THE PHOENIX. A Message from the President. A Diplomates Newsletter. American Board of Family Medicine, Inc. James C. Puffer, M.D.

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1 Summer 2011 American Board of Family Medicine, Inc. THE PHOENIX A Diplomates Newsletter A Message from the President It has been a busy year for us as we have prepared to launch major upgrades to our website to coincide with the rollout of continuous Maintenance of Certification for Family Physicians (MC-FP). You will recall that in last summer s newsletter I outlined the improvements that we have made to MC-FP and announced that they would go into effect for those family physicians that initially certify or renew their certification this year. This will begin a 10-year transition into this new process for all of our Diplomates. Correspondingly, we have had to redesign our website to accommodate these new changes. The website redesign has entailed more than just creating new features to handle the changes that will occur with the introduction of continuous MC-FP, however. We have upgraded almost every aspect of the secure pages that you view every time that you log in to your physician portfolio. In large part, these upgrades have been based upon the feedback that you have given us about the website and the information that we gather every time you use the site. Appreciate that every year our Support Center staff handles about 50,000 phone calls, answers about 12,000 s and conducts approximately 3500 live chats online to assist you with MC-FP. We review these activities regularly not only to improve the service that we deliver to you, but also to improve the functionality of our website. So, when you log in to your physician portfolio after July 28th, you will see an entirely new layout that will allow for more intuitive navigation around the website and a clearer understanding of what you need to do to meet your MC-FP requirements. And for those of you in our existing MC-FP process, you will see that we have created greater flexibility for you as well by adding some of the new features of continuous MC-FP to the old process. Namely, you will be able to take advantage of the mix and match features of the new process and now receive credit for MC-FP modules in the stage in which they were completed, not the stage in which they were started. We hope that you will enjoy the new look and feel of the website; as always, we would appreciate any feedback on how we can continue to improve it to meet your needs. James C. Puffer, M.D. the program is very similar to the current MC-FP process; we have simply increased the flexibility of the program and reduced the need to take the examination to every 10 years. Just meet the stage requirements every three years (valid and unrestricted license, 50 MC-FP points, and 150 CME credits) and pass the exam every 10 years and you are good to go. We have also just launched the 2011 Physician Quality Reporting System (PQRS) previously known to you as the Physician Quality Reporting Initiative (PQRI) module that will allow you to participate in PQRS and receive the 1% bonus on your eligible Medicare billing for Participation is simple; just submit information on quality measures for 30 Medicare Part B beneficiaries with diabetes to our Center for Medicare and Medicaid Services (CMS) approved registry, and we will submit the data to CMS on your behalf. We have seen a steady increase in participation by Diplomates since our registry was first approved with 383 submitting data in 2008, 722 participating in 2009, and 867 in We hope that more of you will take advantage of the registry this year. Remember that participation is free, and in addition to receiving the PQRS bonus, which in many cases has paid for an entire ten-year run of MC-FP, you can also receive MC-FP credit by pairing your PQRS data set with the Diabetes Performance in Practice Module (our software does this effortlessly for you). I want to draw your attention to the article in this issue on our Privacy Policy and how we may use the data that we collect. As you know, we send certification information about our Diplomates to the American Board of Medical Specialties (ABMS) for their use in providing single source verification of a physician s board certification to credentialing agencies. They also license the use of this information to Elsevier, which publishes the Official Directory of the ABMS. You may be contacted by either ABMS or Elsevier to gather additional information; you are not obligated to provide it. The information that we have provided to ABMS is sufficient in and of itself to provide the needed information to verify your certification status. To help those of you that will be entering continuous MC-FP soon, we have created a simple comparison chart to help you visualize the changes between the existing MC-FP process and the one that you will enter after performing successfully on the examination this year and for each succeeding year thereafter. You can view this chart on the page immediately following this message. Essentially, In this issue you will also find information about the growing success of our Multispecialty MOC Portfolio Approval Program, a pilot that we initiated along with the American Board of Internal Medicine and the American Board Pediatrics to afford Diplomates the opportunity to receive MC-FP credit for quality improvement activities in which they were participating at their institutions. continued on page 2

