Maintenance of Certification -MOC- Conference of CAP State Pathology Presidents Washington, D.C. William F. Hickey, MD, FCAP Chair, Education Committee of the CAP June 29th, 2007

Maintenance of Certification (MOC) Requirements for Pathologists: What You Need to Know Based on information from: The American Board of Pathology The CAP Education Committee Presentation/Article by Dr. Eliz. Hammond and the CAP Education Committee

Key MOC Questions Where do we currently stand?? What is MOC? Where did it come from? Who is responsible for MOC? How will it be implemented? What is the CAP doing about it?

Where do we currently stand?? Pathologists certified by the American Board of Pathology (ABP) prior to June 2006 have a “permanent” board certification that will neither expire nor will the ABP require that it be renewed *. Voluntary recertification is available and will not change the status of your original certification. Pathologists certified by the ABP in or after June 2006 will receive a time delimited certificate that must be renewed at least every ten (10) years, but can be renewed as soon as eight (8) years after certification. *The catch: while the ABP does not require recertification, a number of states, third party payers and some hospitals are requiring pathologists to recertify regardless of the ABP’s guidelines.

What is MOC? ABMS Definition: Maintenance of Certification (MOC) is the board certification program for assessment of continuing competence of physicians and encompasses a formal recertification process.

Components for Assessment What is MOC? Program Elements 6 4 Competencies Components for Assessment

6 4 What is MOC? Program Elements Competencies Medical Knowledge Components for Assessment Medical Knowledge Patient Care Practice-based Learning and Improvement Interpersonal and Communication Skills Professionalism Systems-based Practice

4 6 What is MOC? Program Elements Components for Assessment Competencies Components for Assessment Professional standing Commitment to lifelong learning and involvement in a periodic self- assessment process Cognitive expertise Evaluation of performance in practice

Where did MOC come from? In March 1998, ABMS created a Task Force on Competence to “…develop and implement a system for certifying that physicians are competent.” Focus of activities is on evaluation of physicians AFTER initial certification, resulting in the MOC concept

Where did MOC come from? ABMS produced a description of the competent physician and six general competency categories against which physicians should be evaluated They stipulated expectations of specialty boards and timeframe for compliance They approved a statement of their commitment to the MOC program

Who is responsible for MOC? As a member board of the ABMS, the ABP is responsible for developing the MOC program for pathologists In 2006, primary/subspecialty certificates will be 10 years duration. MOC requirements must be completed by certificate expiration date. Candidates may sit for re-certification beginning in eighth year of certificate, but must do so before their certificate expires or they will be deemed to be “not board certified”. (Exams given twice/year.)

How will it be implemented? ABP will determine implementation for each of the four components for assessment of continuing competence.

How will it be implemented? 1. Professional Standing Unrestricted license to practice medicine in the US/Canada Medical staff membership and scope of hospital privileges in pathology Peer attestations as to interpersonal and communication skills, professionalism, and effectiveness in a systems-based practice

How will it be implemented? 2. Lifelong Learning/Self Assessment Learning content specifications focused on topics important for maintaining competence Performance feedback to pathologist to direct ongoing CME Participation mandatory; documentation provided directly to ABP biannually Programs affordable and readily accessible 20 self-assessment modules (SAMs) must be completed every 2 years.

70 Category 1 CME credits each 2 year reporting cycle and at least 20 must be from self-assessment modules 80% of CME must be directly related to individuals’ practice Must maintain an electronic record of activities with ABP-updated every 2 years

Self-assessment Modules (SAMs) Must be in a setting of CME – one module will be equivalent to one hour of CME. Must be a scored exam with a fix passing score The score must be reported to the individual A record of the examination and verification of a passing score must be provided to the ABP by the testing organization. Failing scores on the SAMs are not reported to the ABP and do not meet the requirement for a SAM.

How will it be implemented? 3. Cognitive Expertise Measured by performance on a secure exam (i.e. closed book) Modular exam relevant to individual practice Knowledge fundamental to the field of pathology Diplomates will be eligible to take the exam for 3 years AP/CP diplomates can recertify in one or both Tests will be geared to actual area of practice

Fall 2006: The ABP requested that the Cooperating Societies each nominate four (4) of their members – two (2) in AP and two (2) in CP. From the four nominees the ABP will select two (2), and they will be incorporated into a committee charged with preparing the recertification examination on the “medical knowledge” component (i.e., the cognitive exam). May 2007: The ABP convened a committee composed of anatomic and clinical pathologists who were charged with identifying areas of emerging importance about which practicing pathologists should be aware. Future: The ABP will direct their test committees to develop questions for the exam derived from the areas the Cooperating Societies are offering educational programs and SAMs.

