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:  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?

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?

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

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

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

 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 & safety of U.S. healthcare Purposes of MOC (in a nutshell)

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

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

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

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

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

Healthcare Quality Aims Quality Aim Problem to Address People get the care they needUnderuse People need the care they getOveruse Provided safelyError, harm TimelyDelays Patient-centeredUnresponsive Delivered efficientlyWaste Delivered equitablyDisparities IOM, Crossing the Quality Chasm (2001) Improvement Opportunities

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

 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 MOC Part IV: PQI Project Essentials

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

Detailed MOC Information

Practice Quality Improvement (PQI)

Approved Projects and Templates

MOC Timeline

MOC Timeline

Personal Database (PDB)

PDB Home Screen Welcome back Dr. Jane Doe! You last signed in on :30:12:67

Dr. Jane Doe (ABR ID 99999)

PQI Attestation: Certificates Expiring < 2017

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

Attestation Questions

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

Stakeholders StakeholderWhat MOC should deliver PatientsCompetent physician; safe, quality care DiplomatesStreamline requirements, $$ CredentialiersDelineation of privileges Licensing BoardsMOC as Proxy for MOL Health PlansCost of care  incentives, recognition CMSIncentives / penalties, P4Q Consumer GroupsPatient-centered objectives Business CoalitionsValue: $$ cost/healthcare outcomes

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

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

 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 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 ABR and ABMS Making MOC Better

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

ABR RSNA Lakeside Hall E Northwest side of the hall next to the digital poster area

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