Disclosures

2. Nothing to disclose Disclosures

3. ABR MOC Your Framework for Continuous Professional Development 2011 AUR Annual Meeting A3CR2 April 15, 2011 Boston, MA

4. Mission of the American Board of Radiology “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. . .”

5. Purpose of MOC

6. Purpose of ABR MOC (in a nutshell) • 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.

7. The 6 ACGME & ABMS Competencies • Medical knowledge • Patient care and procedural skills • Interpersonal and communication skills • Professionalism • Practice-based learning and improvement • Systems-based practice

8. The Competency Continuum • 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

9. The 4 MOCComponents 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

10. Component I: Professional Standing • Current, full and unrestricted license • >1 jurisdiction in U.S., territories, Canada • Includes all states of current practice

11. Component II:Lifelong Learning and Self-Assessment • 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.

12. Component III:Cognitive ExpertiseSecure, Proctored Exam • 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

13. Beginning in 2012, DR MOC exams, including subspecialties, will be given at new ABR Chicago Test Center near O’Hare.

14. Component IV:Practice Quality Improvement • >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

15. ABR MOC: a 1-FTE model

16. 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

17. Healthcare Quality Aims Quality AimProblem 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 Waste Delivered equitably Disparities Improvement Opportunities IOM, Crossing the Quality Chasm (2001)

18. PQI Steps: PDSA 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)

19. Criteria for Meaningful Participation in a PQI Project 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

20. http://www. abronline.org

22. http://www. theabr.org

23. MOC is a work-in-progress, just 11 years old. Much remains to be done.

24. What distinguishes ABMS Member Boards from all other boards and professional regulatory entities? 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.” Birth of MOC

25. Chronology of MOC • 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

26. Booking Airline Travel

27. Factors in Flight Selection • 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

28. 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 =

29. What impact are health care reform and the quality and safety movement having on the development of MOC?

30. Age of Transparency and Accountability

31. Quality and Safety Movement Status of U.S. healthcare today: 1) Unsafe2) Fragmented, uncoordinated 3) Redundant 4) Wasteful 5) Inaccessible, maldistributed 6) Expensive

32. Dept. HHS National Strategy for Quality Improvement in Health Care, 03/2011 Priorities • Safer care: reduce harm caused in care delivery • Patient and family engagement • Effective communication, care coordination • Effective prevention, treatment for leading causes of mortality, starting with CV disease • Better health in communities • Affordable quality care through new delivery models

33. 6 Drivers of Healthcare Transformation (ACA 2010) • Performance Measurement • Public Reporting • Payment Reform • Research and Knowledge Dissemination • Education and Certification (Professional Development) • Delivery system change

34. Groups Weighing in on Physician Performance Measurement • Insurers • Quality organizations • Accreditation and Certification • National consumer groups • Business coalitions • Unions • Private Sector Non-profit Organizations • Government • Healthcare professionals/providers

36. 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

37. To accomplish this, the Boards must move from… to… …measuring what candidates/diplomates know “…a culture of pedigree” …measuring what they know and do. “…a culture of improvement”1 1Norman Kahn, CMSS, NQF-ABMS meeting, April 29, 2009

38. Certification and MOC matter to the public

39. 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

40. 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

41. 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 Public values maintenance of board certification

43. Certification matters to individual patients: Evidence for superior care and outcomes is mounting. Early info is available on MOC.

44. The Evidence Base • 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

45. MOC is already a factor in payment reform (ACA 2010). This is just the beginning.

46. ABMS and ABR are working to align MOC with other requirements and incentives, so that participation can serve multiple needs of diplomates and practices.

47. Enhancing MOC for diplomates • MOC for group practices: administrative streamlining • Group participation in MOC Part IV (various models, including “deemed status”) • ABMS/NBME/FSMB: MOC as proxy for MOL • Battling non-ABMS boards over “board-certified” • MOC incentive in PQRS; registry development • Measures development with ABMS & PCPI

48. Although MOC is extremely resource-intensive, ABR has worked hard to keep fees down.

49. For more details, please see the ABR Annual Report at: • http://www.theabr.org/forms/ABR%20annual%20report%202009-10.pdf • Directly accessible from home page, www.theabr.org

50. SUMMARY 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