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The Single Accreditation System: AOA/ACGME Integration At Last!

Welcome to..

The Single Accreditation System:AOA/ACGME Integration At Last! Judith Pauwels, MDAAFP Residency Program Solutions ConsultantDisclosuresI have no conflicts of interest to report regarding this presentation.DisclosuresAnd I DO represent two organizations actively collaborating to assist AOA programs with the SAS:Association of Family Medicine Residency Directors (AFMRD)American College of Osteopathic Family Physicians (ACOFP)Polling Question #1GoalsDescribe the Single Accreditation System process for Sponsoring Institutions and Programs.Discuss Institutional Accreditation and CLER requirements.Discuss common questions related to Program Accreditation in Family Medicine.Identify resources to help!The ultimate goal: Preserving and enhancingthe primary care workforcecritical to health care system reform

SAS Process and TimelinesWhat has changed in the pathways that our students and residents will follow?What is the process for achieving ACGME accreditation for both the Sponsoring Institution, and for the sponsored program?What are the key timelines and dates for doing this?

Medical SchoolMedical SchoolUS MLECOMLEXNRMP MatchNMS MatchResidencyResidencySpecialty BoardsSpecialty BoardsLCMENBMENBOMEAOAAAMCAOAACGMEAOAABFMAOBFPInitial AccreditationResidencyACGMESOAPMatchOPTIAccreditation Status, 2014Sponsoring Institution: Hospital, CHCMD StudentsDO Students

MDDOUpdated 8/6/2015ACGMEPre-accredited ResidencyMedical SchoolMedical SchoolUS MLECOMLEXNRMP MatchNMS MatchResidencySpecialty BoardsSpecialty BoardsLCMENBMENBOMEAOAAAMCAOAACGMEABFMAOBFPInitial AccreditationResidencyACGMESOAPMatchSponsoring Institution: Hospital, CHC, OPTI*Moving to the Unified Accreditation Process:2015-2020ResidencyAOAOPTIMD StudentsDO StudentsOsteopathic RecognitionDO onlyOPTI(?)Unknown

MDDOUpdated 8/6/2015*may applyMedical SchoolMedical SchoolUS MLECOMLEXNRMP MatchNMSMatchResidencySpecialty BoardsSpecialty BoardsLCMENBMENBOMEAOAAAMCAOAACGMEABFMAOBFPMD StudentsDO StudentsInitial AccreditationResidencySOAPMatchAccredited Sponsoring Institution: Hospital, CHCFully Implemented Unified Pathway:2020Osteopathic RecognitionOPTI (?)UnknownDO only

MDDOUpdated 8/6/2015SAS ProcessNote several issues yet to be fully resolved:The Match systems are still separate.Board certification systems are still separate.Separate ACGME requirements for resident pass rates for residency (ABFM) and Osteopathic Recognition (AOA).

SAS Process and TimelinesThe Sponsoring Institution (SI) must receive Institutional Accreditation before a Program can receive initial accreditation.However, both can be in pre-accreditation status and application work move forward simultaneously.

SAS Process and TimelinesAll AOA-only residents must be graduated by 2020.Family Medicine programs must achieve Initial Accreditation by June 30, 2020.Although this is almost 5 years away, the accreditation process will take significant time and resources, with many complex questions still be be answered.Polling Question #2Sponsoring InstitutionsWho can be a Sponsoring Institution (SI)?OrWhat are the responsibilities and authorities of the SI?

16SI ResponsibilitiesInstitution must demonstrate assumption of ultimate financial and academic responsibility for the programs that it sponsors, and be in substantial compliance with other relevant ACGME Institutional Requirements. No distance requirement.17SI ResponsibilitiesOversight of resident/ fellow assignments and of the quality of the learning and working environment, extending to all participating sites.Financial support for administrative, educational, and clinical resources, including personnel.18Institutional AccreditationACGME institutional objectives:SI resources in support of GME.SI oversight of learning and working environment.Structure for SI oversight of programs.SI policies and procedures for GME.

