Transcript ABS MOC Presentation Jan. 2008

Maintenance of Certification
What does it mean for you?
John J. Ricotta MD FACS
Chair Vascular Surgery Board
American Board of Surgery
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

Created by the ABMS and its 24 member boards in a
collaborative effort with other organizations involved in
health care quality
The American Board of Surgery  www.absurgery.org
2008
MOC is supported by:

Federation of State Medical Boards of the U.S. (FSMB)

The Joint Commission

American Hospital Association (AHA)

American Medical Association (AMA)

National Board of Medical Examiners (NBME)

Accreditation Council for Graduate Medical Education (ACGME)

Association of American Medical Colleges (AAMC)

Council of Medical Specialty Societies (CMSS)

Educational Commission for Foreign Medical Graduates (ECFMG)
The American Board of Surgery  www.absurgery.org
2008
Board Certification and
Quality Care

The board movement began in 1917 to set standards for
quality care

There is evidence of a need for continued monitoring and
promotion of quality …
 “To Err is Human,” IOM, 2000


44,000-98,000 Americans die yearly due to preventable errors
“Bridging the Quality Chasm,” IOM, 2001

Health care system fails to translate knowledge into practice
 Harvard Medical School Study, Annals of Internal Medicine, Feb. 2005

Doctors who have been in practice for more years tend to possess less factual
knowledge and are less likely to adhere to appropriate standards of care
The American Board of Surgery  www.absurgery.org
2008
Physician Competencies
The ABMS and ACGME have defined six general competencies as
the foundation for physicians’ training and practice during their
professional lifetime:

Medical Knowledge

Patient Care

Interpersonal and Communication Skills

Professionalism

Practice-based Learning and Improvement

Systems-based Practice
The American Board of Surgery  www.absurgery.org
2008
Four Components of MOC
To assess physician competencies on a continual basis
1.
Professional Standing
2.
Lifelong Learning and
Self-Assessment
3.
Cognitive Expertise
4.
Evaluation of Performance
in Practice
The American Board of Surgery  www.absurgery.org
2008
Transition to MOC

Diplomates are automatically enrolled in MOC once they
certify or recertify in any ABS specialty after July 1, 2005

Until then, “regular” recertification requirements apply

MOC requirements start for a diplomate as of the July 1
following date of certification or recertification

MOC runs in three-year cycles: At the end of each cycle,
diplomates submit information to the ABS regarding their
MOC activities

The ABS will individually contact diplomates a year before
submission is due for MOC
The American Board of Surgery  www.absurgery.org
2008
MOC Requirements Timeline

MOC Year = July 1 to June 30, starting July 1 following certification or recertification

Three cycles of MOC (nine years) must be completed to recertify
MOC Year
MOC Requirement
0
Year of certification or recertification
1
Yearly CME (30 hours Category I, 50 overall)
2
Yearly CME
3
Yearly CME
Reference letters and evidence of CME submitted; license status
and participation in practice assessment verified
4
Same as Year 1
5
Same as Year 2
6
Same as Year 3
7
Same as Year 1
8
Same as Year 2
9
Same as Year 3
8 - 10
Secure examination
The American Board of Surgery  www.absurgery.org
2008
Goals of Vascular MOC Process


Make it easy
Make it relevant
- Use existing vehicles where possible
- Measure things we are already required to
report
- Define scope in a way that will differentiate
Vascular Surgery
- Anticipate what we are likely to report in the
future (modular concept)
The American Board of Surgery  www.absurgery.org
2008
Four Components of MOC
1. Professional Standing

Full and unrestricted medical license


Hospital admitting and operating
privileges


Verified every three years
Must be maintained in the specialty if clinically active
Reference letters from chief of surgery and
chair of credentials committee

From the institution where most work is performed

To be submitted every three years

Must refer to Vascular Privileges
The American Board of Surgery  www.absurgery.org
2008
Four Components of MOC
2. Lifelong Learning and Self-Assessment

Continuing medical education (CME):
30 hours Category I, 50 hours overall annually

Documentation of CME completion to be submitted
every three years

Over the course of three years, one-third of Category I
CME must be a self-assessment activity

50% of CME in Vascular

Self assessment must be in Vascular
The American Board of Surgery  www.absurgery.org
2008
Four Components of MOC
3. Cognitive Expertise

Secure examination

May be taken starting three years prior to certificate
expiration (unchanged)

All MOC requirements must be fulfilled up to that
point to be admissible to the examination
The American Board of Surgery  www.absurgery.org
2008
Four Components of MOC
4. Evaluation of Performance in Practice

Participation in a national, regional or local outcomes
database or quality assessment program
 Verified every three years


Must encompass Vascular specific Practice
Periodic patient communication skills assessment also
to be eventually required
2007 Surgery Recertification Examination: 51% of applicants
said they were participating in outcomes studies. These
individuals also had a lower exam failure rate.
The American Board of Surgery  www.absurgery.org
2008
Fulfilling the Performance in
Practice Requirement

Participation in programs such as these would meet this requirement:

ACS case log system

SVS Carotid Database

Venous Registry


Regional Vascular
Registries

SCIP

PQRI
NSQIP

The ABS is investigating other national, regional, or hospital-specific
programs, and is soliciting diplomates’ input at [email protected]

The ABMS is developing an assessment tool for patient communication
skills that will likely be used in future
The American Board of Surgery  www.absurgery.org
2008
MOC Requirements Timeline

MOC Year = July 1 to June 30, starting July 1 following certification or recertification

Three cycles of MOC (nine years) must be completed to recertify
MOC Year
MOC Requirement
0
Year of certification or recertification
1
Yearly CME (30 hours Category I, 50 overall)
2
Yearly CME
3
Yearly CME
Reference letters and evidence of CME submitted; license status
and participation in practice assessment verified
4
Same as Year 1
5
Same as Year 2
6
Same as Year 3
7
Same as Year 1
8
Same as Year 2
9
Same as Year 3
8 - 10
Secure examination
The American Board of Surgery  www.absurgery.org
2008
Requirements for
Multiple Certificate Holders

Parts 1, 2 and 4 – professional standing, lifelong
learning/self-assessment and performance in practice –
requirements in Vascular can be credited to Surgery
Certificate

Part 3 – cognitive expertise (secure examination) –
must be fulfilled in all disciplines for which a diplomate
holds a certificate
The American Board of Surgery  www.absurgery.org
2008
Benefits of MOC for Diplomates

Improved learning and self-assessment opportunities

Relevant measures of practice performance

Documents a diplomate’s commitment to quality care

Will reduce multiple and/or redundant quality
assessments

Responds to public’s concerns regarding health care
quality and patient safety

Overall improved patient care
The American Board of Surgery  www.absurgery.org
2008
SVS MOC Committee



Donald Jacobs - Part 2 MOC
David Gillespie – Part 4 MOC
Ashraf Mansour – Michigan experience in
Practice Assessment
The American Board of Surgery  www.absurgery.org
2008