continued on page 2

When we originally conceptualized and created Maintenance of Certifi cation for Family Physicians (MC-FP) in 2003, we did so with the commitment that we would rigorously study the impact that it had on the care that family physicians delivered. While the ABFM had obviously conducted and published previous research on its examination, it did not possess the infrastructure nor the resources to support a “research shop” capable of the day-to-day work that would make this commitment a reality. Th erefore, as part of its strategic planning process in 2005 and 2006, our Board of Directors made a strategic commitment that research would become part of the ethos of the ABFM and would be supported with the necessary fi nancial and human resources to make it a successful undertaking.

Armed with this strategic directive, in 2007 we immediately began a search for a full-time research director who would help us create the infrastructure necessary to conduct high quality research to answer the questions we had about our burgeoning MC-FP enterprise. However, as we moved well into the transition from our old recertifi cation paradigm into MC-FP, an interesting thing happened as we undertook the search for this person.

We had many well-qualifi ed applicants apply for the position; but as they scrutinized the job, none of them were willing to accept the challenge. Why, you might ask, would some well-qualifi ed candidate not be interested in a position and a strategic direction that had strong support from our Board of Directors and more than suffi cient funding to guarantee success? Th e answer was rather simple; we had no track record and no attractive research portfolio!

So we moved to Plan B. We sought an external collaborator that would help us jump start our fl edgling research enterprise and create a robust portfolio that would attract an eminent researcher to grow it. We found willing partners in our colleagues from the Robert Graham Center, and we executed a three-year contract with them near the end of 2008. We renewed that contract for another three years earlier this year.

What a wonderful relationship we have created with the Graham Center as a result of these agreements. With a cadre of talented health services researchers, superb research analysts and geospatial information system experts, we have found a committed group of collaborators who have assisted us in beginning to answer some of the important questions that we have about MC-FP. And what has this initial work revealed?

Our fi rst study reported your experience with the fi rst 7000 Diabetes and Hypertension Self-Assessment Modules (SAMs) you completed in the fi rst year of MC-FP and revealed that you found them highly educational and, more importantly, that more than half of you changed the way you practiced as a result of completing a SAM. Th is work led us to ask the question of who was participating in MC-FP and completing SAMs, and we used the 2006 MC-FP cohort (those entering MC-FP in 2006) to answer this question. We found, much to our surprise, that rural family physicians were just as likely to have met their MC-FP requirements as those in metropolitan areas (we had originally hypothesized that rural physicians would be disadvantaged by lack of suffi cient broadband access). However, physicians practicing in areas of dense poverty and underserved areas were less likely to have completed their requirements.

We wondered whether these fi ndings were a phenomenon of just this unique cohort or whether they applied to the larger universe of all family physicians participating in MC-FP, so our next study with our Graham Center colleagues looked at all of our board-certifi ed Diplomates. It showed that 91% of you were participating in MC-FP and confi rmed the fi ndings from our smaller study. Participation was not diff erent along the urban-rural continuum, but did diff er signifi cantly in areas of unmet need and poverty.

Given that participation in MC-FP was so high (it even exceeded our expectations), we sought to determine whether we could begin to discern diff erences in the quality of care delivered by those that were participating versus those that were not. We initially attempted to use Medicare claims data to answer this question, but we quickly realized the methodological challenges of doing so given the insuffi cient size of the Medicare data set to which we initially had access. We began exploring purchasing a larger data set, and while waiting to do so, wondered whether we could use the AAFP’s National Research Network (NRN), a practice-based research network, to gather quality data.

A unique subset of practices exists within the NRN that uses electronic health records that are tied to a common data aggregation mechanism. We entered into a contract with them to conduct a proof of concept study to explore whether we could use the data aggregation system to extract quality information that was tied to physicians who had either completed a Diabetes SAM or Performance in Practice Module (PPM), had completed a diff erent SAM or PPM, or had completed no modules. A

A Message from the PresidentJames C. Puff er, M.D.

Summer 2012

T H E P H O E N I X A D i p l o m a t e s ’ N e w s l e t t e r

American Board of Family Medicine, Inc.

continued from page 1

2

A Message from the President

manuscript is in preparation describing the results of this study, so I cannot share them here with you yet. However, suffi ce it to say that I think we received our money’s worth with this study! Th e methodology in this study nicely complements research that we published last year utilizing prevention quality indicators (PQIs) for diabetes and asthma created by the Agency for Health Care Research Quality (AHRQ) to assess the quality of care provided over time in counties throughout the state of Kentucky. Th us, we have now explored two promising methodologies to study quality and its relationship to MC-FP and will explore a third as soon as we acquire the larger Medicare claims data set with the assistance of the Graham Center.

In addition to the research described above, we have other work that has been submitted for publication or which is in progress. Th is includes work demonstrating the infl uence of participation in MC-FP on medical knowledge as measured by our exam, the results from our fi rst 7000 completed Diabetes PPMs, the eff ectiveness of SAMs in introducing new practice guidelines to family physicians, the factors that facilitated participation in group MC-FP Part IV activity, and the performance on asthma questions on the ABFM examination and its correlation with emergency department visits for asthma exacerbation.

