Council Meeting Honolulu, Hawaii May 4, 2008
Transcript of Council Meeting Honolulu, Hawaii May 4, 2008
Council MeetingCouncil MeetingHonolulu, HawaiiHonolulu, Hawaii
May 4, 2008May 4, 2008
Welcome New MembersWelcome New Members
Bruce A Boston, MD – EndocrinologyBruce A Boston, MD – Endocrinology
Mary Beth Fasano, MD - Allergy and Mary Beth Fasano, MD - Allergy and ImmunologyImmunology
Robert Spicer, MD – CardiologyRobert Spicer, MD – Cardiology
Christine Barron, MD - Child AbuseChristine Barron, MD - Child Abuse
Maintenance of Certification Maintenance of Certification – Pediatrics– Pediatrics
Executive OverviewExecutive Overview
Setting standards of Setting standards of excellence in knowledge and excellence in knowledge and
performance.performance.
Today’s PresentationToday’s Presentation
Review the Maintenance of Review the Maintenance of Certification process and our Certification process and our efforts to reduce redundancy and efforts to reduce redundancy and accelerate improvement accelerate improvement
Preview how collaboration Preview how collaboration among the Primary Care Boards among the Primary Care Boards and with AAP adds valueand with AAP adds value
Why Maintenance of Why Maintenance of Certification – Pediatrics?Certification – Pediatrics?
All Boards are adopting MOCAll Boards are adopting MOC– ABMS-wide action plan for qualityABMS-wide action plan for quality– Meets IOM imperative to improve quality of careMeets IOM imperative to improve quality of care
MOC leads to better careMOC leads to better care– MOC is a commitment to quality MOC is a commitment to quality – MOC helps pediatricians perform more effectivelyMOC helps pediatricians perform more effectively– Helps you meet payer, regulatory and consumer Helps you meet payer, regulatory and consumer
demands for qualitydemands for qualityGreater efficiencies; Improved process; Better care for Greater efficiencies; Improved process; Better care for childrenchildren
Designed BY and FOR Designed BY and FOR Pediatricians Pediatricians
MOC MOC Committee Committee designed a designed a flexible programflexible program
Easily tailored to Easily tailored to your practiceyour practice
Evolving into a Evolving into a more continuous more continuous processprocess
Part 1 – Professionalism in Part 1 – Professionalism in PracticePractice
Valid, unrestricted medical licenseValid, unrestricted medical license
Disciplinary Action Notification SystemDisciplinary Action Notification System– DANS notifies ABP of egregious actions resulting in loss or restriction DANS notifies ABP of egregious actions resulting in loss or restriction
– ABP can revoke certification ABP can revoke certification
Part 2 – Lifelong Learning & Part 2 – Lifelong Learning & Self-AssessmentSelf-Assessment
BenefitsBenefits
OptionsOptions
Online Online accessaccess
CME creditCME credit
Part 3- Cognitive Expertise has Part 3- Cognitive Expertise has evolvedevolved
1993 - 20021969ABMS introduces
Recertification
1980-1991Closed Book
(voluntary)
1993-2002Open Book Exam
(every 7 years)
2003-presentSecure Exam(every 7 years)
2010+Secure Exam
(every 10 years)
MOC PointsADHD Performance Improvement Module 5
ADHD eQIPP Module* 15
Asthma Performance Improvement Module 5
Asthma eQIPP Module* 15
Nutrition eQIPP Module* 15
Vermont Oxford Network (Project 1)** 20
Vermont Oxford Network (Project 2)** 20
California Perinatal Quality Care Collaborative** 20
Blood Stream Infection Project** 20
*Developed and administered by the AAP; requires payment directly to AAP for access.**ABP-approved on-going quality improvement initiatives.
