the abr and you 2014... · the abr and you: a lifelong and not so ... biology, physics ... tjc,...
TRANSCRIPT
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The ABR and You:A Lifelong and Not So
Complicated Relationship
Anthony L. Zietman, MD, FASTROABR Assistant Executive Director for Radiation
Oncology
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Objectives
1. The board system: who, what, why
2. Initial certification
3. The changing landscape
4. Maintenance of certification: why, how, benefits
5. How they do it elsewhere
6. Losing certification
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The Board System
The original boardsOpthalmology, ENT, Ob Gyn, Derm/syph
ABMS formed 1934 – coordinate and standardize
Currently 24 boards under the ABMS>90 subspecialties
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Initial Certification
Biology, Physics – PGY4
Clinical – PGY 5
Orals – PGY 6
Who passes orals?
Board eligibility? – 6 years and out
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Initial Certification
Oral Exam
• To continue
• Case-based and image-rich
• Standardized and calibrated
• Louisville
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The age of physician power:
The linear practice of medicine
Med
School
Residency
Practice
Lic
en
sin
g e
xa
ms
Re
tire
me
nt
Bo
ard
ex
am
s
New
gizmos
or drugs
New
techniques
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Patient and Payer Power
Want physicians who:
• use treatments that are effective and improve outcomes
• are competent and strive to improve their practice
• are safe
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Evidence
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UME GME 1 Yr 5 Yr 10 Yr 15 Yr 20 Yr 25 Yr Retire
Doctor X
MinimalStandard
Competence
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Safety
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Maintenance of CertificationWhy?
• Patients demand it
• Hospital demand it
• Payers demand it
• 1940s discussions began
• 1960s Int Med (voluntary), Family Practice (mandatory)
• 1998 All boards
Who?
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Maintenance of CertificationComponents
Four parts:
I. Professional standing - Licensure
II. Lifelong learning – CMEs: 1/3 self assessment component
III. Cognitive examination
IV. PQI projects
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Maintenance of CertificationTiming
Formerly: 10 year cycle
Now: Continuous “rolling” certification
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Continuous Certification (ConCert)Why?
• Pressures on the “old” MOC program
• CMS: MOC:PQRS Incentive
• American Board of Medical Specialties (ABMS): MOC Public reporting (meeting/not meeting/not required)
• Federation of State Medical Boards:
Maintenance of Licensure (MOL)
• Credentialing and privileging bodies
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So what is ConCert?• Really, a new reporting regimen to assist diplomates
in meeting program requirements• Certificates issued in 2012 and after will no longer
have “valid through” date – instead continuing certification will be contingent on meeting MOC requirements
• Annual look-back used to determine MOC participation status.
Part I continuous Part II and Part IV previous 3 years Part III previous 10 years
• MOC requirements and fees unchanged
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Yearly Progress
Part I: Valid licensure
Part II: 25 CME with 1 SAM
Part III: Exam q 10 years
Part IV: 3 projects q 10 years
Part I: Valid licensure
Part II: 25 CME with 8 SA-CME
Part III: Exam q 10 years
Part IV: 1 project q 3 years
10-Year System ConCert
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2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018
Part 3: Exam passed within previous 10 years
Part 4: 1 PQI completed within previous 3 years
Part 2: 75 CME completed within previous 3 years, at least 25 of which are SA-CME
Part 1: At least 1 valid state medical license
Annual Look-back
(March)
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2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018
Part 3: Exam passed within previous 10 years
Part 4: 1 PQI completed within previous 3 years
Part 2: 75 CME completed within previous 3 years, at least 25 of which are SA-CME
Part 1: At least 1 valid state medical license
Annual Look-back
(March)
2013 credits will not
count towards 2017 totals
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2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018
Part 3: Exam passed within previous 10 years
Part 4: 1 PQI completed within previous 3 years
Part 2: 75 CME completed within previous 3 years, at least 25 of which are SA-CME
Part 1: At least 1 valid state medical license
Annual Look-back
(March)
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Advantages of Continuous Certification
• The number of CME and self-assessment CME credits (SA-CME) counted per year is unlimited
• You may take the MOC exam at any time, as long as the previous MOC exam was passed no more than 10 years ago
• Built-in “catch-up” period of one year – still certified
• Aligns reporting more closely with CMS, TJC, credentialing and state licensing boards
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Part II: SAMs and SA-CME