While much of this work has been done internally or in collaboration with our colleagues from the Graham Center and the AAFP NRN, we have also developed some wonderful collaborative relationships with the National Heart, Lung and Blood Institute, colleagues in the Virginia AAFP state chapter, and researchers at Case Western Reserve University.

So given the expansion of our research endeavors, where are we with the recruitment of our full-time research staff ? In this issue of the Phoenix, we introduce you to three recently recruited new ABFM employees who will create the nucleus of our research division. Bob Phillips, current Director of the Robert Graham Center, will join us in September as Vice President of Research and Policy; Lars Peterson, a promising health services researcher and Pisacano Scholar, will assume the position of Research Director on August 1st; and Alethea Bernard, with over 10 years of experience with health care quality improvement research, began work as our Research Analyst in May.

Elsewhere in this issue, read about our newly elected offi cers and new Directors, including our fi rst ever public Director; let us introduce you to Sean David, our fi rst Puff er/ABFM Fellow at the Institute of Medicine; bring yourself up to date with our

new Board Eligibility and Professionalism, Licensure and Personal Conduct Policies; and review our Privacy Policy to refresh your memory on how we use and protect your personal data. Finally, we provide brief updates on the status of introducing simulation into the MC-FP examination, alternative Part IV activities, our approval from the Center for Medicare and Medicaid Services as a Physician Quality Reporting System (PQRS) Registry in 2012, and how we will be introducing MC-FP into residency training this year.

As always, we hope you enjoy this issue, and we wish you and your families a most relaxing and enjoyable summer!

Follow us on Facebook and Twitter!

ABFM Facebook Pagehttp://www.facebook.com/Th eABFM

ABFM Twitter Feedhttp://twitter.com/Th eABFM

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Th e ABFM is pleased to announce that Robert L. Phillips, Jr., MD, MSPH, will assume the newly created position of Vice President of Research and Policy for the American Board of Family Medicine, eff ective September 1, 2012.

Dr. Phillips is a pre-eminent leader in primary care policy research. As Director of the Robert Graham Center since 2004, Phillips has strengthened the research base on which health policy is developed. As a result of Robert Graham Center research that he directed, health policy makers understand that family medicine and primary care are foundational to an eff ective, sustainable health system.

Dr. Phillips brings that expertise to the ABFM where, in this newly created position, he will guide research eff orts related to MC-FP, continuous clinical quality improvement and improving the health of the public. He will also assist with translation of research into sound policy in Washington, D.C.

Th is research and policy focus at ABFM builds on the collaboration with the Robert Graham Center during the last three years. Th is joint eff ort has enhanced understanding of relationships between Maintenance of Certifi cation and health care quality, of changes in family medicine scope of practice, and of eff ective primary care incentive payments. Th e ABFM and Robert Graham Center will continue as partners, amplifying the voice of family medicine research in

informing policy.

Dr. Phillips’ recruitment to the ABFM marks the beginning of an exciting time in policy studies focused on board certifi cation and quality improvement and refl ects a growing commitment from the ABFM to invest in rigorous, editorially independent research. We understand that our expanded research enterprise may challenge our own beliefs in order to provide better evidence and better policy. We look forward to this enhanced capacity to inform public policy, and to improve the quality and effi ciency of our health care system.

ABFM Expands Research Eff orts Robert L. Phillips, MD, MSPH, the ABFM’s new Vice President of Research and Policy

MC-FP Examination Important Dates—Fall 2012

Registration Begins—online applications available August 2

First Deadline to Submit Online Application—no late fee August 31

Final Deadline to Submit Online Application—with late fee • Priority Seating Ends September 21

Deadline to Submit Special Testing Accommodations Documentation September 21

Last Day to Clear Application Defi ciencies (except license & completion of training) September 28

Last Day to Complete All MC-FP Requirements September 28

Deadline to Make Offi cial Name Change with ABFM for Examination September 28

Deadline to Select Testing Date/Location October 1

All Family Medicine Residency Training Must be Completed on or about this date December 31

Deadline to Withdraw from Examination without Cancellation Fee 30 days prior to scheduled exam

Deadline to Withdraw from Examination without Seat Fee 5 days prior to scheduled exam

Deadline to Change Testing Date/Location 48 hours prior to scheduled exam

Final Deadline to meet all certifi cation requirements (residency verifi cation and licensure) June 30, 2013

Examination Dates November 7, 8, 9, 10

Examination Results December 20

Please visit the website for more details at www.theabfm.org/moc/datescerti.aspx

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Lars Peterson, PhD, MD, a 2008 Pisacano Scholar, graduated from Case Western Reserve University in Cleveland, Ohio, and completed his residency at the Trident/MUSC Family Medicine Residency in Charleston, South Carolina.