Part 4 Menu of Options Part 4 Menu of Options (example)(example)
Committed to Reducing Committed to Reducing RedundancyRedundancy
Joint CommissionJoint Commission – MOC as a – MOC as a surrogate for quality requirementssurrogate for quality requirements
PayersPayers – Working with 20+ payers to – Working with 20+ payers to encourage pay-for-improvementencourage pay-for-improvement
Medicaid/CMSMedicaid/CMS – Recognize MOC with – Recognize MOC with financial incentives/reimbursementfinancial incentives/reimbursement
Federation of State Medical BoardsFederation of State Medical Boards – Remove duplicate requirements; – Remove duplicate requirements; demonstrate how MOC meets 6 core demonstrate how MOC meets 6 core competenciescompetencies
Malpractice Carriers Malpractice Carriers – Reduce – Reduce malpractice premiums (the “Doctors malpractice premiums (the “Doctors Company” in CA)Company” in CA)
Role ofBoard
Certification
Goal: Align to reduce redundancy and accelerate improvement
Collaborating to Bring More ValueCollaborating to Bring More ValuePrimary Care Boards share resources, knowledge to:Primary Care Boards share resources, knowledge to:– jointly develop tools for MOCjointly develop tools for MOC
– present a united front to payers/health plans, regulators, and present a united front to payers/health plans, regulators, and accrediting bodiesaccrediting bodies
– advocate for meaningful recognition/pay-for-improvement programsadvocate for meaningful recognition/pay-for-improvement programs
Long-time AAP and ABP relationship produces results:Long-time AAP and ABP relationship produces results:– Jointly developed self-assessmentsJointly developed self-assessments
– eQIPP modules for improvement approved by the BoardeQIPP modules for improvement approved by the Board
– CME credit for participation in MOC starts in early 2008CME credit for participation in MOC starts in early 2008
Get Started Now: The Physician Get Started Now: The Physician PortfolioPortfolio
Secure personal Web account
abp.org
Questions?Questions?
For Information:For Information:
Jim Stockman, MDJim Stockman, MDPresident/CEOPresident/[email protected]
MOC CommitteeMyles B. Abbott, MD
Julian L. Allen, MD
Laura M. Brooks, MD
H. James Brown, MD
Christopher A. Cunha, MD
Aaron L. Friedman, MD
Hazen P. Ham, PhD
Kevin B. Johnson, MD
Sarah S. Long, MD
Thomas K. McInerny, MD
Paul V. Miles, MD
Robert H. Perelman, MD
Julie K. Stamos, MD
David K. Stevenson, MD
James A. Stockman III, MD
Michele J. Wall, MA
Financial ReportFinancial Report
At our inception in September of 2006, we At our inception in September of 2006, we received agreements for 2-3 years of received agreements for 2-3 years of support at $25,000/year from both support at $25,000/year from both AMSPDC and APPD (total of $50,000/yr).AMSPDC and APPD (total of $50,000/yr).First official financial and activity reports First official financial and activity reports were made to AMSPDC and APPD in the were made to AMSPDC and APPD in the first quarter of this calendar year, first quarter of this calendar year, approximately 15 months into this approximately 15 months into this arrangement. arrangement.
Financial ReportFinancial Report
Costs of activities are expected to increase as our Costs of activities are expected to increase as our activities broaden. We must work to minimize these activities broaden. We must work to minimize these costs to Council while moving forward with our agenda.costs to Council while moving forward with our agenda.In these reports, I outlined a number of potential In these reports, I outlined a number of potential mechanisms for CoPS to enhance its own support, mechanisms for CoPS to enhance its own support, including the initiation of a dues structure.including the initiation of a dues structure.Also outlined a philosophy of partnership with Also outlined a philosophy of partnership with organizations of FOPO while maintaining independence organizations of FOPO while maintaining independence to act as needed to represent subspecialty pediatric to act as needed to represent subspecialty pediatric needs.needs.
