MAINTENANCE OF CERTIFICATIONMAINTENANCE OF CERTIFICATION Part IV Part IV

Practice Performance and ImprovementPractice Performance and Improvement

David L. Gillespie MD, FACS

Professor of SurgeryUniversity of Rochester School of Medicine and Dentistry

Rochester, NY

The American Board of SurgeryThe American Board of Surgery

Maintenance of CertificationMaintenance of Certification

ongoing process ongoing process

continuous improvementcontinuous improvement

Surgeons must demonstrate a program of Surgeons must demonstrate a program of ongoing learningongoing learning

professional assessment professional assessment

self improvement self improvement

Facilitates maintaining expertise within Facilitates maintaining expertise within specialty specialty

The American Board of SurgeryThe American Board of Surgery

Maintenance of CertificationMaintenance of Certification

patient centered initiativepatient centered initiative

demonstrate high degree of demonstrate high degree of professionalismprofessionalism

improve patient care improve patient care

address concerns of public about quality address concerns of public about quality

will strengthen the value of Board will strengthen the value of Board certification  certification  

The American Board of SurgeryThe American Board of Surgery

Maintenance of Certification Maintenance of Certification (“MOC”):     (“MOC”):     

1) 1) Demonstration of Current Professional StandingDemonstration of Current Professional Standing• every 3 years, unrestricted License, privileges to every 3 years, unrestricted License, privileges to

practice, letter of attestation practice, letter of attestation

2) Demonstration of Lifelong Learning and Self 2) Demonstration of Lifelong Learning and Self AssessmentAssessment

• 50 CME credits per year, demonstrate self assessment 50 CME credits per year, demonstrate self assessment

3) Demonstration of Cognitive Expertise3) Demonstration of Cognitive Expertise• recertification examination, once every TEN (10) years.recertification examination, once every TEN (10) years.

4) Evaluation and Improvement of Performance in 4) Evaluation and Improvement of Performance in Practice Practice

The American Board of SurgeryThe American Board of Surgery

Maintenance of Certification Maintenance of Certification (“MOC”):     (“MOC”):     

1) Demonstration of Current Professional Standing1) Demonstration of Current Professional Standing• every 3 years, unrestricted License, privileges to every 3 years, unrestricted License, privileges to

practice, letter of attestationpractice, letter of attestation

2) 2) Demonstration of Lifelong Learning and Self Demonstration of Lifelong Learning and Self AssessmentAssessment

• 50 CME credits per year, demonstrate self assessment50 CME credits per year, demonstrate self assessment

3) Demonstration of Cognitive Expertise3) Demonstration of Cognitive Expertise• recertification examination, once every TEN (10) years.recertification examination, once every TEN (10) years.

4) Evaluation and Improvement of Performance in 4) Evaluation and Improvement of Performance in Practice Practice

The American Board of SurgeryThe American Board of Surgery

Maintenance of Certification Maintenance of Certification (“MOC”):     (“MOC”):     

1) Demonstration of Current Professional Standing1) Demonstration of Current Professional Standing• every 3 years, unrestricted License, privileges to every 3 years, unrestricted License, privileges to

practice, letter of attestation practice, letter of attestation

2) Demonstration of Lifelong Learning and Self 2) Demonstration of Lifelong Learning and Self AssessmentAssessment

• 50 CME credits per year, demonstrate self assessment 50 CME credits per year, demonstrate self assessment

3) 3) Demonstration of Cognitive ExpertiseDemonstration of Cognitive Expertise• recertification examination, once every TEN (10) years. recertification examination, once every TEN (10) years.

4) Evaluation and Improvement of Performance in 4) Evaluation and Improvement of Performance in Practice Practice

The American Board of SurgeryThe American Board of Surgery

Maintenance of Certification Maintenance of Certification (“MOC”):     (“MOC”):     

1) Demonstration of Current Professional Standing1) Demonstration of Current Professional Standing

• every 3 years, unrestricted License, privileges to every 3 years, unrestricted License, privileges to practice, letter of attestationpractice, letter of attestation

2) Demonstration of Lifelong Learning and Self 2) Demonstration of Lifelong Learning and Self AssessmentAssessment

• 50 CME credits per year, demonstrate self 50 CME credits per year, demonstrate self assessment assessment

3) Demonstration of Cognitive Expertise3) Demonstration of Cognitive Expertise

• recertification examination, once every TEN (10) recertification examination, once every TEN (10) years.years.

