Council MeetingCouncil MeetingHonolulu, HawaiiHonolulu, Hawaii

May 4, 2008May 4, 2008

Welcome New MembersWelcome New Members

Bruce A Boston, MD – EndocrinologyBruce A Boston, MD – EndocrinologyMary Beth Fasano, MD - Allergy and Mary Beth Fasano, MD - Allergy and ImmunologyImmunologyRobert Spicer, MD – CardiologyRobert Spicer, MD – CardiologyChristine Barron, MD - Child AbuseChristine Barron, MD - Child Abuse

Maintenance of Certification Maintenance of Certification – Pediatrics– Pediatrics

Executive OverviewExecutive Overview

Setting standards of Setting standards of excellence in knowledge and excellence in knowledge and

performance.performance.

Today’s PresentationToday’s Presentation

Review the Maintenance of Review the Maintenance of Certification process and our Certification process and our efforts to reduce redundancy and efforts to reduce redundancy and accelerate improvement accelerate improvement

Preview how collaboration Preview how collaboration among the Primary Care Boards among the Primary Care Boards and with AAP adds valueand with AAP adds value

Why Maintenance of Why Maintenance of Certification – Pediatrics?Certification – Pediatrics?

All Boards are adopting MOCAll Boards are adopting MOC– ABMS-wide action plan for qualityABMS-wide action plan for quality– Meets IOM imperative to improve quality of careMeets IOM imperative to improve quality of care

MOC leads to better careMOC leads to better care– MOC is a commitment to quality MOC is a commitment to quality – MOC helps pediatricians perform more effectivelyMOC helps pediatricians perform more effectively– Helps you meet payer, regulatory and consumer Helps you meet payer, regulatory and consumer

demands for qualitydemands for qualityGreater efficiencies; Improved process; Better care for Greater efficiencies; Improved process; Better care for childrenchildren

Designed BY and FOR Designed BY and FOR Pediatricians Pediatricians

MOC Committee MOC Committee designed a designed a flexible programflexible program

Easily tailored to Easily tailored to your practiceyour practice

Evolving into a Evolving into a more continuous more continuous processprocess

Part 1 – Professionalism in Part 1 – Professionalism in PracticePractice

Valid, unrestricted medical licenseValid, unrestricted medical license

Disciplinary Action Notification SystemDisciplinary Action Notification System– DANS notifies ABP of egregious actions resulting in loss or restriction DANS notifies ABP of egregious actions resulting in loss or restriction – ABP can revoke certification ABP can revoke certification

Part 2 – Lifelong Learning & Part 2 – Lifelong Learning & Self-AssessmentSelf-Assessment

BenefitsBenefits

OptionsOptionsOnline Online accessaccessCME creditCME credit

Part 3- Cognitive Expertise has Part 3- Cognitive Expertise has evolvedevolved

1993 - 20021969ABMS introduces

Recertification

1980-1991Closed Book

(voluntary)

1993-2002Open Book Exam

(every 7 years)

2003-presentSecure Exam(every 7 years)

2010+Secure Exam

(every 10 years)

MOC PointsADHD Performance Improvement Module 5

ADHD eQIPP Module* 15

Asthma Performance Improvement Module 5

Asthma eQIPP Module* 15

Nutrition eQIPP Module* 15

Vermont Oxford Network (Project 1)** 20

Vermont Oxford Network (Project 2)** 20

California Perinatal Quality Care Collaborative** 20

Blood Stream Infection Project** 20

*Developed and administered by the AAP; requires payment directly to AAP for access.**ABP-approved on-going quality improvement initiatives.

Part 4 Menu of Options Part 4 Menu of Options (example)(example)

Committed to Reducing Committed to Reducing RedundancyRedundancy

Joint CommissionJoint Commission – MOC as a – MOC as a surrogate for quality requirementssurrogate for quality requirements

PayersPayers – Working with 20+ payers to – Working with 20+ payers to encourage pay-for-improvementencourage pay-for-improvement

Medicaid/CMSMedicaid/CMS – Recognize MOC with – Recognize MOC with financial incentives/reimbursementfinancial incentives/reimbursement

Federation of State Medical BoardsFederation of State Medical Boards – Remove duplicate requirements; – Remove duplicate requirements; demonstrate how MOC meets 6 core demonstrate how MOC meets 6 core competenciescompetencies