2 2 A Message from the President This pilot initially began at the Mayo Clinic and has now expanded to the University of Michigan and Advocate Physician Partners. Several other institutions are currently in the application pipeline. We have recently had the American Boards of Allergy and Immunology, Obstetrics and Gynecology, and Physical Medicine and Rehabilitation join us in this endeavor, and we have extended an offer to the remaining 18 ABMS member boards to join us as well. We believe that the pilot has demonstrated the ability to appropriately recognize institutional quality improvement activities that meet our standards, thereby allowing Diplomates participating in those activities to receive appropriate MC-FP credit and avoid the unnecessary and redundant task of completing one of our Part IV activities. We look forward to the successful conclusion of the pilot and its transition to a permanent program. We proudly introduce recently elected officers of our Board of Directors as well as the newly elected members of our Board of Directors in this issue. We also discuss the recently completed standard setting procedures that were conducted by our psychometricians. Over 150 of you participated in this process, and we thank you very much for volunteering and participating in this important endeavor that established the passing standard for our examination for the next three years. Your participation is critical in guaranteeing that the standard is truly peer-based and not arbitrarily established. The Board of Directors and the ABFM staff appreciate the time you took from your practices to help us with this important task, and while I have sent you a certificate recognizing your participation, I want to publicly thank you again here for assisting us with this critical task. On a final note, I want to talk briefly about examination security. Almost two years ago, we learned from our colleagues at the American Board of Internal Medicine of a security breach that compromised a large number of their secure examination items. Physicians taking their examination were being paid to secret questions out of exam centers and provide them to an organizer of a board review course for their examination. The participants in this unprofessional activity were eventually caught in a sophisticated sting operation, and the ABIM is currently pursuing civil and criminal actions. This unfortunate incident has prompted us to review and strengthen our own internal and external examination security measures. The value of the certificate that you hold in large part is dependent upon public belief that your assessment by us has been rigorous continued from page 1 and consistent with the high standards that we have established for board certification in Family Medicine. The final article in this issue of the newsletter highlights some of the sophisticated methodologies that we have in place to guarantee the security of our examination process. Using these methodologies, we unfortunately identify a very small number of individuals every year that attempt to undermine the examination process, falsify certificates, or misrepresent their certification status. When we do so, we take appropriate legal action and notify appropriate state medical boards. We appreciate the assistance that many of you have provided in detecting those that act unprofessionally and thank you for your help in maintain the integrity of the certificates that you hold. On a more positive note, let me extend to all of you my wishes for a most enjoyable summer. I look forward to our inauguration of the new continuous MC-FP process this summer as well as the unveiling of our new and improved website. I hope you let us know if it is meeting your needs, and if not, how we might continue to improve it. Follow us on Facebook and Twitter! ABFM Facebook Page ABFM Twitter Feed

3 3 Continuous MC-FP The Sum of the Parts The upcoming changes to Maintenance of Certifi cation for Family Physicians (MC-FP) better emphasize continuous, life-long learning. The new MC-FP applies to those certifying in 2011 and beyond, and does not affect those currently enrolled in MC-FP until their next MC-FP examination. Use the comparison chart below to explore the changes to the process. Part 1: Professionalism Part 2: Self-Assessment and Life-long Learning Part 3: Cognitive Expertise Part 4: Performance in Practice New Certificates Issued in License verifi ed at end of each Stage 2 Self-Assessment Modules per Stage 300 CME credits in six years before examination Successfully complete examination every 7 years with possible extension to 10 years Modules required to take exam 1 Part 4 Module per Stage New Certificates Issued in 2011 and Beyond License verifi ed continuously At least 1 Self-Assessment Module (SAM) every 3 years Point value assigned to each module Combine with Part 4 to equal 50 points 150 CME credits every 3 years Successfully complete examination every 10 years At least 1 Part 4 Module every 3 years Point value assigned to each module Combine with Part 2 to equal 50 points Verification Written or online verifi cation Written or online verifi cation Stages Failure to Meet Requirements Program based on 3, 3-year Stages with unique requirements in each Keep 7-year certifi cate Required to complete modules to take examination Program based on the same basic requirements every 3 years Listed as Not Certifi ed in ABFM online verifi cation system; this break in certifi cation history will be listed permanently. Removed from ABFM online physician search tool Immediately listed as Certifi ed in online verifi cation system and added to physician search tool upon completion of delinquent requirements

