Osteopathic Continuous Certification (OCC)
For the Public
Recertification
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OSTEOPATHIC CONTINUOUS CERTIFICATION
Fundamental changes are being developed by the AOA Bureau of Osteopathic Specialties (BOS) regarding the way all osteopathic physicians maintain specialty certification. These changes are being driven by the quality movement and concerns regarding patient safety by federal and state agencies, the insurance industry, citizen advocacy groups and the general public and necessitate a response from the osteopathic profession. While all of the current aspects of board specialty certification remain in place, methods are being developed to incorporate practice performance measures and quality improvement into the certification process. This new process has been labeled “Osteopathic Continuous Certification” (OCC) and according to the BOS “provides the practicing physician with the opportunity to constantly evaluate and improve their knowledge base ensuring that they are incorporating evidence based medicine into their practice. Concepts such as disease management, patient safety and continuous quality improvement are embedded in the continuous certification process to ensure that osteopathic physicians involved in the program are providing quality patient centered care. In addition, Osteopathic Continuous Certification can form the foundation for the response to all stakeholders and ultimately lead to better patient care and a level playing field for the evaluation of osteopathic care nationally. Failure to respond to these demands for change may leave the osteopathic profession and the individual osteopathic pediatrician at risk for perceived lower quality and lower reimbursement.”
Recent changes have been proposed by the Federation of State Medical Boards (FSMB) and in Congress which are mandating that physicians participate in “maintenance of certification and licensure” programs. The FSMB feels that the “state medical boards have a responsibility to the public to ensure the ongoing competence of physicians.” The FSMB on December 19, 2009 released for review a draft report from the Advisory Group on Continued Competence of Licensed Physicians. It is expected that the final report will be approved at their House of Delegates meeting on April 24, 2010. In this report, they state that “licensees should be expected to provide documented evidence of compliance with the state medical board’s maintenance of license requirements. As a condition of license renewal, physicians should provide evidence of participating in a program of professional development and lifelong learning that is based on the general competencies model:
- Medical knowledge
- Patient care
- Interpersonal and communication skills
- Practice based learning
- Professionalism
- Systems based practice”
Amendments were introduced in the United States Congress in December 2009 to improve the Social Security Act which will provide “additional incentive payments of 0.5 percentage points” to eligible professionals who ‘satisfactorily submit data on quality measures for a year and have such data submitted on their behalf through a Maintenance of Certification Program which is a program that advances quality and lifelong learning and self assessment of board certified specialty physicians by focusing on the competencies of patient care, medical knowledge, practice based learning, interpersonal and communication skills and professionalism.” In addition, the BOS has submitted a proposal that “all board certified osteopathic physicians are required to fully participate in the OCC process and that all board certified physicians with lifetime certificates must adhere to all requirements for OCC set forth by the specialty certifying board, but will be exempt from the cognitive assessment component of OCC.”
The BOS has mandated that OCC be implemented by all osteopathic boards by 2012. The initial implementation plan was presented to and approved by the BOS in November of 2007. An initial implementation survey was completed by the American Osteopathic Board of Pediatrics (AOBP) in November of 2008 and a formal written plan must be submitted to the BOS by the spring meeting of 2010. Maintenance of Certification (MOC) is mandated of all allopathic certifying boards by the American Board of Medical Specialties (ABMS) and will be in effect beginning in 2010. Both the MOC and OCC process consist of four steps with the OCC process incorporating osteopathic components where applicable and a fifth component which is membership in the American Osteopathic Association (AOA). The majority of the first three and the fifth components are already in place and a part of the certification process. A few changes have been made and will now be detailed.
Part 1.) Professional standing and licensure:
The BOS in 2008 required that all certified osteopathic physicians hold an unrestricted license in the state where they practice in order to achieve and maintain certification. The BOS has mandated that the boards must periodically check the status of their member’s licenses. Actions by State Medical Boards which restrict the license of an osteopathic physician must be reported and the Board must consider the circumstances of the restriction as it considers the certification of the involved individual. Restrictions and revocation of certification may be considered. The AOBP determined at the fall meeting in New Orleans this past October that members will be required to submit a copy of their medical license at the end of each three (3) year CME cycle.
Part 2.) Life long learning and self assessment:
The major part of this component is continuing medical education (CME). Currently, an osteopathic pediatrician must complete 120 hours in every three year cycle with 50 hours being in the designated specialty. This will not change.
In addition, the BOS has required “some amount” of “certifying CME” which will require testing approved by the certifying board. “Certifying CME” content is to be clinically focused and of adequate breadth to cover clinical entities that practitioners commonly treat.
With the inception of the American College of Osteopathic Pediatricians (ACOP) eJournal in 2008, the AOBP saw the opportunity to utilize this vehicle to satisfy the certifying CME self assessment component of OCC. ACOP leadership has graciously allowed this process to become reality. Each eJournal quarterly issue will have an OCC section presenting a relevant review article written by an expert in the chosen subject. This article will be followed by a ten question quiz which can be submitted to the ACOP for CME credit. The AOA has granted one (1) hour of category 1-B credit for this activity. The AOBP has determined that, in each three (3) year CME cycle, members must complete and pass (70% passing rate) fifty percent (50%) of the available quizzes for that cycle. This would represent six of the twelve articles published during the current three year cycle. Articles and quizzes will be archived and available at all times for members to review and submit. The ACOP will submit CME to the AOA and participation activity to the AOBP. It is also the view of the AOBP that any members who participate in PREP or other similar activities approved by the American Academy of Pediatrics (AAP) will also satisfy this component of OCC. It is anticipated that written documentation of successful completion of these types of programs will be accepted by the AOBP to satisfy these requirements. Other similar programs would be considered on an individual basis.
