BY CINDY BORGMEYER
There's no denying that the quality of the American health care system has come under fire in recent years -- and deservedly so, many would say. The issue came to a head when landmark reports from the Institute of Medicine in 1999 and 2001 brought patient safety and quality-of-care problems to the attention of medical professionals, health policy-makers and the public.
Not surprisingly, numerous would-be quality watchdogs have since stepped forward, proposing ways to measure various components of the quality picture -- including physician performance.
Sensing a growing threat to physician autonomy, the American Board of Medical Specialties, which oversees the individual specialty boards, set about developing a program to reassure the American public about the quality of care the nation's physicians provide. At the crux of that program is a process known as maintenance of certification, or MOC, in which every board-certified U.S. physician will be expected to participate.
Joseph Tollison, M.D., deputy executive director of the American Board of Family Practice, met with AAFP officers and staff last month and spoke about the new process. According to Tollison, ABFP is devoted to implementing MOC with a modicum of hassle.
"We are obligated by ABMS to march this thing out, and we're going to do it in the most constructive way possible," Tollison said. "We hope it will become clear that this process has great value to physicians' practices and to their patients. It may look like a burden on the front end, but there's great potential and great expectations on the back end."
The Nitty Gritty
Here's the gist of the new system.
MOC is designed to continuously measure the ongoing competencies of practicing physicians in every specialty. Those competencies are medical knowledge, patient care, interpersonal and communication skills, professionalism, practice-based learning and improvement, and systems-based practice.
ABMS has devised a four-part framework for measuring the six competencies and has charged each of its constituent boards with developing mechanisms to assess diplomates in each of the four areas:
• evidence of professionalism -- for now, this will be measured by maintenance of full, valid and unrestricted licensure. ABFP hopes to soon roll out an ABMS-designed peer/patient satisfaction evaluation tool to help physicians review this additional aspect of professionalism;
• evidence of self-assessment and lifelong learning -- diplomates each year will complete a clinical self-assessment module that uses patient simulation technology to test physicians' medical knowledge and clinical skills in a given disease domain;
• evidence of cognitive expertise -- ABFP will continue to measure this aspect via its comprehensive examination, expanding both the number of test sites and the frequency of exams offered, and completing over the next several years the transition from paper-and-pencil to computerized format; and
• evidence of assessment of performance in practice -- ABFP will conduct electronic chart reviews, comparing that information against evidence-based quality indicators and providing feedback. Physicians will then be expected to complete an individually tailored quality improvement plan during the seven-year MOC cycle, with a repeat audit to determine whether the QI plan has proved effective.
Much of this process no doubt sounds familiar, and it should. To paraphrase ABFP Executive Director James Puffer, M.D., the new process refines, rather than shifts, the paradigm currently used to recertify FPs. Puffer discussed the issue at length in an interview in the inaugural issue of Annals of Family Medicine. Go to http://www.annfammed.org/cgi/content/full/1/1/56 to read the article.
New Beginnings, New Bonds
ABFP will begin phasing in the new program Jan. 1, 2004, for those certifying or recertifying in 2003. Every year thereafter, each certifying or recertifying physician will enter the MOC program. That's where AAFP comes in.
The Academy and ABFP are already working closely together to coordinate the roll-out of the ABFP's first two clinical self-assessment modules -- on diabetes and hypertension -- with AAFP CME initiatives.
Another area that has the two organizations working shoulder-to-shoulder involves assessing evidence of physicians' performance in practice, with the ABFP working to ensure that AAFP QI activities now being designed for members meet ABFP criteria for fulfilling this component.
"We want this to be a truly collaborative relationship," said Tollison of the growing cooperation between the two organizations. "The ABFP and its diplomates are really looking to the Academy to partner with us. This has 'opportunity' written all over it."
"I think the changes our Academy members are being asked to make are completely in keeping with what it means to be a family physician," said AAFP Director John Sattenspiel, M.D., of Salem, Ore., about the new system. "Now we need to help our members get to a place where this is all just part of the landscape of day-to-day practice."
To reach writer Cindy Borgmeyer, e-mail cborgmey@aafp.org.
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Copyright © 2003 by
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