4) 4) Evaluation / Improvement of PracticeEvaluation / Improvement of Practice PerformancePerformance

The American Board of SurgeryThe American Board of Surgery

Part IV MOCPart IV MOCPractice Performance and Practice Performance and

Improvement Improvement

Verification required every three (3) yearsVerification required every three (3) years

involved in one or more assessment involved in one or more assessment programsprograms

focus on analysis of practice performance focus on analysis of practice performance

quantitative assessment quantitative assessment

Use info gained for performance Use info gained for performance improvement improvement

The American Board of SurgeryThe American Board of Surgery

Requirements are subject of active Requirements are subject of active discussion discussion by the ABS, ACS, SVS, SCVSby the ABS, ACS, SVS, SCVS

unclear what programs will qualify unclear what programs will qualify To show Performance Evaluation/ImprovementTo show Performance Evaluation/Improvement

will be more than participation in M&Mwill be more than participation in M&M

Part IV MOCPart IV MOCPractice Performance and Practice Performance and

Improvement Improvement

The American Board of SurgeryThe American Board of Surgery

Part IV MOC- Practice Part IV MOC- Practice Performance and Improvement – Performance and Improvement –

Some examples which might apply include Some examples which might apply include participation in Quality Outcome projects such participation in Quality Outcome projects such

as as

• National Surgical Quality Improvement Project National Surgical Quality Improvement Project (NSQIP), (NSQIP),

• Surgical Care Improvement Project (SCIP) Surgical Care Improvement Project (SCIP)

practice databases such as those being practice databases such as those being developed through developed through

• the ACS web portal the ACS web portal

• the SVS carotid database the SVS carotid database

The American Board of SurgeryThe American Board of Surgery

Part IV MOC- Practice Part IV MOC- Practice Performance and Improvement –Performance and Improvement –

Participation in NSQIP (National Surgery Quality Participation in NSQIP (National Surgery Quality Improvement Program)Improvement Program)

The American Board of SurgeryThe American Board of Surgery

Part IV MOC- Practice Part IV MOC- Practice Performance and Improvement –Performance and Improvement –

NSQIP (National Surgery Quality Improvement Program)NSQIP (National Surgery Quality Improvement Program)

Grew out of the National VA Surgical Risk Study 1991Grew out of the National VA Surgical Risk Study 1991

now offered to all interested hospitalsnow offered to all interested hospitals

2004 ACS began enrolling 2004 ACS began enrolling

• new private sector hospitals into the ACS NSQIP new private sector hospitals into the ACS NSQIP

The American Board of SurgeryThe American Board of Surgery

Part IV MOC- Practice Part IV MOC- Practice Performance and Improvement –Performance and Improvement –

NSQIP (National Surgery Quality Improvement Program)NSQIP (National Surgery Quality Improvement Program)

The ACS NSQIP is available to all private sector hospitals that The ACS NSQIP is available to all private sector hospitals that

• meet the minimum participation requirements, meet the minimum participation requirements,

• complete a hospital agreement, complete a hospital agreement,

• pay an annual fee of $35,000. pay an annual fee of $35,000.

Many benefits by participating Many benefits by participating

• most importantly reduction of surgical morbidity and mortality most importantly reduction of surgical morbidity and mortality

VA NSQIP will continue in parallel system VA NSQIP will continue in parallel system

• will compare its results against the ACS NSQIP private sector datawill compare its results against the ACS NSQIP private sector data

The American Board of SurgeryThe American Board of Surgery

Part IV MOC- Practice Part IV MOC- Practice Performance and Improvement –Performance and Improvement –

Participation in SCIP (Surgical Care Improvement Project)Participation in SCIP (Surgical Care Improvement Project)

The American Board of SurgeryThe American Board of Surgery

Part IV MOC- Practice Part IV MOC- Practice Performance and Improvement –Performance and Improvement –

SCIP (Surgical Care Improvement Project)SCIP (Surgical Care Improvement Project)

A national quality partnership of organizations A national quality partnership of organizations

improving surgical care by reducing surgical complicationsimproving surgical care by reducing surgical complications

Steering committee ACS, CMS, AHA, ASA, AORN, CDC, AHRQSteering committee ACS, CMS, AHA, ASA, AORN, CDC, AHRQ

Goal: reduce preventable surgical M&M by 25 % by the 2010Goal: reduce preventable surgical M&M by 25 % by the 2010

Hospitals can join SCIP to collect and submit dataHospitals can join SCIP to collect and submit data

Hospitals that wish to sign up to participate in SCIP Hospitals that wish to sign up to participate in SCIP

• complete Hospital Letter of Participation and fax itcomplete Hospital Letter of Participation and fax it

The American Board of SurgeryThe American Board of Surgery

SCIP has four modulesSCIP has four modules InfectionInfection

• 7 Infection Prevention Process Measures7 Infection Prevention Process Measures Venous Thromboembolus (VTE)Venous Thromboembolus (VTE)