4 Physician Quality Reporting System Available The ABFM is an approved registry once again for the Physician Quality Reporting System in The deadline to complete all necessary data entry for the 2011 physician quality reporting is January 10, ABFM Diplomates are able to participate by accessing the online physician quality reporting activity in their ABFM physician portfolio at no cost. The 2011 physician quality reporting requirements have changed from the past three years so physicians who have previously participated need to be aware of the changes. First, the name of the program has changed from Physician Quality Reporting Initiative to Physician Quality Reporting System so please be aware of the change as you navigate through the process. Second, all 30 patients included in the sample must be patients covered under Medicare Part B. Physicians who meet the 2011 Physician Quality Reporting System criteria for satisfactory submission of quality measures data for 30 unique, Medicare Part B patients are eligible to earn an incentive payment of 1.0% of their total allowed charges for Physician Fee schedule (PFS) covered professional services furnished during the reporting period, January 1, 2011 December 31, CMS approved financial incentives earned during 2011 reporting are scheduled to be paid in mid-2012 from the federal Supplementary Medical Insurance (Part B) Trust Fund. Again, the deadline to complete all necessary data entry for the 2011 physician quality reporting is January 10, Additionally, Diplomates have the added benefit of combining Physician Quality Reporting System participation with their MC-FP activity. In short, any Diplomate who successfully completes the 2011 Physician Quality Reporting System reporting can continue the activity for MC-FP credit and CME credit by implementing a quality improvement plan along with a post quality improvement data collection to complete the activity as a Performance in Practice Module (PPM). To begin 2011 Physician Quality Reporting today, visit the ABFM website at and login to your Physician Portfolio. If you have any questions about how to start taking advantage of the Physician Quality Reporting opportunity, please contact the ABFM Support Center at or via at help@theabfm.org. ABFM Privacy Policy and the Use of Data for Research Purposes As disclosed in our Privacy Policy, accessible via the link at the bottom of the home page of our web site, the Board considers the status of an individual s participation in and the stage of completion of all MC-FP components, including an individual s certification status and certification history, to be public information. We also use performance information on examinations and other information for research purposes. We will not use any information provided by our Diplomates, including examination score results, in any way which will disclose personal information, and we will only publish information that is presented as aggregate or de-identified data. As further described in that policy we share appropriate information with CME providers to facilitate the posting of CME to meet the MC-FP requirements; we share certain information with the American Academy of Family Physicians (AAFP) and we submit data to the American Board of Medical Specialties (ABMS) in order to facilitate the recognition of board certified physicians to the public and credentialers. The ABMS also publishes the Official Directory of the ABMS, through a contractual relationship with Elsevier. We do not provide ABMS with your address nor do we allow them to use your address for commercial purposes. Diplomates should be advised that if they provide additional details to the ABMS, the AAFP or other entities, that information can be aggregated with data about a Diplomate s certification status and MC-FP participation, into one source of that information. The ABFM cannot prevent the gathering of information directly from you or other sources about you. We can only control the data about you which we gather for our purposes. The ABFM and the ABFM Foundation support research efforts that evaluate the impact of board certification and maintenance of certification (MOC) on patient care, as well as projects that promote excellence in education in family medicine, faculty development, and the creation of knowledge and tools related to certification and MOC. The ABFM Foundation oversees and provides funding for such research and developmental projects, while the ABFM contributes by developing data-sharing agreements and collaborations with researchers. Thus far our primary external research partner has been the Robert Graham Center. These external research projects supplement our internally focused efforts around the construction of the examination; the Clinical Simulation contained within our SAM s, interaction with the other stakeholders about the content of our Maintenance of Certification for Family Physicians (MC-FP) activities, etc. We are not alone in this research effort and other member Boards of the American Board of Medical Specialties are actively engaged in similar efforts. We will collaborate with other ABMS Boards when it is appropriate to do so. ABFM feels that we have a responsibility and duty to our Diplomates and the public to evaluate, publish and react to the results of research that examines the impact of MOC. We are actively looking for research partners, so if you or your colleagues are aware of interesting and valuable efforts that could utilize data which might be included in the database maintained by the ABFM, please contact Michael Hagen, MD (hagen@theabfm.org) with any such ideas or suggestions.

