ABMS Overview: Navigating the Evolution of Board Certification

Jennifer Michael Chief Information Officer and Chief Business Development Officer Presentation Outline

ABMS ABMS Board Standards and ABMS Board Display of Background Certification Innovations Eligibility Board and MOC for MOC Policy Certification and MOC Data

Maintenance of Certification (MOC) Early Advancements in Specialization

• Specialization in medicine has been around for over 100 years taking off in the early 1900s • Rapid growth of industrialization led to innovation in medical technology • Growth in specialization caused concern in the medical community about the competence of specialists • In 1933 a broad range of representatives from across the medical community met to address this concern and established the Advisory Board for Medical Specialists which is now know as the ABMS • Created a national system of standards for recognizing specialists and providing information to the public ABMS Mission Through Ongoing Certification

To Serve

Patients, Families and Communities Setting Improved Professional Quality of Standards Health Care

Demonstrated Expertise About ABMS

24 Member Boards set their MOC program requirements (in compliance with the MOC Standards) that define the education, training and additional assessment requirements for certification. About ABMS

9 Associate Members ABMS Board Certification and MOC

Approximately 880,000+ 550,000 practicing physicians are diplomates are certified by one (or more) of currently participating the 24 ABMS Member in MOC. Boards.

Source: ABMS Certification Database About ABMS

ABMS is the largest self-regulating 40 group of physicians in the United States specialties

87 8 Focused practice designations subspecialties About ABMS

Non-certified 20% physicians in the US Board Certified US physicians by one 80% (or more) ABMS Member Boards Board Certification

Caring for patients, families and communities Board Certification

Professionalism Caring for patients, families and communities Board Certification

Professionalism Caring for

patients,Lifelong families andLearning communities Board Certification

Professionalism Caring for

patients,Lifelong families andLearning communities Assessment Board Certification

Professionalism Caring for Practicepatients, & System Lifelong Improvementfamilies andLearning communities Assessment Board Certification

TRUST What We Heard

“The point of [Certification] is making sure everyone is providing the best quality.”

“It means the doctor “Medicine constantly has gone the extra changes, and you “Good doctors should mile to become an have to keep up with want to be challenged expert in their field.” it.” and up to date.”

Source: Consumer Focus Group Studies ABMS Board Certification and MOC ABMS Board Certification and MOC

ABMS Member Boards set standards for certification in a particular specialty and subspecialty. The standards include necessary education, training requirements, and assessments needed.

Eight Member Boards have Non-time-limited Time-limited continuing certificates that (no longer issued) Certification do not require end dates but have reverification dates for credentialing purposes. ABMS MOC® Overview and FAQs

ABMS MEMBER BOARD TIME LIMITED CERTIFICATES

Time Limited Certificates Annual MOC Reverification American Board of Time Limited Certificates End Dates Duration Date Allergy and Immunology 12/31 10 Anesthesiology 12/31 10 Colon and Rectal Surgery 12/31 10 Dermatology 12/31 10 Emergency Medicine 12/31 10 Family Medicine 12/31 Continuing* 2/15 Internal Medicine 12/31 Continuing* 4/1 Medical Genetics and Genomics 12/31 Continuing* 3/1 Neurological Surgery 12/31 10 Nuclear Medicine 12/31 10 Obstetrics and Gynecology 12/31 1,6 Ophthalmology 12/31 10 Orthopaedic Surgery 12/31 10 Otolaryngology – Head and Neck Surgery 12/31 10 Pathology 12/31 Continuing* 1/31

Continued on Next Slide ABMS MOC® Overview and FAQs (Continued)

ABMS MEMBER BOARD TIME LIMITED CERTIFICATES

Time Limited Certificates Annual MOC Reverification American Board of Time Limited Certificates End Dates Duration Date Pediatrics 12/31 Continuing* 2/15 Physical Medicine and Rehabilitation 6/30, 11/30, 12/31 10 Plastic Surgery 12/31 10 Preventive Medicine 1/31 10 Psychiatry and Neurology 12/31 Continuing* 3/1 Radiology 12/31 Continuing* 3/15 Surgery 12/31 Continuing* 12/31 Thoracic Surgery 12/31 10 Urology 2/28 10