While enrolled in a dual MD/PhD program in health services research at Case Western, Dr. Peterson was selected to join the Primary Care Track, a program to foster leadership and advanced clinical skills in primary care. He also was selected to participate in a medical education curriculum development program. Lars served in multiple leadership roles in family medicine at the local, state, and national levels. He was a co-leader of his Family Medicine Interest Group (FMIG) for three years, and his work on implementing a journal club and a program for 3rd- and 4th- year students helped his FMIG earn its fi rst ever Program of Excellence award from the AAFP. At the state level, Lars served for two years as the chair of the Student Aff airs Committee and also as the student representative on the Board of Directors of the Ohio Academy of Family Physicians. He also served on the AAFP commissions on science and practice enhancement.

Lars’ research focused on how community-level characteristics aff ect both health status and access to health care and whether this relationship varies by rural/urban status. He has authored 12 peer-reviewed manuscripts and has made numerous oral and poster presentations. His commitment to

rural health, rural health research, and involvement with the Ohio Rural Health Scholars program earned him the Student Leadership Award from the National Rural Health Association. Lars envisions a career of patient care as well as research with the ABFM that seeks to validate the value of family medicine to both the health of individuals and the health care system, and also aids in the understanding of community-level eff ects on access to health care and health status.

ABFM Expands Research Eff orts

Alethea Bernard is a performance improvement and research professional. Her area of specialty is bringing policy to practice. Most of her career has been working with Health Services Organizations. In addition, Ms. Bernard has spent almost 10 years of her professional life as a process improvement specialist conducting research and advising others. Now, she has transitioned to serving as a Research Analyst with the American Board of Family Medicine.

Ms. Bernard was one of two patient safety fellows chosen for the National VA Interprofessional Patient Safety Fellowship at the Lexington, Kentucky site. Th e fellowship was a national VA program available in only six VA’s in the United States. Th e purpose of her fellowship was to gain in-depth experience in patient safety practice and leadership.

As a fellow, she was involved in several activities including the Surgical Checklist Initiative, OR Flow Improvement Project, the Blood Management (Transfusion) Process Improvement Initiative, the Learner’s Perception Survey Results Taskforce, the Learning Resources Redesign Committee, the Compensation and Pension Improvement System Redesign Initiative, and various other activities.

She also served as the Kentucky Institute for Health Care Improvement (IHI) Open School Chapter Leader and was an American College of Healthcare Executives (ACHE) Student Associate. She has also been involved with the Root Cause Analysis (RCA) and Healthcare Failure Mode and Eff ective Analysis (HFMEA) process and with the Patient Safety Clearing House Committee. Ms. Bernard’s primary focus is working with systems redesign and process improvement.

Ms. Bernard graduated with a Bachelor of Social Work in 2000. Soon thereafter, she continued her education and received her Master of Public Administration in 2005. Ms. Bernard has also obtained her Master of Health Administration. All degrees were awarded by the University of Kentucky.

Lars Peterson, PhD, MD, the ABFM’s New Director of Research

Alethea Bernard, MHA, MPA, the ABFM’s New Research Analyst

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Simulation in the MC-FP Part III ExaminationHow many times have you walked out of your ABFM certifi cation/recertifi cation examination saying to yourself, “Th at test really didn’t give me a chance to demonstrate my skill in managing patients?” Although the literature confi rms that physicians must possess some fundamental core of knowledge to practice eff ectively, the standard cognitive examination provides limited ability to assess a candidate’s ability to effi ciently and eff ectively manage a patient. Th e ABFM has included clinical simulations in the MC-FP Part II Self-Assessment Modules (SAMs) since its inception in 2004. Th e Clinical Simulation (ClinSim) mated to each SAM Knowledge Assessment (KA) provides a means for evaluating how Diplomates apply the information they encountered in the SAM KA in a patient management context. Additionally, the SAM exposure to the simulation interface and operation has at this point provided all of our Diplomates the opportunity to become familiar with the simulator’s operation, enough so that the Board now feels that the Part III examination can include simulations as part of the process.

Th e ClinSim application uses a dynamic generation process to create patient scenarios: each time the simulator fi res up, it creates a unique patient from a database of clinical signs, symptoms, and population characteristics. Since most characteristics follow normal distributions, most of these simulations appear similar but remain functionally unique. Th is creates challenges in developing scoring algorithms that can provide reliable, reproducible and defensible results that can integrate with scores assessed on the examination’s traditional multiple-choice item format. Th e ABFM is engaged in a research eff ort to develop such a scoring system based on “Value of Information” concepts based in decision theory. Th e ABFM is working with family medicine and other experts in decision theory to create, validate, and implement such a system.

Incorporating simulation into the Part III examination process represents a challenging endeavor for the ABFM. Rest assured that thiscomponent won’t appear on your Part III examination until the ABFM is certain that the simulation process provides consistent, fair,and reliable assessments of Diplomates’ clinical management prowess.

Did you know that the ABFM has a program to evaluate externally-developed quality improvement eff orts for potential Maintenance of Certifi cation for Family Physicians (MC-FP) Part IV credit? Th e ABFM has approved activities from national organizations such as the American Academy of Family Physicians (AAFP) and the National Committee for Quality Assurance (NCQA), but the ABFM also has approved activities from various large and small health care organizations.

