Peer review monthly: Board certification and peer review

I recently had the opportunity to attend a conference held by the American Board of Medical Specialties (ABMS) regarding the implementation of maintenance of certification (MOC). For those of you who may not be familiar with it, MOC is the approach that the ABMS is pursing to make board certification more relevant to defining the current competency of its diplomats. MOC is also intended to stimulate physician self examination and improvement. The initiative has great merit but is currently going through some growing pains. 

One of the goals of the conference was to help the ABMS’s individual specialty boards add value to the MOC process for both their diplomates and the other healthcare stakeholders. Based on this dialog, the ABMS as a whole and its individual boards plan to design and implement MOC that will make board certification a more compelling and accurate measure of physician quality.

I was privileged to serve on a panel that discussed the relationship of MOC to hospital credentialing and privileging. The other panel members included a representative from The Joint Commission and a physician who is also a hospital chief operating officer. The questions for our panel were:

1. Could all hospitals make board certification a requirement for credentialing and privileging?
2. If so, what changes need to be made to reach that goal?

All panel members agreed that board certification was an important and useful criterion for hospitals to require of physicians to obtain medical staff membership. It was also agreed that for some hospitals and for some specialties, it might be unrealistic. 

Board certification’s role in privileging is less clear because it does not always correlate directly to the privileges practitioners initially request. It was viewed as even less applicable to practitioners reapplying for privileges.

A paper published in the August, 2009 Archives of General Surgery, which was discussed at the conference, indicated that while two-thirds of hospitals require board certification for initial privileges, 77% of those have exceptions if a practitioner fails to recertify. This makes sense because if a medical staff has peer review data to demonstrate that a practitioner is currently competent to perform the privileges he or she exercises, it is difficult to revoke those privileges based on an exam that may relate to other privileges the practitioner is not requesting or using. Similarly, from a regulatory perspective, unless MOC could be a source of data for OPPE, hospitals will continue to evaluate competency independent of the board status.

Where does this leave MOC? Clearly, unless MOC can provide hospitals with privilege-specific data, there will be no change in the future regarding how board certification is used for privileging.

The component of MOC that addresses performance data is Part IV: practice performance assessment. One conference panel reported some of the specialty boards’ efforts to link Part IV to physician competence. The American Board of Orthopedic Surgery and the American Board of Internal Medicine in particular have attempted to create a data driven system to evaluate current competency and help their diplomates improve clinically and professionally over the course of their careers. At this stage, however, the other boards are in various stages of defining their approach.

Will MOC ever drive credentialing and privileging through Part IV and should it? First, because of the individual boards’ relative autonomy, practitioners should not expect a single answer to that question for some time, if ever. Second, even if these boards created databases that address physician competency, the question of who should interpret that data will likely remain at the individual healthcare organization level.

Although MOC may not become the sole driver of credentialing and privileging, I came away from the conference impressed by the ABMS’s desire to make certification relevant to a number stakeholders in healthcare beyond their own diplomates. I suggest you stay tuned over the next few years to see what happens.

Next month I will discuss the orthopedic field’s approach to using peer references as a serious component for MOC.

To join the discussion on the Credentialing Resource Center blog regarding board certification as an indicator of physician competence, click here. Also visit HospitalistLeadership.com to learn more about board certification for hospitalists.

Robert Marder, MD, CMSL, is the vice president of The Greeley Company, a division of HCPro, Inc. in Marblehead, MA.