5 ABFM teams with ABIM and ABP for Multi-Specialty MOC Portfolio Approval Program (Portfolio Program) The ABFM has teamed with the American Boards of Internal Medicine (ABIM) and Pediatrics (ABP) to pilot a program that allows external organizations to approve their internally developed quality improvement (QI) efforts for Maintenance of Certification (MOC) Part IV credit. ABFM, ABIM, and ABP Diplomates participating in those QI activities receive MOC Part IV credit from their certifying board. This pilot, the Multi-Specialty MOC Portfolio Approval Program (Portfolio Program), is an extension of the already existing pathways created by ABFM, ABIM and ABP for approving externally developed QI activities. The pilot began in 2009 and is expected to end in 2013, with a permanent Portfolio Program launching in late 2012 or early Several different types of organizations, both large and small, were approached about participating in the pilot. Those organizations that are approved and active participants in the pilot are, Mayo Clinic, the University of Michigan, and Advocate Physician Partners. Four other organizations are in the application process: the Medical Society of Virginia, HIVQual-US, Massachusetts General Hospital, and the Permanente Federation which includes all eight Kaiser Regions. The Portfolio Program has several benefits to organizations: (1) it reduces the effort and cost associated with applying to multiple ABMS Member Boards for approval of QI activities; (2)it allows physicians to receive MOC Part IV credit for participating in QI activities within their local organization; (3) recognizes efforts aimed at improving patient care in their workplace that aligns with the organization s mission, values, and goals and (4) it fosters communication among participating organizations to learn and share successful QI practices. In February 2011 the pilot was opened up to participation by Diplomates from other ABMS member boards, and in recent months the American Boards of Allergy and Immunology (ABAI) and Physical Medicine and Rehabilitation (ABPMR) have joined the ABFM, ABIM, and ABP in the pilot. In early June the current participants plan to meet in Chicago with other interested boards to explore expansion to as many ABMS member boards as possible. This pilot provides Diplomates the opportunity to receive MOC Part IV credit for the QI activities they were already performing at their home institutions and is another exciting dimension of our MOC program. 5 ATTENTION: Diplomates Who Certified in 2005 Diplomates who certified or recertified in 2005 are required to complete 3 MC-FP modules for Stage Two by December 31, 2011, in order to remain eligible for the 10-year certification path. For Stage Two requirements, Diplomates are required to complete 2 Part II modules (SAMs) and 1 Part IV module (PPMs, MIMMs or an approved alternative). NOTE: Several of the available Part IV options are activities which require various periods of time to complete, anywhere up to three months or more. Diplomates who need to complete a Part IV module as a Stage Two requirement in calendar year 2011 are encouraged to select and begin a Part IV activity early. Diplomates who do not complete Stage Two requirements will retain their 7-year certification and will have to complete the MC-FP requirements (6 SAMS and 1 Part IV) for the 7-year cycle before completing the application for the next exam. ATTENTION: Diplomates Who Certified in 2008 Diplomates who certified or recertified in 2008 are required to complete 3 MC-FP modules for Stage One by December 31, 2011, in order to remain eligible for the 10-year certification path. For Stage One requirements, Diplomates have the option to complete 3 Part II modules (SAMs) or 2 Part II modules and 1 Part IV module (PPMs, MIMMs or an approved alternative). NOTE: Several of the available Part IV options are activities which require various periods of time to complete, anywhere up to three months or more. Diplomates who want to complete a Part IV module as a Stage One requirement in calendar year 2011 are encouraged to select and begin a Part IV activity early. To guarantee your eligibility for the 10-year certification, you must successfully complete 3 MC-FP modules by the end of this year.

