Increasingly, efforts to boost quality and gain better value from the worlds most costly healthcare system are including attention to maintenance of certification, a little-understood but rigorous process by which physicians maintain board certification.
For example, Democratic presidential candidate Hillary Rodham Clinton, in laying out the quality portion of her three-part healthcare reform plan in August, specifically touted these programs as a key step in enhancing quality. From the presidential campaign trail to hospital and health plan board rooms, maintenance of certification is a growing force in the industry.
So what is maintenance of certification anyway? It is a voluntary process, above and beyond licensure, designed to ensure that practicing physicians stay current in their specialties. Given how rapidly science changes, it is easy to understand how doctors have trouble keeping up. Maintenance of certification requires that physicians demonstrateon an ongoing basisthe knowledge and skills that are needed to deliver excellent care.
How does maintenance of certification affect healthcare quality and why does it matter to healthcare organizations and other stakeholders? Consider recent events.
Several of the nations biggest health plansincluding Aetna, Cigna Corp., Humana, UnitedHealth Group and national and regional Blue Cross and Blue Shield organizationsare embracing maintenance of certification as part of their recognition and reward programs. Physicians who do not participate are not highlighted in plan directories and miss out on higher plan reimbursements. Savvy hospital leaders, meanwhile, are examining ways to use elements of maintenance of certification to respond to the Joint Commissions new requirements for physician credentialing and privileging. Furthermore, the National Quality Forum and the AQA alliance will be considering maintenance of certification for quality measurement endorsement.
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 also 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 a 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 that 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.
Cary SennettSenior vice presidentStrategy and Clinical AnalyticsAmerican Board of Internal MedicinePhiladelphia
Christine CasselPresident and chief executive officerAmerican Board of Internal MedicinePhiladelphia