Meanwhile, the concept is gaining traction in the public sector. When Clinton laid the foundation for her healthcare reform proposals, the first step, she said, is to lend the support of the federal government to (the Maintenance of Certification) process to help our doctors stay on the top of their game. In fact, lending that support by offering higher Medicare reimbursement to doctors who have participated in Maintenance of Certification programs is a natural extension of HHS Secretary Mike Leavitts efforts to use the purchasing power of the government to accelerate quality improvement. Such a proposal has the support of the Disclosure Groupa broad-based coalition of 30 leading purchasers and consumer organizationswhich has requested that the CMS strongly consider recognizing participation in enhanced Maintenance of Certification programs as one way to participate in the Physician Quality Reporting Initiative.
Why is Maintenance of Certification becoming so important? For almost a century, not-for-profit certifying boardsunder the umbrella of the American Board of Medical Specialtieshave set high and progressively more-challenging standards for physicians who want to be recognized as specialists (like internists or surgeons) or subspecialists (like cardiologists or gastroenterologists). Historically, certification was a once-in-a-lifetime event; physicians passed an examination at the end of their training, and were certified forever. But once-in-a-lifetime certification doesnt make sense given how rapidly medical science is changing.
In fact, most of what doctors learn in training is out of date 10 years later; the need for doctors to keep up has never been more urgent. A recent analysis of the scientific literature led by Harvard Medical Schools Niteesh Choudhry, published in the Annals of Internal Medicine, concluded physicians who have been in practice for more years and older physicians possess less factual knowledge, are less likely to adhere to appropriate standards of care, and may also have poorer patient outcomes.
Maintenance of Certification programs go beyond testing knowledge, to assess the other skills that are essential for delivering high quality care in the complex and dynamic healthcare delivery system. As the Institute of Medicine has concluded, high-quality care depends not only on what doctors know, but upon a broad range of skills that includes communication and the ability to work effectively with others in a system. Maintenance of Certification emphasizes a systems-based approach to care; it is one of the few ways that practicing physicians are exposed to and can learn such concepts.
Certifying boards require multifaceted maintenance of certification to assure that physicians demonstrate that broad range of skills throughout their practice lifetimes. Data from numerous sources suggest that physicians who are certified get better results.
Recent research provides additional evidence: board-certified physicians provide care to patients with acute myocardial infarction consistent with national guidelines more often than their noncertified counterparts; board certification is associated with higher rates of preventive services in the Medicare population; and physicians who are not board-certified are more likely to have been subject to professional disciplinary action. Furthermore, an overwhelming majority of Americans polled by the Gallup Organization in 2003 preferred board-certified physicians, and many indicated they would find a new doctor if they found their physician had failed to recertify.
Recent events show that the issue of Maintenance of Certification is rapidly moving into the mainstream. As healthcare payers, institutions and even presidential candidates see how important it is to improving healthcare quality and value, physicians are getting the message. Board certificationearned and maintainedis the mechanism through which they can demonstrate that they are prepared, committed and accountable to meet the highest standards of professionalism.