July 2007 • www.clinicalendocrinologynews.com Practice Trends 33 Certification in Hospital Medicine Is on Its Way

BY BRUCE JANCIN setting in which the work takes place. Denver Bureau Emergency medicine and intensive care medicine fall within the same category. D ALLAS — Board certification for hos- Here’s what hospitalist certification pitalists is coming—and most likely will through the ABIM is likely to look like: initially take the form of a Recognition of A candidate will have to be trained and Focused Practice granted by the American board certified in internal medicine and Board of Internal Medicine, according to must practice as a hospitalist for 3 years be- speakers at the annual meeting of the So- fore applying to enter the MOC pathway ciety of Hospital Medicine. seeking the RFP. The candidate must EWS N This Recognition of Focused Practice demonstrate a focus on hospital medicine

(RFP) in Hospital Medicine would be the by meeting a patient volume requirement EDICAL first ABIM credentialing that doesn’t re- and providing leadership of quality im- M quire discrete formal training, relying in- provement projects. LOBAL stead on practice-based learning. The plan Having met that threshold, the physi- G is for hospitalists to tap into the ABIM’s ex- cian then enters into the self-evaluation isting maintenance of certification (MOC) programs and practice improvement mod- LSEVIER mechanism, which every ABIM-certified ules that make up the MOC, which will be /E ANCIN physician already must go through peri- tailored for hospitalists. Unlike general in- J odically to demonstrate ongoing compe- ternists, who have to go through the MOC RUCE tence and a commitment to continuous process every 10 years, it’s likely that hos- B lifelong learning, explained ABIM board of pitalists will be on a 3-year cycle, accord- Under the proposed certification program, hospitalists probably will have a 3-year directors member and past SHM president ing to Dr. Wachter. cycle for their recertification, according to Dr. Robert M. Wachter of the ABIM. Dr. Robert M. Wachter, professor and as- After completing the MOC, the candi- sociate chairman of medicine at the Uni- date becomes eligible to take a secure Critical Care Medicine, the American Col- ists are internists. But a family physician in versity of California, San Francisco. exam. The test will cover core content in lege of Chest Physicians, and the Ameri- the audience who practices hospital med- The ABIM, which had previously en- internal medicine—including ambulato- can Thoracic Society. Despite concerns icine asked where all of this leaves him as dorsed the concept of an RFP in Hospi- ry care—that every internist should know, expressed within the ACP about the po- well as the pediatrician-hospitalists. Dr. tal Medicine, voted unanimously in early but the emphasis will be on hospital med- tential effects of the plan to develop the Gorman replied that the American boards June to approve recommendations by a icine. “More sepsis, less osteoporosis,” Dr. RFP in Hospital Medicine, ABIM and of family medicine and pediatrics are board subcommittee that Dr. Wachter Wachter said. ACP leaders have expressed support for watching the ABIM certification proposal chairs. The RFP plan goes next to the Upon passing, the physician will earn the process, in conjunction with develop- closely and—if it’s passed by the American American Board of Medical Specialties, the RFP in Hospital Medicine sheepskin. ment of a parallel RFP in Comprehensive Board of Medical Specialties—are likely to composed of 24 member boards, for final Down the line—perhaps in a decade— Internal Medicine. The focused practice create similar pathways. approval. hospital medicine might very well evolve proposal still awaits approval by the “Our biggest problem at SHM is every- Although a handful of hospital medicine into a separate field within internal med- American Board of Medical Specialties, body wants to partner with us,” said SHM fellowships exist and some internal medi- icine, with its own residency tracks or fel- Dr. Christine K. Cassel, president and chief executive officer Dr. Laurence cine residency programs offer a hospital- lowship training, but that’s an issue for an- CEO of the ABIM, and Dr. John Tooker, Wellikson, who characterized hospital ist track, such training isn’t the norm and other day, he added. Executive Vice President and Chief Exec- medicine as “the X-Games of medical is unlikely to become so anytime soon. But Society of Hospital Medicine president utive Officer of the ACP, said in a joint specialties.” the ABIM has established a template for Dr. Mary Jo Gorman said the SHM began statement. Today hospitalists work in well over recognition of new fields of internal med- investigating certification in 2004. Mile- Prior to ABIM’s approval of the certifi- 2,600 hospitals. Currently, 40% of com- icine in the absence of discrete training. stones along the way included the disci- cation proposal, Dr. Wachter predicted munity hospitals have hospitalists, up from The criteria are contained in the ABIM’s pline’s continued eye-catching growth— that it would pass because hospital medi- 29% in a 2003-2005 survey. New and Emerging Disciplines in Internal it is the fastest-growing field in the history cine meets the ABIM’s NEDIM II criteria “Who cares that hospitalists are there Medicine II (NEDIM II) report. Hospital of medicine, having rocketed from sever- and the specialty can show that hospitalists 24/7?” he asked, ticking off the answer: medicine is the first candidate for certifi- al hundred members a decade ago to improve efficiency and may also improve “Primary care physicians, surgeons, or- cation under its auspices. Others that may 20,000 today—along with publication of quality of care, although the quality ad- thopedists, emergency physicians, in- follow include HIV medicine and ambu- a document defining the core competen- vantage is supported at this point by sug- ternists, patients, subspecialists.” latory internal medicine, according to Dr. cies in hospital medicine and the launch gestive rather than compelling evidence. At the close of the update, Dr. Gorman Wachter. of the society’s official peer-reviewed “The board thinks the world of what all asked the audience if they favored the cer- In recent decades, boards have certified Journal of Hospital Medicine, noted Dr. of you do for a living. I’ve never heard any- tification process they had just been new specialties formed around novel pro- Gorman, CEO of Advanced ICU Care, St. thing at any ABIM meeting other than full briefed on. In an impressive display, the cedures such as cardiac electrophysiology, Louis. support for the growth of the hospitalist hands of literally all of the roughly 1,000 or special populations such as geriatrics She said the SHM has met for “vigorous field,” he told the packed hall at the SHM attendees shot up. When she next inquired and palliative care medicine. Hospital discussions” with other stakeholders in meeting. who was not interested in utilizing the cer- medicine is an example of a site-specific certification, including the American Col- The SHM has partnered with ABIM be- tification process, not a single hand could medical specialty defined largely by the lege of Physicians (ACP), the Society of cause roughly 90% of practicing hospital- be seen. ■ PQRI Reporting Will Require Some Use of Coding Modifiers