* Starting in 2012, these boards have no end dates to their certifications. Pathology transitioned their certifications in January 2016, Medical Genetics and Genomics transitioned in September 2017, and Surgery transitioned in 2018. To maintain certification from their specialty board, physicians must successfully complete specialty-specific requirements throughout their ongoing MOC cycles. ABMS Board Certification and MOC

GOALS OF THE ABMS PROGRAM FOR MOC

Provide a systematic, rigorous, relevant method for on-going assessment and learning in knowledge, skills, judgment and professionalism in medicine Improve the Improve health quality of care outcomes and provided to patient safety patients and Trusted by Believed in by communities the Public the Profession ABMS MOC: One-Four-Six

One Continuing Certification Program (must have achieved initial Board Certification) Four Elements within One Program 1 2 3 4

Professionalism Lifelong Learning Assessment of Improvement in and Professional and Self- Knowledge, Judgement Medical Practice Standing Assessment and Skills ABMS/ACGME Six Core Competencies

1 2 3 4 5 6

Medical Practice-based Patient Care Systems-based Interpersonal and Professionalism Knowledge Learning and and Practice Communication Improvement Procedural Skills Skills Standards and Innovations MOC MOC Standards

GENERAL STANDARDS

Member Boards’ MOC program will incorporate all six core competencies Member Boards Member Boards will will work to engage in CQI of Throughout the In a manner that best increase program their Programs for Program for serves the needs of value, relevance, MOC and engage MOC patients and is and meaning in an ABMS-wide relevant to the while being review process specialty and the sensitive to time, practice of the administrative diplomate burden and costs MOC Standards

PROFESSIONALISM AND PROFESSIONAL STANDING

Identify and convey Establish and maintain a Establish a process to professionalism expectations to process that offers the consider circumstances diplomates and opportunity for re-entry to of actions taken against a incorporate certification diplomate’s license or other professionalism learning and assessment determination of activities into MOC unprofessional conduct and act appropriately MOC Standards

LIFELONG LEARNING AND SELF - ASSESSMENT

• Focuses on current relevant knowledge and ongoing advances in the specialty

Each Member Board • Incorporates accredited CME (free of commercial will establish and bias – control of commercial interest) document requirements: • Works to ensure access to learning tools that address gaps in specialty/own practice

• Integrates Patient Safety into MOC program requirements MOC Standards

ASSESSMENT OF KNOWLEDGE, JUDGMENT AND SKILLS

Secure • Encourages new methods of assessment and examination of evaluation diplomates’ knowledge of core content, judgment and skills no less • Encourages feedback to diplomates about often than every examination performance in order to assist in lifelong 10 years learning and self-assessment activities MOC Standards

IMPROVEMENT IN MEDICAL PRACTICE (IMP)

Each Member Board will Each Member Board should incorporate practice encourage diplomate assessment and improvement involvement in performance activities across a diplomate’s improvement activities within career in ways that allow the context of the health care specialty-relevant, performance- team and system with other in-practice assessment and care-related QI programs improvement The Value of MOC in the Future

Supports physicians

• Mechanism to identify knowledge and practice gaps that direct learning Protects the Ensures a • Demonstration to patients and profession credential that is colleagues that the specialist is up-to- separate from date employment • Supports local quality improvement activities • Satisfies federal and other assessment activities ABMS Member Boards are Responding

Offering greater flexibility in how diplomates meet Improvement in Medical Practice requirements

Involving diplomates in MOC decision-making processes • Surveys, focus groups, committee appointments

Expanding activities accepted for Lifelong Learning and Self-Assessment • All Member Boards now accept accredited CME

Making examination more practice-relevant, formative, less burdensome • Remote proctoring, access to approved resources • More focus on clinical decision-making/patient management • Greater use of mobile technology • Credit for quality improvement activities diplomates do in their practice environment • Registry participation ABMS Innovations

Aligns CPD with 18/24 organization. Relevance 717,000 Boards give 95 unique MOC IMP credit Burden physicians QI/PI/safety organizations to diplomates received IMP goals. who Physician credit. meaningfully Engagement 3,100+ participate in qualifying QI/PI activities activities of sponsor systems. Portfolio Program Sponsor Organizations Innovations in Assessment