• 2 VTE Prevention Process Measures2 VTE Prevention Process Measures Cardiac Prevention ModuleCardiac Prevention Module

• 1 Cardiovascular Prevention Measure1 Cardiovascular Prevention Measure RespiratoryRespiratory

• Delayed implementation to use these measure Delayed implementation to use these measure in expanding the ICU Core Measure Setin expanding the ICU Core Measure Set

Part IV MOC- Practice Part IV MOC- Practice Performance and Improvement –Performance and Improvement –

The American Board of SurgeryThe American Board of Surgery

Part IV MOC- Practice Part IV MOC- Practice Performance and Improvement – Performance and Improvement –

Some examples which might apply include Some examples which might apply include participation in Quality Outcome projects such participation in Quality Outcome projects such

as as

• National Surgical Quality Improvement Project National Surgical Quality Improvement Project (NSQIP), (NSQIP),

• Surgical Care Improvement Project (SCIP) Surgical Care Improvement Project (SCIP)

practice databases such as those being practice databases such as those being developed through developed through

• the ACS web portal the ACS web portal

• the SVS carotid database. the SVS carotid database.

The American Board of SurgeryThe American Board of Surgery

Part IV MOC- Practice Part IV MOC- Practice Performance and Improvement –Performance and Improvement –

ACS Practice Based Learning System (case log system)ACS Practice Based Learning System (case log system)

The American Board of SurgeryThe American Board of Surgery

Part IV MOC- Practice Part IV MOC- Practice Performance and Improvement –Performance and Improvement –

ACS case log systemACS case log system

allows surgeons to track their cases and outcomes allows surgeons to track their cases and outcomes

convenient easy-to-use. convenient easy-to-use.

Can compare personal outcomes to others Can compare personal outcomes to others confidentiallyconfidentially

opportunities for training from learning modules opportunities for training from learning modules

The American Board of SurgeryThe American Board of Surgery

Part IV MOC- Practice Part IV MOC- Practice Performance and Improvement –Performance and Improvement –

ACS case log systemACS case log system

The American Board of Surgery has The American Board of Surgery has • identified Practice Based Learning and Improvement as a core competency. identified Practice Based Learning and Improvement as a core competency.

in the future the case logging system could support in the future the case logging system could support • submission of case logs for maintenance of certification (MOC).submission of case logs for maintenance of certification (MOC).

open only to members of the American College of Surgeons. open only to members of the American College of Surgeons.

To register for the system you will need to log in to the ACS Web site.To register for the system you will need to log in to the ACS Web site.

The American Board of SurgeryThe American Board of Surgery

Part IV MOC- Practice Part IV MOC- Practice Performance and Improvement –Performance and Improvement –

SVS carotid databaseSVS carotid database

The American Board of SurgeryThe American Board of Surgery

Part IV MOC- Practice Part IV MOC- Practice Performance and Improvement –Performance and Improvement –

SVS carotid databaseSVS carotid database

ensures eligibility for CAS reimbursement.ensures eligibility for CAS reimbursement. • CMSCMS require data collection on CAS for reimbursement require data collection on CAS for reimbursement

offers confidential benchmarking reportsoffers confidential benchmarking reports• Site-specific CEA vs. CAS baseline risk factors and complicationsSite-specific CEA vs. CAS baseline risk factors and complications

over time in your facility.over time in your facility. to other institutions to other institutions by individual providerby individual provider

"Real time" access to all your data for analysis."Real time" access to all your data for analysis.

The American Board of SurgeryThe American Board of Surgery

Part IV MOC- Practice Part IV MOC- Practice Performance and Improvement –Performance and Improvement –

SVS carotid databaseSVS carotid database

Facility benefitsFacility benefits• available nowavailable now• easy-to-useeasy-to-use• cost-effective way to meet CMS regulations for CAScost-effective way to meet CMS regulations for CAS• downloadable databasedownloadable database• Collection of ongoing follow-upCollection of ongoing follow-up• Collects both stenting and open repair data for comparison. Collects both stenting and open repair data for comparison. • Real-time comparative reports.Real-time comparative reports.

one-time enrollment fee of $1,000 one-time enrollment fee of $1,000 annual subscription fee of $3,000annual subscription fee of $3,000

The American Board of SurgeryThe American Board of Surgery

Part IV MOC- Practice Part IV MOC- Practice Performance and Improvement –Performance and Improvement –

The ABS is investigating other data systemsThe ABS is investigating other data systems

PersonalPersonal

national, national,

regional, regional,

hospital-specific hospital-specific

and is soliciting input and is soliciting input

e-mail at e-mail at mocpart4@absurgery.orgmocpart4@absurgery.org

The American Board of SurgeryThe American Board of Surgery