Recently approved activities include:

• NCQA Physician Recognition Program: Patient Centered Medical Home (using the revised 2011 guidelines)

• Annenberg Center for Health Sciences at Eisenhower: Optimizing Fracture Prevention in Patients with Osteoporosis

• Maine Quality Counts Learning Initiative: Improving Developmental, Autism, and Lead Screening

• North Carolina Academy of Family Physicians: Improving Delivery of Care for Adolescents

• Yakima Regional Medical and Cardiac Center: Improving Colorectal Screening Rates in Yakima County

For a complete listing of approved Part IV alternative activities and participation availability, visit our website at https://www.theabfm.org/moc/partivact.aspx.

If you have questions about this program visit https://www.theabfm.org/moc/altact.aspx. If you would like to receive information about the program requirements and an application to have a quality improvement eff ort considered for MC-FP Part IV credit, please contact Nichole Lainhart, Program Manager of MC-FP Alternative Activities, at nlainhart@theabfm.org or at 888-995-5700, extension 1230.

ABFM and Alternative Part IV Activities

New SAM LaunchedTh e ABFM is pleased to announce the release of a new SAM topic—

Mental Health in the Community. Look for the release of Hospital Medicine later in 2012.

6

Th e ABFM is an approved registry once again for the Physician Quality Reporting System in 2012. Th e deadline to complete all necessary data entry for the 2012 physician quality reporting is January 10, 2013. ABFM Diplomates are able to participate by accessing the online physician quality reporting activity in their ABFM physician portfolio at no cost.

For the 2012 Physician Quality Reporting System, physicians must indicate a performance met for at least one patient for each measure (reference the reporting template within the Physician Quality Reporting System for details on meeting performance met for each measure). Additionally, all 30 patients included in the sample must be patients covered under Medicare Part B. Physicians who meet the 2012 Physician Quality Reporting System criteria for satisfactory submission of quality measures data for 30 unique, Medicare Part B patients are eligible to earn an incentive payment of 0.5% of their total allowed charges for Physician Fee schedule (PFS) covered professional services furnished during the reporting period, January 1, 2012 – December 31, 2012. CMS approved fi nancial incentives earned during 2012 reporting are scheduled to be paid in mid-2013 from the federal Supplementary Medical Insurance (Part B) Trust Fund. Again, the deadline to complete all necessary data entry for the 2012 physician quality reporting is January 10, 2013.

Additionally, Diplomates have the added benefi t of combining Physician Quality Reporting System participation with their MC-FP activity. In short, any Diplomate who successfully completes the 2012 Physician Quality Reporting System reporting can continue the activity for MC-FP credit and CME credit by implementing a quality improvement plan along with a post quality improvement data collection to complete the activity as a Performance in Practice Module (PPM).

To begin the 2012 Physician Quality Reporting today, visit the ABFM website at www.theabfm.org and log in to your Physician Portfolio. If you have any questions about how to start taking advantage of the Physician Quality Reporting opportunity, please contact the ABFM Support Center at 877-223-7437 or at help@theabfm.org.

2012 Physician Quality Reporting System Available

Board EligibilityTh e American Board of Family Medicine defi nes the 7-year period of board eligibility as (1) the period that begins January 1, 2012 for any physician eligible to apply for certifi cation prior to that date; (2) the period that begins upon the date of successful completion of an ACGME accredited Family Medicine residency training program, on or after January 1, 2012, in accordance with all ABFM policies and procedures (or upon successful application for reciprocity as defi ned by our reciprocity agreements); or (3) the period that begins upon the date of loss of certifi cation on or after January 1, 2012.

In order to represent themselves as board eligible, the physician must comply with the Guidelines for Professionalism, Licensure and Personal Conduct. In addition, the physician must continue to meet the requirements for MC-FP or the MC-FP Entry or Re-Entry processes.

After expiration of the 7-year period of board eligibility, a family physician can regain eligibility only by successfully completing at least one year of additional training in an accredited family medicine residency training program (or an ABFM approved alternative) and by completing the MC-FP Re-Entry Process.

Newly introduced resident requirements for initial certifi cation will include participation in MC-FP. Th e fi rst group of residents that will be required to participate in this new process will be those entering family medicine residencies on or after June 1, 2012, including those residents who receive advanced placement credit for prior training in another specialty. Residents must meet the following requirements before they will be able to sit for the examination.

Completion of fi fty (50) MC-FP points prior to the MC-FP Examination, which must include:

Minimum of one (1) Self-Assessment Module (Part II)

Minimum of one (1) Performance in Practice Module (Part IV) with data from a patient population (or an ABFM approved alternative Part IV activity with patient population data)

Residents will access the modules and track their individual progress through their respective physician portfolios via the ABFM website at www.theabfm.org. Th ere will be no cost associated with completing ABFM developed Part II and Part IV modules.

Residents to Participate in MC-FP Beginning 2012

7

Last year, the Institute of Medicine selected Sean P. David, MD, Clinical Associate Professor of Family and Community Medicine at Stanford University School of Medicine, as the 2011-2013 James C. Puff er, MD/American Board of Family Medicine Fellow at the Institute of Medicine. David was selected from an outstanding group of nominees because of his accomplishments in family medicine, and specifi cally his work on smoking cessation and health promotion.