How will it be implemented? 4. Evaluation of Performance in Practice Compliance with published practice and report content guidelines Consideration being given to: Laboratory accreditation required Inter- and intra-laboratory improvement and quality assurance programs that are approved by the ABP. Attestation of participation required every 2 years. (Use of accepted templates for complete reporting ??)

Candidates must provide attestations as to interpersonal and communication skills, professionalism, ethics, and effectiveness in systems-based practice --4 references must be provided at beginning of year 4 and again when applying for exam: 1) ABP certified pathologist 2) Individual in senior administration 3) Physician in another specialty 4) Technologist or PA who works with diplomate

Why is MOC important to you? All board-certified pathologists* will be required to demonstrate evidence of lifelong learning You will have to acquire education addressing the six competency categories You will need a mechanism for tracking your CME participation Health care organizations may require similar evidence from ALL physicians, including pathologists Patients want evidence of ongoing competence * Certified after 2006 ABP is relying on CAP & others to provide programs of self-assessment & lifelong learning. CAP members will need to demonstrate evidence of lifelong learning which may at some point require CME credits in specific competence categories.

What is the CAP doing? etc. Keeping members informed of MOC Offering education in the emerging areas targeted by the ABP - Working with the ABP on tests - Designing and offering SAMs - Providing an electronic, on-line tracking tool for CME & SAMs Laboratory accreditation etc.

Questions?

Finis

Appendix Slides

Competency Categories Medical Knowledge Patient Care Practice-based Learning and Improvement Interpersonal and Communication Skills Professionalism Systems-based Practice

Medical Knowledge Demonstrate knowledge about established and evolving biomedical, clinical, and cognate (e.g., epidemiological and social-behavioral) sciences and the application of their knowledge to pathology. Anatomic Pathology Clinical Pathology

Patient Care Demonstrate a satisfactory level of diagnostic competence and provide appropriate and effective consultation in the context of pathology services. Informed decision-making Colleague and patient education Information Technology use Performance of procedures Preventive health services

Interpersonal and Communication Skills Demonstrate interpersonal and communication skills that result in effective information exchange and teaming with patients, their patients’ families, and professional associates. Building Relationships Communication Teamwork Empowerment

Professionalism  Demonstrate a commitment to carrying out professional responsibilities, awareness of the fiscal aspects of our actions in practice, adherence to ethical principles, and sensitivity to a diverse patient population. Leadership Ethics Respect for Diversity Financial Responsibility

Practice-Based Learning and Improvement Investigate and evaluate diagnostic and laboratory practices, appraise and assimilate scientific evidence, and improve laboratory practices and patient care. Practice Analysis Assimilation of External Data Process and Outcome Improvement

Systems-Based Practice Demonstrate an understanding of national, regional and local health care systems and an ability to utilize the resources of those systems in providing medical care. Practice and System Integration Medical Practice & Delivery Systems Practice Economics

Identification of MOC Categories Demonstrate interpersonal and communication skills that result in effective information exchange and teaming with patients, the patients’ families, and professional associates. Demonstrate a satisfactory level of diagnostic competence and provide appropriate and effective consultation in the context of pathology services.

Identification of MOC Categories Demonstrate ability to investigate and evaluate diagnostic and laboratory practices in your own lab, appraise and assimilate scientific evidence, and improve laboratory practices and patient care. Demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to diverse patient population.

Identification of MOC Categories Demonstrate understanding of and contribution to local, regional, and national health care systems, and support health care in system-based practice definition. Demonstrate knowledge about established and evolving biomedical, clinical, and cognate sciences and the application of this knowledge to pathology.