Malpractice Carriers Malpractice Carriers – Reduce – Reduce malpractice premiums (the “Doctors malpractice premiums (the “Doctors Company” in CA)Company” in CA)

Role ofBoard

Certification

Goal: Align to reduce redundancy and accelerate improvement

Collaborating to Bring More ValueCollaborating to Bring More ValuePrimary Care Boards share resources, knowledge to:Primary Care Boards share resources, knowledge to:– jointly develop tools for MOCjointly develop tools for MOC– present a united front to payers/health plans, regulators, and present a united front to payers/health plans, regulators, and

accrediting bodiesaccrediting bodies– advocate for meaningful recognition/pay-for-improvement programsadvocate for meaningful recognition/pay-for-improvement programs

Long-time AAP and ABP relationship produces results:Long-time AAP and ABP relationship produces results:– Jointly developed self-assessmentsJointly developed self-assessments– eQIPP modules for improvement approved by the BoardeQIPP modules for improvement approved by the Board– CME credit for participation in MOC starts in early 2008CME credit for participation in MOC starts in early 2008

Get Started Now: The Physician Get Started Now: The Physician PortfolioPortfolio

Secure personal Web account

abp.org

Questions?Questions?

For Information:For Information:

Jim Stockman, MDJim Stockman, MDPresident/CEOPresident/CEOJim.Stockman@abpeds.org

MOC CommitteeMyles B. Abbott, MD

Julian L. Allen, MD

Laura M. Brooks, MD

H. James Brown, MD

Christopher A. Cunha, MD

Aaron L. Friedman, MD

Hazen P. Ham, PhD

Kevin B. Johnson, MD

Sarah S. Long, MD

Thomas K. McInerny, MD

Paul V. Miles, MD

Robert H. Perelman, MD

Julie K. Stamos, MD

David K. Stevenson, MD

James A. Stockman III, MD

Michele J. Wall, MA

Financial ReportFinancial Report

At our inception in September of 2006, we At our inception in September of 2006, we received agreements for 2-3 years of received agreements for 2-3 years of support at $25,000/year from both support at $25,000/year from both AMSPDC and APPD (total of $50,000/yr).AMSPDC and APPD (total of $50,000/yr).First official financial and activity reports First official financial and activity reports were made to AMSPDC and APPD in the were made to AMSPDC and APPD in the first quarter of this calendar year, first quarter of this calendar year, approximately 15 months into this approximately 15 months into this arrangement. arrangement.

Financial ReportFinancial ReportCosts of activities are expected to increase as our Costs of activities are expected to increase as our activities broaden. We must work to minimize these activities broaden. We must work to minimize these costs to Council while moving forward with our agenda.costs to Council while moving forward with our agenda.In these reports, I outlined a number of potential In these reports, I outlined a number of potential mechanisms for CoPS to enhance its own support, mechanisms for CoPS to enhance its own support, including the initiation of a dues structure.including the initiation of a dues structure.Also outlined a philosophy of partnership with Also outlined a philosophy of partnership with organizations of FOPO while maintaining independence organizations of FOPO while maintaining independence to act as needed to represent subspecialty pediatric to act as needed to represent subspecialty pediatric needs.needs.

CommitmentCommitment

Task Force ReportsTask Force Reports

Fellowship Application ProcessFellowship Application ProcessFellowship Core CurriculumFellowship Core CurriculumAdvocacy Advocacy Communications Communications Relationships with Regulatory Relationships with Regulatory AgenciesAgenciesPipeline/Reimbursement Pipeline/Reimbursement

Fellowship Application Task Force:Fellowship Application Task Force:CoPSCoPS

HawaiiHawaiiMay 4, 2008May 4, 2008

The Charge and The MembersThe Charge and The Members

Task Force Charge:Task Force Charge:– Respond to the recommendations of FOPORespond to the recommendations of FOPO– Consider delaying the start of fellowship application Consider delaying the start of fellowship application

processprocess– Proposed date: Fall of the 3Proposed date: Fall of the 3rdrd year of Residency year of ResidencyCo-Chairs:Co-Chairs:– Tom Abshire (Hematology-Oncology) (Hematology-Oncology)– Sharon Oberfield (Endocrinology) (Endocrinology)Members:Members:– Judy Aschner (Neonatology) (Neonatology)– Chris Kennedy (Emergency Medicine) (Emergency Medicine)– Josef Neu (Neonatology) (Neonatology)– Steven Wassner (Nephrology) (Nephrology)