ABMS Member Boards are collaborating to explore how adult learning theories and emerging technologies can inform new approaches to assessment of knowledge and skills. Longitudinal Assessment Pilots • Web-based longitudinal assessment platform incorporating spaced repetition to increase retention in addition to assessing knowledge and judgment • Mobile and desktop access

ABMS collaborating • Diplomates able to customize content/items to with Member Boards align with their practice to pilot new • Flexible administration in terms of completion approach to time and place recertification examination • Immediate feedback on strengths, weaknesses, and gaps in knowledge to guide future learning • Dashboard for real time performance monitoring ABMS Boards Developing Longitudinal Assessments CertLink® Boards Other Boards

Colon & Rectal Surgery Allergy & Immunology Pediatrics Dermatology Anesthesiology Plastic Surgery Medical Genetics & Genomics Emergency Medicine Psychiatry & Neurology Nuclear Medicine Family Medicine Preventative Medicine Otolaryngology – Head and Neck Surgery Internal Medicine Radiology Pathology Obstetrics & Gynecology Surgery Physical Medicine & Rehabilitation Ophthalmology Thoracic Surgery Orthopaedic Surgery Urology Neurological Surgery CertLink®

• Mobile and web-based platform • Diplomate dashboard • Confidence and relevance ratings • Boards determine areas for diplomate customization • Diplomate feedback captured Key Program Elements of CertLink® Pilots — Hallmarks

Longitudinal Emphasis on administration with targeted feedback spaced repetition to help close knowledge gaps

• Results • Immediate and Practice Flexible accumulated detailed critiques relevance with administration over time to • Diplomate diplomates able which allows for inform dashboard to customize diplomates to summative displays areas of content coverage complete at time decisions strength and and place of their weakness choosing CertLink® Platform

Assessmen t Delivery Feedback Dashboard ABMS Continuing Certification Directory ABMS Continuing Certification Directory

METHODS

Member Boards’ Diplomate CME Stakeholder Community Engagement Engagement Engagement ABMS Continuing Certification Directory 670 17 2000+ accredited CME activities ABMS Member Boards indexing Unique MOC approvals for activities Physician Well-being activities 94% 91% of learners who completed an activity indexed in of learners who completed an activity the Continuing Certification Directory would indexed in the Continuing Certification recommend the activity to others practicing in their Directory rated the activity as good to specialty excellent ABMS Board Eligibility Policy Board Eligibility Policy

ABMS and its This policy A candidate's Physicians who do Member Boards became eligibility for Board not achieve established limits to effective Certification by an certification within the the time that may January 1, ABMS Member specified time period lapse between a 2012. Board (Board Eligible will need to meet re- physician’s period) expires on a entry requirements of completion of date determined by their individual residency training the Member Board. Member Board(s) to and achievement of regain Board Board Certification. Eligibility in their specialty. Board Eligibility Policy

That date must be no fewer than three (3) and no more than seven 3 (7) years following the successful completion of accredited training, No fewer than and in accordance with the corresponding Member Board requirements, plus time (if any) in practice required by the ABMS three Member Board for admissibility to the certifying examination.

Transition dates refer to candidates who had completed their training but not yet achieved initial certification in a specialty as of the ABMS Board Eligibility Policy's effective date. Therefore, if the candidate 7 had completed training, but had not become Board Certified before No more than the effective date (Jan 1, 2012), then they have until that Boards’ seven transition date to be considered board eligible. Board Eligibility Policy

BOARD ELIGIBLE PERIODS AND TRANSITION DATES

SPECIALTIES SUBSPECIALTIES

American Board of Board Eligible Period Board Eligible Period Transition Date Transition Date (+practice requirement) (+practice requirement)

Allergy and Immunology 5 years * No subspecialties Anesthesiology 7 years * 7 years * Colon and Rectal Surgery 7 years1 12/31/2023 No subspecialties Dermatology 5 years * 5 years * Emergency Medicine 5 years 12/31/2019 7 years * Family Medicine 7 years * 7 years * Internal Medicine 7 years 12/31/2019 7 years * Medical Genetics and Genomics 7 years * 7 years * Neurological Surgery 3-4 years2 * 1/1/2025 Nuclear Medicine 7 years * No subspecialties Obstetrics and Gynecology 7 (+1) years * 8 years 1/1/2020 Ophthalmology 7 years * No subspecialties