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SAM and SA-CME
• SAMs– Primarily in-person CME activities that count as SA-
CME
• SA-CME– All “enduring” Category 1 CME activities
– “Enduring” activities include journal CME, CD/DVD, archived webinars, podcasts
• Reporting– Automatically: ASTRO Gateway feed to ABR
– Self-entered: Log in to myABR and record
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Part IV: Practice Quality Improvement (PQI)
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PQI: Things to keep in mind
• PQI does not require IRB approval or publication
• PQI can be done as individual or as a part of a group or practice
– Individual and Group MOC participation templates available on the ABR website
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PQI Essential Elements1
• Select project, metric(s), and goal
• Collect baseline data
• Analyze data
• Create and implement improvement plan
• Re-measure
• Self-reflection
1Retain documentation on project in the event of a random MOC audit
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DO
STUDYACT
PLAN
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Individual Project Example #1Project Title: Breast Cancer: Hormonal Therapy for Stage IC - IIIC Estrogen Receptor/ Progesterone Receptor (ER/PR) Positive Breast Cancer
Project Description: Percentage of female patients aged 18 years and older with Stage IC through IIIC, ER or PR positive breast cancer who were prescribed tamoxifen or aromatase inhibitor (AI) during the 12-month reporting period.
Baseline Data Collection (Numerator): Number of patients who were prescribed tamoxifen or aromatase inhibitor (AI) during the 12-month reporting period.
Data Analysis: analyze data
Improvement Plan & Implementation: create and implement an improvement plan to address the root cause performance
Re-measure: gather additional data using baseline data criteria
Self-reflection: short statement describing how the project outcome has impacted clinical practice.
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Individual Project Example #2
Project Title: Oncology: Medical and Radiation – Pain Intensity Quantified
Project Description: Percentage of patient visits, regardless of patient age, with a diagnosis of cancer currently receiving chemotherapy or radiation therapy in which pain intensity is quantified.
Baseline Data Collection (Numerator): Patient visits in which pain intensity is quantified.
Data Analysis: analyze data
Improvement Plan & Implementation: create and implement an improvement plan to address the root cause performance
Re-measure: gather additional data using baseline data criteria
Self-reflection: short statement describing how the project outcome has impacted clinical practice.
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Individual Project Example #3Project Title: Documentation of Urinary, Bowel, Sexual function at baseline
Project Description: Complete documentation of urinary and sexual function (ideally with IPSS and SHIM scores) and of bowel function is essential to determine the role of radiation in the management of prostate cancer and to determine the rorole of role of radiation in subsequent symptoms seen at follow-up.
Data Analysis: Collect data
Improvement Plan & Implementation: create and implement an improvement plan to address the root cause performance
Re-measure: gather additional data using baseline data criteria
Self-reflection: short statement describing how the project outcome has impacted clinical practice.
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Group PQI Project Participation
• Group participation PQI requirements are very similar to individual project requirements and include:– at least 2 or more ABR diplomates– identification of a team leader – at least 3 team meetings (kick-off, data and root cause
analysis, improvement plan development)
• Individuals may participate in group PQI projects and receive credit. “Meaningful participation includes:– attending at > 3 team meetings– completing a personal self-reflection– attesting to project completion on myABR– securing access to project records (in case of audit)
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Lapse/Loss of Certification
Lapse• “Fall off cliff”• Out of clinical practice – illness, administration
Retire
Lost• Certification follows license
Re-entry
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The UK Experience
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The UK Experience
Everything that the US has plus a portfolio containing:
• Log of all significant events
• Feedback from patients
• Feedback from peers
• Review of complaints and compliments
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The UK Experience
Annual review by a revalidation officer with the following supporting documents:
• Statement of scope of practice
• Statements of probity and health
• Goals for coming year
• Supporting information drawn from daily practice
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Conclusions
The relationship with the ABR is lifelong
• It can be incorporated into your working life
• It is relevant to your working life
• It will become essential if you are to remain credentialed, on insurers lists, and be paid
• For overburdened physicians it may feel like a “final straw” but really it isn’t