AOBOG OCC Osteopathic Continuous Certification Presented by Carolyn

AOBOG OCC Osteopathic Continuous Certification Presented by Carolyn W. Quist, DO, FACOOG (dist. ) Vice Chair, AOBOG

Learning objectives • To learn what Osteopathic Continuous Certification (OCC) means • To review the 5 components of Osteopathic Continuous Certification • To review the start date of OCC • To review the newest component of OCC: Part 4 -Practice Performance Assessment • To review what loss of certification means

What is OCC? Osteopathic Continuous Certification • A Process for Board certified DOs to demonstrate and maintain competency in knowledge and skills in their specialty area • An assessment tool to enhance the quality of health care • A way for the public to have a “quality standard” for their personal physician • Mandated by the AOA’s Bureau of Osteopathic Specialists (BOS) and in the works since 2009 • The Board sets the standards and uses evidencebased medicine to back it up. • Is a 6 -year re-occurring certification process

5 Components of OCC • Part 1 • Part 2 • Part 3 • Part 4 • Part 5 Professional standing; Unrestricted license in 1: 50 states; adhere to AOA Code of Ethics Std 120 hours CME requirements- every 3 years; 50 CME hrs. in specialty Cognitive assessment: psychometrically valid formal proctored exam (FPE) - once every 6 years (anytime in last 2 years of 6 -year cycle) Practice Performance Assessment and Improvement modules, includes Communications Module (Pt surveys (CAHPS)) Continuous AOA membership – Part 4 is the only new requirement to maintenance of Certification

WE WANT YOU! TO LOOK AT YOUR CERTIFICATE EXPIRATION DATE! If you have a time-limited certificate (with an expiration date), then you are required to enter OCC. If you have a non time-limited certificate, you are highly encouraged to enter the OCC process.

Who is required to do OCC? • Anyone with a Time-limited certificate, i. e. , has an expiration or anniversary date on it! – Time-limited certificates started July 2002 for AOBOG. • The anniversary date is established by the date of the initial certification. • The formal written proctored exam (component 3 of OCC) may be taken no earlier than 2 years prior to the anniversary date of your certification.

When does OCC go into effect? • January 1 st, 2013 – Anyone with a time-limited certificate must go to the AOBOG. org website to create a user profile and then register for OCC. – You will be given instructions on how to complete the assignments once registered. – There will be an initial entry plan for those physicians whose time -limited certificates end prior to a full 6 -year OCC cycle. • OCC is Voluntary for physicians with non time-limited or “nonexpiring” certificates at this time but strongly encouraged! Non time-limited certificate holders must maintain their certification by remaining a member of the AOA and keeping CME up-todate, otherwise they will lose the original certification.

Patient Protection and Affordable Care Act • • • In 2010 - The Affordable Care Act charged the Department of HHS with developing a National Quality Strategy SEC. 3011. NATIONAL STRATEGY. ‘‘PART S—HEALTH CARE QUALITY PROGRAMS ‘PART D—HEALTH CARE QUALITY IMPROVEMENT ‘‘Subpart I—Quality Measure Development Maintenance of Certification Programs have been added pg. 247 of which Practice Assessment is Required

CMS Requirements for a Practice Assessment • Initial assessment using evidence-based medicine • Survey of patient experience with care • Implementation of quality improvement intervention to address identified weakness • Reassess performance improvement after intervention

AOA versus ABMS What’s the difference between OCC and MOC? 6 year cycles AOBOG ABOG Part 1 Professional standing; unrestricted license; attestation forms; patient surveys Part 2 120 hours CME requirements every 3 years (50 in specialty) Lifelong learning (LLL) articles: complete 120 questions/year Part 3 Formal proctored written exam once every 6 years Cognitive expertise written exam once every 6 years Part 4 PPA modules: 5 required per 6 year cycle (one of which is Communications Module (patient surveys)) PPSA modules: 1 every year x 5, must complete in 12 months Part 5 AOA membership None

7 core competencies incorporated into OCC Components • Osteopathic Philosophy/Osteopathic Manipulative Medicine • Medical Knowledge • Patient Care • Interpersonal and Communication Skills • Professionalism • Practice-Based Learning and Improvement • Systems-Based Practice – See AOA website for more information (www. osteopathic. org/occ)