Continued on Next Slide Board Eligibility Policy (Continued)

BOARD ELIGIBLE PERIODS AND TRANSITION DATES

SPECIALTIES SUBSPECIALTIES

American Board of Board Eligible Period Board Eligible Period Transition Date Transition Date (+practice requirement) (+practice requirement)

Orthopaedic Surgery 5 years3 * 7 (+2) years4 * Otolaryngology – Head and Neck Surgery 5 years * 1/1/2025 Pathology 5 years * 7 years5 * Pediatrics 7 years6 * 7 years * Physical Medicine and Rehabilitation 7 years 12/31/2019 7 years 12/31/2020 Plastic Surgery 7 (+1) years * 7 (+2) years7 * Preventive Medicine 7 years * 7 years * Psychiatry and Neurology 7 years * 7 years * Radiology 6 years * 10 years 1/1/2025 Surgery 7 years 7/1/2022 1/1/2025 Thoracic Surgery 7 years8 * 7 years9 * Urology 6 years * 6 years10 *

* These Member Boards had board eligibility policies in place prior to the effective date of the ABMS Board Eligibility Policy, and therefore no future transition date is provided. State Legislation (2016-2019)

IN State Laws (2016-2019)

ME Continuing Board Certification — Vision for the Future

• A collaborative effort brought together multiple stakeholders

• Physicians • Professional Medical Organizations • National Specialty & State Medical Societies • Hospitals & Health Systems • General Public & Patients • 24 Member Boards of ABMS

• Tasked with envisioning a system that is responsive to the needs of those who rely on it and is relevant, meaningful and of value to physicians. ABMS Initial First Steps

• Oversight Committee • Commitment to longitudinal / other formative assessments • Commitment to revising standards • Commitment to collaboration in implementation • Meet with key stakeholders • Recognize • Roadmap offered by the Commission report Final Report • Work already being done by the boards • Need for a consequential decision Building on Our Positive Momentum

Member Board program Redesigned ABMS Vision Initiative innovations governance structure Recommendations

• Relevance • Accountability • Developed by our stakeholders, including • Flexibility • Stakeholder Council practicing physicians • Clear road map for the future Display of Board Certification and MOC Data Data Display

All Member Boards of ABMS publicly Primary Source Verification provided display which diplomates are through ABMS Solutions participating in MOC.

All Diplomate information Certification Matters provides available through ABMS public information CertificationMatters.org Certification MattersTM — Public Website ABMS Professional Product

ABMS® Board Certification Credentials Profile A Service provided by the American Board of Medical Specialties New Search | Search Results | Feedback | Save Physician | Print

To become Board Certified, a physician must achieve expertise in a medical specialty or subspecialty that meets the profession-driven standards and requirements of one (or more) of the 24 ABMS certifying boards. To maintain Board Certification, the certifying boards may require physicians, depending on their date of initial certification, to participate in on-going programs of continuing learning and assessment (Maintenance of Certification) designed to help them remain current in an increasing complex practice environment. Jane Doe (ABMSUID – 0000) Viewed: 6/21/2017 3:09:59 PM DOB:CST Private Education: 1987 MD (Doctor of Medicine) Address: Private Bethesda, MD 20817-2732 (United States) Individual 0000000000 NPI1 Hide Active Medical License(s)2: DC MD000000 MD D00000 Certification:

American Board of Pediatrics

Pediatrics — General Status Duration Occurrence Start Date-End Date Participating in MOC

Expired Time-Limited Recertification 09/26/2001 – 12/31/2008 No Expired Time-Limited Initial Certification 10/12/1994 – 12/31/2001 Learn more about Pediatrics MOC Program

American Board of Psychiatry & Neurology

Psychiatry — General Status Duration Occurrence Start Date-End Date Participating in MOC

Active Lifetime Initial Certification 01/30/1994 - Not Required ?