Task Force RecommendationsTask Force RecommendationsCurrent ERAS participantsCurrent ERAS participants– Dec date: GI, Heme Onc, Rheum, Dec date: GI, Heme Onc, Rheum, NephrologyNephrology, Neonatal, Neonatal– July date: ERJuly date: ER

Current Match participantsCurrent Match participants– Spring match dates: Rheum, Heme Onc, Spring match dates: Rheum, Heme Onc, CardiologyCardiology, GI, GI– Fall match date: Neonatal, Fall match date: Neonatal, Critical CareCritical Care, ER, ER

Encourage the use of ERAS for July 2009 academic Encourage the use of ERAS for July 2009 academic year (2010 ERAS cycle)year (2010 ERAS cycle)Consider two match dates to coincide with ERAS:Consider two match dates to coincide with ERAS:– 33rdrd week in May of 2nd yr of residency week in May of 2nd yr of residency– 11stst week of December of 3rd yr of residency week of December of 3rd yr of residency

Offer date coincides with one of two match datesOffer date coincides with one of two match datesEvaluate yearlyEvaluate yearly

Questionnaire to CoPS Questionnaire to CoPS RepresentativesRepresentatives

Focus first on ERASFocus first on ERASShould fellowship programs utilize ERAS?Should fellowship programs utilize ERAS?

If so, what release date?If so, what release date?– December 1 (19 mos prior to starting December 1 (19 mos prior to starting

fellowship)fellowship)– July 15th (11 1/2 mos prior)July 15th (11 1/2 mos prior)

Should there be a match (NRMP)?Should there be a match (NRMP)?– If so, which date?If so, which date?– Spring of 2nd yr (May, 14 mos prior)Spring of 2nd yr (May, 14 mos prior)– Fall of 3rd yr (November, 8 mos prior)Fall of 3rd yr (November, 8 mos prior)

Survey: ERAS ParticipationSurvey: ERAS ParticipationAcademic Peds: noAcademic Peds: no - Genetics: no- Genetics: no* Adol Med: no* Adol Med: no -- Heme Onc: yesHeme Onc: yesAllergy/Immunol: yesAllergy/Immunol: yes - * - * ID: noID: noCardiology: noCardiology: no - Neonatal: yes- Neonatal: yesChild Abuse: noChild Abuse: no - Nephrology: yes- Nephrology: yesChild Psych: no responseChild Psych: no response - Neurology: no- Neurology: no* Critical care: no* Critical care: no - Pulmonary: no- Pulmonary: noDerm: noDerm: no - Rheumatology: yes- Rheumatology: yesDevelopmental: noDevelopmental: no - ER: yes- ER: yes* Endocrine: no* Endocrine: no - GI: yes- GI: yes

* Subspecialties in bold have interest in ERAS

B Li, Joe Neu

Judith Campbell, Mary-Ann Shafer, Steve Feig

CoPS Task Force on Fellowship Core Curriculum

Fellowship Core Curriculum:Current issues

Outline

How do we meet the ABP requirements? Do we go beyond it?

Fewer Gen-X fellows want the research path – do we need additional tracks?

How do we document competence?

Questions for the task force

Fellows core curriculum – < 5

Increasing mandated requirements

Less duplication between divisions

More efficient – in light of work hour restrictions

Use best people in department

Provide wider array of topics and skill development – career counseling, administrative and leadership skills

ABP Scholarly Requirements –

Biostatistics, research methods, design

Prep for applications to IRB, for funding

Critical literature review, EBM

Ethical principles – in research

Teaching skills – principles of adult learning , teaching, curriculum development, provision of feedback and assessment (in a variety of settings)

ACGME 6 core competencies + …

Patient careMedical knowledgeInterpersonal skills (IS)Professionalism (P)Practice-based learning (PBL)Systems-based learning (SBL)

Teaching skills Scholarly skills

OtherAdministrative Leadership Career developmentCareer counselingPersonal planning

The future – fellowship tracks?

