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Phoenix Winter 2010 MH.indd

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					          Winter 2010                              American Board of Family Medicine, Inc.



THE PHOENIX
   A Diplomates’ Newsletter

A Message from the President
                                                                                                           James C. Puffer, M.D.
Earlier this year, I received an email from a Diplomate who             in the last issue of the Phoenix, developing our next iPhone
wished to disagree with one of the answers and its corresponding        application, scoring and validating the December examination,
critique in our Well Child Self-Assessment Module (SAM). The            and preparing for the extensive yearly process of updating our
question dealt with routine screening that should be performed          database with the results of this year’s December examination
on a child with Down syndrome, and specifically with obtaining          and the completed Maintenance of Certification for Family
screening cervical spine films between the ages of 3 and 5 to rule      Physicians (MC-FP) stage data. Nevertheless, they have humored
out atlantoaxial instability. Since I have some familiarity with this   me by agreeing to create the SAM Forums. They have also
issue, I wrote back and shared my opinion with him.                     suggested that I stop jogging!
In my return email, I noted that while the answer and critique
certainly conformed to the recommendations from the source
from which the question originated, the Policy Statement
                                                                            “We know that our Diplomates
on Health Supervision for Children with Down Syndrome                       speak very highly of the SAM
developed by the American Academy of Pediatrics Committee on                Study Group concept and
Genetics, I tended to agree with him. I indicated that while the
original policy was written in 2001 and reaffirmed as recently as           frequently comment that
2007, this specific recommendation was, for the most part, based            they are some of the very
on expert opinion. Furthermore, I added that even the Special
Olympics no longer required evidence that these radiographs
                                                                            best educational activities in
had been performed as a condition for participation and that the            which they participate. The
only situation in which I would feel compelled to recommend                 major reason typically given
and obtain these films was if a child with Down syndrome was
planning to participate in a contact sport. Finally, I wrote that           for these positive statements
even in the original policy statement, the Committee hedged on              is the healthy dialogue that is
this issue by noting that significant controversy surrounded this
specific recommendation. The Diplomate thanked me for the
                                                                            generated around the SAM
reply and for sharing my thoughts with him about this issue.                questions, their answers and
Why, might you ask, do I share this story with you? Well, during            the critiques.”
my early morning jog—always a dangerous time our staff will tell
you since this is when much of their “extra” work is generated—
the day after trading emails with this physician, I asked myself        Basically, Diplomates will be able to share their thoughts about
why the dialogue regarding this topic necessarily needed to be          each question during the review process, and they will be able to
limited to just the two us. We know that our Diplomates speak           review the comments that their colleagues have provided about
very highly of the SAM Study Group concept and frequently               the same question. This will provide the opportunity for the
comment that they are some of the very best educational activities      development of a rich and robust online learning community
in which they participate. The major reason typically given for         to further enhance the Diplomate’s learning experience. The
these positive statements is the healthy dialogue that is generated     discussion threads should provide nuanced understanding of the
around the SAM questions, their answers and the critiques.              principal learning points underlying each question. Additionally,
Why shouldn’t we, I asked myself, try to replicate this experience      much as we have already done for the question in the scenario
online? And thus the concept of SAM Forums was born!                    that I have described above, we will be able to review the set of
                                                                        comments for each question during our annual review of the
Our staff is busy with the second phase of our website redesign,        SAMs and revise and edit accordingly. We hope that you will
refining the business rules for our move to the next iteration of       enjoy this new feature; you can expect to see the Forums around
Maintenance of Certification for 2011 that I described to you           the end of the first quarter next year.
                                                                                                                      continued on page 2
                       2


A Message from the President
                                                                                                                 continued from page 1

