ABMS Enhanced Public Trust Initiative 2008 2011 A Progress Report
Enhancing the Public Trust In 1933, the founding principles of the American Board of Medical Specialties (ABMS) focused on helping to assure the proper qualifications of a medical specialist for the public trust. The high standards for clinical practice and the evaluation system set up by the ABMS Member Boards have served the public well. Patients, physicians, insurers and other health care institutions view ABMS as a gold standard and a primary source of selfregulation for the profession. In recent years, increased public interest in health care quality and physician accountability has prompted us to even greater focused action. The Enhanced Public Trust Initiative set our sights on engaging more broadly with the public and on making sure that the ABMS MOC program is adding value to physicians and improving the quality and safety of patient care. Our work during the EPTI time period has been marked by dedication to physician excellence and an absolute focus on patients and the public s trust in the profession. Kevin B. Weiss, MD ABMS President and CEO 2007-2012 In early 2008, ABMS President and CEO Dr. Kevin Weiss challenged us to elevate our work in the public trust by adopting the ABMS Enhanced Public Trust Initiative 2008-2011 (EPTI). Through the EPTI activities, ABMS made a commitment to: Expand our public relationships for gathering personal perspectives on our programs and decision-making, and for sharing information about the education and certification of physicians. Align our programs with other forms of assessment, including state, national and international programs, to establish Board Certification and ABMS Maintenance of Certification (ABMS MOC ) as an asset to improve the quality and safety of health care. Support the evolution of Board Certification and ABMS MOC standards by the ABMS Member Boards, thereby increasing the relevance of these programs to physicians clinical practice and helping them provide better care. The achievements shared in this report are the results of our efforts and the measure of the EPTI s success. The momentum of the EPTI activities also frames the ABMS Strategic Plan for 2012-2015. Under the new Plan, we maintain our commitment to professionalism, health care quality and physician accountability. We intend to make ABMS MOC well embedded and accepted in our nation s health care system. We also will find ways to make the program more valuable to the more than 375,000 physicians, across all specialties, who are currently participating in an ABMS MOC program. Finally, we will continue to build on our network of partnerships with like-minded institutions across the country and around the globe committed to making a difference in health care quality. 2
Expanding Public Relationships Through Communications and Transparency Through the ABMS MOC program, the ABMS community of Member Boards serves the consuming public every day with a collective passion for promoting quality in medicine and patient safety. This commitment requires responding affirmatively to the public s need for greater accountability and transparency in health care. It also means making information easily available to the public, which gives an accurate and up-to-date certification status for all ABMS Member Board Certified physicians. L. Edward Bryant Jr., JD ABMS Board of Directors Public Member 2001-2012 Public Engagement EPTI is the most recent effort in the evolution of ABMS as an organization working in the public trust and expanding public engagement in all facets of our mission driven activities. Initially, this meant analyzing our organizational structure and examining how information is exchanged at all levels, between all the Member Boards and Associate Members of ABMS and with the public. It meant nurturing a new public involvement program and advancing our public advocacy role for promoting high-quality care through a valued certification process. New platforms for engagement, like the ABMS National Policy Forum in Washington, D.C., that first convened in 2009, continue to bring together stakeholders from purchaser, government and consumer groups to discuss physician accountability and the role of physician standards in achieving improved health care performance and effectiveness. Engaging the public online with new offerings like CertificationMatters.org expanded public access and understanding regarding individual physician Board Certification and MOC status. Public awareness of both Board Certification and MOC importance was enhanced as ABMS communications reached an estimated audience of millions through various online, print and broadcast media outlets. Currently in 2012, more than 15 public members are active within the ABMS Board, standing committees and/or task forces. CertificationMatters.org supported nearly 1,100,000 Board Certification searches in 2011. This represents more than a 30% increase over prior year. Nearly 50,000 visitors per month utilize the abms.org home page. The site s public input policy feature, an outcome of EPTI, enables comment on new specialties and subspecialties being considered for approval. Board Certification ranks #2 among factors determining the choice of a physician.* * Source: 2010 ABMS Consumer Survey Donald M. Berwick, MD, MPP, former Administrator for the Centers for Medicare & Medicaid Services (CMS), outlined the challenges physicians face in optimizing health care resources, enhancing the health care experience and reducing costs to achieve better care and a better health care system during the 2011 ABMS National Policy Forum. Introduced in 2011, CertificationMatters.org enables visitors to find physicians who are Board Certified, as well as check physicians MOC status. This allows more informed decisions about who provides their care. 3
