Russell G. Postier, MD, FACS Russell G. Postier, MD, FACS This presenter will not discuss any commercial This presenter will not discuss any commercial product or service. Nor will the presentation product or service. Nor will the presentation include discussion of any off-label and/or include discussion of any off-label and/or investigational use of any products or investigational use of any products or services. This presenter will not use any services. This presenter will not use any trade names in his presentation. The trade names in his presentation. The presenter does not have any relationship with presenter does not have any relationship with the commercial supporters of this program. the commercial supporters of this program. The sponsoring unit will not include The sponsoring unit will not include discussion of any commercial product or discussion of any commercial product or service, nor will they discuss any off-label service, nor will they discuss any off-label and/or investigational use of any product or and/or investigational use of any product or service. Trade names will not be used. service. Trade names will not be used.
Transcript
Russell G. Postier, MD, FACSRussell G. Postier, MD, FACS
This presenter will not discuss any commercial This presenter will not discuss any commercial product or service. Nor will the presentation product or service. Nor will the presentation include discussion of any off-label and/or include discussion of any off-label and/or investigational use of any products or services. This investigational use of any products or services. This presenter will not use any trade names in his presenter will not use any trade names in his presentation. The presenter does not have any presentation. The presenter does not have any relationship with the commercial supporters of this relationship with the commercial supporters of this program.program.
The sponsoring unit will not include discussion of The sponsoring unit will not include discussion of any commercial product or service, nor will they any commercial product or service, nor will they discuss any off-label and/or investigational use of discuss any off-label and/or investigational use of any product or service. Trade names will not be any product or service. Trade names will not be used.used.
The American Board of SurgeryThe American Board of Surgery
MOC: What it Means for the Rural MOC: What it Means for the Rural SurgeonSurgeon
Rural Surgery SymposiumRural Surgery Symposium
Grand Forks, North DakotaGrand Forks, North Dakota
September 17,l 2007September 17,l 2007
MAINTENANCE OF MAINTENANCE OF CERTIFICATIONCERTIFICATION
The American Board of SurgeryThe American Board of Surgery
The American Board of SurgeryThe American Board of Surgery
Orthopaedic SurgeryOrthopaedic Surgery OtolaryngologyOtolaryngology PathologyPathology PediatricsPediatrics Physical Medicine and Physical Medicine and
RehabilitationRehabilitation Plastic SurgeryPlastic Surgery Preventive MedicinePreventive Medicine Psychiatry & NeurologyPsychiatry & Neurology RadiologyRadiology SurgerySurgery Thoracic SurgeryThoracic Surgery UrologyUrology
MOC is an initiative of MOC is an initiative of the American Board of the American Board of
Medical Specialties Medical Specialties ((ABMSABMS)) and its 24 member boards:and its 24 member boards:
SurgerySurgery DermatologyDermatology Emergency MedicineEmergency Medicine Family PracticeFamily Practice Internal MedicineInternal Medicine Medical GeneticsMedical Genetics Neurological SurgeryNeurological Surgery Nuclear MedicineNuclear Medicine Obstetrics & Obstetrics &
GynecologyGynecology OphthalmologyOphthalmology
The American Board of SurgeryThe American Board of Surgery
What is Maintenance of What is Maintenance of Certification?Certification?
A program of continuous learning and improvement A program of continuous learning and improvement
that goes beyond the 10-year recertification that goes beyond the 10-year recertification “snapshot”“snapshot”
Designed to document that diplomates are Designed to document that diplomates are maintainingmaintainingthe necessary competencies to provide quality care the necessary competencies to provide quality care
Created by the ABMS and its 24 member boards in Created by the ABMS and its 24 member boards in a collaborative effort with other organizations a collaborative effort with other organizations involved in health care quality involved in health care quality
The American Board of SurgeryThe American Board of Surgery
Why MOC?Why MOC? The new “gold standard” of physician certificationThe new “gold standard” of physician certification
Upholds the meaning of board certification as a Upholds the meaning of board certification as a standard of qualitystandard of quality
Demonstrates to patients and peers a diplomate’s Demonstrates to patients and peers a diplomate’s commitment to continual practice improvement and commitment to continual practice improvement and lifelong learninglifelong learning
Allows diplomates to take a proactive position in the Allows diplomates to take a proactive position in the health care quality debate, using surgeon-developed health care quality debate, using surgeon-developed
metrics and reportingmetrics and reporting methods methods
The American Board of SurgeryThe American Board of Surgery
MOC is supported by:MOC is supported by: Federation of State Medical Boards of the U.S. (FSMB)Federation of State Medical Boards of the U.S. (FSMB)
The Joint Commission The Joint Commission
American Hospital Association (AHA)American Hospital Association (AHA)
American Medical Association (AMA)American Medical Association (AMA)
National Board of Medical Examiners (NBME)National Board of Medical Examiners (NBME)
Accreditation Council for Graduate Medical Education Accreditation Council for Graduate Medical Education
(ACGME)(ACGME)
Association of American Medical Colleges (AAMC)Association of American Medical Colleges (AAMC)
Council of Medical Specialty Societies (CMSS)Council of Medical Specialty Societies (CMSS)
Educational Commission for Foreign Medical Graduates Educational Commission for Foreign Medical Graduates
(ECFMG)(ECFMG)
The American Board of SurgeryThe American Board of Surgery
Board Certification and Board Certification and Quality CareQuality Care
The board movement began in 1917 to set standards for The board movement began in 1917 to set standards for quality carequality care