While on the topic of group learning           Technology (HIT). This is the result           We encourage you to meet our content
activities, let me share another innovation    of almost two years of interaction with        development staff in this issue. They
that you will see introduced next year         the ONC to create synergy between              help create and maintain the items for
– our group PPM software. As you will          maintenance of certification (MOC) and         our examinations, develop and refine the
read in this issue, we have a number of        the meaningful use of HIT. The contract        content for our SAMs and PPMs, and
Part IV activities that can be used to         provides funding to each of the three          devise strategies for constantly reviewing
meet your MC-FP requirements. Some             primary care boards for the development        the medical literature to make certain
of these approved activities take place        of MOC tools that will assist Diplomates       that the content that we create is always
within learning collaboratives, and we         with meeting meaningful use requirements       grounded in sound evidence. Please take a
want to foster and cultivate these unique      while also receiving credit for MOC.           moment to learn a little more about each
educational experiences by making it as                                                       of these remarkable individuals and the
easy as possible to participate in them.       I mentioned our iPhone applications            terrific work that they do on your behalf.
Therefore, we are in the process of creating   early in this message, and in this issue, we
software, much like our SAM Study              introduce you to our inaugural application     Before closing, I want to make certain
Session software, that will allow learning     that was launched in November. This free       that you are aware that you still have time
collaborative leaders to enter data for all    application provides ready access to all of    to submit data to qualify for the 2010
of the actively participating Diplomates       our exam preparation materials as well as      Physician Quality Reporting Initiative
in their group at one time. For each           important dates for the examinations and       bonus. Take a moment to read the article
participating Diplomate, the software will     the exam application process. We have          in this issue that outlines what you need
automatically populate the data cells within   had close to 2500 downloads in the first       to do to qualify for the 2% bonus based on
the respective Performance in Practice         month since the application was launched.      your applicable 2010 Medicare billings.
Module (PPM) that the group is using.          We are in the process of creating future       The average bonus received by participating
                                               applications that will allow Diplomates        Diplomates in 2008 and 2009 was enough
In this issue you will also learn about the    to monitor their progress in MC-FP and         to cover the one-time payment fee for ten
recent success in securing a contract with     help the public find board-certified family    years of MC-FP!
the Office of the National Coordinator         physicians.
(ONC) for Health Information                                                                  On a final note, please allow me to wish
                                                                                              you, on behalf of all of us at the American
                                                                                              Board of Family Medicine, a wonderful
  ATTENTION:                                                                                  and joyous Holiday Season. We look
  Diplomates Who Certified in 2004                                                            forward to celebrating a healthy and
                                                                                              prosperous year with you in 2011.
  Diplomates who certified or recertified in 2004 are
  required to complete 3 MC-FP modules for Stage
  Two by December 31, 2010, in order to remain eligible                     ATTENTION:
  for the 10-year certification path. For Stage Two
  requirements, Diplomates are required to complete 2                       Diplomates Who Certified in 2007
  Part II modules (SAMs) and 1 Part IV module (PPMs,
  MIMMs or an approved alternative).                                        Diplomates who certified or recertified in 2007
                                                                            are required to complete 3 MC-FP modules for
  NOTE: While there is not enough time left in 2010 to                      Stage One by December 31, 2010, in order to
  start and complete most of the PPMs, there is still time                  remain eligible for the 10-year certification path.
  to complete a MIMM or a PSM.                                              For Stage One requirements, Diplomates have the
                                                                            option to complete 3 Part II modules (SAMs) or
  To receive your 3-year extension at the end of this                       2 Part II modules and 1 Part IV module (PPMs,
  calendar year, you must hold a currently valid, full, and                 MIMMs or an approved alternative).
  unrestricted license to practice medicine in the United
  States or Canada on December 31, 2010.                                    NOTE: While there is not enough time left in
                                                                            2010 to start and complete most of the PPMs,
  Diplomates who do not complete Stage Two                                  there is still time to complete a MIMM or a PSM.
  requirements will retain their 7-year certification
  and will have to complete the MC-FP activities                            To guarantee your eligibility for the 10-year
  (6 SAMS and 1 Part IV) for the 7-year cycle before                        certification, you must successfully complete 3
  choosing a test center in January for the next exam.                      MC-FP modules by the end of this year.
                                                                                                                3



ONCHIT and the ABFM
While the Affordable Care Act (ACA, the health reform law) has received tremendous attention since being passed by Congress in
2010, a component of the American Recovery and Reinvestment Act (ARRA, the “stimulus” bill) has similar potential to influence the
U.S. health care system. Specifically, the Health Information Technology for Economic and Clinical Health Act (the “HITECH” Act)
included features designed to support and stimulate adoption of electronic health records (EHR’s) and health information technology
(HIT). Under the HITECH Act, the Office of the National Coordinator for Health Information Technology (ONCHIT) and the
Centers for Medicare and Medicaid Services (CMS) have developed criteria for “meaningful use” of HIT. The law includes financial
incentives for physicians to implement HIT and demonstrate meaningful use as it’s defined. The law includes penalties for those
providers who don’t demonstrate meaningful use by 2015.

To facilitate Diplomates’ ability to satisfy the meaningful use criteria and the associated financial incentives, the American Board
of Medical Specialties (ABMS), and the American Boards of Pediatrics (ABPeds), Internal Medicine (ABIM), and ABFM have
teamed up to develop Maintenance of Certification (MOC) components that will help Diplomates meet these requirements. ABMS,
ABPeds, ABIM and ABFM have successfully concluded a sole-source contract with ONCHIT to support development of these tools.
In year one of the contract, ABPeds will develop knowledge assessments (MOC Part II) regarding HIT and patient safety. ABFM
will create simulations to complement the knowledge assessments (much like ABFM’s existing Self-assessment Module, or SAM,
structure.) In the second and third years of the contract, ABIM will develop comprehensive performance improvement and care
transition modules. All three boards will revise their existing MOC materials to align with meaningful use wherever possible, again in
an effort to enable Diplomates to demonstrate and document meaningful use through their ongoing MOC activities.