Aligning Our Programs With Other Forms of Assessment Over the course of the EPTI, ABMS has moved forward in all the ways we hoped. The ABMS MOC program standards for clinical practice continue to be refined, and the Board Certification process remains unequaled in the profession. Our program has engendered great interest from private enterprise, government and health care plans concerned with regulation and evaluation, expanding our opportunities to talk about quality health care on a national level. As a result, we have strengthened our partnerships, forged new alliances and built organizational capacity for the future. John B. McCabe, MD 33rd Chair ABMS Board of Directors 2010-2012 ABMS, the Member Boards and the ABMS Research and Education Foundation (ABMS REF) have developed important relationships and collaborations with health agencies of the federal government, state medical boards, medical associations, private health care organizations and health plan providers that are expanding the growth and acceptance of our Board Certification and ABMS MOC programs in the quality and efficacy of our nation s health care. The ABMS Ambassadors Network, created in 2011, raises awareness of Member Board Certification among state and national policy makers. The collaborative aligned engagement between ABMS and leading health care stakeholders is detailed in this report. In addition to Government Engagement (below) and Quality Influencer Engagement (page 5), several other recent activities merit mention. ABMS and the National Quality Forum (NQF) co-sponsored a stakeholder summit on physician accountability. ABMS also joined the National Priorities Partnership convened by NQF. ABMS REF is in its sixth year working with Improving Performance in Practice (IPIP), a state-based collaborative, which helps physicians deliver better care for chronic conditions and preventive care. The list of ABMS collaborations is long. Collaborations like these help create synergy in health care improvement efforts and minimize overlap of requirements providers must meet. Government Engagement ** CMS Working with the U.S. Congress led to recognition of the ABMS MOC program as one of the ways physicians can meet the continuous learning requirements of the CMS Physician Quality Reporting System. HHS Office of National Coordinator of Information Technology Contracted with ABMS thereby assisting Member Boards in developing activities for their MOC programs to enhance the knowledge and use of information technology. FSMB, NBME Collaboration on development and pilot of a service model to support state medical boards in implementing Maintenance of Licensure (MOL). CMS Episode Grouper Project After a year of participating in a collaborative effort to develop a prototype, the project team (including ABMS REF) was selected by CMS for full build out of this Medicare measurement system. 4
Dr. Weiss providing testimony before the U.S. Senate Committee on Finance in 2008 on ways to improve health care system quality. This was part of the valuable discussions which led to the signing of the Patient Protection and Affordable Health Care Act into law in 2010. The FSMB Maintenance of Licensure (MOL) framework and the ABMS MOC program support a physician s commitment to lifelong learning, facilitate the provision of quality of health care and seek standards of excellence that have long been a hallmark of American medicine. While MOL and MOC are different in their scope, and Board Certification is not required for medical licensure, we have recommended that physicians engaged in MOC activities should be recognized by state medical boards as being in substantial compliance with MOL. Quality Influencer Engagement ** Robert Wood Johnson Foundation (RWJ) ABMS REF participated in the High Value Health Care Project: Characterizing Episodes and Costs of Care (C3 project) funded by a grant from RWJ. in 2011 to advance the quality of specialty-based certification efforts outside the U.S. ABMS Singapore, LLC, is the first effort in a specialty certification support program with the Singapore Ministry of Health. Humayun J. Chaudhry, DO, FACP President and Chief Executive Officer Federation of State Medical Boards (FSMB) BCBSA Exploration of the use of claims data to inform ABMS MOC program assessment activities. ABMS International, LLC, and ABMS Singapore, LLC ABMS International, LLC, was established AMA In partnership with ABMS convened the Physician Consortium for Performance Improvement (AMA- PCPI) with a focus on developing practice performance measures for ABMS MOC quality improvement. ** Centers for Medicare & Medicaid Services (CMS), U.S. Department of Health and Human Services (HHS) Federation of State Medical Boards (FSMB), National Board of Medical Examiners (NBME) BlueCross BlueShield Association (BCBSA), American Medical Association (AMA) MOC Matters, created in 2011, is an online suite of registry based tools that can help physicians fulfill the CMS Maintenance of Certification Physician Quality Reporting System requirements and become eligible for an incentive payment. 5
