1. SPECIALTY BOARD CERTIFICATION… WHAT’S HAPPENING NOW?
Presented By:
Christina Giles, CPMSM, MS C. Giles & Associates
MAMSS 36th Annual Conference
Friday, May 10, 2019

2. OBJECTIVES
Identify the options for specialty board certification for physicians
Compare the four specialty board certifications available for physicians
Discuss the recommendations from the ABMS Vision Council and considerations for revisions to the various ABMS boards’ MOC programs

3. SPECIALTY CERTIFICATION
Like the Mona Lisa – what does certification actually mean? Is it a personalized interpretation?
According to the Vision for the Future Commission: More than ½ (56%) of the general public queried said they always consider bc when choosing a physician, more than ¼ (28%) said they sometimes consider it and 16% said they never consider it.
More than 84% said they believe that bc physicians provide higher-quality care than non board certified
Issues of competition in board certification, maintenance of such certification, and the extent of government involvement will always be at the forefront of any board certification discussion

4. MSP Certification Per NAMSS Website:
Certification by NAMSS puts you in the driver’s seat: It increases your potential for advancement in any healthcare environment and indicates to your supervisor(s) and accreditation surveyors that you are an expert in the field, both which enhance your value and job security. Here are some other reasons for credentialing specialists to seek certification by NAMSS:
More than 27% of current certificants received a salary increase as a result of their certification by NAMSS.
Gain confidence and demonstrate professional competence in the application of your knowledge.
NAMSS certificants cite recognition and respect from peers and supervisors as a top value of certification.
By increasing your breadth of knowledge beyond one particular healthcare environment, you increase your marketability, should you choose to seek new employment.
Certificants with the CPMSM designation have proven their in-depth knowledge of medical staff bylaws, hospital procedures and standards, management processes and accreditation standards, policies and procedures, which will help them communicate better with physicians and all key stakeholders.

5. WEBSITES TELL US….
A measure of training, experience and life-long learning
Demonstrated expertise
Raises the bar of excellence in patient care
Ensures physician compliance with national standards and promotes life-long learning
A physician has chosen to achieve expertise in a medical specialty or subspecialty by meeting the profession-driven standards and requirements of one (or more) of the 24 ABMS certifying boards.
Beginning of a physician’s personal commitment to providing quality patient care.
A voluntary process that indicates a practicing physician’s mastery of the core body of knowledge and skills in his or her chosen specialty at a specific time. (ABPS)
professional development and assessment that is aligned with other professional expectations and requirements within health care.

6. DID YOU KNOW? Physicians have four options for certification…
American Board of Medical Specialties (ABMS)
American Osteopathic Association Certification (AOA)
American Board of Physician Specialties (ABPS)
The National Board of Physicians and Surgeons (NBPAS)

7. American Board of Medical Specialties www.abms.org
Founded in 1933
For Allopathic & Osteopathic physicians
880,000 certified physicians
24 member boards
40 specialties
85 subspecialties
Has had a “monopoly” on the certification situation

8. 9 Associate Members Borrowed this slide from Jennifer Michael
Chief Information Officer and Chief Business Development Officer
NCF Presentation 2/2019

9. American Osteopathic Association Board Certification https://certification.osteopathic.org
Founded in 1944
For Allopathic & Osteopathic physicians
16 Specialty Boards
29 Primary specialties
77 Subspecialties

10. American Board of Physician Specialties (ABPS) www.abpsus.org
Founded in 1950
For allopathic & osteopathic physicians
18 specialties
Can achieve BC in an area with extensive experience but not necessarily a residency

11. National Board of Physicians and Surgeons www.nbpas.org
Believe that ABMS’ changes to MOC require physicians to engage in various activities that waste their time, cost too much money and there is no data that exists to justify these labor-intensive, expensive activities
For Allopathic & Osteopathic physicians
Founded in 2015
6000 diplomates

12. Continuing Certification
Based on a fundamental axiom – A single point-in-time assessment early in a physician’s career provides insufficient basis for making a statement about the ongoing, career-long knowledge, skills and abilities of a physician.
Certification is not akin to a medical diploma that has an enduring dimension – but more like a medical license that has a period of expiration
Final Report from The Vision Commission
Taken from the Final Report of the Vision for the Future Commission.

13. NAMSS RECERTIFICATION…
The NAMSS recertification program has been established to assure a level of continued competence through the ongoing enhancement of knowledge and skills in the field of provider credentialing and medical services management.
Continued competence is defined by NAMSS as demonstrating knowledge, skills, or ability to proficiently perform as a certified provider credentialing specialist or as a certified professional in medical services management throughout the certificants’s professional career. The NAMSS recertification program promotes continued competence throughout the certificants’career in the medical services profession by requiring submission of continuing education credits every three years.
 Single certificants must earn thirty (30) CE credits. Dual certificants must earn forty five (45) CE credits. For single certificants, fifteen (15) of thirty (30) required hours must be NAMSS approved credits. For dual certificants, twenty five (25) of the forty five (45) required hours must be NAMSS approved credits. 