ABFM embarked on this effort to develop yet another dimension of value for our MOC program. We hope that you’ll find these
tools useful in demonstrating your meaningful use of HIT!



2010 Physician Quality Reporting Initiative (PQRI)
The deadline to complete the 2010 PQRI reporting is January 10, 2011. There is still time to participate. The ABFM is an approved
PQRI registry for 2010, and ABFM Diplomates are able to complete their 2010 PQRI activity online in their physician portfolio at
no cost. Participants have the opportunity to receive a 2.0% incentive payment for Physician Fee Schedule (PFS) covered professional
services furnished during the reporting period, January 1, 2010 – December 31, 2010. The Medicare, Medicaid, and SCHIP Extension
Act of 2007 (MMSEA) authorized CMS to make PQRI incentive payments for satisfactory reporting of quality measures data in
2010.

The requirement for including 30 patients in the registry changed in 2010, so physicians who have participated in the last two years
need to be aware of the changes. The 30 patients included in the registry no longer need to be consecutive, as was the case for the past
two years. Physicians who meet the 2010 PQRI criteria for satisfactory submission of quality measures data for 30 unique patients earn
an incentive payment of 2.0 % of their total allowed charges for Physician Fee Schedule (PFS) covered professional services furnished
during the reporting period, January 1, 2010 – December 31, 2010. CMS approved financial incentives earned during 2010 reporting
are scheduled to be paid in mid-2011 from the Federal Supplementary Medical Insurance (Part B) Trust Fund. Again, the deadline to
complete the 2010 PQRI reporting is January 10, 2011.

Additionally, Diplomates have the added benefit of combining PQRI with their MC-FP activity. In short, any Diplomate who
successfully completes the 2010 PQRI reporting can continue the activity for MC-FP credit and CME credit by implementing a
quality improvement plan along with a post quality improvement data collection to complete the activity as a Performance in Practice
Module (PPM).

The ABFM has applied to become an approved registry again in 2011, and looking forward to next year, new details and incentives
will be in place based upon the passage of recent legislation. One significant revision will be a name change; the program known
currently as the Physician Quality Reporting Initiative will be called the Physician Quality Reporting System (PQRS) next year.
Other detailed requirements about PQRS will be announced in the spring of 2011, so look for details on the ABFM website and in
the next Phoenix newsletter.

To begin 2010 PQRI reporting today, visit the ABFM website at www.theabfm.org and login to your Physician Portfolio. If you have
any questions about how to start taking advantage of the PQRI reporting opportunity, please contact the ABFM Support Center at
877-223-7437 or via email at help@theabfm.org.
                     4



MC-FP Part IV

Maintenance of Certification for Family Physicians (MC-FP) is comprised of four parts: professionalism (Part I), self-
assessment and lifelong learning (Part II), cognitive expertise (Part III), and performance in practice (Part IV). The
professionalism and cognitive expertise requirements should be old hat to most Diplomates by now, and most should also be
comfortable with the self-assessment and lifelong learning requirement at this time. However, the performance in practice
requirement is still new and confusing to many Diplomates.
Part IV, performance in practice, is designed to assess how a Diplomate cares for patients in his practice and identifies areas
in which to intervene and, hopefully, improve patient care. A basic Part IV activity requires that a physician assess his practice
and select an area for improvement. Then the physician must implement an evidence-based intervention to try to improve
care and, after a predetermined interval, reassess his practice. Many times this is accomplished using PDSA (Plan, Do, Study,
Act) cycles or other QI methodologies.
The ABFM recognizes that many physicians already do quality improvement (QI) work as part of their daily practice.
We want to minimize redundant work, so we have developed eight Part IV activities (Performance in Practice Modules,
PPMs) that address common health topics and assess common, nationally endorsed indicators. Additionally, we have created
an Alternative Part IV Activity Approval Program to which institutions and larger groups of physicians can apply for
consideration of Part IV activities that they themselves develop. Currently, more than 20 institutions have applied for and
received approval for numerous QI activities.
For physicians who do not provide continuing care or who have an interruption in their practice, the ABFM offers alternatives
to the PPM: Methods in Medicine Modules (MIMMs), the Patient Safety Improvement Program (PSIP), and the newly
released Hand Hygiene module. These activities do not require direct access to continuity practice populations, but do
include quality improvement concepts and activities that satisfy the MC-FP Part IV requirement.
Information about all of the available Part IV activities and the alternative activity approval program can be found on our
Website at https://www.theabfm.org/moc/part4.aspx.




