goal is that a physician will be able to see the status of his/her full license application in real time.

13. Next steps Application Redesign - Train staff on new form; - Post redesigned application on Board’s website by late June 2019; - Require that physicians submitting full license applications on or after September 1, 2019 use the redesigned form; and - Incorporate feedback into next version. Online Licensing Application • Select winning bid by early September 2019; • Begin project in early Fall 2019; and - Online licensing system active for initial full and limited applicants in 2020. Improved Applicant Communication - Hire additional Licensing Division Staff member; • Create email templates for physician status; • Train Licensing Division Staff on use; and • Begin project in Fall 2019.

14. UPCOMING CHANGES TO THE BOARD’s Licensing Process The Board has approved the following changes to the Board’s full license application process: • All initial full license applicants will be required to complete an application with FCVS (requirement effective as part of online licensing project); • Streamlining the Board request for malpractice documentation; • Extend administrative approval to allow the Executive Director to approval eligible applications for licensure. .

15. Require FCVS FOR INITIAL FULL LICENSE APPLICANTS As a part of the Board’s online license application, all full license applicants will be required to complete an application with FCVS. Reasoning: • Strengthen medical credential and identity verification: FSMB is recognized as the leading expert in medical document verification, especially for international medical graduates (IMGs). • Align staff work with mission: Licensing Analysts would be able to focus on medical competence and qualification issues. • Reduce license processing times: Licensing Division would be able to process more applications in less time.

16. streamline Medical Malpractice information Medical malpractice question remains the same: Has any medical malpractice claim ever been made against you, whether or not a lawsuit was filed in relation to the claim? (You must report any medical malpractice claims that have been made against you, even if the claim against you was dropped, dismissed, settled, adjudicated or otherwise resolved). Applicants who answer “No”: List malpractice liability carriers and provide claims history reports for the last 10 years. Applicants who answer “Yes”: List malpractice liability carriers and provide claims history reports for the last 10 years, as well as, listing the malpractice liability carrier and providing claims history report for the relevant claim.

17. Benefits of this streamlined malpractice approach Significant improvements to the application experience. The vast majority of physician applicants answer “No” to the medical malpractice questions. Substantial reduction in Licensing Division staff performing low-value tasks. This allows for Licensing Division staff to perform at greater efficiency and to focus on high-value work.

18. administrative approval of eligible applications The Board approved the Executive Director’s authority to confer administrative approval on eligible applications that do not require Licensing Committee review. Current approval is for June thru September 2019. The administrative approval of applications, subject to the Board’s approval and ongoing oversight, will be reviewed by the Board on a quarterly basis to decide whether to continue or reconsider the practice.

19. Benefits of Administrative approval The Board and the Licensing Committee can dedicate more of its time and attention to cases that require in-depth review. Licensing Division staff are better able to focus on ensuring that limited license applicants are able to start their training programs on time. Physicians applying for a full license are approved a few days earlier than they would have otherwise, benefiting them, patients and employers.

20. Improvement in Operations The Board and its staff strongly believe that with these changes, the Board can significantly improve its operations while upholding physician standards and patient safety. Over the next twelve months, the Board hopes to: - Reduce processing time by at least four weeks; - Improve the application experience; and - Strengthen credential verification.

21. Updates to Law/Policy • Board Policy 19-01, Request for waiver of 243 CMR 2.03(1)(d) – Requirement for Satisfactory Completion of Thirty-Six (36) Months of Postgraduate Training for International Medical Graduates (Adopted May 2, 2019) • Board Policy 18-02, Interim Policy on Compliance with the Alzheimer’s and Related Dementias Training Requirement

22. Board policy 19-01 On May 2, 2019, the Board adopted policy 19-01 that allows an IMG to request a waiver of the Board’s requirements of completion of thirty-six months of postgraduate training. In order to be considered under this policy, an applicant must submit: 1) A completed application that does not contain either additional waiver requests OR any issues or affirmative answers that would require review by the Board’s Licensing Committee; and 2) A waiver request asking the Board to process his or her application following successful completion of at least thirty-two (32) months of progressive ACGME accredited, AOA approved or accredited Canadian postgraduate training; and

23. Board Policy 19-01 (cont’d) • A total of four (4) Supervisory Board Evaluation forms completed by the applicant’s program director, with one evaluation for each year of training and a summative evaluation covering at least thirty-two (32) months of training. Only applicants who have achieved a rating of “Superior” on each of the eight evaluation categories on all four (4) Supervisory Board Evaluation forms will qualify for a waiver pursuant to this policy. Applicants who do not meet the Board’s requirement for a waiver will be processed pursuant to the Board’s standard procedure, following submission of documentation of successful completion of thirty-six (36) months of progressive ACGME accredited, AOA approved or accredited Canadian postgraduate training and a summative evaluation covering thirty-six (36) months of training

24. Board Policy 18-02 Chapter 220 of the Acts of 2018, An Act Relative to Alzheimer’s and Related Dementias in the Commonwealth, requires that physicians, among others, take a one-time educational course on Alzheimer’s disease and related dementias. Limited Applicability This educational training requirement only applies to licensees who serve adult populations. As part of its coordinated plan for the implementation of Sections 3 and 9 of this statute, the Board adopts the following interim policy, effective immediately: All applicants and licensees who apply for a license from November 7, 2018 through June 30, 2019, shall hereby be granted an administrative waiver of the Alzheimer’s educational training requirement for this licensing cycle. All licensees will have until November 6, 2022 to complete this one-time requirement.

25. Thank you Questions?