6 6 ABFM Elects New Officers and Board Members The American Board of Family Medicine is pleased to announce the election of four new officers and three new board members. The new officers elected at the ABFM s spring board meeting in April are: Warren P. Newton, MD of Chapel Hill, North Carolina, elected as Chair; Arlene M. Brown, MD of Ruidoso, New Mexico as Treasurer; Samuel Jones, MD of Fairfax, Virginia as Chair Elect; and Michael G. Workings, M.D. of Detroit, Michigan as Member-at-Large, Executive Committee. In addition, the ABFM welcomes this year s new members to the Board of Directors: Laura M. Brooks, MD of Lynchburg, Virginia; Jimmy H. Hara, MD of Los Angeles, California; and James Kennedy, MD of Winter Park, Colorado. The returning members of the Board include: Diane K. Beebe, MD of Jackson, Mississippi; Howard Blanchette, MD of Valhalla, New York; Erika Bliss, MD of Seattle, Washington; Thomas H. Cogbill, MD of LaCrosse, Wisconsin; Craig W. Czarsty, MD of Oakville, Connecticut; Alan K. David, MD of Milwaukee, Wisconsin; Susan C. Day, MD of Philadelphia, Pennsylvania; Carlos Roberto Jaén, MD of San Antonio, Texas; Kailie R. Shaw, MD of Tampa, Florida. The ABFM Board of Directors looks forward to working with the new members as it continues to implement and enhance the Maintenance of Certification for Family Physicians (MC-FP) program and the important task of sustaining the mission of the ABFM. For more information on the current Board members, please visit the Board of Directors page on our website. Warren P. Newton, M.D. Arlene M. Brown, M.D. Laura M. Brooks, M.D. Samuel Jones, M.D. Michael G. Workings, M.D. Jimmy H. Hara, M.D. James Kennedy, M.D.

7 7 Passing Standard for the MC-FP Exam Stays at 390 Through 2013 Because the demands of practice can change over time, the American Board of Family Medicine has a policy that the minimum passing score (MPS) for the MC-FP examination must be reviewed once every three years. The current MPS is 390 and was set in This standard was reviewed again in 2008; therefore the MPS must be re-evaluated before the scoring of the 2011 examinations. Standard setting, in the context of a medical certification examination, is a judgmental process that defines a point on an ability continuum, in which scores at or above the standard imply that the examinee has the decision making ability and fund of information to practice at the level of expertise implied by the certification. The point at which the organization asserts that a candidate has sufficient expertise is a policy decision and the candidate s pass-fail status is an expression of that policy decision. The standard setting data collection procedures and the subsequent statistical analyses aid in reducing the many individual judgments into group judgments, but they are nevertheless judgments. None of these recommendations can be considered correct in any empirical sense, but they can serve as a basis for policymakers to make an informed decision. No method will relieve the policymakers from rendering a judgment regarding the appropriate level for the passing standard. The standard setting processes used by ABFM were a modified Angoff procedure, the Beuk compromise, and the Hofstee procedure. The Angoff method presents a set of test questions to raters and asks them to estimate the probability that an examinee who is just barely worthy of the credential would answer the question correctly. These ratings are aggregated across items for each rater to produce a raw score to pass for the set of items they saw. These raw scores are averaged across raters to produce a group MPS recommendation. As you can see this is a content-referenced approach. The Beuk and Hofstee methods are procedures to temper the content-referenced approach with a population-based approach, essentially what percentage of the population does the rater believe are at least at the level of ability the certification should imply. In June 2011, the Examination Committee reviewed the MPS. The Examination Committee concluded that the existing standard of 390 continues to function well as a threshold for identifying the minimum level of medical knowledge and decision-making ability that a board-certified family physician should have. As a result, 390 was retained as the passing standard. This standard will be applied to the summer 2011 MC-FP examination. The