Board of Regents/
Governors address MOC reform and strategies for enhancing 

Sunday’s joint meeting of the American College of Surgeons (ACS) Board of Regents (B/R) and Board of Governors (B/G) featured an update on health policy reform and two panel sessions: one on Maintenance of Certification (MOC) and the other on how the B/G, other medical societies, and the ACS Young Fellows Association (YFA) communicate with their constituents.

J. Patrick Walker, MD, FACS, ACS Governor, South Texas Chapter, described a bill moving through the Texas state legislature earlier this year that would have mandated that hospitals and insurers not use MOC as criteria in selecting staff physicians. The final bill that passed in the legislature provided that insurers and health plans could not differentiate between physicians based on MOC status, and the Texas Medical Board could not require MOC for licensure. Hospitals also could not differentiate between physicians based on MOC status unless the hospital’s medical staff determines MOC-appropriate criteria for use at their facility. “This was the part that was critical,” Dr. Walker said. “We call this bill a relative victory.”

Some observations that came out of this debate include the fact that physicians value initial certification, dissent, and support regarding MOC cuts across specialties; most physicians are unaware of efforts to change MOC; and individuals’ beliefs with regard to this issue are rooted more in emotion than facts, Dr. Walker noted.

Margo C. Shoup, MD, FACS, chair of the American Board of Surgery (ABS) diplomates committee, described the results of a survey of 30,000 diplomates conducted this summer. According to Dr. Shoup, of the respondents to the survey (response rate=25 percent), 85 percent believe that ABS assessment modules should be based on core surgical principles, 84 percent think the content should be practice-specific, and 23 percent think the modules should be based on core journal content.

“Only 13 percent want to keep the 10-year model we have right now,” Dr. Shoup said. “The majority want shorter exams and a shorter timeframe.”

In considering how to incorporate diplomate feedback into the MOC process, Dr. Shoup said the ABS committee decided to organize the test into two sections: half would comprise 20 questions testing core knowledge—such as perioperative care, risk assessment, common complications, and pain management—and the other half would feature 20 practice-related questions.

Other viable MOC-related options could include the ACS Surgical Education and Self-Assessment Program, the Breast Education and Self-Assessment Program, credit assigned for leadership roles, credit for involvement in quality initiatives, and credit for publishing or reading select journal articles, Dr. Shoup said.

Susan K. Mosier, MD, MBA, FACS, discussed how the American Board of Ophthalmology (ABO) is transforming certification. “As you know, MOC in all the specialties has been widely criticized for its inflexibility. In ophthalmology, we’ve heard that rigidity in the requirements creates a burden for busy practitioners who are unable to weave the activities into their existing lifelong learning and professional development habits. In addition, many diplomates find the closed-book examination component stressful due to the time that must be spent away from practice and the unpleasant test center experience they encounter,” Dr. Mosier said.

According to Dr. Mosier, the ABO’s continuous certification of the future will “recognize the personal achievement of high standards; offer an evolving program menu with customizable options; and provide a framework built around a new, user-friendly assessment platform that tests what you know, measures what you learn, and helps you continue to advance to the next level as a practitioner.”

For the first time in 2017, the ABO permitted diplomates to take the closed-book examination via computer off site, and the result was so positive, according to Dr. Mosier, that the option will be available year-round beginning in January 2018.

“So, without abandoning its high standards, the board is transitioning to a new kind of assessment tool that is longitudinal in design; incorporates both learning and assessment with detailed, immediate feedback given to the test-taker; and capitalizes on the technology available in 2017 to deliver the content via computer, tablet, or mobile device,” she said.

“All of the boards are currently working to decrease the anxiety factors that are associated with the current MOC process,” said ACS Executive Director David B. Hoyt, MD, FACS, during the panel’s question-and-answer session. “The boards and the organizations are coming together in a way that we haven’t seen before. It’s about MOC, but it is also about our principles of self-determination.”

The next part of the joint session focused on health policy reform. According to Christian Shalgian, Director, ACS Division of Advocacy and Health Policy, there are 45 issues that are important to the ACS, including the Affordable Care Act, health information technology, and performance measurement. “We could be putting our resources into a lot of areas, but we don’t have the bandwidth. We are working in partnerships where we can have the most impact at the congressional level and at the regulatory level, but we need your help,” Mr. Shalgian said.

The Quality Payment Program (QPP)—another key issue that the ACS Division of Advocacy and Health Policy is tracking—was established under the Medicare Access and CHIP (Children’s Health Insurance Program) Reauthorization Act (MACRA) of 2015, which called for moving toward a value-based payment system. “We are expecting the new rules for the 2018 Quality Payment Program in the next 10 days,” said Mr. Shalgian, noting that the College will provide materials to help educate health care providers on the new rules.

Mr. Shalgian said the College is taking a leadership role on several policy and regulatory initiatives related to the QPP, including development of the ACS-Brandeis Advanced Alternative Payment Model (A-APM). APMs provide a model for paying physicians that differs from the fee-for-service construct with the goal of improving the quality and value of care provided, reducing growth in health care spending, or both. The ACS-Brandeis A-APM recognizes the team-based nature of surgical care and is flexible, allowing providers to design the care pathways that work best for each patient and practice. Quality is measured through an episode-based measure framework based on the College’s Surgical Phases of Care concept. Health care professionals who provide quality care would be eligible to share in savings and, because the model is designed to meet the A-APM criteria, may qualify for the 5 percent incentive payment.

“We are leading the efforts for APMs,” Mr. Shalgian said. “Our proposal is the only one gaining traction in Washington, DC, right now.”

The final panel session addressed the importance of evolving communication strategies, and described how medical societies, ACS YFA, and the B/G strive to communicate with members and peers.

Dr. Mosier outlined the communications structure of the American Academy of Ophthalmology (AAO): the AAO council is equivalent to the ACS B/G and its board of trustees is similar to the College’s B/R. “The Council serves as an advisory body to the Board of Trustees, and it serves as a channel for bidirectional communication between the membership and the board,” Dr. Mosier said.

The primary method for gaining input from AAO members are council advisory recommendations, which is a process that allows for “thorough deliberation and discussion of complex issues in an open meeting [format]” and offers the opportunity for Council members to “develop and suggest policy to the Board of Trustees,” Dr. Mosier said. She noted that the AAO’s communication process works because it “facilitates timely, bidirectional communication between academy members and the board of trustees, thus making the decision-making body more accessible to members.”

James W. Suliburk, MD, FACS, described best practice communication strategies to reach members of the ACS YFA. “Over the last couple of years, we’ve implemented the ‘rule of 7s’ to disseminate information downstream,” Dr. Suliburk said. “This means that we send a message seven times through seven different channels,” including e-mail (direct and mass), texting/SMS (short message service), social media, and other pathways.

According to Dr. Suliburk, successful downstream communication to YFA members requires repetition and infographics. “We keep it visual when we can because that is what it takes to get through to our membership,” he said.