Through the ABMS Multi-specialty Portfolio Approval Program (Portfolio Program), most ABMS Member Boards delegate to approved institutions the ability to designate and award Part IV MOC credit. Through an application and review process, the Portfolio Program approves institutions that conduct quality improvement projects that may qualify for Part IV MOC credit. Those institutions identify projects that meet the Portfolio Program’s standards and award Part IV MOC credit to physicians who meet requirements for project participation.
Complete information about the national Program is available on the Program's web site: http://mocportfolioprogram.org, a summary is provided below.
Participating boards. Currently participating are the American Boards of:
|Allergy and Immunology||Otolaryngology|
|Emergency Medicine||Physical Medicine|
|Family Medicine||Plastic Surgery|
|Internal Medicine||Preventive Medicine|
|Medical Genetics||Psychiatry and Neurology|
|Obstetrics & Gynecology||Radiology|
|Orthopaedic Surgery||Thoracic Surgery|
(Not yet participating are the Boards of Colon & Rectal surgery, Nuclear Medicine, and Neurological Surgery.)
In addition to the common requirements under the Program, each board offers other options for physicians to engage in activities that provide Part IV credit.
Need for the Program. The Program arose from the desire of several specialty boards to provide a more efficient way to recognize the participation of physicians in quality improvement (QI) efforts that meet Part IV requirements. Many physicians were already participating in meaningful QI efforts in their own practices. However, no easy way existed for this participation to be documented as meeting a board’s standards.
One existing option for receiving credit for participation in QI was for a physician to participate in a Part IV QI activity (“module”) made available by the Board. However, the available modules for individuals were limited to the scope of change that an individual could initiate, while projects involving many physicians may address broader changes in the infrastructure and delivery of care. Another option was to submit an application for a Board to review and approve an institution’s QI project. However, this resulted in Boards having to review an increasingly large number of applications and several Boards reviewing the same application if it involved physicians from more than one specialty. A more relevant and efficient mechanism was needed to recognize and document physicians’ participation in QI in their regular work.
General requirements. The participating Boards agreed upon a set of Standard and Guidelines that an institution would have to meet in order to be delegated the ability to designate Part IV credit. The requirements are at the levels of the:
Institution – Have the infrastructure and capability to support physician involvement in ABMS MOC, demonstrate past success in improving quality of care, make training and educational opportunities on quality improvement available, and have auditable processes for overseeing the institution’s program.
QI projects – Have leadership and management at the initiative level that will ensure adherence to the participation criteria; address care the physician can influence in one or more of the six Institute of Medicine quality dimensions; have specific, measurable, relevant, and time-appropriate aims for improvement, use appropriate, relevant, and evidence-based (when available) performance measures; use recognized, valid, established quality or performance improvement methodology; include appropriate prospective and repetitive data collection and reporting of performance data so that diplomates access, reflect on, and act upon the data at least three times, (including baseline and at the conclusion of the activity) during the course of their meaningful participation in a quality initiative designed for MOC Part IV; attempt or plan to translate or implement an improvement into routine care, or disseminate or spread and sustain an existing improvement into practice; and possess sufficient and appropriate resources to develop, support and conclude the activity without real or perceived conflict of interest.
Physicians – Their activities within the initiatives are directly related to the physician’s clinical practice or organizational/leadership role in improving care; the physician is actively involved throughout the entire specified activity in order to understand experience basic QI/PI principles; and the physicians are able to verify and will attest that they have participated throughout the entire specified QI/PI initiative, met with others involved in the improvement activities, reviewed their performance data, helped develop and/or implement changes to the activities, and personally reflected on the impact of the initiative on their practice or organizational role.
Physician Assistants. The American Academy of Physician Assistants (AAPA) is exploring with the ABMS Portfolio Program the option for physician assistants to meet their MOC requirement for performance improvement when they participate in improvement efforts overseen through institutions approved by the ABMS Portfolio Program. While those discussions occur, AAPA and Michigan Medicine are piloting this type of arrangement for QI efforts approved by Michigan Medicine. For QI initiatives that Michigan Medicine oversees and that meet requirements of the ABMS Portfolio program, Michigan Medicine can award AAPA PI-CME credit to physician assistants if physician assistants meet the participation requirements that apply to physicians. Currently Michigan Medicine reports the participation of physician assistants to AAPA. This credit applies to the MOC requirement for performance improvement/QI of the National Commission on Certification of Physician Assistants (NCCPA).