CommitmentCommitment
Task Force ReportsTask Force Reports
Fellowship Application ProcessFellowship Application Process
Fellowship Core CurriculumFellowship Core Curriculum
Advocacy Advocacy
Communications Communications
Relationships with Regulatory Relationships with Regulatory AgenciesAgencies
Pipeline/Reimbursement Pipeline/Reimbursement
Fellowship Application Task Force:Fellowship Application Task Force:CoPSCoPS
HawaiiHawaii
May 4, 2008May 4, 2008
The Charge and The MembersThe Charge and The Members
Task Force Charge:Task Force Charge:– Respond to the recommendations of FOPORespond to the recommendations of FOPO– Consider delaying the start of fellowship application Consider delaying the start of fellowship application
processprocess– Proposed date: Fall of the 3Proposed date: Fall of the 3rdrd year of Residency year of Residency
Co-Chairs:Co-Chairs:– Tom Abshire (Hematology-Oncology) (Hematology-Oncology)– Sharon Oberfield (Endocrinology) (Endocrinology)
Members:Members:– Judy Aschner (Neonatology) (Neonatology)– Chris Kennedy (Emergency Medicine) (Emergency Medicine)– Josef Neu (Neonatology) (Neonatology)– Steven Wassner (Nephrology) (Nephrology)
Task Force RecommendationsTask Force RecommendationsCurrent ERAS participantsCurrent ERAS participants– Dec date: GI, Heme Onc, Rheum, Dec date: GI, Heme Onc, Rheum, NephrologyNephrology, Neonatal, Neonatal– July date: ERJuly date: ER
Current Match participantsCurrent Match participants– Spring match dates: Rheum, Heme Onc, Spring match dates: Rheum, Heme Onc, CardiologyCardiology, GI, GI– Fall match date: Neonatal, Fall match date: Neonatal, Critical CareCritical Care, ER, ER
Encourage the use of ERAS for July 2009 academic Encourage the use of ERAS for July 2009 academic year (2010 ERAS cycle)year (2010 ERAS cycle)Consider two match dates to coincide with ERAS:Consider two match dates to coincide with ERAS:– 33rdrd week in May of 2nd yr of residency week in May of 2nd yr of residency– 11stst week of December of 3rd yr of residency week of December of 3rd yr of residency
Offer date coincides with one of two match datesOffer date coincides with one of two match datesEvaluate yearlyEvaluate yearly
Questionnaire to CoPS Questionnaire to CoPS RepresentativesRepresentatives
Focus first on ERASFocus first on ERAS
Should fellowship programs utilize ERAS?Should fellowship programs utilize ERAS?If so, what release date?If so, what release date?
– December 1 (19 mos prior to starting December 1 (19 mos prior to starting fellowship)fellowship)
– July 15th (11 1/2 mos prior)July 15th (11 1/2 mos prior)
Should there be a match (NRMP)?Should there be a match (NRMP)?– If so, which date?If so, which date?– Spring of 2nd yr (May, 14 mos prior)Spring of 2nd yr (May, 14 mos prior)– Fall of 3rd yr (November, 8 mos prior)Fall of 3rd yr (November, 8 mos prior)
Survey: ERAS ParticipationSurvey: ERAS Participation
Academic Peds: noAcademic Peds: no - Genetics: no- Genetics: no
* Adol Med: no* Adol Med: no -- Heme Onc: yesHeme Onc: yes
Allergy/Immunol: yesAllergy/Immunol: yes - * - * ID: noID: no
Cardiology: noCardiology: no - Neonatal: yes- Neonatal: yes
Child Abuse: noChild Abuse: no - Nephrology: yes- Nephrology: yes
Child Psych: no responseChild Psych: no response - Neurology: no- Neurology: no
* Critical care: no* Critical care: no - Pulmonary: no- Pulmonary: no
Derm: noDerm: no - Rheumatology: yes- Rheumatology: yes
Developmental: noDevelopmental: no - ER: yes- ER: yes
* Endocrine: no* Endocrine: no - GI: yes- GI: yes
* Subspecialties in bold have interest in ERAS
B Li, Joe Neu
Judith Campbell, Mary-Ann Shafer, Steve Feig
CoPS Task Force on Fellowship Core Curriculum
B Li, Joe Neu
Judith Campbell, Mary-Ann Shafer, Steve Feig
CoPS Task Force on Fellowship Core Curriculum
Fellowship Core Curriculum:
Current issues
Fellowship Core Curriculum:
Current issues
Outline
How do we meet the ABP requirements? Do we go beyond it?
Fewer Gen-X fellows want the research path – do we need additional tracks?
How do we document competence?
Questions for the task force
Fellows core curriculum – < 5
Increasing mandated requirements
Less duplication between divisions
More efficient – in light of work hour restrictions
Use best people in department
Provide wider array of topics and skill development – career counseling, administrative and leadership skills
ABP Scholarly Requirements –
Biostatistics, research methods, design
Prep for applications to IRB, for funding
Critical literature review, EBM
Ethical principles – in research
Teaching skills – principles of adult learning , teaching, curriculum development, provision of feedback and assessment (in a variety of settings)
ACGME 6 core competencies + …
Patient care
Medical knowledge
Interpersonal skills (IS)
Professionalism (P)
Practice-based learning (PBL)
Systems-based learning (SBL)
Teaching skills
Scholarly skills
Other
Administrative
Leadership
Career development
Career counseling
Personal planning
The future – fellowship tracks?