Structure for SI oversight of programsCritical elements:Institutional commitment to GME.Designated Institutional Official (DIO):May be the Program Director in single-program SI (SPSI).An engaged Graduate Medical Education Committee (GMEC).

Structure for SI oversight of programsGMEC structure:DIO, program directors.Must include residents/fellows (at least two).Must include patient safety/quality officer (or designee).For SPSI: must include at least one person from outside the program whos involved with GME.Must meet at least quarterly, and keep minutes of these meetings.

Structure for SI oversight of programsGMEC responsibilities:Oversight of learning environmentOversight of sponsored programs accreditation status, and annual evaluation activitiesCompliance with policies

SI GME policies and proceduresResident/fellow recruitment and selectionResident/fellow contract, including specific list of what must be in the contractPromotion, appointment renewal, and dismissalGrievancesResident services (behavioral health, policies on harassment, disabilities, impairment)Supervision, duty hoursVendor interactionsNon-competitionClosures and reductions, disasters

SI oversight of learning and working environment: CLER

What is CLER?The Clinical Learning Environment Review (CLER) is a mechanism by which the ACGME assesses a Sponsoring Institution (SI) to evaluate its commitment to developing a culture of quality, patient safety, and performance improvement for both resident education and patient care.CLER Focus AreasSponsoring InstitutionsWho can be a Sponsoring Institution (SI)?

27Polling Question #3PROGRAM requirementsCommon Requirements:Apply to ALL programs, regardless of specialty.Specialty-specific Requirements:Define each specialty.

Common Program RequirementsAffiliation of Sponsoring and Participating Institutions, and PLAsSpecifications about program director and facultyGeneral information about resident appointments, educational program, and the competenciesExpectations of resident scholarly activityEvaluation systemsResident supervisionResident duty hours

Family Medicine Program Requirements: potential issues Program size (minimum 4-4-4)Specifications for the Family Medical PracticeProgram director qualifications and time allocated to programCore faculty ratio and time allocated to programFaculty roles; scholarly activityRotation / experience requirements

31Family Medicine Program Requirements: potential issues Supervision requirementsEvaluation system complexities:Incorporating the MilestonesDirect observationsCCC (Clinical Competency Committee)Administrative complexities:PEC (Program Evaluation Committee)ADS (Accreditation Data System) reports

32Financial ConsiderationsFederal and state GME funding streams:CMS rules only relate to accreditation in that either AOA or ACGME accreditation is required to claim residents.Program must maintain AOA accreditation until Initial Accreditation by ACGME is received.Sponsoring Institution costsProgram costs for meeting ACGME requirementsProgram Pre-accreditationProcess:Writing the PIF (Program Information Form)Submitting the PIF and attachments in ACGME ADS (Accreditation Data System)Site visitDeadlines for submission on ACGME website for the specialty (note: includes site visit!)

Program Pre-accreditationProcess:Initial accreditation will be for two years.If not approved the first time, the program can continue to revise its plans and then reapply, until June 2020.

Program Pre-accreditationPrograms must start reporting all required ACGME annual information:ADS annual updateResident surveyFaculty surveyMilestone assessment and reportingCan simultaneously start application for Osteopathic Recognition

Polling Question #4Networking for StrengthFundamental belief in the need for primary care, and specifically family medicine, for our patients and communities.Core value that all of us working together are stronger than working in isolation.NO program has found all of this easy.But ALL programs have found this rewarding!

ResourcesAccreditation Navigation Attend an intensive two-session program to cover all aspects of the transition to ACGME accreditation and to provide a networking opportunity with fellow directors and experienced faculty. See details at www.afmrd.org/anAssociation of Family Medicine Residency Directors (AFMRD) Become a member and have access to the members only toolbox and discussion list.Residency Program Solutions When a program consultation is called for, AAFPs RPS has experienced consultants to meet your needs.