As a Puff er/ABFM/IOM Anniversary Fellow, David is working with eminent researchers, policy experts, and clinicians from across the country as they collaborate on initiatives convened by the IOM to provide nonpartisan, evidence-based guidance to national, state, and local policymakers, academic leaders, health care administrators, and the public. He also receives a research stipend of $25,000. Named in honor of James C. Puff er, president and chief executive offi cer of the ABFM, the fellowship program enables talented, early career health policy and science scholars in family medicine to participate in the work of IOM and further their careers as future leaders in the fi eld.

“I am particularly pleased that the selection committee chose Dr. David as one of our inaugural fellows,” Puff er said. “His bright career to date has been infl uenced by the unique intersection of basic science, behavioral health, clinical medicine, and public policy, and I believe he will benefi t immensely from his immersion in the work of the Institute.”

David’s research is aimed at advancing the science to help patients quit smoking. Working with an international multidisciplinary research team, David has led several pharmacogenetic clinical trials of bupropion and nicotine replacement therapy and functional neuroimaging studies of nicotine dependence. He has more than 50 publications, mainly on smoking cessation, genetics, genomics, and public health, and is a co-leader of the STOMP (Study of Tobacco Use in Minority Populations) Genetics Consortium.

David received a BS in zoology and MD at the University of Washington, an MS in health and social behavior from the Harvard School of Public Health, and a PhD in pharmacology from the University of Oxford. His residency training was with the New Hampshire/Dartmouth Family Medicine Residency Program, where he was chief resident and developed and led several health promotion programs with the C. Everett Koop Institute at Dartmouth.

IOM Anniversary Fellows continue their main responsibilities while engaging part-time over a two-year period in the IOM’s health and science policy work. A committee appointed by the president of IOM selects fellows based on their professional accomplishments, potential for leadership in health policy in the fi eld of family medicine, reputation as scholars, and the relevance of their expertise to the work of the IOM.

Jennifer DeVoe, MD, of Oregon Health Sciences University in Portland has been selected as the Puff er /IOM Fellow beginning in 2013.

Diplomates who certifi ed or recertifi ed in 2006 are required to complete 3 MC-FP modules for Stage Two by December 31, 2012, in order to remain eligible for the 10-year certifi cation path. For Stage Two requirements, Diplomates are required to complete 1 Part II module (SAMs), 1 Part IV module (PPMs, MIMMs or an approved alternative) and 1 module of choice.

Diplomates who do not complete Stage Two requirements will retain their 7-year certifi cation and will have to complete the MC-FP requirements (6 SAMS and 1 Part IV) for the 7-year cycle before completing the application for the next exam.

ATTENTION: Diplomates Who Certifi ed/Recertifi ed in 2006

Diplomates who certifi ed or recertifi ed in 2009 are required to complete 3 MC-FP modules for Stage One by December 31, 2012, in order to remain eligible for the 10-year certifi cation path. For Stage One requirements, Diplomates have the option to complete 3 Part II modules (SAMs) or 1 Part II module, 1 Part IV module (PPMs, MIMMs or an approved alternative) and one module of choice.

To guarantee your eligibility for the 10-year certifi cation, you must successfully complete 3 MC-FP modules by the end of this year.

Sean David MD, Selected as Puff er/IOM Fellow

ATTENTION: Diplomates Who Certifi ed/Recertifi ed in 2009

8

ABFM Elects New Offi cers and Board MembersTh e American Board of Family Medicine is pleased to announce the election of four new offi cers and four new board members. Th e new offi cers elected at the ABFM’s spring board meeting in April are: Samuel Jones, MD, of Fairfax, Virginia, elected as Chair; Diane K. Beebe, MD, of Jackson, Mississippi as Chair Elect; Michael G. Workings, MD, of Detroit, Michigan as Treasurer; Erika Bliss, MD, of Seattle, Washington, as Member-at-Large, Executive Committee. In addition, the ABFM welcomes this year’s new members to the Board of Directors: Christine C. Matson, MD, of Norfolk, Virginia; David W. Mercer, MD, of Omaha, Nebraska; Keith L. Stelter, MD, of Mankato, Minnesota; and Marcia J. Nielsen, PhD, MPH, of Lawrence, Kansas, as the fi rst public member to serve on the ABFM’s Board of Directors.

Th e returning members of the Board include: Howard Blanchette, MD of Valhalla, New York; Laura M. Brooks, MD of Lynchburg, Virginia; Alan K. David, MD of Milwaukee, Wisconsin; Susan C. Day, MD of Philadelphia, Pennsylvania; Jimmy H. Hara, MD of Los Angeles, California; Carlos Roberto Jaén, MD of San Antonio, Texas; James Kennedy, MD, of Winter Park, Colorado; and Kailie R. Shaw, MD of Tampa, Florida.

Th e ABFM Board of Directors looks forward to working with the new members as it continues to implement and enhance the Maintenance of Certifi cation for Family Physicians (MC-FP) program and the important task of sustaining the mission of the ABFM. For more information on the current Board members, please visit the Board of Directors page on our website.

