ABR: A New Era - The American Board of Radiology

ABR: A New EraWhat’s s It All About&How Do I Participate?Gary J. Becker, M.D.Executive DirectorARRS Annual Meeting, April 15, 2008

When you hear “ABR MOC”, , do you think…• Certification hasn’t done anything for me?• Please, ABR,…no more requirements?• I thought I was done with examinations?• Executive West, Louisville, KY?• MOC annual fees?• Okay, I don’t like it, but I’ll do it. Now how?

The ABR Listensere are some of the responses…Concern Response Additional Remarksertificationas doneothing for me.• Certification servespatients and thepublic.• Loss of “turf”multi-factorial• Does not indicate failure ofboard certification.

The ABR Listensere are some of the responses…Concern Response Additional Remarkslease, ABR,no moreequirements• License requirements• CME requirements veryfamiliar; SAMs & PQIadded• MOC: all specialties;state boards, payers,other stakeholders• There is no turning backfrom the transformation inhealthcare.• ABR MOC will be best andsimplest way to remainlicensed in the future.

• The main purpose of the ABMS and itsMember Boards, including the ABR, isto improve healthcare safety and qualityby establishing standards for…• Initial certification• Maintenance of Certification

Quality of Care Has Multiple DimensionsElements of Quality CarePeople get the care they needPeople need the care they getProvided safelyTimelyPatient-centeredDelivered efficientlyDelivered equitablyType of Quality ProblemUnderuseOveruseInjury, death, latentDelaysUnresponsiveWasteDisparitiesIOM, Crossing the Quality Chasm (2001)

Medical ErrorINSTITUTE OF MEDICINE“44,000 - 98,000 Americansdie each year as a result ofpreventable errors caused byfaulty systems or processesused in their care.”More deaths than:1999-Breast CA-AIDS-MVAs

The IOM Findings in PerspectiveAssume 71,000 deaths per year…194 deaths per day…Equivalent to…One 737 loadedwith passengerscrashing everyday……allyear longIf this were the safety record of the airline industry,would any of us fly to radiology meetings?

Overall, About Half of RecommendedCare Is DeliveredAbout 50-54% of carethat Americansreceive…… meetsqualitystandardscGlynn EA, Asch SM, Adams J, et al. The quality ofealth care delivered to adults in the United States.Engl J Med 2003;348:2635-45.

Failure of U.S. Healthcare System*• 47 million Americans without healthinsurance• Only 59% of Americans receive healthbenefits through an employer• Insurance unaffordable• Employer-backed healthcare system hasceased working for average Americans*Data current to end 2006

Health Care Spending as a Share of U.S.Economic Output Rising Steadily

INSTITUTE OF MEDICINE2001Calls for fundamental change inaims, with delivery of healthcarethat is:• Safe• Effective• Patient centered• Timely• Efficient• Equitable

Physician Responsibility in the new era:“Every patient deserves a competentphysician every time.” 1To Maintain the Privilege of Self-Regulation, we must…• Evaluate our competence• Commit to lifelong professional development• Provide public the evidence of our competence1Leach DC. ACGME Bulletin, December 2005: 2-3

Stakeholders Interested in Measurement ofPhysician Performance• The Joint Commission: National Patient Safety Goals• NCQA: Accred., Certification, Physician Recognition• NQF: List of 30 safe practices• IOM: Top 20 national healthcare priorities• IHI: 100,000 Lives Campaign (now 5 million)• National Patient Safety Foundation• State medical boards: sentinel event reporting• Payers (including CMS): P4P, PQRI

What is MOC Today?• A process designed to document thateach physician specialist certified by aMember Board of ABMS, maintains thenecessary competencies to providequality patient care

The 6 Competencies• Medical knowledge• Patient Care• Interpersonal and Communication Skills• Professionalism• Practice-based Learning and Improvement• Systems-based Practice

The 4 MOC Components• Professional Standing• Lifelong Learning and Self-assessment• Cognitive Expertise• Practice Performance Improvement(ABR’s Practice Quality Improvement—PQI)

The ABR Listensere are some of the responses…Concern Response Additional Remarksthought Ias finishedith exams• ABMS requirement• Case-based• If you’re practicingin areas you declare,you should have notrouble• Don’t expect to get 100%;practices vary; can’t cover it all.• General content: pertinent toeveryone.