The ACOP has developed a Pediatric OMT program for their residency training programs called POMT. The board will require that all members successfully complete this program every cycle. The program is readily available from the ACOP and will also be available on the AOBP website.
Part 3.) Demonstration of Cognitive Expertise (Examination Process)
Currently, members must pass a secure written examination in order to achieve certification in General Pediatrics. In October of 2008, the AOBP recommended that the certificate term be extended from seven (7) to ten (10) years. This recommendation was approved by the BOS in April of 2009. All time limited certificates issued from 2009 and later will be for ten years. All time limited certificates issued in 2008 and before will expire on December 31st of the seventh year after issuance. All candidates who take and pass the recertification examination in 2009 and after will be issued a ten year certificate.
The BOS determined in April of 2009 that members who hold a lifetime certificate cannot be required to take the recertification exam in order to maintain their certification. However, these individuals will be encouraged to voluntarily participate in the examination portion of the OCC process (part 3). Lifetime members will be required to participate in parts 1, 2, 4, & 5. It is expected that bodies such as State Medical Licensing Boards and the Federation of State Medical Boards will recommend that physicians participate in a periodic “assessment of knowledge process” (a secure examination) in order to maintain licensure. It is anticipated that once the lifetime certificate holder has voluntarily entered the OCC process, he/she will remain in the process and will be expected to meet all requirements as they come due. Failure of the exam will not affect the lifetime date of the certificate. Lifetime certificate holders who pass the exam will receive verification that they have passed the recertification exam.
The AOBP is in the process of developing a public access program on the AOBP website (aobp.org) which will list the certification status of all members. All certificate holders (time limited and lifetime) will have reports regarding their status/participation in parts 1, 2, 3 & 5 of the OCC process on this website. Time limited certificate holders and lifetime certificate holders who are participating in part 4 of OCC will have their activity in part 4 reported as well. It is anticipated that the AOBP will simply note that a member does or does not meet the current requirement for a particular part of the OCC process.
Part 4.) Practice Performance Assessment:
Practice performance assessment evaluates physicians in their clinical practice according to specialty specific standards for patient care. Physicians demonstrate that they can assess their quality of care as compared to their peers and national benchmarks. Physicians can then apply interventions to improve patient care and then re-assess their care.
Currently, the AOA has the Clinical Assessment Program (CAP) in place for adult care. There is a residency based program in family practice for immunizations which is the only current pediatric oriented program within the CAP. The AOBP has contracted with the AOA CAP program to develop Pediatric specific modules within the CAP program. The board has identified the following areas for development:
A) Asthma
B) Diabetes management: Once again, an adult program is in place and can be modified for use in the pediatric age group.
C) Attention Deficit Disorder
D) Pediatric Health Maintenance and Preventive Care: This will include:
- Immunizations
- Screenings
Lead
Anemia
TB
Growth & Development Measures
- Newborn Discharge Assessment
Metabolic screens
Hearing screens
RSV assessment
Weight assessments
Feeding assessments
Jaundice assessments
- Pediatric Obesity Screening and Management
Weights & BMI Assessments
Diet & Exercise
Labs
Blood Pressure
Lipids/Glucose screens
Subject matter experts have been identified to assist AOA staff in developing these programs and clinical practice guidelines and assessments are being developed. It is hoped that a viable Pediatric CAP program will be in place in 2010. It is anticipated that members will be required to complete one CAP module every three years corresponding to the CME cycle. Other similar programs are in place with the AAP and participation in the eQIPP program will satisfy these requirements as well.
Part 5.) Membership in Professional Osteopathic Organizations:
Currently, all members certified by the AOBP must be members of the AOA. This will not change. Membership in specialty and state organizations is strongly encouraged but not a requirement for certification.
Much work remains to be done by the AOBP in order to make the OCC process an efficient and viable tool for each of us to use. The AOBP is well beyond the planning stage in this process and it is hoped that a workable program will be in place by the end of 2010, well in advance of the 2012 deadline. Further refinements will undoubtedly be necessary and future communications will detail those changes.
Sub-specialists are expected to participate in this process as well. Details regarding sub-specialty programs are in the planning stages. CAP programs have been chosen with sub-specialist participation in mind. The ABP is using specialty specific reading lists for their sub-specialists to submit to satisfy lifelong learning components. It is anticipated that the AOBP program for the sub-specialist will be similar. Once again, details are in the planning stages and specific details will be forthcoming.
Sincerely,
Fernando Gonzalez, DO, FACOP, FAAP
Chairman, AOBP
Content Disclaimer: The information provided in the American Osteopathic Board of Pediatrics (AOBP) web site is provided for information purposes only and does not constitute a legal contract between the AOBP and any person or entity unless otherwise specified. Information on the AOBP website is subject to change without prior notice. Although every reasonable effort is made to present current and accurate information, the AOBP makes no guarantees of any kind.
©2010, American Osteopathic Board of Pediatrics