For many physicians, maintaining certification is but one of a number of non-clinical activities that require additional time and energy. The ABFM is working to balance the importance of providing a mechanism for family physicians to demonstrate their ongoing competency and improvement with the additional burden and expense the federal efforts to move to value-based payment will add to physician work. For this reason, the ABFM is investing heavily to align continuous certification with value-based payment requirements, in a manner that will both reduce burden and bend value-based payments to primary care’s value. A description of these multi-faceted efforts is described below.
1. PRIME Registry
For family physicians who have difficulty retrieving data for quality reporting from their EHRs, ABFM is providing tools to turn EHR data into information. PRIME dashboards inform patient and population quality and their measures populate MOC portfolios to tailor QI choices to the most meaningful of activities. These data are reported at the physician’s discretion to meet value-based payment reporting and other needs. Through the PRIME registry, we will merge EHR-pulled data with measure submission to produce a more inclusive registry. More information here: https://www.theabfm.org/primeregistry/
2. TRADEMaRQ (Trial of Aggregate Data Exchange for MOC and Raising Quality)
This refers to a federally funded study that seeks to answer 3 questions: (1) Can family physicians who are in systems that measure quality send whole-panel quality measures to the ABFM?; (2) can those data be used to better address quality improvement needs at the practice level?; and (3) will this process result in improved quality? Participation in TRADEMaRQ is one path into the PRIME Registry.
3. PRIME Support & Alignment Network
The ABFM partnered with the AAFP to support the large federal effort to help practices succeed with value-based payments. The ABFM saw this as a way to secure important resources for helping family medicine practices, and to assist with reducing the burden and planning required for family physicians to accomplish practice improvement activities. ABFM is giving Part IV credit and making the PRIME Registry free for 6,000 board-certified family physicians who join a Practice Transformation Network.
4. Measure Development
The PRIME Registry is a federally certified Qualified Clinical Data Registry, which means it can propose better primary care measures to CMS for payment. ABFM’s research collaborations with the Robert Graham Center prepare and allow us to produce better measures for value-based payment. Having the data, capacity to analyze them, and develop/test measures will help us recommend pay-for performance measures that family physicians believe are important. ABFM wants meaningful quality improvement to count for multiple things, so we hope, over time, to move Practice Improvement Activities (Part IV) into the PRIME Registry with the goal that when a family physician completes a Performance in Practice module, they also complete a Clinical Practice Improvement Activity (one of the new value-based payment measures).
5. Population Health
The ABFM is working to integrate social determinants of health data with clinical data in the PRIME Registry. The goal is to help prepare family medicine practices for understanding the impact of social determinants on individual patients and populations they serve so that interventions to improve care can be planned with these in mind. Through this effort, community-level quality improvement efforts that count for maintaining certification and value-based payments will be developed. This also helps with preparation for payment adjustments based on social determinants, expected in 2017.
6. Evolution of Continuous Certification
The ABFM uses research and feedback from its Diplomates to continuously improve certification. More than 80% of Diplomates told us that the Knowledge Self-Assessment (KSA) portion of Part II was valuable for updating their knowledge, but only 60% said the same for the Clinical Skills portion. In response, the ABFM is separating these 2 components and making them independent options. We are working on another Part II solution that allows Diplomates to receive questions on their smart devices and answer fewer KSA questions but more often. Other boards have found that their Diplomates favor this method, and educational research supports it for improving learning. Our internal research will also lead to improvements in the certification examination which will be announced later this year.
Certifying boards can, and should, play a critical role in reducing burden and burnout by helping physicians demonstrate ongoing competency and respond to requirements for improving care quality. The ABFM is committed to helping its Diplomates through work at the practice and policy levels on your behalf, and we welcome your partnership in this process.
TRADEMaRQ was supported by grant number R21HS022583 from the Agency for Healthcare Research and Quality. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality.
- © 2016 Annals of Family Medicine, Inc.