hysicians who choose to participate in Medicare’s pay year. CMS officials have selected 74 quality measures and ing or religious objections. Pfor reporting program do not have to satisfy quality in- physicians are expected to report on between one and three Ǡ Modifier 3P is used to indicate that the service was not dicators to receive a bonus. But in some cases, they will need measures, depending on how many apply to them. provided for systems reasons such as insurance coverage to cite why they did not follow evidence-based guidelines. When reporting on measures, physicians must include limitations or a lack of resources to provide the service. Under the Physician Quality Reporting Initiative (PQRI), a CPT-II code or G-code. Some measures may also re- Ǡ Modifier 8P is a performance measure reporting mod- which at presstime was slated to begin July 1, reporting quire that physicians add a modifier to the CPT II code ifier and indicates that the action was not performed and for certain measures will include adding a coding modi- if the service was not provided. These modifiers are not the reason has not been specified. fier explaining why a service was not performed. For ex- used when reporting G codes. The CPT-II modifiers in- Specific instructions on when to use a modifier in the ample, the service may not have been provided because clude performance measure exclusion modifiers and a 2007 PQRI Specifications Document, which is available it was not medically indicated or the patient declined. performance measure reporting modifier. For example: online at www.cms.hhs.gov/pqri. CMS officials also plan The PQRI is a voluntary program that allows physicians Ǡ Modifier 1P is used to show that the service was not to issue a detailed handbook on how to implement PQRI to earn a bonus payment of up to 1.5% of total allowed indicated or is contraindicated for medical reasons. measures in clinical practice, which will include when to Medicare charges for reporting on certain quality measures. Ǡ Modifier 2P is used to indicate that the service was not use CPT-II modifiers. The program will run from July 1 through the end of the provided for patient reasons, such as the patient declin- —Mary Ellen Schneider