Michael G. Workings, MD

Christine C. Matson, MD

Diane K. Beebe, MD Samuel Jones, MD

Erika Bliss, MD

David W. Mercer, MD

Keith L. Stelter, MD Marcia J. Nielsen, PhD, MPH

9

continued on page 12

In the course of the certifi cation, recertifi cation, and Maintenance of Certifi cation for Family Physicians (“MC-FP”) process, the American Board of Family Medicine, Inc. (“ABFM”) must collect and utilize email addresses as well as personal, professional, and in some cases, fi nancial information from and regarding Diplomates, examination candidates and physicians participating in MC-FP. ABFM has issued the following Privacy Policy to govern ABFM’s collection, use, and disclosure of such information, and to explain to you ABFM’s policies and practices regarding the privacy of information. Our goal in establishing the Privacy Policy is to assure each person disclosing information of the sensitivity of the information and the care to be utilized by ABFM in protecting the confi dential nature of the information and material.

Waiver of Privacy PolicyTh ere may be limited instances where a person may desire to waive application of the Privacy Policy. ABFM has prepared a General Release and Waiver that may be used in the event a physician desires to waive application of the Privacy Policy for any purpose. In order to waive application of the Privacy Policy, a physician must sign the General Release and Waiver and return the signed document to the ABFM offi ces. A copy of the General Release and Waiver may be obtained by contacting James C. Puff er, M.D., President of ABFM, 1648 McGrathiana Parkway, Ste. 550 Lexington, KY 40511.

Candidate and Diplomate InformationIn order to identify and determine the qualifi cation of physicians to be candidates to sit for examinations or to participate in MC-FP, ABFM requires that applicants provide personal contact and identifying information, as well as personal, educational, and professional background information. Th is information is utilized by ABFM to identify an applicant, determine an applicant’s eligibility and qualifi cation to become a candidate for certifi cation or recertifi cation, and to communicate with the applicant. Similar information will be required to assist participants in MC-FP.

ABFM considers the status of an individual’s participation in and the stage of completion of all MC-FP components, including an individual’s certifi cation status and certifi cation history, to be public information. ABFM reserves the right to publish and share public information in any and all public forums determined by ABFM to be reasonable, including the posting of public information on the ABFM website, sharing the public information with medical licensure boards, managed care organizations, third party payors, or others. While ABFM generally regards all other information about individuals as private and confi dential, there are times that ABFM must release certain information in order to fulfi ll its responsibilities as a medical specialty board and as a Member Board of the American Board of Medical Specialties (“ABMS”).

Th ere may be other times that ABFM may release information as determined by ABFM to be reasonable and in the interest of ABFM to fulfi ll its mission and purposes.

ABFM specifi cally regards the results of an individual’s Certifi cation, Recertifi cation or In-Training examination as private and confi dential. Th e ABFM may, however, make available the aggregate examination results of a group of examinees from the same training program or review course. Any disclosure will only be made refl ecting the aggregate percentage of examination results and the disclosure will not identify the examinees or their individual results.

While ABFM will not use individual examination results or confi dential fi nancial information for commercial purposes, ABFM specifi cally reserves the right to share information with the American Academy of Family Physicians (“AAFP”) and other CME providers and approved external providers who have applied for and received ABFM approval of their module for MC-FP purposes, on identifying or other information and aggregate examination results for purposes of updating ABFM fi les and records, completing, crediting or maintaining continuing medical education, and for the completion of components of MC-FP, or for other purposes intended to assist ABFM in carrying out its purposes as a medical specialty board.

ABFM reserves the right to make personal and identifying information (including email addresses) available for use in connection with the Journal of the American Board of Family Medicine, a periodic research journal sponsored by ABFM as its offi cial journal publication. ABFM also reserves the right to make personal and identifying information (including email addresses) available for use by and in connection with the Pisacano Leadership Foundation, Inc., and the ABFM Foundation, Inc., both not-for profi t corporations maintained by ABFM as supporting organizations.

Except as outlined herein, ABFM will not provide such information to third parties, except in response to the order of a court or other administrative agency or tribunal of competent jurisdiction. ABFM will notify the physician aff ected prior to complying with any such order.

ABFM will use performance on examinations and other information for research purposes.

ABFM reserves the right to disclose information in its possession regarding any individual whom it determines, in its sole and absolute discretion, has violated ABFM rules or procedures, engaged in misrepresentation or unprofessional behavior, or demonstrates signs of impairment.

Personal and Financial InformationIn connection with registration of examination candidates and the administration of certifi cation and recertifi cation examinations, as well as MC-FP, ABFM will collect personal information such as names, street or post offi ce box addresses, email addresses, etc., and in some cases fi nancial information (such as credit card information). ABFM will restrict access to fi nancial information collected by ABFM to ABFM employees and contractors who need to know this information in order to conduct the business and aff airs of ABFM.