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                                                                                               5



ABFM Launches New Exam Prep iPhone App




The ABFM is pleased to announce the launch of its new iPhone app, the ABFM Exam Prep app. This mobile
application provides family physicians with useful information to assist with preparation for the ABFM Main-
tenance of Certification Exam. This module turns your iPhone into an invaluable tool for keeping you in touch
with what you need to know as you enter your certification or recertification year.
Features of the free, downloadable ABFM Exam Prep app include:
Exam Prep documents and videos—including the detailed ABFM Guide for Exam Preparation document
Upcoming Exam Dates—a quick view of future dates
Links to the ABFM website and the Journal of the American Board of Family Medicine website
Practice Quiz—Over 200 questions addressing problems commonly encountered by family physicians. Each
practice quiz presents 10 questions followed by a clear rationale for the correct answer including the associated
reference.
While not a substitute for a well-designed and executed study plan, the ABFM App is an additional tool to help
prepare for the Maintenance of Certification Exam. This module is designed for family physicians, but the ques-
tions may be useful for medical students and other health care providers as well.
                      6


ABFM Content Development Department




             Left to right: Roger Fain, Emily Garriott, Susan Hill, Lisa Bell, William DeBord (Nichole Lainhart, not pictured)

The Content Development Department is responsible for the development and maintenance of the assessment materials used for the
ABFM’s Maintenance of Certification process. Members of the department work with a wide variety of family physicians to create
and review examinations and self-assessment activities. This department is also responsible for assembling and preparing the materials
for publication. The final product may be presented at commercial testing centers, over the Internet, or in a printed version.

Lisa Bell contributes to the day-to-day activities of the department, including word processing and maintenance of the test item
banks. In addition, she is also responsible for meeting planning, both for the department and for the ABFM Board of Directors. Lisa
graduated from Lexington Community College, attended the University of Kentucky, and has been with the Board since 1990.

William De Bord has been the ABFM’s Information Specialist since 2005. He has developed a series of automated online searches to
maintain and update the references for the ABFM Self-Assessment Modules (SAMs), as well as for other components of the ABFM’s
Maintenance of Certification process. He also oversees a small medical library at our offices. William has a B.A. in history from
Marshall University and a master’s degree in library science from the University of Kentucky. He previously worked for the Eastern
Kentucky Health Sciences Information Network in Morehead, Kentucky, where his duties included consulting with medical libraries
in South America.

Roger Fain, Senior Editor, is in charge of developing the ABFM’s examinations, including the primary certification examination,
the In-Training Examination that residents take each year, the Sports Medicine CAQ Examination, and the knowledge assessment
component of the Self-Assessment Modules (SAMs). He has a B.A. in Education and an M.A. in English from the University of
Kentucky, where he taught freshman English for 7 years before coming to the Board in 1984.

Emily Garriott began working for the ABFM in September of this year and is learning about the exam development process while
also editing test items and exam drafts. Emily has a B.A. in English from Humboldt State University and an M.A. in English from
the University of Kansas. Before coming to the ABFM she worked for the Thoroughbred Times in Lexington and for the University
Press of Kansas.
                                                                                                             continued on page 7
                                                                                                                7



                                         Support Center Holiday Hours
                                              (all times Eastern)


    End of Year Sunday Coverage                                                                12:00pm – 5:00pm
    (November 28—January 2)


    Holidays
    Friday, December 24                                                                        8:30am – 5:00pm
    Saturday, December 25                                                                      Closed
    Sunday, December 26                                                                        9:00am – 5:00pm

    New Year’s Day 2011
    Friday, December 31                                                                        8:30am – 5:00pm
    Saturday, January 1, 2011                                                                  12:00pm – 5:00pm
    Sunday, January 2, 2011                                                                    9:00am – 5:00pm




ABFM Content Development
                                                                                                               continued from page 6

Susan Hill’s responsibilities include maintaining the ABFM test item banks and producing examinations in both electronic and
printed formats. Such duties involve use of various types of word processing, database, and test presentation software. Susan graduated
from Lexington Community College, attended the University of Kentucky, and has been with the Board since 1983. Prior to that, she
worked as a transcriptionist at Good Samaritan Hospital in Lexington.

Nichole Lainhart’s major responsibility is the Quality Improvement component (Part IV) of maintenance certification. In addition,
she is involved with exam development, including editing and proofreading test items and examinations. Nichole has a B.A. in English
from the University of Kentucky and has worked at the Board since 2006. She was previously employed by the University Press of
Kentucky as an editing supervisor.
                 8
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The American Board                       LEXINGTON, KY
                                          PERMIT # 850
of Family Medicine

1648 McGrathiana Parkway, Suite 550
Lexington, Kentucky 40511-1247

                 Phone: 859-269-5626
                     Fax: 859-335-7501


    www.theabfm.org

				
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