Nothing to disclose
2011 AUR Annual Meeting
A3CR2
April 15, 2011
Boston, MA
“To serve patients, the public, and the
medical profession. . .”
“. . .by certifying that its diplomates have
acquired, demonstrated, and maintained a
requisite standard of knowledge, skill, and
understanding. . .”
 Improve the quality & safety of U.S. healthcare
by
 Demonstrating to the public that physicians
certified by the ABR maintain the necessary
competencies to provide safe, high-quality
patient care.
 Medical knowledge
 Patient care and procedural skills
 Interpersonal and communication skills
 Professionalism
 Practice-based learning and improvement
 Systems-based practice
 Acquire competencies in residency training
 Demonstrate competencies (and achieve
Milestones) in training
 Pass the certifying examination
 Continue development of competencies,
proficiencies, and expertise throughout career
 Demonstrate your continuous professional
development through MOC’s Four Components
I:
Professional standing
II:
Lifelong learning and self-assessment
III: Cognitive expertise
IV: Evaluation and improvement of
performance in practice*
*ABR’s
Practice Quality Improvement—PQI
 Current, full and unrestricted license
 >1 jurisdiction in U.S., territories, Canada
 Includes all states of current practice
 250 Category I CME credits /10-yr cycle
 20 SAMs /10-yr cycle
– 4 non-interpretive skills SAMs
– 16 clinical content SAMs
 If 1 subspecialty certificate>6 SAMs in subspec.
 If 2 subspecialty certificates>6 SAMs, each subspec.
 1 examination /10-yr cycle
 20%: non-interpretive skills (ABR-directed)
 80%: clinical content (practice-profiled)
– Composition affected by subspecialty certificates
– “Levels” (fundamental, advanced) depend on profile
 Study guides on web; aim: content outlines
 >3 PQI projects /10-yr cycle
 Must attest to activity (on PDB) each year
 Self-designed projects
 Group projects prioritized by institution
 Sponsored (pre-qualified by ABR) projects,
including registries
1 FTE model helps those with
subspecialty certification
250 CME credits/10 yrs, not 500
20 SAMs/10 yrs, not 40
1 modular exam to maintain 2 certificates
PQI requirement of 1 diplomate, not 2
Quality Aim
Problem to Address
People get the care they need
Underuse
People need the care they get
Overuse
Provided safely
Error, harm
Timely
Delays
Patient-centered
Unresponsive
Delivered efficiently Improvement
Waste
Delivered equitably Opportunities
Disparities
IOM, Crossing the Quality Chasm (2001)
1)
2)
Select project
Select appropriate measure,
performance target
Baseline unbiased measurement
(eg. 30-50 consecutive patients)
Collect, analyze results (did/did not
meet target)
Create improvement plan, implement
Re-measure
Analyze (did/did not meet target), etc.
Narrative self-reflection ( 1 paragraph)
Plan
Do
Reflect
Act
3)
4)
5)
6)
7)
8)
Study
 Active collaboration in project design
and/or implementation (>3 meetings)
 Collection, submission, and review of
project data in keeping with project’s
measurement plan
 Implementation of interventions to improve
care, as guided by project
 Completion of minimum duration of
participation established by project leader
David L. Nahrwold, M.D.
ABMS Executive Committee
Retreat
January 1998
“The ABMS and its member boards have the obligation
to assure the public that their doctors are competent…”
“...this should be done through the certification and
recertification process.”
 1998:
Committee on Competence
 1999:
ABMS adopts 6 competencies
 2000:
4 MOC components adopted
All 24 Boards commit to MOC
 2006:
MOC programs of all Boards approved
 2007:
ABR MOC: All parts (I-IV) operating
Kevin Weiss: ABMS Pres. & CEO
 2008- ABMS MOC Standards
Present: Emphasis on alignment, MOC value
 Tucson origin: limited carriers, flights
 Carrier: Does AA fly there?
 Flight choice #1 vs. #2: meeting schedule, $$$
 Schedules + nonstops / connections
 Return options, compounded travel
 Frequent flyer miles: balance nearing ticket threshold
 Equipment: not really
 Pilot qualifications
Airline Transport Pilot License
(ATPL) (FAA-qualified to fly
commercial jetliners): Highest
=
Have embraced:
Have relinquished:
Standards
Individuality of approach
Team/crew training, responsibility
Autonomy
Checklists
Dependence on memory, experience
Mandatory training, simulation
Experience as it comes: “hit-or-miss”
Federal oversight
Self-regulation
Primacy of passenger safety
All other possible considerations
Board Certified and
Participating in MOC
=
?
1) Unsafe
2) Fragmented, uncoordinated
3) Redundant
4) Wasteful
5) Inaccessible, maldistributed
6) Expensive
Performance Measurement
Public Reporting
Payment Reform
Research and Knowledge Dissemination
Education and Certification (Professional
Development)
Delivery system change
 Insurers
 Quality organizations
 Accreditation and Certification
 National consumer groups
 Business coalitions
 Unions
 Private Sector Non-profit Organizations
 Government
 Healthcare professionals/providers
To earn the public’s trust and maintain a
portion of our professional privilege to
self-regulate, we will have to…
…deliver quality, affordable care
…engage in physician performance
assessment and improvement
…demonstrate outcomes through
public reporting
To accomplish this,
the Boards must
move from…
to…
…measuring what
candidates/diplomates know
…measuring what they
know and do.
“…a culture of pedigree”
“…a culture of
improvement”1
1Norman
Kahn, CMSS, NQF-ABMS meeting, April 29, 2009
Board Certification=Gold Standard
August 2003 Gallup Poll:
When asked:
“When given the choice between a board
certified physician and a physician who was not
board certified but was recommended by a
trusted friend or family member…”
75% opted for a board certified physician
23% opted for the physician recommended
by a friend or family member
Board Certification=Gold Standard
May 2008 Opinion Research Corp. Telephone Poll
When asked:
“Key factors when choosing a doctor…”
95% bedside manner; communication skills
91% board certification
82% friend or family member recommendation
78% doctor’s hospital affiliation
75% doctor’s office location
60% hospital or school where doctor trained
Public values maintenance of
board certification
2010 ABMS Public Opinion Poll
95%: important for docs to maintain board certification
45%: would look for a new doctor
41% : would stop referring family or friends
Many studies link Board Certification
to higher quality care
–IM, cardiology, vascular surgery, orthopedics
–Lower mortality, shorter LOS (AMI, acute CHF):
Health Affairs, August 2010
MOC- Early info from MOC exams:
–High scores correlate with prior residency
program director ratings
–Can identify patient care deficiencies, enable
feedback, targeted Part II & IV activities
–ABR working on evidence base
http://www.theabr.org/forms/ABR%20
annual%20report%202009-10.pdf
Directly accessible from home page,
www.theabr.org
 Professional (only) self-regulation in medicine is past
 Shared professional regulation is here. Expectation:
continuous professional development (CPD).
 MOC is your framework for CPD.
 Healthcare reform: transparency and accountability
 ABMS, Boards including ABR are working to be…
– Responsive
– Proactive
– Innovative
 …to strengthen the role of board certification in
demonstrating your continuing competence