The ABR Listensere are some of the responses…Concern Response Additional Remarksxecutiveest• Exams will becomputer- administered,case-based, in examcenters throughout thecountry;• National society mtgs• Wide geographicdistribution was ABR’starget, to reduce expenseand inconvenience fordiplomates.

The ABR Listensere are some of the responses…Concern Response Additional RemarksOC Annual Fees• MOC is continuous• Fees are cost-based• PDB: sign on >1x/yr• Includes all exam fees(no separate exam fees)

The ABR Listensere are some of the responses…Concern Response Additional Remarksow do I satisfyy requirements?• Sign up for MOC• Visit your personaldatabase (PDB)• Update your address,email address, contactinfo, so we can keep youinformed. Followinstructions in PDB.

http://www.theabr.orgIf you visithttp://www.abr.org...

http://www.theabr.org

http://www.theabr.orgPDBhttp://www.abronline.org

MOC Agreement

Prorated MOC Implementation

Transition to Full MOC Implementation

MOC Component I

MOC Component I

MOC Component II

MOC Component II - Qualified SAMs

My Component II – Progress Report

MOC Component III – Cognitive ExamPractice Profile DeclarationProcess under development

MOC Component III: Practice ProfiledCognitive ExamEXAMCONTENTVIR Thoracic Cardiac NeuroGeneralContent

In MOC, Component 4 (PQI) iswhere “the rubber meets the road”!

MOC Component IV – PQI

PQI Timeline & Milestone Tracking

Components of Care in DR• Procedure request• Procedure scheduling• Environment of care• Procedure personnel• Procedure protocol• Safety• Interpretation• Finalization• Communication• Outcomes

Has defining function(s)System RulesEach part can affect the wholeEach part alone insufficient for system to functionEach part depends on behavior and properties of atleast one other part of the systemJulia J. Mohr, MSPH, Ph.D., ABMSAckoff, 1974

Implications of Healthcare as a SystemPhysician alone cannot improve patient healthPreoccupation with elements can be too narrowand non-productiveSystem view critical to understanding andimproving patient outcomes, safety, and qualityQI methods emphasize systems approach

VIR Example #1• During a selective carotid arteriogram inpreparation for a carotid stent placement, thepatient suddenly experiences a grand malseizure. Cause: Lidocaine local anestheticinjected (in error) intra-arterially into the brainby a very experienced interventionalradiologist• Inadequate safeguards in the system of care

VIR Example #2• An experienced and well-respected IRperforms a thoracentesis on the wrongpatient.• Inadequate safeguards in place in thesystem of care

1 21) Identify opportunity forimprovement2) Identify metric to use3) Develop plan1) Baseline data gathering2) Begin analysis of dataPLANACTDOSTUDYPDSA41) Determine neededimprovements2) Implement change1) Complete analysis2) Summarize3

Where are we heading?Regional, Regional, national nationaldatabases databases begin beginData Data sharing, sharing, comparisoncomparisonQUALITY QUALITY OF OF CARE CAREIMPROVESIMPROVESNATIONALLY!!!NATIONALLY!!!Understanding Understanding of of systemsbasedpracticesystemsbased practiceYears 1-5 1Years 6-10 6PQI TimelineBest Best practices practices emerge emergePractice-based Practice based learning, learning,improvement improvement routine routineRobust Robust databases,databases,improvement improvement targets targetsPQI PQI topics topicsupdated updated based based on onhealthcarehealthcarepriorities prioritiesEngagement in processEngagement in processSimple Simple PQI PQI Projects Projects

Quality HealthcareMinimal shiftin overall qualityGoal:an overallqualityshiftPatientsIdentifyoutliersLow QualityBest Practice