14. What are your practitioners saying?
WHAT DO YOU THINK?
What are your practitioners saying?

15. CONTINUING CERTIFICATION (MOC)
What are the physicians’ issues?
What should the programs include?
ABMS Program for MOC within a four-part framework:
Part I: Professionalism and Professional Standing
Part II: Lifelong Learning and Self-Assessment Part III: Assessment of Knowledge, Judgment, and Skills
Part IV: Improvement in Medical Practice Professionalism - how physicians carry out their responsibilities safely and ethically
Patient Safety - how physicians use patient safety knowledge to reduce harm and complications
Performance Improvement - how physicians use the best evidence and practices compared with peers and national benchmarks to treat patients
Incorporating Judgment into Examinations – assessing not just what the physicians know but what they do with that knowledge
When asked if they value MOC, 1 in 10 physicians (12%) said they do, nearly half (46%) said they have mixed feelings, 41% said they do not
Concerns included: 58% - cost; 52% burdensome, 48% does not accurately measure my ability as a clinician; 43% - Does not help me improve my practice in a meaningful way
When asked what should be considered: 84% - continuing medical education; 52% -self- assessment questions delivered at regular intervals, 34% - open book exams, 24% - assessment of the quality and safety of care provided

16. MOVEMENT AWAY FROM EXAM…
Longitudinal and other innovative formative assessment strategies
Using repetition & relevance & modern technology in order to promote learning and retention and transfer of information to patient care situations
Assessments should be grounded in adult learning principles
Let’s look at American Board of Anesthesiology’s MOCA 2.0
Adult learning principles include: frequent, spaced learning with timely feedback; repeated for reinforcement, gap analysis to aid focus

17. ABA MOCA 2.0
The redesigned Maintenance of Certification in AnesthesiologyTM (MOCA®) program, MOCA 2.0®, provides diplomates with opportunities to continuously learn and demonstrate proficiencies to provide better patient care. It offers a more relevant and personalized approach to helping diplomates assess their knowledge and address knowledge gaps.
MOCA 2.0 is a web-based learning platform. At its core is MOCA Minute®, an interactive learning tool that replaces the decennial MOCA exam.

18. Longitudinal Assessment
Dashboard
Borrowed this slide from Jennifer Michael
Chief Information Officer and Chief Business Development Officer
CertiLink is ABMS’ online assessment platform that some of the boards will be using
NCF Presentation 2/2019

19. Vision for The Future Recommendations…
Continuing certification (CC) must integrate professionalism, assessment, lifelong learning and advancing practice to determine the continuing certification status of a diplomate.
CC must change to incorporate longitudinal & other innovative formative assessment strategies that support learning, identify knowledge and skills gaps and help diplomates stay current. Boards must offer an alternative to point-in-time examinations of knowledge.
Must regularly communicate with their diplomates about the standards for the specialty and encourage feedback about the program.
Must have consistent processes and requirements for continuing certification that are fair, equitable, transparent, effective & efficient.
Must enable multi-specialty and subspecialty diplomates to remain certified across multiple ABMS Boards without duplication of effort.
report recommends all ABMS boards move to assessments that are “formative” (“assessment of a physician with the primary purpose of providing feedback for learning and improvement…without passing judgement”), not “summative” (“assessment of learning with the primary purpose of establishing whether performance at a single defined point in time meets established performance standards, permanently recorded in the form of a score”). 

20. Vision for The Future Recommendations…
Must facilitate and encourage independent research to build on the existing evidence base about the value of continuing certification
Must change a diplomate’s certification status when continuing certification standards are not met.
Must have clearly defined remediation pathways to enable diplomates to meet continuing certification standards in advance of and following any loss of certification
Must make publicly available the certification history of all diplomates, including their participation in the continuing certification process.
Must comply with all ABMS certification and organizational standards, including financial stewardship and ensuring that diverse groups of practicing physicians and the public voice are represented.

21. Should it be required or optional?
“LET DOCTORS DECIDE IF THEY NEED CREDENTIAL PROGRAMS”
Bill introduced recently in RI by Senator James Sheehan (2019-S 0301)
On behalf of rank and file doctors to protect that profession from the requirements of unproven and involuntary credentialing beyond required yearly professional development
Introduced to recommend that MOC remain voluntary – allowing physicians to choose whether or not to participate
Maintaining certification would not be required by the state or insurance companies

22. ACCORDING TO NBPAS..
10 states have pending legislation concerning not requiring MOC (IN, NH, NY,RI,NJ, MD
4 states have passed strong support laws: OK, TX, TN, GA
6 states have passed weak support laws: WA, AZ, KY, NC, SC, ME

23. How do we deal with these changing times?
Lots Going On…
How do we deal with these changing times?
Keep educated…read and research
Timely interviews with physicians on Credentials and Medical Executive Committee
Stay abreast of changes in your state
Remember – FLEXIBILITY is the Game!

24. If we can’t change the situation – we need to keep on going!!!!
THANK YOU!! Christina Giles C. Giles & Associates