Pediatric Pediatric FellowFellow

Lab/trans Lab/trans researchresearch

Clinical Clinical researchresearch EducationEducation

Quality &Quality &Admini-Admini-strativestrative

Other: Other: ethics, ethics,

health policy health policy

NIH-NIH-funded funded

researcherresearcher

NIH- & NIH- & non-NIH non-NIH

researcherresearcherClinician Clinician educatoreducator

Clinician Clinician admini-admini-stratorstrator

Clinician Clinician ++

How to implement?

Local strategies– Coalesce current institutional offerings

– Develop new coordinated core curriculum

– Place curriculum on intranet (ANGEL)

National strategies– Develop shared web-based curricula

– Increase offerings at PAS

How to document competence?

Record attendance

Pass local exam

Develop skill-based criteria

Pass national exam – 7% of ABP sub-specialty exam in 2010 will cover scholarly

Combinations of above

QuestionsWhat are the key FCC elements within the 6 core competencies, teaching & scholarly curriculum, as well as outside it?

What is most useful strategy for pediatric departments that don’t have a ‘super’ fellowship core curriculum director?

What is an effective yet practical approach to documenting competence?

Example format: 2 hour sessions

Introduction – background, why important Didactic overview ( 30 min) or panel discussion (1 hr)Small group exercise or Q&A (1 hr)– Case-based scenario, exercise, role playing

Present solution to entire group (15 min)Evaluation – identify top 3 points learnedFaculty debriefing

Advocacy Task Force

Charge

Determine ways in which CoPS can be proactive in promoting child health and subspecialty activities

Fine Print

The term "advocacy" is used broadly here, meaning not just representing ourselves to Congress and state legislatures, or speaking out publicly when necessary, but also to insure our participation with other organizations that make decisions pertinent to our patients and our subspecialties. Developing a standing approach to advocacy would thus permit CoPS to anticipate issues of importance to us and to influence their resolution.

MembersH. William SchnaperRobert PerelmanMarianne FeliceRobert McGregorRichard Martini*Daniel Lee CourySharon E. OberfieldB U.K. LiThomas AbshireJudy L. AschnerAnn TiltonMichael HenricksonChris Harrison

“Target” Organizations

FOPO organizations“Adult” subspecialty societiesGovernment agencies– Local– State– Federal

The Public

Issues to Consider

Funding of pediatric research and training grants GME, especially for fellow trainingFederal and state children's health care plansPharmaceutical/device industry interactions with academic medicineBilling/coding/reimbursementLinking of Quality of Care to reimbursementTransition between pediatric and adult care: Medical Homes

Modus Operandi

Model activities from pediatric subspecialty societies with strong advocacy programsCollaborate with AAP, which has well-developed advocacy programAlso, work with corresponding “adult” subspecialty societiesYet seek to find our own “voice”Develop a list of priorities based upon both our greatest needs and synergy with other organizations

Operational Concerns

We need to be comprehensive in our analysis of the issues but focused in our choice of prioritiesWe also should seek synergy with other pediatric organizationsIt has been difficult to elicit a response after several e-mailsWe need to select a more permanent task-force chair who is a voting member of CoPS

Communications Task ForceCommunications Task Force

Richard Mink, ChairRichard Mink, ChairJames BaleJames BaleJudith CampbellJudith CampbellGail McGuinnessGail McGuinnessPaul MoorePaul MooreBruce BostonBruce Boston

James PerrinJames PerrinDavid RubinDavid RubinBruder StapletonBruder StapletonDonald VernonDonald VernonSteven WassnerSteven Wassner

Committee ChargeCommittee Charge

to address the core needs of our to address the core needs of our organization to communicate effectively organization to communicate effectively with ourselves and the memberships of with ourselves and the memberships of our constituent subspecialties. our constituent subspecialties.

CoPS Communication SurveyCoPS Communication Survey39 respondents39 respondents– some incompletesome incomplete– 36 voting members36 voting members– 3 non-voting members3 non-voting members

22 (56%) program directors22 (56%) program directorsAt least one representative from every At least one representative from every subspecialty except Child Psychiatrysubspecialty except Child Psychiatry

Number of OrganizationsNumber of OrganizationsHow many different organizations/sections/ How many different organizations/sections/ associations represent your subspecialty?associations represent your subspecialty?

Membership in OrganizationsMembership in OrganizationsAre ALL subspecialists a member of at least one Are ALL subspecialists a member of at least one of these organizations? of these organizations?