Enhancing the Value of Board Certification and MOC For Physicians and the Public-At-Large Over the course of the EPTI, the ABMS Member Boards continued development of their MOC programs to respond to the variability in physician competence, improvements to health care quality and to best meet the needs of the public and physician community. Higher standards for the ABMS MOC program were approved in 2009. Later that same year, MOC Guiding Principles were adopted. These provide a framework for the creation of standards and benchmarks to track performance over time, gauge progress toward performance improvement and toward public reporting. To ensure that the gains made during the EPTI initiative continue, the ABMS Strategic Plan for 2012-2015 has a focus on ABMS MOC program activities. This includes making MOC more valuable to physicians by helping them deliver higher quality care to patients. For many years the public has depended on ABMS as a trusted source of information on physicians and as an advocate for physician quality. Supported by the continuous learning MOC program, our ability to deliver on that commitment is greater than ever. Thomas E. Norris, MD Vice Chair ABMS Board of Directors 2010-2012 Complementing this effort, and providing an important clarification point to the public, is the new Board Eligibility policy approved in 2011. The policy describes candidate eligibility for Board Certification with respect to the period between completion of Accreditation Council for Graduate Medical Education (ACGME)-accedited training and the attainment of Board Certification. Other groups contributing to Board Certification value include the ABMS Ethics and Professionalism Committee (2011), Patient Safety Work Group (2011) and a joint ABMS and Accreditation Council for Continuing Medical Education (ACCME) effort to further integrate Continuing Medical Education (CME) and the MOC program. The EPTI achievements we ve shared are not an end, but a beginning. The Conceptual Framework for MOC Standards 2015 was endorsed by the ABMS Board of Directors in 2011. These principles will be used to guide the next iteration of the ABMS MOC program and enhance the value of Board Certification within the physician community and to the public-at-large. Physician Engagement Nearly 800,000 physicians are Board Certified by an ABMS Member Board. Over 375,000 physicians currently participate in an ABMS MOC program, a nearly 20% increase over prior year. 91% of the public believes Board Certification is important.* 95% of the public believes their doctor s participation in MOC is important.* Evidence-based findings support better outcomes for Board Certified physicians, and new studies measure the benefits of physician participation in the ABMS MOC program. * Source: 2010 ABMS Consumer Survey 6
Representatives from the ABMS Member Boards discuss their initiatives for implementing the ABMS MOC program. Activities through the EPTI have raised the bar for continuous certification to benefit patients, physician practices and the broader health care community. ABMS Maintenance of Certification: The Six Core Competencies In 2010, ABMS and the Accreditation Council for Graduate Medical Education (ACGME) added increased emphasis on procedural skills within the Patient Care core competency. During the EPTI program, ABMS continued to lead positive change and made stronger alliances with the licensing, certification and quality improvement communities while looking inward to discuss and implement important initiatives in preparation for the challenges ahead. 7
A Collaborative Effort We greatly appreciate the diligent work of the ABMS Board of Directors, Member Board leadership and staffs, the ABMS committees and work groups and the ABMS office team to advance the activities of EPTI. In particular, we are grateful for the wisdom, knowledge and skills of the volunteers that served on the EPTI Priorities Task Force and the EPTI Governance Task Force. EPTI Priorities Task Force (2008-2009) John G. Clarkson, MD (Ophthalmology) Larry R. Faulkner, MD (Psychiatry and Neurology) Francis P. Hughes, PhD (Anesthesiology) Shepard Hurwitz, MD (Orthopaedics) Frank R. Lewis Jr., MD (Surgery) John B. McCabe, MD R. Barrett Noone, MD (Plastic Surgery) Margaret E. O Kane, MHS (Public Member) James C. Puffer, MD (Family Medicine) Mary Ann Reinhart, PhD James A. Stockman, III, MD (Pediatrics) James M. Vanderploeg, MD, MPH (Preventive Medicine) Kevin B. Weiss, MD (ABMS) ABMS Senior Leadership and Staff EPTI Governance Task Force (2008-2009) L. Edward Bryant Jr., JD (Public Member) Christine K. Cassel, MD (Internal Medicine) Joel A. DeLisa, MD, MS (Physical Medicine and Rehabilitation) John B. McCabe, MD William K. McVisk, JD (ABMS General Counsel) Robert H. Miller, MD, MBA (Otolaryngology) Lloyd B. Morgan (Public Member) Margaret E. O Kane, MHS (Public Member) Mary Ann Reinhart, PhD David J. Schoetz Jr., MD (Colon and Rectal Surgery) Stephen I. Wasserman, MD (Allergy and Immunology) Kevin B. Weiss, MD (ABMS) www.abms.org Officers of ABMS and ABMS REF 2008-2012 John B. McCabe, MD Chair, 2010-2012 Vice Chair, 2008-2010 Joel A. DeLisa, MD, MS (Physical Medicine and Rehabilitation) Chair, 2008-2010 Thomas E. Norris, MD, MS (Family Medicine) Vice Chair, 2010-2012 Valerie Parisi, MD, MPH (Obstetrics and Gynecology) Secretary-Treasurer, 2009-2012 Stephen I. Wasserman, MD (Allergy and Immunology) Secretary-Treasurer, 2006-2009 Kevin B. Weiss, MD President and CEO, 2007-2012 ABMS Member Boards Allergy and Immunology Anesthesiology Colon and Rectal Surgery of Dermatology Emergency Medicine Family Medicine Internal Medicine Medical Genetics Neurological Surgery Nuclear Medicine Obstetrics and Gynecology Ophthalmology Orthopaedic Surgery Otolaryngology of Pathology of Pediatrics Physical Medicine and Rehabilitation of Plastic Surgery Preventive Medicine Psychiatry and Neurology of Radiology Surgery Thoracic Surgery of Urology To verify physician certification, call 1-866-ASK-ABMS or visit www.certificationmatters.org. 2012 American Board of Medical Specialties. All rights reserved.