There is evidence of a need for continued monitoring and promotion There is evidence of a need for continued monitoring and promotion of quality …of quality …
– ““To Err is Human,” IOM, 2000To Err is Human,” IOM, 2000
44,000-98,000 Americans die yearly due to preventable errors44,000-98,000 Americans die yearly due to preventable errors
– ““Bridging the Quality Chasm,” IOM, 2001Bridging the Quality Chasm,” IOM, 2001
Health care system fails to translate knowledge into practiceHealth care system fails to translate knowledge into practice
– Harvard Medical School Study, Annals of Internal Med., Harvard Medical School Study, Annals of Internal Med.,
Feb. ’05Feb. ’05
Doctors who have been in practice for more years tend to Doctors who have been in practice for more years tend to possess less factual knowledge and are less likely to adhere to possess less factual knowledge and are less likely to adhere to appropriate standards of careappropriate standards of care
The American Board of SurgeryThe American Board of Surgery
Physician CompetenciesPhysician Competencies
Medical KnowledgeMedical Knowledge
Patient CarePatient Care
Interpersonal and Communication Interpersonal and Communication Skills Skills
ProfessionalismProfessionalism
Practice-based Learning and Practice-based Learning and ImprovementImprovement
Systems-based PracticeSystems-based Practice
The ABMS and ACGME have defined six general competencies as the foundation for physicians’ training and practice during their professional lifetime:
The American Board of SurgeryThe American Board of Surgery
Four Components of MOCFour Components of MOCTo assess physician To assess physician
competencies on a continual basiscompetencies on a continual basis
1.1. Professional Standing Professional Standing
2.2. Lifelong Learning and Lifelong Learning and Self-AssessmentSelf-Assessment
3.3. Cognitive ExpertiseCognitive Expertise
4.4. Evaluation of Evaluation of Performance Performance in Practice in Practice
The American Board of SurgeryThe American Board of Surgery
American Board of SurgeryAmerican Board of SurgeryMOC ProgramMOC Program
The following slides give an overview of the ABS The following slides give an overview of the ABS MOC Program as it is initially being implemented MOC Program as it is initially being implemented
The program will evolve as new learning and The program will evolve as new learning and assessment methods become availableassessment methods become available
MOC requirements run in three-year cycles, MOC requirements run in three-year cycles, beginning the July 1 following certification or beginning the July 1 following certification or recertificationrecertification
The ABS intends for MOC to be as flexible as The ABS intends for MOC to be as flexible as possible to allow diplomates to satisfy its possible to allow diplomates to satisfy its requirements in ways most compatible with their requirements in ways most compatible with their practice environmentpractice environment
The American Board of SurgeryThe American Board of Surgery
Four Components of MOCFour Components of MOC
1. Professional Standing1. Professional StandingABS Requirements:ABS Requirements:
Full and unrestricted medical licenseFull and unrestricted medical license– To be verified To be verified every three yearsevery three years
Reference letters from chief of surgery Reference letters from chief of surgery and chair of credentials committeeand chair of credentials committee– From the institution where most work is performedFrom the institution where most work is performed
– To be submitted To be submitted every three yearsevery three years
The American Board of SurgeryThe American Board of Surgery
Continuing medical education (CME):Continuing medical education (CME):30 hours Category I, 50 hours overall 30 hours Category I, 50 hours overall annuallyannually– Documentation of CME completion to be submitted Documentation of CME completion to be submitted
every every three yearsthree years
Self-assessment evaluationSelf-assessment evaluation– To be completed To be completed every three yearsevery three years in conjunction in conjunction
with CMEwith CME
The American Board of SurgeryThe American Board of Surgery
CME & Self-Assessment ResourcesCME & Self-Assessment Resources ACS has added ACS has added Selected Readings in SurgerySelected Readings in Surgery and and
Surgical Index Surgical Index to its educational toolsto its educational tools
JACSJACS now offers self-assessment related to selected now offers self-assessment related to selected articlesarticles
The ABS is encouraging the development of The ABS is encouraging the development of additional resources by specialty surgical additional resources by specialty surgical organizationsorganizations
The ABS is compiling a list of CME and self-The ABS is compiling a list of CME and self-assessment resources for MOC on its website, assessment resources for MOC on its website, www.absurgery.orgwww.absurgery.org
The American Board of SurgeryThe American Board of Surgery
Four Components of MOCFour Components of MOC
3. Cognitive Expertise3. Cognitive Expertise
ABS Requirement:ABS Requirement:
Secure examinationSecure examination – May be taken starting May be taken starting three years priorthree years prior to to
– All MOC requirements must be fulfilled up to All MOC requirements must be fulfilled up to that point to be admissible to the that point to be admissible to the examinationexamination
The American Board of SurgeryThe American Board of Surgery
Four Components of MOCFour Components of MOC
4. Evaluation of Performance 4. Evaluation of Performance in Practicein Practice
ABS Requirements:ABS Requirements:
Participation in a national, regional or local Participation in a national, regional or local outcomes outcomes database database or quality assessment process or quality assessment process verified verified every three yearsevery three years
Periodic Periodic patient communication skills assessmentpatient communication skills assessment also to be also to be required – not yet finalizedrequired – not yet finalized
2006 Surgery Recertification Examination: 2006 Surgery Recertification Examination: 51% of applicants said they were 51% of applicants said they were participating in outcomes studies. These participating in outcomes studies. These individuals also had a lower exam failure rateindividuals also had a lower exam failure rate..
