Four measures intended to further enhance physician qualifications assessed through the Maintenance of Certification program were adopted by the American Board of Medical Specialties on March 16. The ABMS approved the following four requirements as “developmental standards” that will be piloted, tested for feasibility, and reevaluated within five years:
1. Documentation that physicians are meeting requirements for self-assessment and continued medical education.
2. Evidence of participation every two to five years in practice-based assessment and quality improvement.
3. Completion of a patient safety self-assessment program at least once during each MOC cycle.
4. Assessment of communication skills for all physicians with direct patient care.
The communication skills assessment requirement will become a core tenet of physician assessment and MOC. A pilot study involving two or more ABMS member boards will take place in 2009 with reporting to physicians for reflection in 2010. Physicians who provide direct patient care must participate in communication skills assessments starting with patients in 2010 and with peers in 2012, while those without direct patient contact are exempt; other exemptions may be defined during the 2009 pilot year. Public reporting is expected to begin in 2011.
Physician communication skills will be evaluated using surveys approved by the ABMS Committee on Oversight and Monitoring of Maintenance of Certification. One such survey was developed by the Consumer Assessment of Healthcare Providers and Systems program, known as CAHPS, which is funded and administered by the U.S. Agency for Healthcare Research and Quality; AHRQ works closely with a consortium of public and private organizations.
The CAHPS patient survey initially is expected to be a validated, standardized instrument consisting of approximately seven items. For the first three years, it will be a paper survey distributed in-office and returned by mail.
ABMS member boards, including the American Board of Neurological Surgery, may offer the survey as a part of the Practice Performance Assessment requirement. Each member board has been encouraged to add CAHPS supplemental items to the communication core or additional tools for assessing professionalism and communication skills to fulfill requirements for other MOC components.
The implementation of the CAHPS survey as proposed by the ABMS provoked controversy among its member boards. The primary opposition to the survey instrument relates to the implementation of a “one size fits all” survey for different specialties, which may not be reflective of the practice of some specialists. The American Board of Neurological Surgery is actively involved in these discussions and will be integrally involved in the development of a neurosurgery-specific survey instrument.
The four new MOC requirements grew out of the ABMS’ 2008—2011 Enhanced Public Trust Initiative, which is intended to increase commitment to quality healthcare and transparency in physician accountability. The ABMS Committee on Oversight and Monitoring of Maintenance of Certification outlined this uniform set of standards and set timelines for officially adopting the new MOC program elements.
The ABMS is the medical organization that oversees physician certification in the United States. It assists its 24 member boards in their efforts to develop and implement educational and professional standards for the evaluation and certification of physician specialists. The ABMS is recognized by the key healthcare credentialing accreditation entities as a primary equivalent source of board-certification data for medical specialists.
William T. Couldwell, MD, PhD, is a director of the American Board of Neurological Surgery, and an ABNS delegate to and voting member of the American Board of Medical Specialties. Dr. Couldwell is editor of the AANS Neurosurgeon and secretary of the AANS. The author reported no conflicts for disclosure.
For Further Information
- American Board of Medical Specialties, www.abms.org
- American Board of Neurological Surgery, www.abns.org
- Consumer Assessment of Healthcare Providers and Systems, www.cahps.ahrq.gov