MPS will be reviewed again before the scoring of the 2014 examination. Security on the MC-FP Examination The American Board of Family Medicine certifies those physicians who meet the standards delineated by ABFM policy. Successful participation in Maintenance of Certification, including success on the examination, results in a certificate that the physician can present to the public, credentialing organizations, and employers, as an independent indicator of their knowledge base and quality of practice which is of value to both the physician and the public. The examination is an important component of the maintenance of certification process because it demonstrates that each Diplomate has adequate competence with the body of relevant knowledge and is capable of making sound professional decisions. If the public has reason to believe that the demonstration has been less than rigorous or is capable of being subverted, then the value of the certification credential is lessened. For these reasons, ABFM takes all aspects of exam security very seriously. Security at the test center is crucial for several reasons. It is important that the person testing really is the person being certified. This is why identification is required at testing time and your personal validation code is required in order to start the exam. Also, candidates are not permitted to bring most things into the test center, including paper, calculators, phones, watches, and more. These restrictions help to limit the communication with other people during the examination and help to ensure that the answers given to the test questions represent the candidate s responses, not someone else s. Furthermore, it is important that the test questions are not being copied and removed from the room. Candidates should be aware that disclosing any examination materials including the nature or content of test questions, before, during, or after the examination is prohibited. The ABFM has a copyright on all test content and the disclosure of test material may be a violation of law. Violations of confidentiality and/or candidates rules will result in the invalidation of the candidate s exam and can result in criminal prosecution or civil liability and/or disciplinary actions by ABFM or possibly licensing agencies. It would be nice to assert that this type of scrutiny is unnecessary with physicians; however, ABFM detects such incidents almost every year. Other medical certification boards have reported similar problems. In addition to the security measures that go on at the test center, ABFM is always looking for new statistical methods to detect unusual patterns in the data that could indicate problems. Across the testing industry, statistical checks when used in conjunction with the video monitoring which takes place in the test centers, have produced actionable evidence of irregular behavior. Another effective continued on page 8

8 8 The American Board of Family Medicine 1648 McGrathiana Parkway, Suite 550 Lexington, Kentucky Phone: Fax: Security on the MC-FP Examination continued from page 7 process used is web searching. Sometimes people try to sell questions that they have taken from the exam to someone involved with a review course. The ABFM is constantly monitoring web sites for apparent misuses and/or disclosure of our copyrighted material. That usage is clearly illegal and unethical. Legal action is sometimes warranted to protect the integrity of the exam. Such illegal activity has been recently detected by the American Board of Internal Medicine and they are currently taking action against the physicians who participated in such activity with regard to their exam. In the end, your board certification has value so long as the public believes in its integrity. If you are aware of someone trying to subvert the certification process, please report the problem to ABFM s security group: security@theabfm.org. Trying to subvert the certification process is illegal, unethical and unprofessional. Please help us in defending the integrity of your credential. MC-FP Exam moves to April beginning in 2012 Dates for the Spring 2012 MC-FP Exam for 2012 have been determined. Test dates are: April 6, April 7, April 9, April 10, April 11, April 12, April 13, April 16, April 17, April 18, April 19, and April 21. All MC-FP examinations are administered at Prometric Test Centers.