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Practice improvement modules will serve as resources for orthopaedists as they participate in the American Board of Orthopaedic Surgery’s Maintenance of Certification™ process. After orthopaedists enter patient data into the modules, the tools will enable them to track patient outcomes and complications. Then, after comparing the results to national benchmarks, orthopaedic surgeons will develop and implement improvement plans.


Published 5/1/2010
Harry N. Herkowitz, MD; David F. Martin, MD; Shepard R. Hurwitz, MD

How will MOC measure performance?

New tools will help evaluate and enhance quality of care

Maintenance of Certification™ (MOC), the American Board of Orthopaedic Surgery’s (ABOS) process for evaluating orthopaedic surgeons with time-limited certificates, is a valuable way to maintain and improve the quality of care orthopaedists provide to patients. As outlined in the recently enacted Patient Protection and Affordable Care Act, physicians who participate in MOC will also be eligible for an added benefit. The Act amends the Physician Quality Reporting Initiative to establish a participation pathway for physicians who complete a qualified Maintenance of Certification program with their specialty board of medicine. The pathway will allow those who meet certain requirements to earn an additional 0.5 percent incentive from the federal government from 2011 to 2014.

As MOC evolves, the ABOS will continue to offer new resources that help orthopaedic surgeons navigate the process. The ABOS is placing special emphasis on developing tools and processes related to the fourth component of MOC: evaluating performance in practice. Resources are being developed to help orthopaedists measure their performance and implement improvement strategies.

Using PIMs
The ABOS is working with the AAOS and orthopaedic specialty societies to develop practice improvement modules (PIMs), Web-based tools that will enable orthopaedists to review a specific component of their practice. The use of these tools, which are still in the early stages of development, will be voluntary in the foreseeable future.

To begin using a module, an orthopaedist enters patient data into the module. Data related to 10 cases of primary total joint replacement, for example, might include information such as patient demographics and whether deep vein thrombosis prophylaxis, antibiotics, and other safety measures were used. The module would then be used to help track outcomes and complications. After reviewing the results compared to national benchmarks, the surgeon can develop and implement an improvement plan that includes educational activities specific to the practice. Finally, the orthopaedist can assess 10 more cases with the same diagnosis and review the results.

A module for carpal tunnel syndrome has already been developed by John G. Seiler III, MD, and Marybeth Ezaki, MD, senior directors of the ABOS, with input from the American Society for Surgery of the Hand, American Board of Plastic Surgery, and the American Board of Surgery. This Web-based module is now live and being field-tested. After any necessary modifications are made to the module, it will become available to all applicants for the surgery of the hand recertification examination.

The initial group of seven to eight PIMs is scheduled to be ready for field testing by 2011. Eventually, PIMs will cover all practice areas within the specialty of orthopaedic surgery. The ABOS has not yet set the timeframe within the 10-year MOC process for when the initial modules and follow-up modules would need to be completed.

The ABOS is also exploring other performance improvement activities that would qualify for credit within MOC, such as participation in the American Joint Replacement Registry and other databases. These databases would need to contain quality assessment tools that fulfill the performance improvement requirements established by the American Board of Medical Specialties, the parent board of all medical specialties, including the ABOS.

Enhancing communication, patient safety
Other performance improvement components in development include communication and patient safety assessments. Communication between patients and their orthopaedic surgeons will be evaluated through patient surveys, which will also be used to assess interactions between patients and staff in physicians’ offices. The ABOS is reviewing several different communication tools for implementation before the end of 2010.

In addition, the ABOS is reviewing patient safety modules developed by the Academy to determine whether they will qualify for credits in the MOC process. These modules are available at no cost to AAOS members on Orthopaedic Knowledge Online.

Visit the
ABOS Web site for updates about MOC tools and resources. Diplomates may obtain a detailed view of the MOC timeline for their specific recertification year by clicking on the “Diplomates” tab and selecting the year their certificate will expire.

The ABOS office is also available to answer questions at (919) 929-7103.

Harry N. Herkowitz, MD, is president of the ABOS. He can be reached at hherkowitz@beaumont.edu

David F. Martin, MD, is the chair of the ABOS MOC Committee. He can be reached at dmartin@wfubmc.edu

Shepard R. Hurwitz, MD, is the executive director of the ABOS. He can be reached at shurwitz@abos.org

More about MOC
The MOC process evaluates applicants on the following four components on a continuing basis:

  • Part I: Evidence of professional standing
  • Part II: Commitment to life-long learning and self-assessment
  • Part III: Evidence of cognitive knowledge
  • Part IV: Evidence of performance in practice

As part of each component, MOC requires diplomates to do the following:

  • Hold a full and unrestricted license to practice (Part I)
  • Obtain 120 AMA PRA Category 1 Continuing Medical Education (CME) Credits™ in each of two consecutive 3-year cycles, totalling 240 credits over 6 years, including at least 20 credits during each cycle from one or two scored and recorded self-assessment examinations (Part II)
  • Complete a secure cognitive examination (Part III)
  • Meet requirements detailed on the ABOS Web site to demonstrate acceptable performance in practice (Part IV)

Orthopaedic specialty societies offer a wide range of resources that can help orthopaedists obtain CME credits, as does the AAOS. Visit www.aaos.org/moc to learn more.