New Certification Requirements

Michelle DiBaise, MPAS, PA-C, DFAAPA

New Certification Requirements: strategic threats and opportunities to your CME programs

1. Understand the changes to certification maintenance requirements. 2. Indentify tools and resources available to help your members

understand certification of maintenance changes. 3. Discussion of the threats that will arise to your CME program as a

result of new certification maintenance changes. 4. Identify opportunities for PI-CME activities that can be integrated

with practice, local and state level quality improvement initiatives5. Provide feedback about the Academy’s strategic plan around

certification maintenance changes. 6. Recognize and integrates opportunities into your strategic plan in

the following three areas: e- learning, self assessment, PI-CME

Understand the changes to certification maintenance requirements

Current Maintenance Requirements

• Every two years - CME

50 Category 2CME

50 Category 1 CME

• Every 6 years - PANRE Se-ries

1 0 1 2 3 4 5 6

Cycle 1Cycle 2Cycle 3

Certification Maintenance Changes

Beginning 2014, two major changes:

• Recertification exam cycle extended to 10 years

I I I IYear - 0 2 4 6

I I8 10 (PANRE)

Cycle - 1 2 3 4 5

Certification Maintenance Changes

• 20 Category 1 Credits must be earned through directed CME

• Performance Improvement CME

And/Or• Self-assessment CME

Series1

30

20

2 Year CME Cycle Requirement

Self-assessment and PI-CME

Traditional Cat. 1 CME

PI-CME• 2001 – AMA Task Force on PI-CME

– Developed criteria, parallel systems adopted by AAFP and AOA

• Integrating QI concepts– Quality/Performance Measures (EBM concepts)– Measuring Baseline Performance– Interventions– Re-measurement

CME Credit for PIThree stages for CME credit:

A Identify evidence-based measure and assess practiceB Intervention(s)C Re-measure; document improvement

5 CME credits/stage; 20 for complete project

PI-CME Stage ALearning from current practice performance assessment

• Assess current practice using identified performance measures

• Chart reviews or some other appropriate mechanism

• Participants should be actively involved in analysis of collected data– Key to understanding causes of variations in performance

– Key to selecting the best intervention

PI-CME Stage BLearning from the application of PI to patient care

• Implement an intervention designed to improve on the performance measures selected in Stage A

• The PI-CME activity and faculty should provide guidance for selecting & tracking the applied intervention

• Intervention should be specific to the participant’s practice setting and patient base

PI-CME Stage C Learning from the evaluation of the PI CME effort

• Re-assess and reflect on performance in practice measured after the implementation of the intervention(s) in Stage B

• Compare to the assessment done in Stage A using the same performance measures.

• Summarize any practice, process and/or outcome changes that resulted from the PI CME activity.

What is Self-Assessment?

• NCCPA Definition:– The process of conducting a systematic review of

one’s own performance, knowledge base or skill set, usually for the purpose of improving future performance, expanding knowledge or honing skills

Role of Self-Assessment in CPD

Miller’s Pyramid of Clinical Competence

Behavior

CognitionFocus of Self-Assessment

Who is affected and when?2014 • PAs whose current 6 year cycle ends in 2014

• New graduate PAs who pass PANCE in 2014

2015 • PAs whose current 6 year cycle ends in 2015• New graduate PAs who pass PANCE in 2015

2016 • PAs whose current 6 year cycle ends in 2016• New graduate PAs who pass PANCE in 2016

2017 • PAs whose current 6 year cycle ends in 2017• New graduate PAs who pass PANCE in 2017

2018 • PAs whose current 6 year cycle ends in 2018• Newly Graduate PAs who pass PANCE in 2018

2019 • PAs whose current 6 year cycle ends in 2019• Newly Graduate PAs who pass PANCE in 2019

2020 • Fully Implemented for all certified PAs

1/6 of PA population or ~20,000 PAs*

1/3 of PA population or ~40,000 PAs

1/2 of PA population or ~60,000 PAs

2/3 of PA population or ~80,000 PAs

5/6 of PA population or ~100,000 PAs

Total PA population or ~120,000 PAs

*Assumes 6,000 new graduates and 14,000 recertifying PAs (1/6 of the certified population) per year

Who is involved in the change of certification maintenance process? Why is this changing?

Set New Requiremen

ts

Establish

Criteria

Develop & Provi

de CME Activities

Notify & Support PAs

Document &

Report

PA and Physician Specialty Organizations, Medical Education Companies

Collaborative Development of Review Criteria

• Convened “Certification Maintenance Advisory Panel”– Professional Education Commission, Greg Thomas, PA (NCCPA), Nancy Davis,

PhD (NIQIE), Bernie Stuetz PA-C, Staff

CHARGE

• Establish accreditation review criteria that will be the basis for judging what is acceptable for self assessment and PI-CME requirements.

• Make a recommendation about how to apply the review criteria to non-clinical settings

Completed over last 4 months, criteria and recommendation on non-clinical settings to be delivered to NCCPA in coming weeks

Criteria common to both PI-CME and Self Assessment

• Meaningful

• Practical

• Harmonization with other medical specialty boards

• Values team based collaboration with physician and other members of the healthcare team

• Modularized approaches are acceptable. 20 hours of a combination of PI-CME and/or Self Assessment CME will be the basis of the 2 year requirement with a completion of 40 hours of each type within an 8 year cycle. This encourages linkage between self assessment and PI-CME, and selecting activities that are practical for the practice setting.

Non-Clinical Recommendation• Practice setting and activities defined as those that contribute to

improved patient safety or healthcare quality either directly or indirectly– Teaching– Administrative leadership in a healthcare setting or PA professional

association setting– Additional practice settings approved by PEC

• Align with 6 competencies• Directly or Indirectly improves the health of the public

What are you hearing?

• Angst?• Enthusiasm?• Uncertainty?• Ambivalence?

We need to understand how the changes are perceived by PAs and why they feel that way in order to capitalize on the opportunity

Indentify tools and resources available to help your members understand certification of maintenance

changes

Resources

• AAPA website• NCCPA website• NCCPA personal certification record (“my record”) to check

individual transition timeline:Transition to the New Certification Maintenance Process “Your first 10-year certification maintenance cycle will begin with the 2018 - 2020 cycle, at which time new CME requirements will go into effect for you. Read more about the new process.”

Resources• AAFP, “Understanding METRIC and Performance Improvement”

MeasuringEvaluating and Translating Research Into Care

• AAP, Education in Quality Improvement for Pediatric Practice (EQIPP)• ACP, Medical Knowledge Self Assessment Program (MKSAP)• AOA, Clinical Assessment Program• Local health care delivery systems – quality improvement initiatives