The American Board of SurgeryThe American Board of Surgery
Fulfilling the Performance in Fulfilling the Performance in Practice RequirementPractice Requirement
Participation in SCIP, NSQIP, NTDB, UNOS, STS database, Participation in SCIP, NSQIP, NTDB, UNOS, STS database, SAGES database, burn registries, and bariatric surgery SAGES database, burn registries, and bariatric surgery databases would meet this requirementdatabases would meet this requirement
Participation in CMS’ Physician Quality Reporting Participation in CMS’ Physician Quality Reporting Initiative (PQRI) or the ACS case log system would also Initiative (PQRI) or the ACS case log system would also meet this requirementmeet this requirement
The ABS is investigating other national, regional, or The ABS is investigating other national, regional, or hospital-specific data systems, and is soliciting hospital-specific data systems, and is soliciting diplomates’ input diplomates’ input via e-mail at via e-mail at [email protected]@absurgery.org
The ABMS is developing an assessment tool for patient The ABMS is developing an assessment tool for patient communication skills that will likely be used in futurecommunication skills that will likely be used in future
The American Board of SurgeryThe American Board of Surgery
MOC Requirements TimelineMOC Requirements Timeline MOC Year = July 1 to June 30, starting July 1
following certification or recertification
MOC MOC
YearYearMOC RequirementMOC Requirement
00 Year of certification or recertificationYear of certification or recertification11 Yearly CMEYearly CME22 Yearly CMEYearly CME33 Yearly CME + self-assessmentYearly CME + self-assessment
Reference letters and evidence of CME/self-Reference letters and evidence of CME/self-assessment submitted; license status and assessment submitted; license status and participation in practice assessment verified.participation in practice assessment verified.
44 Same as Year 1Same as Year 155 Same as Year 2Same as Year 266 Same as Year 3Same as Year 377 Same as Year 1Same as Year 188 Same as Year 2Same as Year 299 Same as Year 3Same as Year 3
88 -- 1010 Secure examinationSecure examination
The American Board of SurgeryThe American Board of Surgery
Requirements for Requirements for Multiple Certificate HoldersMultiple Certificate Holders
Parts 1, 2 and 4Parts 1, 2 and 4 of MOC – of MOC – professional professional standing, lifelong learning/self-assessment standing, lifelong learning/self-assessment and performance in practice and performance in practice – performed in – performed in compliance with one certificate may be compliance with one certificate may be credited to any other ABS or ABMS credited to any other ABS or ABMS certificatescertificates
Part 3Part 3 – – cognitive expertise (secure cognitive expertise (secure examination)examination) – – must be fulfilled in all disciplines for which must be fulfilled in all disciplines for which diplomate holds a certificatediplomate holds a certificate
The American Board of SurgeryThe American Board of Surgery
Benefits of MOC for Benefits of MOC for DiplomatesDiplomates
Improved learning and self-assessment Improved learning and self-assessment opportunitiesopportunities
Relevant measures of practice performanceRelevant measures of practice performance
Will reduce multiple and/or redundant quality Will reduce multiple and/or redundant quality assessmentsassessments
Responds to public’s concerns regarding health Responds to public’s concerns regarding health care quality and patient safetycare quality and patient safety
Overall improved patient careOverall improved patient care
A system of continual self-assessment and practice A system of continual self-assessment and practice improvement:improvement:
The American Board of SurgeryThe American Board of Surgery
ConclusionConclusionMOC will provide a more MOC will provide a more comprehensive, continuous comprehensive, continuous
assessment of the rural assessment of the rural physician’s competencies and physician’s competencies and allow diplomates to assume a allow diplomates to assume a proactive role in the quest for proactive role in the quest for