Why should I participate? • Benefits of participating in OCC include demonstrating: – adherence to the AOA Code of Ethics and specialty standards – a commitment to lifelong learning – continuous quality improvement of practice – membership in the osteopathic professional community – quality assurance to the public

Part 4 -Practice Performance Assessment and Improvement “Measures are the only way we can really know if care is safe, efficient, effective and patient-centered. While measures come from many sources, performance measures give us a way to assess healthcare against recognized standards. ”

The Difference a Good Measure Can Make • Why measure? – Drives improvement – Inform consumers – Influence payment • What to measure? – Biggest return in a better quality of life – Initially: patient and family engagement, care coordination, safety, population health, overuse, and palliative and end-of-life care. Now we are looking at evidence-based initiatives

AHRQ # 208 • Public Reporting of quality – Reviewed 198 articles – Individual clinicians and organizations, responded to public reports by making positive changes in their behavior. Studies found that hospitals were more likely to offer new services, policies were changed, surgeons with worse outcomes left surgical practice, and quality improvement activities increased. – Almost all identified studies found no evidence or only weak evidence that public reporting affects the selection of health care providers by patients or their representatives. • AHRQ Publication No. 12 -E 011 -EF. Rockville, MD. Agency for Healthcare Research and Quality. July 2012. www. effectivehealthcare. ahrq. gov/reports/final. cfm.

Descriptions of the OCC Components We will break down the requirements of each of the 5 components of the OCC process in more detail!

OCC Part 1 • Professional standing • Individual must register online • Must attest to having an unrestricted license in at least 1: 50 states or Canada - if restricted, must submit letter with explanation and cases will be reviewed individually • Adhere to AOA Code of Ethics - if problem exists and not reported, could lose certification. (See RES. NO. B-64 A/2011) • Participate in a CAHPS-C&G-like survey: Consumer Assessment of Healthcare Providers and Systems-this will be one of the required PPA modules under Part 4

Osteopathic Pledge of Commitment As members of the osteopathic medical profession, in an effort to instill loyalty and strengthen the profession, we recall the tenets on which this profession is founded – the dynamic interaction of mind, body and spirit; the body’s ability to heal itself; the primary role of the musculoskeletal system; and preventive medicine as the key to maintain health. • I pledge to: • Provide compassionate, quality care to my patients; • Partner with them to promote health; • Display integrity and professionalism throughout my career; • Advance the philosophy, practice and science of osteopathic medicine; • Continue life-long learning; • Support my profession with loyalty in action, word and deed; and • Live each day as an example of what an osteopathic physician should be.

CAHPS-C&G Surveys

OCC Part 2: Continuous Medical Education

Usual AOA CME Requirements 30 1 -A credits= face-to-face CME conference 50 Specialty CME Credits-any category CAQ Specialty CME credits (as applicable) 120 CME Credit hours total due every 3 years A minimum of 50 specialty credits must be Ob-Gyn related

Description Maximum # of Credits/cycle Annual OMED Conference and Exposition Determined annually by each specialty board AIDS Seminars (any osteopathic or allopathic) 5 Risk Management/Patient Safety 5 Ethics 0 AOA Specialty College Conferences & Seminars ALL AOA State Society Seminars 25 Medical Journals/Home Study Courses 20 Scientific Exhibits 5 AMA/PRA courses Specified by Board

Specialty CME Description Maximum # of Credits/cycle Formal Teaching in the Specialty Specified by Board Standardized Life Support Specified by Board Specialty Certifying Board Test Construction 15 Publications 15 Healthcare Facility Meetings 0 Hospital inspections 0 Acute Care Hospital Programs 25 College of Osteopathic Medicine Seminars 25 Osteopathic Foundation Seminars 25 Practice Performance Assessment and Improvement Modules To be Determined

Component 3: Secure written exam once every six years

Part 3 Cognitive Assessment: Formal Proctored Exam (FPE) • Take and Pass the psychometrically valid formal proctored examination once every 6 -year cycle • Separate fee • Given once a year and can be taken in either of the last 2 years of the 6 -year OCC cycle • Must pass prior to the expiration of your certificate • See AOBOG. org website for specifics • Receive category 1 -B credits for passing: 15 hours