HIPAA Privacy RuleRecently, the Department of Health and Human Services fi nalized regulations regarding new privacy protections for certain health information under the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”). As part of the certifi cation, recertifi cation and Maintenance of

ABFM Privacy Policy

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I. ProfessionalismProfessionalism is the basis of medicine’s contract with society. It demands placing the interests of patients above those of the physician, setting and maintaining standards of competence and integrity, and providing expert advice to society on matters of health. Th e American Board of Medical Specialties (ABMS) has defi ned professionalism as follows:

“Medical professionalism is a belief system about how best to organize and deliver health care, which calls on group members to jointly declare (“profess”) what the public and individual patients can expect regarding shared competency standards and ethical values, and to implement trustworthy means to ensure that all medical professionals live up to these promises”.1

Professionalism is embodied in the physician–patient relationship and includes, but is not limited to:

• A commitment to serve others• Dedication to the use of one’s knowledge to achieve ethical, fair and just results• Continued enhancement of one’s own knowledge and skills• Fairness, courtesy, honesty and respect for patients, colleagues, and the public• Contributing to the public good• Education of the learners and the public about the profession, it uses and limitations• Accepting responsibility for one’s own professional conduct as well as that of others in the profession

Th e principles and responsibilities of medical professionalism must be clearly understood by both the profession and society. Essential to this contract is public trust in physicians, which depends on the integrity of both individual physicians and the whole profession.2

Specifi cally, the ABMS has clearly indicated how professionalism functions best:

“For medical professionalism to function eff ectively there must be interactive, iterative, and legitimate methods to debate, defi ne, declare, distribute, and enforce the shared standards and ethical values that medical professionals agree must govern medical work. Th ese are publicly professed in oaths, codes, charters, curricula, and perhaps most tangible, the articulation of explicit core competencies for professional practice (see, for example, the ACGME Core Competencies). Making standards explicit, sharing them with the public, and enforcing them, is how the profession maintains its standing as being worthy of public trust.”3

In an eff ort to further delineate and make explicit the standards by which the ABFM will assess two aspects of professionalism, namely personal conduct and licensure, the following policy has been established by the ABFM Board of Directors.

To obtain and maintain certifi cation, a physician is expected to demonstrate: the principles embodied in accepted statements of professional responsibility and ethical behavior (such as the Hippocratic Oath and the Declaration of Geneva); the precept of primum non nocere (fi rst, do no harm); the application of moral principles, values, and ethical conduct to the practice of medicine; the skill, competence and character expected of a physician; and, compassion and benevolence for patients.

A. Demonstration of unethical, unprofessional, or immoral behavior, misrepresentation of Diplomate status or Board Eligible status or fraud, cheating on or attempting to subvert an ABFM examination, incompetence, discompetence (performance falling somewhere between competence and incompetence), or impairment, may be suffi cient cause for the ABFM to rescind Diplomate status, deny eligibility for an examination, invalidate the results of an examination, or other action as judged appropriate by the ABFM.

B. Furthermore, a physician’s professionalism shall be called into question and reviewed by the Credentials Committee of the American Board of Family Medicine at such time as the physician is sanctioned by a legally constituted entity with control over aspects of a physician’s practice of medicine, including, but not limited to, entities of the Federation of State Medical Boards, the U.S. Drug Enforcement Administration, the Centers for Medicare and Medicaid Services, and Institutional Review Boards and Ethics Committees of Medical Schools, Hospitals, and Medical Clinics.

C. All physicians are subject to this policy, including commissioned medical offi cers of the armed forces of the United States and medical offi cers of the United States Public Health Service or the Department of Veterans Aff airs of the United States in the discharge of their offi cial duties and/or within federally controlled facilities.

Guidelines for Professionalism, Licensure, and Personal Conduct

11

II. Licensure To obtain and maintain certifi cation, a physician must hold a currently valid, full and unrestricted license to practice medicine in all jurisdictions in the United States, its territories, or Canada, in which the physician holds a license, subject to the exceptions noted in Section II. B. 1-4 below.

A. Any license (including but not limited for purposes of example only, training, charity, military, practicing, inactive, etc.) shall be deemed “restricted” for purposes of this policy if, as a result of action by a State or other legally constituted Board responsible for exercising jurisdiction and control over licensure (hereinafter called “State Medical Board”), the physician:1. shall have had his/her license revoked; surrendered his/her license or cancelled or not renewed their license in lieu of investigation

or any disciplinary/adverse action as tantamount to a revocation;2. shall have had his/her license suspended for a specifi ed period of time;3. shall have been made subject to special conditions, requirements, or limitations, regardless of whether or not such conditions,

requirements, or limitations are imposed by order of the State Medical Board or are the result of a voluntary agreement between the physician and the State Medical Board, such conditions to be determined by the Credentials Committee of the American Board of Family Medicine as those which aff ect, restrict, alter, or constrain the practice of medicine (including, but not limited to, supervision, chaperoning during the examination of patients, limitations on the prescription of medication, or limitations on site or type of practice and limitation on hours of work.

B. A physician’s license shall not be deemed “restricted” for purposes of this policy if the physician:1. shall have received letters of concern or reprimand not resulting in one of the stipulations which are enumerated in Section II. A.