Pediatric Pediatric FellowFellow
Lab/trans Lab/trans researchresearch
Clinical Clinical researchresearch EducationEducation
Quality &Quality &Admini-Admini-strativestrative
Other: Other: ethics, ethics,
health policy health policy
NIH-NIH-funded funded
researcherresearcher
NIH- & NIH- & non-NIH non-NIH
researcherresearcher
Clinician Clinician educatoreducator
Clinician Clinician admini-admini-stratorstrator
Clinician Clinician ++
How to implement?
Local strategies
– Coalesce current institutional offerings
– Develop new coordinated core curriculum
– Place curriculum on intranet (ANGEL)
National strategies
– Develop shared web-based curricula
– Increase offerings at PAS
How to document competence?
Record attendance
Pass local exam
Develop skill-based criteria
Pass national exam – 7% of ABP sub-specialty exam in 2010 will cover scholarly
Combinations of above
QuestionsWhat are the key FCC elements within the 6 core competencies, teaching & scholarly curriculum, as well as outside it?
What is most useful strategy for pediatric departments that don’t have a ‘super’ fellowship core curriculum director?
What is an effective yet practical approach to documenting competence?
Example format: 2 hour sessions
Introduction – background, why important
Didactic overview ( 30 min) or panel discussion (1 hr)
Small group exercise or Q&A (1 hr)– Case-based scenario, exercise, role playing
Present solution to entire group (15 min)
Evaluation – identify top 3 points learned
Faculty debriefing
Advocacy Task Force
Charge
Determine ways in which CoPS can be proactive in promoting child health and subspecialty activities
Fine Print
The term "advocacy" is used broadly here, meaning not just representing ourselves to Congress and state legislatures, or speaking out publicly when necessary, but also to insure our participation with other organizations that make decisions pertinent to our patients and our subspecialties. Developing a standing approach to advocacy would thus permit CoPS to anticipate issues of importance to us and to influence their resolution.
MembersH. William SchnaperRobert PerelmanMarianne FeliceRobert McGregorRichard Martini*Daniel Lee CourySharon E. OberfieldB U.K. LiThomas AbshireJudy L. AschnerAnn TiltonMichael HenricksonChris Harrison
“Target” Organizations
FOPO organizations
“Adult” subspecialty societies
Government agencies– Local– State– Federal
The Public
Issues to Consider
Funding of pediatric research and training grants
GME, especially for fellow training
Federal and state children's health care plans
Pharmaceutical/device industry interactions with academic medicine
Billing/coding/reimbursement
Linking of Quality of Care to reimbursement
Transition between pediatric and adult care: Medical Homes
Modus Operandi
Model activities from pediatric subspecialty societies with strong advocacy programs
Collaborate with AAP, which has well-developed advocacy program
Also, work with corresponding “adult” subspecialty societies
Yet seek to find our own “voice”
Develop a list of priorities based upon both our greatest needs and synergy with other organizations
Operational Concerns
We need to be comprehensive in our analysis of the issues but focused in our choice of priorities
We also should seek synergy with other pediatric organizations
It has been difficult to elicit a response after several e-mails
We need to select a more permanent task-force chair who is a voting member of CoPS
Communications Task ForceCommunications Task Force
Richard Mink, ChairRichard Mink, Chair
James BaleJames Bale
Judith CampbellJudith Campbell
Gail McGuinnessGail McGuinness
Paul MoorePaul Moore
Bruce BostonBruce Boston
James PerrinJames Perrin
David RubinDavid Rubin
Bruder StapletonBruder Stapleton
Donald VernonDonald Vernon
Steven WassnerSteven Wassner
Committee ChargeCommittee Charge
to address the core needs of our to address the core needs of our organization to communicate effectively organization to communicate effectively with ourselves and the memberships of with ourselves and the memberships of our constituent subspecialties. our constituent subspecialties.
CoPS Communication SurveyCoPS Communication Survey
39 respondents39 respondents– some incompletesome incomplete– 36 voting members36 voting members– 3 non-voting members3 non-voting members
22 (56%) program directors22 (56%) program directors
At least one representative from every At least one representative from every subspecialty except Child Psychiatrysubspecialty except Child Psychiatry
Number of OrganizationsNumber of OrganizationsHow many different organizations/sections/ How many different organizations/sections/ associations represent your subspecialty?associations represent your subspecialty?
Membership in OrganizationsMembership in OrganizationsAre ALL subspecialists a member of at least one Are ALL subspecialists a member of at least one of these organizations? of these organizations?