Child & Adolescent Psychiatry — Subspecialty Status Duration Occurrence Start Date-End Date Participating in MOC

Active Lifetime Initial Certification 09/11/1994 - Not Required

1 NPI: Not for Primary Source Verification (PSV). 2 State of Licensure provided by Federation of State Medical Boards (FSMB): Not for Primary Source Verification (PSV). ABMS Professional Product

John Doe (ABMSUID – 0000)

DOB: 04/08/1952 Education: 1977 MD (Doctor of Medicine) Address: Private

Individual NPI1 123456 Show Active Medical License(s)2: NM 987654

Certification:

American Board of Internal Medicine

Status: Certified Internal Medicine — General

Status Duration Occurrence Start Date-End Date

Active Lifetime Initial Certification 09/16/1981 -

Status: Certified Critical Care Medicine — Subspecialty Status Duration Occurrence Start Date-End Date Reverification Date

Active Time-Limited Recertification 08/31/2007 – 12/31/2017 04/01/2019 Status: Certified Pulmonary Disease— Subspecialty Status Duration Occurrence Start Date-End Date Reverification Date

Active MOC Recertification 09/01/2016 - 04/01/2019

Participating in Maintenance of Certification (MOC) — Yes

1 NPI: Not for Primary Source Verification (PSV). 2 State of Licensure provided by Federation of State Medical Boards (FSMB): Not for Primary Source Verification (PSV). ABMS Professional Product

2016 ABMS Professional Product

John Smith (ABMSUID – 000000) Viewed: 7/10/2018 3:32:49 PM CST

DOB: 05/30/1980 Education: 2007 MD (Doctor of Medicine) Address: 9 Stuyvesant Oval New York, NY 10009 (United States)

Individual NPI1 1538340344 Show Active Medical License(s)2: 2016 Certification:

American Board of Radiology

Diagnostic Radiology - General Status Duration Occurrence Start Date-End Date Participating in MOC

Converted MOC Initial Certification 07/01/2012–10/16/2017 No

Interventional Radiology and Diagnostic Radiology - General Status Duration Occurrence Start Date-End Date Reverification Date Participating in MOC

Active MOC Initial Certification 10/16/2017 - 03/02/2019 Yes

Vascular & Interventional Radiology - Subspecialty Status Duration Occurrence Start Date-End Date Participating in MOC

Converted MOC Initial Certification 11/10/2014–10/16/2-17 No

Learn more about Radiology MOC program

1 NPI: Not for Primary Source Verification (PSV). 2 State of Licensure provided by Federation of State Medical Boards (FSMB): Not for Primary Source Verification (PSV). ABMS Professional Product

John Smith (ABMSUID – 000000) Viewed: 7/10/2018 3:21:24 PM CST

DOB: Private Education: 1977 MD (Doctor of Medicine) Address: Private Christchurch (New Zealand)

Individual NPI1 1518922681 Show Active Medical License(s)2: 2016 Certification:

American Board of Family Medicine

Family Medicine- General Status Duration Occurrence Start Date-End Date Participating in MOC

Active Time-Limited Recertification 07/23/2009-12/31/2019 Yes

Expired Time-Limited Recertification 07/12/2002-12/31/2009

Expired Time-Limited Recertification 07/14/1995-12/31/2002

Expired Time-Limited Recertification 07/14/1989-12/31/1996

Expired Time-Limited Initial Certification 07/09/1982-12/31/1989

Designation of Focused Practice in Hospital Medicine – Family Medicine Designation

Status Duration Occurrence Start Date-End Date

Active Time-Limited Designation 10/29/2012-12/31/2022

1 NPI: Not for Primary Source Verification (PSV). 2 State of Licensure provided by Federation of State Medical Boards (FSMB): Not for Primary Source Verification (PSV). 4/3/2019 ABMS Board Certification Credentials Profile

ABMS® Board Certification Credentials Profile A service provided by the American Board of Medical Specialties New Search | Search Results | Email For Feedback | Save Physician | Print Profile

Eric Yan ( ABMSUID - 1027033 ) Viewed:4/3/2019 3:57:47 PM CST

DOB: Private Education: 2008 MD (Doctor of Medicine) Address: San Francisco, CA 94122-4543 (United States)

