Thinking Together: Optimizing Maintenance of Certification for Your IP

9/9/2014
Thinking Together:
Optimizing Maintenance of
Certification for Your IP
Laura Couch
Tamara John, MPH
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Welcome and Introductions
• Who we are:
 Laura Couch, Sr. Administrator, MOC External Activities, ABP
 Tamara John, MPH, Program Manager, Children’s National Health System- DC
PICHQ
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MOC: The 6 Core Competencies
Part 1 – Professional Standing
Patient care, Interpersonal & communication
skills, Professionalism
Part 2 – Knowledge Assessment
Patient care, Medical knowledge,
Practice-based learning &
improvement, Systems-based practice
Part 3 – Cognitive Expertise
Medical knowledge
Part 4 – Performance In Practice
Patient care, Practice-based learning
& improvement, Interpersonal
& communication skills, Professionalism,
Systems-based practice
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Part 4: Performance in Practice
• Web-based Activities
 ABP Performance Improvement Modules (PIM)
 AAP EQIPP
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Workplace-based Quality Improvement Projects (QIPA)
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Credit for Quality Improvement (QI) projects published in
peer-reviewed articles and posters
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Quality Improvement Project
Applications (the QIPA program)
• Projects can be applied for and approved one at a time
(QIPA application)
• Institutions and groups can apply for “Portfolio status” and
manage and approve their Part 4 projects internally
 24 Pediatric portfolio sponsors
 22 Multispecialty portfolio sponsors
• Over 650 projects have been approved from 136
organizations
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Workplace vs Web-based Part 4 credit
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ABP Continuous Certification:
TO DO List:
BEFORE your current certificate expires
Complete 40 points in Part 2
Self-assessment activities
Complete 40 points in Part 4
QI activities
Complete 20 points in either
Part 2 or Part 4 activities
Complete your online Reenrollment Application
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Physician Portfolio
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Let’s move on to
Part 4 QI project approval
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Does your project meet
ABP MOC Standards for approval?
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Has a defined aim
Addresses one or more of the Institute of Medicine quality dimensions
Requires meaningful participation by pediatricians
Structured project using accepted QI methodology
Collects measurement data over time and uses it for routine feedback to
participants to see if improvement occurs
Systematically test changes to improve care
Based in an organization that can manage project and attestation processes
Has adequate funding to meet stated aims and to complete the project.
No use of commercial funding for content development
Is HIPAA compliant
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Key Points
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Specific Aims (improve X by Y% over Z period of time)
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Measures (process; outcomes; and balancing) tied directly to the aim.
Recommend use of nationally approved measures where available
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All participants agree to the same aims and measures
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Education about QI science should be part of the project
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Results are reported using run or control charts to show the data over
time. If project hasn’t started or just beginning, provide examples of
charts to be used
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Are you running multiple successful
QI projects?
You may want to consider becoming
a portfolio sponsor.
What does that mean?
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Portfolio Sponsor
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Reviews QI projects internally against ABP standards
Has centralized management and oversight of many projects
Originate and manage multiple Quality Improvement (QI) projects
Develop and run a large number of QI projects that are managed centrally
through an established infrastructure and overseen by a formal governance
body
• Agree to establish an internal project review committee using ABP standards
• Can approve projects without having to submit an individual application for
each project
• Agree to resolve any disputes internally
• Agree to submit a periodic progress report
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Portfolio Sponsor Standards
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Must have a minimum of 3 QI projects to apply
Able to demonstrate past experience and success with QI
Leadership Attention to QI
Organization-wide priorities and strategy for improvement
Oversight of progress in quality issues
Infrastructure for governance and management of QI
Resources for QI
Physician involvement in QI
Training, education, and professional development in QI
Resources to manage an ABP MOC portfolio
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Portfolio Sponsor Standards Cont.
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Designate a Portfolio Manager
Reviewing and approving QI projects
Notify ABP of approved projects
Track physician participation
Attestations & attestation dispute resolution
Notify ABP of MOC activity completion
Implement auditable processes
Periodic report
Apply for renewal
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How to Apply for Portfolio Status?