•For “NO”–5: more than 95%–12: 75%-95%–2: 50%-74%
Communication with LeadersCommunication with LeadersDo you think that if CoPS corresponded through Do you think that if CoPS corresponded through the leaders of these organizations, information the leaders of these organizations, information would reliably be communicated to all members?would reliably be communicated to all members?
Program Director OrganizationsProgram Director OrganizationsDoes your subspecialty have an organization or Does your subspecialty have an organization or association dedicated to fellowship program directors? association dedicated to fellowship program directors? If so, are ALL Program Directors members?If so, are ALL Program Directors members?
PD Communication with LeadersPD Communication with LeadersDo you think that information communicated by CoPS Do you think that information communicated by CoPS to the leader(s) of the organization(s) would be reliably to the leader(s) of the organization(s) would be reliably distributed to the subspecialty program directors?distributed to the subspecialty program directors?
Communication with Leaders/PDsCommunication with Leaders/PDsWould you prefer that CoPS communicate directly with Would you prefer that CoPS communicate directly with the Program Directors or should all fellowship information the Program Directors or should all fellowship information be distributed by the leader of the organization, if one be distributed by the leader of the organization, if one exists?exists?
Communication of Fellowship Task Communication of Fellowship Task Force RecommendationsForce Recommendations
The Fellowship Application Task force distributed a draft of The Fellowship Application Task force distributed a draft of their recommendations prior to the fall meeting. Did you their recommendations prior to the fall meeting. Did you circulate this proposal to the Program Directors in your circulate this proposal to the Program Directors in your subspecialty prior to the meeting? After the meeting?subspecialty prior to the meeting? After the meeting?
Who Should CoPS Represent?Who Should CoPS Represent?In your opinion, should CoPS communicate with all In your opinion, should CoPS communicate with all members of the specialty, even those that are not members of the specialty, even those that are not members of one of the subspecialty organizations? members of one of the subspecialty organizations?
Initial RecommendationsInitial Recommendations
communicate with all subspecialistscommunicate with all subspecialists
use e-mail as the predominate method of use e-mail as the predominate method of communicationcommunication– brief newsletters 2-3 times/yearbrief newsletters 2-3 times/year
targeted communication to leaders of targeted communication to leaders of organizations and/or fellowship program organizations and/or fellowship program directorsdirectors
Dues Structure?Dues Structure?
Departmental dues - $1,500 (5+ divisions)Departmental dues - $1,500 (5+ divisions)
Divisional dues - $300 (any division with training program)Divisional dues - $300 (any division with training program)
Individual dues - $100 Individual dues - $100
Societal dues - $3,000 Societal dues - $3,000
ASP currently has 922 members representing 78 medical schools and affiliated teaching hospitals:
875 departmental members representing 55 departments of internal medicine and 603 divisions.
43 divisional members representing 27 divisions. 15 societal members representing internal medicine specialty societies.
Dues Structure?Dues Structure?
IssuesIssues– Goal setting: x% self-supporting by 20??.Goal setting: x% self-supporting by 20??.– Have’s vs. have not’sHave’s vs. have not’s– Multiple organizationsMultiple organizations– Avoiding double-dipping (AMSPDC)Avoiding double-dipping (AMSPDC)
New “projects”New “projects”
OPDAOPDA
Transition from residency to fellowship Transition from residency to fellowship (timeline).(timeline).
Workforce evaluationsWorkforce evaluations
Medical homeMedical home
Pedialink revampPedialink revamp
Division head trainingDivision head training
OPDAOrganization of Program Director Organizations
Council of Medical Specialty Societies
OPDA
Promote the role of the residency director and residency program director societies in achieving
excellence in graduate medical education
OPDAPeer interaction
Information sharing
Collaborative problem solving
Meetings on GME issues
Reports from AAMC, ACGME, NRMP, NBME, ECFMG, etc.
Meet in March and November at O'Hare
OPDA
OPDA representative on NRMP Board of Directors
Ex-officio representative on ACGME Council of Review Committee Chairs
Fall meeting infoFall meeting info
Tuesday, September 16, 9am – 5pm Wednesday, Tuesday, September 16, 9am – 5pm Wednesday, September 17, 8am - 3pmSeptember 17, 8am - 3pm
Alexandria, VA Alexandria, VA
(prior to APPD's meeting September 18-19)(prior to APPD's meeting September 18-19)
• $225 registration fee$225 registration fee• Travel costs on ownTravel costs on own• 100% representation100% representation