Maintenance of certification and licensing: What you need to know

Current Psychiatry. 2013 February;12(02):17-20

February 1, 2013|Psychiatry

New system emphasizes self-assessment, performance improvement

Part IV, the PIP activity, has raised the most concern. The PIP component focuses on quality improvement in 2 parts: a clinical module and a feedback module. This targets active clinicians, and both modules focus on quality improvement activities. The clinical module consists of a baseline chart review by the physician MOC applicant in which results are compared with best practices or practice guidelines. The practitioner-applicant repeats a second chart review after a period of time to determine if intervening practice improvements had a positive impact.

The feedback module consists of reviews of clinical performance by patients, peers, or other second parties such as other practice staff or administrators. These are repeated after a period of time to determine whether practice improvements have been effective.

The PIP model (assessment, practice improvement, reassessment) parallels requirements for Performance Improvement CME (PICME) activities. The American Medical Association (AMA) developed PICME at approximately the same time ABMS was creating MOC. PICME is aimed at changing physician behavior within the context of their clinical practice and is divided into 3 stages:

Stage A: learning from current practice performance assessment
Stage B: learning from the application of performance improvement to patient care
Stage C: learning from the evaluation of the PICME effort.

Clinicians can earn 5 AMA Physician’s Recognition Award (PRA) Category 1 Credits^™ by completing each of the first 2 stages, and 10 additional credits by completing Stage C.³ Many accredited CME providers have developed PICME activities that meet the MOC Part IV criteria for ABPN. A list of available activities to meet ABPN Part IV of MOC can be found on the ABPN’s website (see Related Resources). Many of these activities also meet requirements for other specialty certifications and/or provide alternative CME credit (eg, American Academy of Family Physicians [AAFP] credit).

For example, a coalition of academic, nonprofit, and business organizations—the NOW Coalition for Bipolar Disorder— developed an online quality improvement activity (see Related Resources), which the ABPN certified for assessment and PIP points. It also is certified for 20 points toward the Self-Evaluation of Practice Performance MOC requirement through the American Board of Internal Medicine’s Approved Quality Improvement Pathway, 20 AMA PRA Category 1 Credits™, and 20 Prescribed Credits by the AAFP. Many physicians hold multiple board certificates, and this kind of activity can simultaneously meet requirements for licensure and several MOC programs.

Merging requirements

Clinical Point

MOC components are being integrated into relicensure, institutional credentials, and reimbursement models

Although many ABPN diplomates are not subject to the MOC process because of “grandfather” provisions, the basic components of ABMS’ MOC are being integrated into relicensure, institutional credentials, and reimbursement models. In 2004, the Federation of State Medical Boards (FSMB) began work on a plan for MOL. This was in response to concerns about the current focus on CME credit as a measure of continuous professional development while recognizing that health care has intensified its focus on patient safety, measuring patient outcomes, and system-based health care delivery.⁴ The core components of MOL include:

reflective self-assessment
assessment of knowledge and skills
PIP.

The FSMB plan does not include a mandatory exam and does not require physicians to participate in MOC or Osteopathic Continuous Certification for DOs. However, because of the similarities between MOL and MOC, the FSMB recommends that state medical boards recognize physicians who are actively participating in an MOC program as essentially meeting the MOL requirements. The first group of state medical boards began testing MOL during summer 2012. Each state and territorial medical board will adopt its own version of MOL as it has with its current licensing requirements. Adopting MOL by all medical boards could take several years. However, there is no question that the principles behind MOC will become part of new state licensing requirements.

Effects on reimbursement

In 2012, the Centers for Medicare and Medicaid Services’ Physician Quality Reporting System MOC Program Incentive provided a 0.5% incentive payment to physicians participating in a qualified MOC program.⁵ Other insurers are examining similar reimbursement incentives tied to practice assessment and improvement. Public reporting of quality metrics also is becoming more prevalent in practice and reimbursement incentives.

Related Resources

Pinals DA. Ready or not, here it comes: maintenance of certification. J Am Acad Psychiatry Law. 2011;39(3):294-296.
American Board of Psychiatry and Neurology, Inc. www.abpn.com.
Maintenance of certification. American Board of Psychiatry and Neurology, Inc. www.abpn.com/moc_products.asp.
NOW coalition performance improvement (PI) CME activity. NOW Coalition for Bipolar Disorder. www.nowbipolar.org/pi-cme.php.

Disclosure

Dr. Kues reports no financial relationship with any company whose products are mentioned in this article or with manufacturers of competing products.

References

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