Create an account with our online application system
MOCAM: https://www.mocactivitymanager.org/
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Create a Portfolio Sponsor Application
• To create an application select “Portfolio Sponsor Readiness Checklist”
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Next Steps
• Once you submit the Readiness Checklist the ABP will release the
application(s). The number of applications released depends on the
number of already approved individual QI projects
• Complete the application
• We review all of the application from the online program and will email
you with clarification requests or approvals
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Writing a Strong Application
• Review the standards
• Use the application in MOCAM
 https://www.mocactivitymanager.org/
• Be concise
• Respond to all items
• Include all requested exhibits/examples
• Schedule a call with the ABP beforehand
• Email with questions [email protected]
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Fees
• $500 application fee for each individual project
• $500 fee for portfolio status
• $500 to renew project approval after 2 years
• Once application is submitted in MOCAM, an invoice will be
emailed with 48 hours. Include invoice with your check
• Note: fees are subject to change
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Next up:
Experience Speaks
Tamara John, MPH, Program Manager, Children’s National Health SystemDC PICHQ
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QI INFRASTRUCTURE: CHILDREN’S NATIONAL
 QI engine: DC Partnership to Improve
Children’s Healthcare Quality
 “Improvement Partnership”- established
2005
 Seed funding from Commonwealth Fund
 Mentoring from VCHIP & other state IP’s through
National Improvement Partnership Network
(NIPN)
 Experience & infrastructure for internal, local &
regional QI
 Academic home: Children’s National
Medical Center (Washington DC)
 Goldberg Center for Community Pediatric
Health
 Funding: Children’s National Health
Network (CNHN)
 1400+ community providers partnered via
group purchase, continuing education & QI
 MOC portfolio sponsor by ABP (Part 4 QI)
(2013)
GROWING PORTFOLIO OF QI MOC PROJECTS
 Improving Childhood Immunizations in DC
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CNMC, DC DOH, Unity Health, DC Medicaid, MCO’s
 Improving Childhood Obesity Screening &
Management in Practice Setting
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CNHN, CNMC Obesity Institute
 Improving Asthma Care in Practice I & II
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CNHN, IMPACT DC, DC & MD AAP
 Improving Mental Health Screening in Primary Care
Practice
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DC AAP, DC DBH, DHCF, Georgetown
 Screening for Autism & Developmental Disabilities
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Maryland DHMH, Parents Place, MD AAP, CNHN
 Transition Planning for Children with Epilepsy
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Maryland DHMH, Parents Place, MD AAP, CNHN
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 Safe Sleep Nursery QI Project
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R Moon, NICHD
 Breastfeeding Nursery QI Project
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Our largest project had over 250
community participants from
more than 40 pediatric practices
More than 100 providers
attested for MOC credit
R Moon, NICHD
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MAP OF PARTICIPATING PRACTICES
Asthma Year 1
Asthma Year 2
Mental Health Year 1
QI INFRASTRUCTURE
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STAFF & RESOURCES
Program Workgroup:
 2.5 FTE
 Project Lead (FT)
 Medical Director (PT)
 Consultants/Content Experts (varies by project)
Tools available to our workgroup
 QI TeamSpace- QI data management System
 WebEx
 Microsoft Office Suite
 Survey Monkey
 Creativity
QI RECIPE
 Team-based practice = team-based practice
improvements
 Participants receive individual MOC & CME credit
 I’m too busy: develop virtual QI MOC
model that aligns with demands of busy
practice
 Web-based learning (live or asynchronous)
 We leverage expertise, technology & virtual
environment to support QI in the practice
setting
 “Best practice” learning & implementation at
individual, team practice & regional level
 Hands on & remote coaching, reinforcement &
support
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CME CREDIT FOR MOC QI ACTIVITIES
 Developed CME application & learning objectives for overall QI
project and each QI component of learning collaborative
 Learning session
 Chart audit & data review
 Monthly team meetings to review data & plan/review PDSA cycles
 Monthly project calls to review practice/aggregate performance & share
tips and learning
 Participating clinicians earn CME credit hour-for-hour based
on participation, evaluations & attestation
 Approved for up to 30 hours CME credit
 Most providers averaged 12-15 hours
DOCUMENTING
MEANINGFUL
PARTICIPATION
Without the chaos
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KEYS TO SUCCESS
 Define your participation criteria before your project begins
 Be upfront with your participants
 What are your expectations for meaningful participation
 Set the standards and stick to it (you can be lenient in a case by case basis )
 Keep it simple
 Make it easy for your participants to meet your program requirements
 Create diagrams
 Provide clear documentation describing your requirements
 Do not recreate the wheel
 There are plenty of resources out there that can be modified for your needs
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If not, create tools that can be replicated and are easy to use
WHAT DOES THE PROJECT LOOK LIKE
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DOCUMENT YOUR PARTICIPATION REQUIREMENTS & EXPECTATIONS
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Chart Audit Reports
In QI TeamSpace
Note: The best internet platform to
use while entering your data on QI
TeamSpace is FireFox or Google
Chrome.
