In late December, the American Board of Emergency Medicine sent letters to its diplomates outlining the process for Part 4 of its Maintenance of Certification program. ACEP does not set the requirements for continuous certification. However, because many ACEP members expressed confusion about the ABEM letter, ACEP is attempting to clarify the process for its members. ACEP President-Elect Sandy Schneider, M.D., had a conversation with ABEM President Debra Perina, M.D., to pose the frequently asked questions and elicit some ideas about how to best complete the Part 4 section. Here is an excerpt of their conversation. (For the entire transcription, visit www.ACEP.org.)
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ACEP News: Vol 29 – No 03 – March 2010Dr. Sandy Schneider, ACEP President-Elect: The letter sent by ABEM outlines the requirements for Part 4 of the Maintenance of Certification (MOC) program. Can you tell me where the letter came from, the background behind these requirements, and the timing?
Dr. Debra Perina, ABEM President: The American Board of Medical Specialties (ABMS) is the organization that oversees ABEM and the other 23 medical specialty boards. The ABMS set written requirements to guide MOC programs. All 24 ABMS member boards, which include ABEM, must develop a MOC program. Each specialty can add additional specificity in its requirements, consistent with the practice in their specialty. This program was developed in response to the patient safety movement, consumer advocacy groups, and the federal government asking for transparency and accountability in the physician ongoing education and credentialing process.
SS: Can you break this down so we can understand exactly what is going to happen? I see there are two parts. Start with the patient communication survey.
DP: The Communications Professional Activity must be conducted one time in your 10-year cycle, which starts at the point when you are certified or recertified. At one time during that 10-year cycle, each physician must complete an activity related to communication and professionalism.
If your hospital uses Press-Gainey and your patients are included in the results of that survey, you can use those results to meet this requirement. Many hospitals use that or other surveys to study communications between the physician and the patient. Acceptable surveys for Part 4 activities must include questions and measure communication/listening, providing information, and showing concern for the patient.
SS: My hospital uses Press-Gainey. Can I use the score from my department, or do I have to do more?
DP: It depends on the specific feedback you are receiving. If you are getting feedback related to your practice in particular, it would be applicable. It depends how the survey is structured, because some hospitals give you specific feedback and some don’t. Many hospitals have the information but just don’t drill down to that degree. You should definitely ask for specific feedback as a starting point.
SS: What if I work in multiple emergency departments? Do I have to get surveys from each, or can I just pick one?
DP: Pick one. You do not need one from each emergency department you work in.
SS: What if my hospital doesn’t have Press Ganey or a similar survey?
DP: There are a number of things you can do. Some groups actually have someone who follows up with patients, either randomly selected or some subsegment of patients, such as those who left against medical advice. These callers often ask patients about the communication they received and the experience they had. They compile the responses and give it back to the group. If 10 of your patients were included, that would count. You could also create a four- or five-question survey that covers the communication categories mentioned previously and ask 10 patients to complete it and return it to you. Their responses would count, because you are assessing your ability to communicate with those patients.
SS: Let’s talk about quality assurance.
DP: The Patient Care Practice Improvement Activity is a four-step process that you have to complete twice during your 10-year cycle. You collect data that reflect what you are doing with your patients now. Then you compare those data to evidence-based guidelines. This allows you to assess where you are in your practice and answer questions such as, “Am I where I want to be?” and “Am I doing what I want to do?”
If you are hitting those benchmarks, that’s great. You can move on to look at something else. But if you are not hitting those benchmarks, you have the chance to develop a plan to do things a little better. Once you develop the plan and implement some new strategies, you then go back and resurvey 10 patients to see if you have improved things.
A perfect example is the ubiquitous aspirin in suspected STEMI. You want to give aspirin to those patients 100% of the time. We know many hospitals are looking at this initiative and giving feedback on patients who should have received aspirin. If you are missing patients, you need to consider and plan for how to remember to give aspirin the next time. You resurvey, or in this case the hospital will resurvey for you. This allows you to determine whether you are improving your efforts at giving aspirin to chest pain patients. This is one example of a qualifying activity that physicians are already doing.
SS: So, I would not have to hunt up and figure out which of the 2,000 patients we treated were mine?
DP: Correct. As long as you know your patients were included in the 2,000 and your group discussed this initiative, created some benchmarks, implemented changes as a group, and remeasured for progress, this would count.
SS: Do I have to submit my data to you?
DP: No. We do not want your individual data. We are only asking that you attest to the fact that you are doing these types of projects.
SS: Some emergency physicians work as locum tenens, provide care on cruise ships, or work internationally. What tips do you have for people who work in alternative types of practice?
DP: As far as the patient communication piece goes, you can develop your own questions and ask patients to complete and return them to you on site or through the mail.
In terms of patient improvement activity, if you don’t have a patient survey instrument available to you, there are patient improvement modules that you can take. The ABMS Quality Improvement in Practice (QIP) Program is approved to satisfy Part 4.
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