New Attendee Orientation Physician Accountability for Physician Competence Summit VI July 8-9, 2008 New Attendee Orientation

Overview Background Streams of work underway Status of conversation What to expect next week

Background First summit held in March 2005 Broad spectrum of stakeholders invited Accrediting bodies, professional organizations, licensing boards, payers, insurers, specialty boards, medical schools, residency programs, public Scenario planning selected as format Question: How will the healthcare community evaluate, measure and document for the public, the ongoing competence of a physician? Give quick scan of environment leading up to summit: IOM report re: medical errors raises nation’s awareness of issue Insurers’ move towards pay for performance mechanisms as means of controlling costs Erosion of public trust/satisfaction with health care system Within that context, groups like ACGME, ABMS, ACCME take the lead in talking about continuing competence o physicians. FSMB takes up charge and begins studying role of SMBs in ensuring continued physician competence. Significant concerns that unless we’re able to gain support of physician community, any effort to implement maintenance of licensure requirements is dead in the water (e.g., Nevada, Texas) Summit initially positioned to gather input on role of SMBs. Obtaining funding from RWJ to host; initially convened an advisory group to help plan, but we were increasingly cognizant of the many institutions pursing similar strategic initiatives, yet there appeared to be limited coordination across institutions to ensure that the resulting “systems” would be coordinated, non-duplicative, meaningful, etc. Began to view the summit as an opportunity for the profession to really look at what it means to “self-regulate” and to think strategically about what changes need to happen now to ensure that the profession upholds its commitments to the public in the future. Summit was subsequently repositioned as the first in a series of focused meetings aimed at creating a shared vision for the future of physician self-regulation as it relates to measuring and evaluating the continued competence of physicians. Extended invitations to about 50 people representing a broad cross-section of stakeholders: Academic medicine payers (blue cross/blue shield association insurers (Physicians Insurance Association of America) medical boards specialty boards specialty societies public (CAC, RWJ Foundation) 45 people accepted. Selected a method of strategic thinking called scenario planning as format for the meeting and retained a consulting group called Innovation Labs to facilitate With the help of a sponsor group to shape the program, the core “question” we ultimately agreed to develop solutions for is “how does the healthcare community…” Sponsor group included David Leach from ACGME, Steve Clyman from NBME, JT, Bill Harp from the Virginia Board of Medicine, and Chris Cassel from ABIM.

Developing Scenarios Identified trends and drivers influencing environment, healthcare, medicine Examples Growing sophistication of patients/public Globalization of economy/healthcare Role of government in healthcare Rapid changes in technology and science Aging population Rising costs of healthcare Spread of internet

Developing Scenarios Used most critical and unpredictable trends to create five stories describing US healthcare system in 2020 Techno Community Alliance Data Cacophony Federal Tarbaby Brave New World happyhealthcare.com

Developing Scenarios Using most critical and unpredictable trends, created five stories describing US healthcare system in 2020 Techno Community Alliance Data Cacophony Federal Tarbaby Brave New World happyhealthcare.com

By the End of First Summit There Was… Consensus that Status quo not acceptable Collaboration will be critical to effecting change Agreement to meet again, continue dialogue Willingness to use scenarios as mechanism for involving organizations in the conversation

Status of PAPC Initiative Five summits to date, sixth July 8-9 A variety of conversations along the way Used scenarios to understand implications of measuring competence from five perspectives Explored ways that competence might be measured within each scenario Considered how regulatory system might look if critical components were “taken away” Probed how future regulatory system “ought” to look in an ideal world

Evolving Streams of Work Good Medical Practice-USA Improving coordination along continuum (e.g., discussions between licensing and certifying boards to improve interface) “E-folios” National Alliance for Physician Competence