Download the Practice chart audit
workbook form in your practice
folder
· Use the workbook as a tool to
document your chart reviews
· You can print the workbook
sheets to make your data entry
easier
Baseline Chart Audit Report
Monthly Chart Audit Report
30 charts for the entire practice
10 charts for the entire practice
Include patients seen between the
months on August 1 2013
and January 31 2014
Include patients seen during the chart
audit month.
I.e.: May chart audit only has pts. seen
in may
Submit your chart audit
report by May 5th, 2014
Submit you chart audit result by
the 5th of the following month
i.e.: May’s chart audit is due June 5th
Basic Chart Audit Notes:
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Include patients: 1-18 yrs. old
Visits Types: Well Child/Teen
50% of your reviewed charts
should come from children < 5
years, 11 months
Reporting Tips:
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If you have 30 or more charts to
choose from for the entire
practice:
· Select every third chart to
include in your chart audit
report
If you have 20-29 charts to
choose from for all providers:
· Select every second chart to
include in your chart audit
report
If you only have 10-19 charts to
choose from for your entire
practice
· You can use your entire list
for your chart audit report
How to submit your
data.
Make sure that all participating
providers are represented in each
chart audit report
1) Under your practice team folder click on “Chart Audit Form”
2) Select the month you want to complete: April, May, etc.
3) Click on “Form Entry” at the top of the page
4) Add the number of rows you want. Each row corresponds to the number
of patient charts you are reporting.
5) Once you have entered your data, make sure that you hit the “save as
draft” button on the bottom of the page. Make sure your data is correct.
6) To submit your data, click on the “Save and submit” button
Data Submission
The Team Leader or designated data
enterer will submit all chart audit
data to QI TeamSpace
QI Coach
The QI Coach will review your data
and provide you with a data snapshot
on a monthly basis
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CREATING DOCUMENTS TO HELP
TRACK MEANINGFUL PARTICIPATION
MAINTAINING YOUR SANITY
WITH THE HELP OF AVAILABLE TECHNOLOGY
 Benefits of Using Microsoft Excel
 If you own a computer with you most likely have or can purchase Microsoft
Excel
 Low tech database
 Most people have a basic understanding on how to use Excel and if not,
there is always Google.
 Easy to share data with staff and project participants
 What information should you track
 Only track the information you really need to identify meaningful
participation
 Basic Provider information
 Required Activities
 Monthly/quarterly data submission
 Team and Provider level
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TRACKING & REPORTING CHART AUDIT DATA
DOCUMENTING PARTICIPATION:
QI & CME ACTIVITIES
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SURVEY MONKEY
MICROSOFT EXCEL
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LESSONS LEARNED
Plan & communicate project goals, deliverables and expectations
clearly
Repeat frequently
Develop (or adapt) tools for tracking & participation
Keep it simple
Be accessible to coach & support
TAMARA JOHN
[email protected]
(P)202-476-5481
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Questions?
MOC diplomate questions: [email protected]
Application questions: [email protected]
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