Performance Improvement Methods: Not Just For Maintenance of Certification

The 2008-11 Enhanced Public Trust Initiative of the American Board of Medical Specialties is a call for greater oversight and accountability of board-certified medical physicians to assure quality patient care and management [1]. The American Board of Medical Specialties Maintenance of Certification (MOC) program is designed to promote excellence in patient care and to support physicians’ commitment to lifelong learning and continued professional development. The MOC process also assures the public that board-certified physicians remain current in knowledge of their specialty and that it has been put into practice to fulfill the directive by the Enhanced Public Trust Initiative. Although the issues of quality of care, lifelong learning, and professional development are essential for physicians, there is debate over how one measures these issues. The current state of MOC requires physicians to participate in a 4-part process: I. Licensure and professional standing II. Lifelong learning and self-assessment II. Cognitive expertise IV. Practice performance assessment In short, a physician must keep a valid license, complete education and selfssessments, take a “high-stakes” test, and demonstrate performance improvement. For art IV, physicians “are evaluated in their clinical practice according to specialtypecific standards for patient care. They are asked to demonstrate that they can assess he quality of care they provide compared to peers and national benchmarks and then pply the best evidence or consensus recommendations to improve that care using ollow-up assessments [2].” The American Board of Physical Medicine and Rehabilitation (ABPMR hence, there often is a hidden value beyond the requirement for MOC. Performance improvement, in general, is a methodology that requires utilization of improvement tools and understanding of processes. It takes time to learn, time to implement, and time spent on evaluating errors and processes that result in yet more time being required to make appropriate changes. The silver lining is that the PIP can be the path to continuous improvement for a practice. PIPs require defining a project, selecting a team, setting goals for improvement, initiating a pilot, and evaluating the result. To meet the minimum requirements of certification, a physician could complete a project and “call it a day”; however, with some planned effort, gains in practice performance can be realized. New skill sets can be developed and used, and practice processes can be refined and become more efficient. Practices may become less expensive to run, and process or patient outcomes improved. That is the point at which return on the investment of time spent is realized! By improving the efficiency of the billing service, correcting errors in patient scheduling, streamlining the process of prior approvals, maximizing the frequency of laboratory monitoring, or ensuring the adherence to clinical guidelines, the results of a PIP can lead to continuous improvement in all or any aspects of clinical practice. These same methodologies can lead to improved patient care and a stronger bottom line. For example, an audit can identify that hemoglobin A1C levels are not checked regularly in patients with diabetes, that 20% of bills are returned unpaid for incorrect coding, or that