1-3 of these Guidelines, even if such letters are made part of the physician’s record;2. shall have voluntarily entered into a rehabilitation or remediation program for impairment, dependency, or practice improvement

with the approval of a State Medical Board not resulting in one of the stipulations which are enumerated in Section II. A.1-3, or a requirement from the State Medical Board to obtain the Board’s permission to reenter medical practice;

3. shall have been placed on probation without any specifi c sanction, condition, requirement, or restriction on practice as described in Section II. A. 3 above;

4. shall hold an unrestricted license to practice medicine in the jurisdiction in which he/she currently practices, and, for all other licenses held, shall have received no new restrictions or sanctions as described in Section II. A. 1-3 above, nor received a letter of reprimand, censured or placed on probation, for the 6 years prior to applying for certifi cation or recertifi cation.

III. Personal ConductPhysicians must recognize responsibility to patients fi rst and foremost, and be responsible for maintaining respect for the law.

A. Conviction of a misdemeanor or a felony, related or not related to the practice of medicine, resulting in incarceration or probation in lieu of incarceration, or the entry of a guilty, nolo contendere plea or an Alford plea, or deferred adjudication without expungement, may be judged as suffi cient cause to rescind Diplomate status, deny eligibility for an examination, invalidate the results of an examination, or other action as judged appropriate by the ABFM.B. In order to properly and timely process actions the ABFM routinely requests information from the physician. Th e physician shall be required to submit to the ABFM the information, documentation or material (“Required Data”) requested by the ABFM. Th e Required Data shall be the information and material necessary and appropriate for the disposition of any action under consideration by the ABFM. ABFM shall submit the request to the physician, in writing, utilizing any commercially acceptable form of transmission, including electronic communication (where available), or facsimile, or US Mail, or a commercial carrier. Th e request shall state in detail the Required Data and the due date that the Required Data is to be provided to the ABFM. All responses and submissions of Required Data must be timely, complete and accurate. If the physician fails to provide complete and accurate responses within 60 calendar days following the date of the ABFM request, the ABFM may proceed with the action under consideration, including, but not limited to an adverse action resulting in the suspension or revocation of Diplomate status or the determination that the physician is ineligible for MC-FP components.

IV. Maintenance of Certifi cationTo participate in Maintenance of Certifi cation (MC-FP) a physician must fulfi ll all of the requirements stipulated for participation in the four components designed to assess important physician characteristics.

A. A physician’s participation in MC-FP shall be terminated if, as a result of action by a State or other legally constituted Board responsible for exercising jurisdiction and control over licensure, a physician’s license is revoked, surrendered prior to, during, or following an inquiry or investigation, or permanently restricted.B. A physician’s participation in MC-FP shall be terminated if the Credentials Committee of the ABFM determines that there is

continued on page 12

12

T h e A m e r i c a n B o a r d o f F a m i l y M e d i c i n e

w w w . t h e a b f m . o r g

1648 McGrathiana Parkway, Suite 550

Lexington, Kentucky 40511-1247

Phone: 859-269-5626

Fax: 859-335-7501

Certifi cation process, ABFM may require you to submit patient information of a type and nature which could be subject to HIPAA.

However, ABFM requires that any such patient health information be “de-identifi ed” in accordance with the HIPAA regulations, such that all identifying information and markers which could be used to reasonably identify the patient in question are removed. ABFM does not intend to accept any patient information which has not been de-identifi ed in accordance with the HIPAA privacy regulations. It is the applicant’s responsibility to de-identify the patient health information before submission to ABFM. While ABFM will assist in the de-identifi cation process, ABFM cannot and will not be responsible for the applicant’s violation of privacy requirements under HIPPA. If you have questions regarding de-identifi cation or would like more information regarding de-identifi cation requirements, please contact ABFM.

While ABFM is committed to the privacy of patient information, ABFM has received a legal opinion that it is not a “covered entity” under the HIPAA privacy regulations and thus not subject to those obligations. Further, ABFM is not a “business associate” of those physicians (or “covered entities”) who submit de-identifi ed patient information to ABFM. ABFM has received an opinion of counsel to this eff ect, a copy of which may be obtained by contacting James C. Puff er, M.D., President of ABFM, 1648 McGrathiana Parkway, 5th Floor Lexington, KY 40511.

1EPCOM-ABMS Professional Work Group2Medical Professionalism in the New Millennium: A Physician Charter. Th e ABIM Foundation, the ACP Foundation, and the European Federation of Internal Medicine, 2004.3EPCOM-ABMS Professional Work Group

ABFM Privacy Policy continued from page 9

Guidelines for Professionalism continued from page 10

evidence of one or more demonstrations of unprofessional behavior or actions as enumerated in Section I. A, B and C of these Guidelines.C. A physician’s participation in MC-FP shall be terminated if the Credentials Committee of the ABFM determines that there is evidence of unlawful activity as enumerated in Section III. A of these Guidelines.

V. AuthorityTh e American Board of Family Medicine shall have sole power and authority to determine whether the evidence or information before the Committee is suffi cient to constitute grounds for revocation of any Certifi cate issued by the American Board or other action as judged appropriate. Th e above policies will be eff ective on January 31, 2012, their date of adoption by the Board of Directors of the ABFM and may be revised or amended pursuant

to appropriate authority of the ABFM.