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TQIP and MOC, Credentials and Licensing, and PFP

Mark A. Malangoni, MD FACS Associate Executive Director American Board of Surgery

Trauma Quality Improvement Program (TQIP) Annual Scientific Meeting and Training 2013

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I have nothing to disclose

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What is Maintenance of Certification?

• A program of continuous learning and improvement that goes beyond the 10-year recertification “snapshot”

• Documents that diplomates are maintaining the necessary competencies to provide quality care

• Provides a more frequent and comprehensive assessment of medical performance

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American Board of Surgery Maintenance of Certification Program Components

Professional Standing

Lifelong Learning and Self-assessment

Cognitive Expertise

Evaluation of Performance in Practice

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ABS-MOC Part 4 – Essential Characteristics

• The activity must track meaningful and measurable patient outcomes. Processes of care or composite indicators associated with improved outcomes, reduced complications, or a better quality of life for patients may be included

• The parameters assessed must be important, scientifically acceptable, useable, relevant, and easy to collect

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ABS-MOC Part 4 – Essential Characteristics

• Results must be provided to the surgeon at least yearly and preferably every 6 months

• A comparative analysis of individual and group results must be provided

• The method for tracking procedures and outcomes should minimize selection bias

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ABS-MOC Part 4 – Essential Characteristics

• The activity must include the ability for re-assessment and comparison after implementation of a quality improvement activity based on analysis of the results

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ABS-MOC Part 4 – Desirable Characteristics

• The information should be risk-adjusted when possible

• The time between recording of information and reporting of results should be minimized

• The activity should provide comparisons over different time periods in order to track the effect of quality improvement activities

• Data collection should be done by adequately trained third party personnel when possible

• The information should be subject to audit to assure its validity and reliability

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TQIP for MOC

• Reports will be based on risk adjusted analysis conducted for TQIP

• Surgeons will receive reports on risk adjusted outcomes for patients in TQIP categories selected from analyses, such as mortality and excess LOS for blunt multisystem, penetrating, and traumatic brain injury

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TQIP for MOC • The reports will also provide non- risk adjusted information on complications and other outcomes, providing context for the surgeons’ results.

• TQIP will offer support for interpretation of the results

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How does “NTDB-Surgeon” work?

• Proposed new field in NTDB will link surgeons to patients in their NTDB submission

• NTDB data will be used to produce risk adjusted reports, based on TQIP models

• Reports will include outcomes for patients treated by participating surgeons

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Confidentiality

• Reports can be accessed only by participating surgeon

• ACS will confirm surgeon participation to ABS but will not provide reports or other details to ABS

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Credentials and Licensing- FAQs

• Can I remain board certified if I don’t participate in MOC?

• My patients are often cared for by my partners. How does that affect my report?

• My results are great! Now what?

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Credentials and Licensing- FAQs

• Those can’t be my results! I wasn’t responsible for the complications.

• Are my hospital privileges going to be affected by the this?

• Is my medical license in jeopardy by my participation?

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Pay for Performance (P4P)

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Principles of High Value Healthcare

• Measure performance • Demonstrate accountability • Show improvement

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National Quality Strategy

• Better care • Healthy people/healthy communities • Affordable care

-HHS Secretary K. Sibelius

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NQS Priorities • Ensure that each person and family is engaged as partners in their care

• Promote effective communication and coordination of care

• Promote the most effective prevention and treatment practices for the leading causes of mortality

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NQS Priorities • Work with communities to promote wide use of best practices to enable healthy living

• Make quality care more affordable for individuals, families, employers, and governments by developing and spreading new health care delivery models

• Make care safer by reducing harm caused in the delivery of care

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Identify focus for improvement • Define the measures • Set goals and targets

Initiate the activity • Collect the information

Analyze the results • Compare with goals and targets • Identify deficiencies and analyze the

causes

Refine the process and assess improvement • Needs assessment

Quality circle

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Physician Quality Reporting System (PQRS)

• E-Rx • EMR use • Results reporting

• Claims • Registry • GPRO

• Maintenance of certification

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PQRS Maintenance of Certification Program

• Must participate in MOC “more frequently” than usual

• Must participate in a patient experience of care survey (Surgery-CAHPS or institutional)

• Must perform a practice assessment activity

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PQRS Maintenance of Certification Program

Pay for participation 2013- 0.5% bonus 2014- 0.5% bonus 2015- 1.5% penalty, based on 2013 participation

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