•For “NO”–5: more than 95%–12: 75%-95%–2: 50%-74%

Communication with LeadersCommunication with LeadersDo you think that if CoPS corresponded through Do you think that if CoPS corresponded through the leaders of these organizations, information the leaders of these organizations, information would reliably be communicated to all members?would reliably be communicated to all members?

Program Director OrganizationsProgram Director OrganizationsDoes your subspecialty have an organization or Does your subspecialty have an organization or association dedicated to fellowship program directors? association dedicated to fellowship program directors? If so, are ALL Program Directors members?If so, are ALL Program Directors members?

PD Communication with LeadersPD Communication with LeadersDo you think that information communicated by CoPS Do you think that information communicated by CoPS to the leader(s) of the organization(s) would be reliably to the leader(s) of the organization(s) would be reliably distributed to the subspecialty program directors?distributed to the subspecialty program directors?

Communication with Leaders/PDsCommunication with Leaders/PDsWould you prefer that CoPS communicate directly with the Would you prefer that CoPS communicate directly with the Program Directors or should all fellowship information be Program Directors or should all fellowship information be distributed by the leader of the organization, if one exists?distributed by the leader of the organization, if one exists?

Communication of Fellowship Task Communication of Fellowship Task Force RecommendationsForce Recommendations

The Fellowship Application Task force distributed a draft of their The Fellowship Application Task force distributed a draft of their recommendations prior to the fall meeting. Did you circulate this recommendations prior to the fall meeting. Did you circulate this proposal to the Program Directors in your subspecialty prior to proposal to the Program Directors in your subspecialty prior to the meeting? After the meeting?the meeting? After the meeting?

Who Should CoPS Represent?Who Should CoPS Represent?In your opinion, should CoPS communicate with all In your opinion, should CoPS communicate with all members of the specialty, even those that are not members of the specialty, even those that are not members of one of the subspecialty organizations? members of one of the subspecialty organizations?

Initial RecommendationsInitial Recommendations

communicate with all subspecialistscommunicate with all subspecialistsuse e-mail as the predominate method of use e-mail as the predominate method of communicationcommunication– brief newsletters 2-3 times/yearbrief newsletters 2-3 times/year

targeted communication to leaders of targeted communication to leaders of organizations and/or fellowship program organizations and/or fellowship program directorsdirectors

Dues Structure?Dues Structure?

Departmental dues - $1,500 (5+ divisions)Departmental dues - $1,500 (5+ divisions)Divisional dues - $300 (any division with training program)Divisional dues - $300 (any division with training program)Individual dues - $100 Individual dues - $100 Societal dues - $3,000 Societal dues - $3,000

ASP currently has 922 members representing 78 medical schools and affiliated teaching hospitals:

875 departmental members representing 55 departments of internal medicine and 603 divisions.

43 divisional members representing 27 divisions. 15 societal members representing internal medicine specialty societies.

Dues Structure?Dues Structure?

IssuesIssues– Goal setting: x% self-supporting by 20??.Goal setting: x% self-supporting by 20??.– Have’s vs. have not’sHave’s vs. have not’s– Multiple organizationsMultiple organizations– Avoiding double-dipping (AMSPDC)Avoiding double-dipping (AMSPDC)

New “projects”New “projects”

OPDAOPDATransition from residency to fellowship Transition from residency to fellowship (timeline).(timeline).Workforce evaluationsWorkforce evaluationsMedical homeMedical homePedialink revampPedialink revampDivision head trainingDivision head training

OPDAOrganization of Program Director Organizations

Council of Medical Specialty Societies

OPDA

Promote the role of the residency director and residency program director societies in achieving

excellence in graduate medical education

OPDAPeer interactionInformation sharingCollaborative problem solvingMeetings on GME issuesReports from AAMC, ACGME, NRMP, NBME, ECFMG, etc.Meet in March and November at O'Hare

OPDAOPDA representative on NRMP Board of DirectorsEx-officio representative on ACGME Council of Review Committee Chairs

Fall meeting infoFall meeting info

Tuesday, September 16, 9am – 5pm Wednesday, Tuesday, September 16, 9am – 5pm Wednesday, September 17, 8am - 3pmSeptember 17, 8am - 3pm

Alexandria, VA Alexandria, VA (prior to APPD's meeting September 18-19)(prior to APPD's meeting September 18-19)

• $225 registration fee$225 registration fee• Travel costs on ownTravel costs on own• 100% representation100% representation