Individual NPI 1 : Unknown Show Active Medical License(s) 2 : 2016

Board Certification(s):

American Board of Anesthesiology Occupation Status: Retired - Notified As of 2016

Anesthesiology - General

Status Duration Occurrence Start Date - End Date Retired Time-Limited Initial Certification 10/08/2015 - 12/31/2025

Learn more about Anesthesiology MOC program

1 NPI: Not for Primary Source Verification (PSV). 2 State of Licensure provided by Federation of State Medical Boards (FSMB): Not for Primary Source Verification (PSV).

Notice: It is up to the user to determine if the physician record obtained from this service is that of the physician being sought.

With the exception of our Medical Specialists Online (MSO) product, all information as presented by ABMS Solutions products are approved for business use and are considered Primary Source Verified (PSV) and meet the primary source verification requirements as set by The Joint Commission, NCQA, URAC and other key accrediting agencies.

The ABMS physician specialty certification data provided by ABMS Solutions/CertiFACTS Online is proprietary and copyrighted by the American Board of Medical Specialties (ABMS®) and subject to the intellectual property laws of the United States. © 2019, ABMS Solutions, LLC, All Rights Reserved.

Product names and logos are all marks of the American Board of Medical Specialties.

https://certifacts.abms.org/DCReport.aspx?singleresult=true&abmsuid=1027033 1/1 Questions? FAQ’s for Credentialing Specialists

• What is a reverification date? ABMS Member Boards that have eliminated end dates recognize that some entities may still need a certification end date to complete Primary Source Verification. To assist in this process, we encourage credentialers to utilize an annual reverification date, provided by each Member Board. Please note that physician certification status will only change once a year, unless a certificate is revoked for disciplinary reasons. Therefore, by utilizing the annual reverification date suggested, one will have accurate information about a physician's current certification status. • How is the reverification date used? For credentialers who may need an end date to complete Primary Source Verification, the individual Member Boards provide an annual reverification date to ensure accurate certification status. • Why does the display of MOC on a physician’s profile not include effective dates of certification? The ABMS MOC program is part of a rigorous process that continually assesses and enhances physicians’ medical knowledge, judgment, professionalism, clinical techniques, and communication skills. Therefore, it is separate from a physician’s general and subspecialty certification(s). FAQ’s for Credentialing Specialists (cont.)

• How will MOC participation be displayed on a physician’s profile? The participating in MOC display will include the status of all a physician’s specialty (and subspecialty, if any) certificates. For each specialty and subspecialty certificate listed, either a “Yes”, “No” or “Not Required” response will be given as to whether that physician is in compliance with the MOC requirements of his or her member board for that certificate. The physician’s certifying board(s) determines his other MOC participation status. • What does it mean if a physician is listed as not required to participate in MOC? A physician listed as not required to participate in MOC indicates that the physician became board certified in his or her specialty before his or her certifying board established its MOC program. According to the policy of that physician’s certifying board, he or she is therefore not required to be involved in its MOC program. Resources

• ABMS website: www.abms.org • ABMS Updated Standards: http://www.abms.org/media/1109/standards-for-the-abms-program-for-moc-final.pdf • Overall MOC Program: http://www.abms.org/board-certification/steps-toward-initial-certification-and-moc/ • MOC Part II Requirements by Board: https://www.abms.org/media/176514/abms-moc-lifelong-learning-and- self-assessment-part-ii-requirements-20180716.pdf • MOC Part IV Requirements by Board: https://www.abms.org/media/176513/abms-moc-improvement-in-medical-practice-part-iv-requirements- 20180716.pdf • ABMS Board Eligibility Policy http://www.abms.org/board-certification/board-eligibility/ • ABMS MOC Directory • https://www.mededportal.org/abmsmoc/continuingeducation/ • FAQs http://www.abms.org/media/176508/abms-moc-board-eligibility-overview-bd-20180211.pdf • ABMS Solutions (Professional PSV Products) • (800) 733-2267 abmssolutions.com Thank You

Jennifer Michael Chief Information Officer and Chief Business Development Officer [email protected]