In their thoughtful Health Affairs Blog posting, Alan Muney and Peter Orszag emphasize the importance of practice assessment in providing “a sustainable method for a continuous infusion of quality and affordability into our health care system.” However, they are mistaken in stating that “no medical specialty board certification process reviews how a physician actually practices in the office.” The American Board of Medical Specialties (ABMS) Program for Maintenance of Certification (MOC) addresses this need, through the Programs for MOC developed and implemented by the 24 medical specialty member boards that comprise ABMS.
For example, Part II of the MOC process addresses lifelong learning and self-assessment, and some of the activities must be based on identified specialty and/or practice gaps. Part IV directly addresses practice performance assessment and improvement with the goal of improving patient care based on performance data. Many ABMS Member Boards are using self-assessment modules and performance in practice modules (PIMS) as part of their Part II and Part IV activities.
Physician participation in these MOC activities is linked to enhanced clinical performance and improved patient care. Studies have cited improvement in clinical care areas ranging from cardiology to pediatrics and covering chronic conditions including asthma, diabetes and depression. Additionally, physicians who participate in such activities have improved their ability to identify gaps in knowledge and/or care. ABMS provides access to annotations of research studies and articles that reflect these types of findings.
Although many MOC Part IV requirements focus on the individual provider, more are beginning to address quality improvement at the practice and/or organization level. For example, hospital-based PIMs developed by the American Board of Internal Medicine address multiple conditions using performance data collected by the institution for reporting to the Centers for Medicare & Medicaid Services. As part of the MOC Portfolio Program, physicians participate in multi-disciplinary quality improvement activities, which directly relate to their clinical practice or a process that affects clinical outcomes. They are required to describe the change and its effect on the delivery of care and, at the same time, work with care team members to conduct the actual activity. Organizations involved in the MOC Portfolio Program have demonstrated past success in improving quality of care.
Like Muney and Orzag, ABMS believes that Board Certification should be based, in part, on how physicians actually practice medicine and not solely on their “book knowledge”. The Program for MOC evaluates both.