Good Medical Practice - USA Emerged from recognition of need for a common framework and language Describes behaviors and values that competent physicians demonstrate under normal circumstances Envisioned as a blueprint or guide for physicians and those who educate, license and certify them Ongoing questions about purpose, utility, level of detail Website set up to post “living” document and capture feedback – https://gmpusa.org/ Good Medical Practice document describes competent medical practice. GMP is a tool or blueprint rather than a standard. If widely endorsed and implemented, could serve as the foundation for how physicians in this country are educated, trained and regulated. It is written for physicians, but also will assist members of the public in understanding what they may expect of physicians. The document’s content is organized around the six core competencies developed by the ACGME in collaboration with the ABMS. Summit V: Discussion of next steps, including development of a process for incorporating feedback Explore tools and methods that could be used to measure competencies described in the document

Observations People are staying at the table Number of participating organizations is growing Learning is critical to creating shared mental models and finding “breakthrough” solutions “Self-organizing” style of work minimizes “hierarchy” and politics Summits are fun, intellectually stimulating

Challenges Keeping people at the table Engaging broader audience Practicing physicians Public Understanding real-life implications to practicing physicians Politics Demonstrating outcomes

Lessons along the way Community, conversation, collaboration are critical to success A “shared” mental model of what “ought” to be helps people stay focused on the vision Individual champions important, but “organizational” commitment needed to sustain effort

Looking to the Future Need take the time to build consensus and ownership Continue to introduce diversity into the conversation People will self-organize around issues about which they are passionate Find “wins” early on View issues from perspective of constituents

Participants (to date) Medical Licensure American Association of Osteopathic Examiners Federation of State Medical Boards Iowa Board of Medical Examiners Kentucky Board of Medical Licensure Michigan Bureau of Health Professions North Carolina Medical Board Oregon Board of Medical Examiners South Carolina Board of Medical Examiners Virginia Board of Medicine Medical Education American Medical Association – LCME Association of Academic Health Centers Association of American Medical Colleges Coalition for Physician Enhancement East Tennessee State University Harvard School of Public Health Johns Hopkins Medical Institution Texas A&M Health Science Center UMDNJ School of Osteopathic Medicine University of Medicine and Dentistry of New Jersey University of Miami School of Medicine Physician Membership Organizations American Academy of Family Physicians American College of Cardiology American College of Physicians American Medical Association American Osteopathic Association College of Physicians and Surgeons of Saskatchewan Council of Medical Specialty Societies National Medical Association The Medical Society of Virginia Health Systems and Payors American Hospital Association Blue Cross/Blue Shield Association Blue Cross/ Blue Shield of Illinois Catholic Health Initiatives Crozer-Keystone Health System Specialty Certifying Boards American Board of Family Medicine American Board of Internal Medicine ABIM Foundation American Board of Medical Specialties American Board of Pediatrics American Board of Surgery AOA Bureau of Osteopathic Specialists American Osteopathic Board of Emergency Medicine Assessment/Accrediting Organizations Accreditation Council for Continuing Medical Education Accreditation Council for Graduate Medical Education Clinical Skills Evaluation Collaboration Educational Commission for Foreign Medical Graduates The Joint Commission Medical Council of Canada National Board of Medical Examiners National Board of Osteopathic Medical Examiners Foundations and Public AARP Agency for Healthcare Research and Quality Bridgekeeper Citizens Advocacy Center Commonwealth Fund Consumers Union Milbank Memorial Fund National Committee for Quality Assurance National Institute for Quality Improvement and Education Robert Wood Johnson Foundation Other Columbia Law School Medbiquitous Physician Insurers Association of America Santa Fe Institute, Los Alamos National Laboratory Steege/Thomson Communication Virginia House of Delegates 66 organizations represented – A total of 125 individuals have attended a summit thus far. Most participants are members of other organizations as well and, therefore, bring more than one perspective to the discussion (for example, some individuals are practicing physicians, but are not listed as such). This list comprises the organization for which people were invited to participate in the PAPC initiative. The number of participants continues to grow; increasingly, we are getting requests to participate in the initiative in addition to extending specific invitations. We hope to double the number of participants at the next meeting.

Questions?