The following slides were produced by the American Board of Pathology and are available on their website http://www.abpath.org/MOCindex.htm Under: MOC Presentation

Maintenance of Board Certification (MOC) • Response to ABMS initiative • ABP MOC program is part of an ABMS-wide MOC process involving all 24 specialty boards • Beginning in 2006 ABP issued time-limited primary and subspecialty certificates of 10 years duration • Participation in the MOC process is required for all diplomates certified after 2005 and must be completed no later than 10 years after initial certification

Requirements For MOC Parts I-IV Part I: Professional Standing Part II: Life-Long Learning and Self-Assessment Part III: Cognitive Expertise Part IV: Evaluation of Performance in Practice

Part I--Professional Standing Maintenance of a full and unrestricted license Restricted license leads to disqualification for MOC until restriction is removed Diplomates must notify ABP of restriction within 60 days after its imposition Documentation of medical staff membership and privileges or, if not applicable, diplomate must submit a description of their practice

Part II--Life Long Learning and Self-Assessment 70 Category 1 CME credits each 2 year reporting cycle and at least 20 must be from self-assessment modules 80% of CME must be directly related to individuals’ practice Must maintain an electronic record of activities with ABP-updated every 2 years

Self-Assessment Programs May address knowledge in a particular area or review of specific medical literature Each program must include a self- administered examination Diplomate must meet a minimum performance level Feedback immediately after examination is preferred

Part II--Life Long Learning and Self-Assessment Topic lists and references representing important advancements in diagnostic pathology will be published annually by the ABP These will: Serve as a template for CME and self-assessment Assist pathologists to prepare for MOC exam Direct MOC test question development Focus on practical “need to know” information that is used in daily practice and required for competence Cover all disciplines of pathology

Part III--Cognitive Expertise MOC examination is mandatory Closed book examination Given at least once per year Must be taken no later than 10 years after initial certification May be taken as early as year 8 Potential 3 year period of qualification

Part III--Cognitive Expertise Examinations as relevant as possible to individual practice settings AP/CP certified individuals may chose to be examined (maintain their certification) in AP/CP, AP only or CP only Individuals with subspecialty certification may choose to maintain only their subspecialty certification

Part III--Cognitive Expertise Modular exams relevant to the individual practice settings (exact nature of modules is under development) Exams will include: Fundamental knowledge Current clinically-valid practice-related knowledge Emphasis on information new to field since last certification Practice environment knowledge, such as regulations, CLIA standards, laboratory management, coding, etc.

Part IV--Performance in Practice Candidates must provide attestations as to interpersonal and communication skills, professionalism, ethics, and effectiveness in systems-based practice 4 references must be provided at beginning of year 4 and again when applying for exam ABP certified pathologist Individual in senior administration Physician in another specialty Technologist or PA who works with diplomate

Part IV--Performance in Practice Documentation of laboratory accreditation Accrediting agency must be appropriate for the diplomate’s scope of practice Laboratory participation in inter-laboratory improvement and QA programs approved by the ABP Attestation of participation must be provided every 2 years

Part IV--Performance in Practice Diplomate must participate in inter- and intra-laboratory improvement and QA activities and programs appropriate for their professional activities Attestation of participation must be submitted to the ABP every 2 years

Part IV--Performance in Practice Practice performance will be further assessed by documentation of use of appropriate protocols, outcome measurements, and practice guidelines Evaluation of performance in practice will include assessment of the 6 ACGME-ABMS core competencies

SIX CORE COMPETENCIES IN MEDICAL PRACTICE Medical knowledge Patient care Interpersonal and communication skills Professionalism Practice-based learning and improvement skills Systems-based practice

MOC EVALUATION ACCORDING TO THE 6 CORE COMPETENCIES Competencies Record Checklist Global Rating 360 Portfolio/Log Cognitive Review of Performance Exam Medical knowledge X X X X Patient care X X X X Interpersonal & communication skills X X Professionalism X X Practice-based X X X X learning and Improvement skills Systems-based practice X X X X X

Failure to meet MOC Requirements Must participate and demonstrate satisfactory performance in all 4 parts of MOC Performance below expectations requires an implementation plan to improve performance Failure to satisfy performance criteria results in loss of certification December 31st of 10 year anniversary of initial certification

Transition to MOC Holders of non-time limited certificates: Will retain voluntary recertification Participation in MOC does not place original certificate in jeopardy Holders of time-limited certificates: Must participate in MOC Candidates for initial certification: Must participate in MOC after certification

Nature of Involvement of Cooperating Societies in MOC Cooperating Societies will play an important role in: Content development (ad hoc committees in AP and CP) CME courses Self-assessment tools Programs for evaluation of practice performance Assisting in verification of diplomates’ participation in performance improvement programs ? Remedial education programs