The Right Tools for the Job • Component 4 is the Practice Performance Assessment and Improvement • Diplomates must engage in continuous improvement through comparison of their personal practice performance measured against national standards for his or her medical specialty

Part 4: PPAs or PIMs Practice Performance Assessment modules or Practice Improvement Modulesmany names for the same thing! • Requirement: 5 online modules completed per 6 -year OCC cycle - Diagnosis specific chart review • AOBOG PPA Committee reviews the data against national benchmarks or creates the benchmarks based on collated data received • Physician receives a report – with recommendations for Improvement if necessary • Implement the practice improvement program and then reassess practice in a specified amount of time • Charts must be from an individual physician and not a group practice

O-CAT is a PIM developed by Meaningful Measurements AOBOG will be using O-CAT (Osteopathic Continuous Assessment & Training) from Meaningful Measurements as our platform for the PPAs. O-CAT is a tool for physicians to track the pulse of their practice. • Benchmark • Engage in methods of improvement • Benchmark again

Part 4 -Collecting data • Register to start one on the AOBOG website and then will be linked to O-CAT. • Stage A: Each module involves a short introduction with 3 -4 key points, 2 -4 key references, and yes/no questions per chart. • A certain # of charts will be pulled per module depending on the topic. • Same questions for each chart. (You do not mail charts in but you are subject to potential audit, so keep a list. ) • Answer attestation information. • Data is submitted back to AOBOG for review, and/or compared to predetermined national benchmarks.

Part 4 - Board will Evaluate Physician Data • Stage B: Receive email discussing results and giving a completed status or suggesting improvements if necessary. • Incomplete status: Diplomate will review the literature and engage in practice improvement. • Select from educational interventions and practice improvements designed for sustained improvement in patient care. – Identify an improvement goal and build an Action Plan using the interventions and systems tools within the PPA module. – Complete one educational activity and apply what you have learned in practice.

Component 4 - Required PPA • Osteopathic Continuous Assessment & Training (OCAT) Communications Module • Focuses on Core Competencies of: – Interpersonal & Communication Skills – Patient Care – Professionalism – Osteopathic Philosophy • This must be one of the 5 modules you do in your 6 -year OCC cycle.

Part 4 - Stage C • Stage C: 1 to 6 months later, an email is sent for follow up instructing the physician to review the module, and submit an attestation on changes that were made in your practice as a result of the module. • You will have to pull and document a second series of charts if you did not receive a satisfactory score the first time through. • Compare your Stage A and Stage C survey and performance results • Receive CME credits of AOA category 1 -B per module

PPA Modules • All 5 modules must be completed by September 15 th of the 6 th year of your OCC cycle.

Part 5: Continuous Membership

Loss of Certification • If a Time-limited diplomate doesn’t complete all OCC components in a 6 -year cycle before September 15 th of the 6 th year… – they will no longer be certified. – Re-entry into the process varies depending on timing. See FAQs page on AOBOG. org. • Non time-limited certificate holders: if you lose your certification for any reason, you must take the formal proctored exam at the next administration and then enter the OCC process.

Dual Certifications – AOA/ABMS • The AOA BOS is currently discussing what, if any, aspects of ABMS’ Maintenance of Certification (MOC) program may be applicable to OCC. • The AOBOG will post all developments to our website – www. aobog. org. • Right now, please make sure you are registered for OCC through the AOBOG website.

Clinically Inactive Physicians • A diplomate will have to provide an attestation through petition that they are not involved in any clinical activity and submit documentation. • Will participate in all Parts of the OCC process-but will have to be individualized for this group. – Communication survey module required • If desire to re-enter clinical practice will be required to take and pass the written proctored exam first if they have been out of practice for two years or more

AOA OCC dashboard

AOBOG. org Keeping Informed

Questions / Concerns? Carolyn W. Quist, DO Vice Chair American Osteopathic Board of Obstetrics and Gynecology 142 E. Ontario St. , 4 th Floor Chicago, IL 60611 800 -621 -1773, ext. 8271 or 312 -202 -8271 www. aobog. org AOA Division of Certification (800) 621 -1773, ext. 8266 certification@osteopathic. org