1. Jeffrey W. Britton, MD, FAAP President Wisconsin Chapter, American Academy of Pediatrics

2.  Part 1: Professional standing (hold a valid, non- restricted medical license)  Part 2: Lifelong learning and self-assessment (Prep SA, ABP courses, other Part 2 courses)  Part 3: Cognitive expertise (Secure exam)  Part 4: Improving Professional Practice (ABP approved QI projects)  Requirement every 5 years with exam every 10 years

3.  Asthma eQIPP (AAP) Spirometry, Asthma control test  Adolescent Depression Screening (ABP) PHQ-9 (teen), Mental Health Resources  Handwashing (ABP) Handwashing signage in rooms; Post results in nurse break room

4.  Busy work  Not relevant to my practice  Repetitive  No support from my administration  My employer already measures me on other quality metrics, why do I need to do this too?

5.  Current MOC-4 structure has pediatricians doing finite projects selected from a menu, with finite data collection (3 cycles of ten), usually done as manual chart review (or patient survey)  How do we move this from finite projects to ongoing work to continuously improve quality?

6.  HEDIS (NCQA): The Healthcare Effectiveness Data and Information Set (HEDIS) Used by more than 90 percent of America's health plans 81 measures across 5 domains of care. Makes it possible to compare the performance of health plans on an "apples-to-apples" basis. Many health plans report HEDIS data to employers or use their results to make improvements in their quality of care and service. Employers, consultants, and consumers use HEDIS data, along with accreditation information, to help them select the best health plan for their needs.

7.  Weight assessment/nutrition & activity counseling  Childhood immunizations  Adolescent immunizations  HPV vaccine for female adolescents  Appropriate testing for children with pharyngitis  Medication management for asthma  Asthma medication ratio  WCE visits first 15 month  WCE visits age 3-6  Adolescent well visits

8.  HEDIS measures are measurable from claims data  May or may not be physician-specific  Many do, however, reflect goal of providing quality care

9.  Wisconsin Collaborative for Healthcare Quality  Publicly reports and brings meaning to performance measurement information that improves the quality and affordability of healthcare in Wisconsin  Multi-stakeholder, voluntary consortium of Wisconsin organizations, including the health systems, medical groups, clinics, and hospitals

10.  Adolescent immunizations (Tdap, MCV4)  Childhood immunizations (complete at age 2)  Depression screening, age 12 and older

11.  Need enough pediatric measures  Measures need to be individual measures  Measures should have clinical relevance If these criteria are met, can ongoing, continuous quality metrics be used for MOC?

12.  Ongoing measurement of entire practice, rather than brief period of sampling  For employed physicians, the availability of administrative staff to help devise improvement strategies and monitor progress  From a national standpoint, the ability to push a particular measure nationally by adding it to the panel (example; HPV measures)  Public reporting

13.  Part 1: No change  Part 2: Continued expansion of continuing education options that would count. MOC has threatened the future of CME conferences, unless part 2 credit can be earned at meetings  Part 3: If secure exams are here to stay, they should at least be done in a less threatening environment than a ProMetric testing station

14.  On a national level, ABP and AAP should be involved with quality metric development and encouragement of WCHQ-like organizations  Establish a set of pediatric quality metrics that is reviewed and updated annually.

15.  For physicians whose data is reported to a quality metric organization (like WCHQ): Maintain all quality scores over a specified threshold (e.g., 25 th %tile), or Submit information regarding PDSA attempts to increase scores annually (minimum 1 intervention annually for each score below threshold)

16.  For physicians whose data is not reported (small groups or individual practices): Option of annual measurement against the metrics, by manual chart review and submission of data Option of finite quality projects (i.e., the present system)

17. I have no idea, but I look forward to today’s discussions about quality metrics and the future of MOC