10/5/2016

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Update from NCCPA

Denni J. Woodmansee, MS, PA-CChair, NCCPA Board of Directors

Presentation Outline

• About NCCPA

• The Certification Maintenance Process– Focus on Recent Changes to CME Requirements

• The Latest on Potential Changes to PANRE

A Brief Overview of NCCPA

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About NCCPA

• Only national certifying body for PAs

• Certifying PAs since 1975

• Passionate about PAs and the patients you serve

– Promote qualifications and roles of certified PAs to various audiences (physicians, employers, state medical boards, public, etc.)

– Engage in significant communications/PR efforts on your behalf: www.PAsDoThat.net

Our Current Board of Directors

10 PAs, 6 physicians and 2 public members, including nominees from...

• American Academies of:

─ Family Physicians

─ Pediatrics

─ Physician Assistants

• American College of Physicians

• American Medical Association

• American Osteopathic Association

• Association of American Medical Colleges

• Federation of State Medical Boards

• PA Education Association

• US Department of Veterans Affairs

But that’s only part of the story…

PA Involvement with NCCPA Adds Up!

• 77 PA item writers serve on item writing committees, writing questions that appear on PANCE, PANRE and the CAQ exams

• In 2015, NCCPA hosted 34 PA team meetings to develop and validate exam questions, set passing standards

• 59 PAs spent three days with us working to identify content that represents core medical knowledge

• 15 PAs serve on promotion and publicity councils, supporting our efforts to generate story ideas and press coverage for the profession

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PA Involvement with NCCPA Adds Up!

• 72 PAs served on 2015 Practice Analysis workgroups, helping identify the knowledge, skills and abilities that were included on that survey

• Approximately 16,000 PAs responded to the Practice Analysis survey

• Nearly 100,000 PAs have completed the PA Professional Profile

• In 2015, 29 PAs participated in a 3-day focus group to talk about PANRE

• More than 30,000 participated in survey of all certified PAs about proposed new PANRE model

PAs Do That!Help us tell others about the great work you do!

Share What You Do In Practice!

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Certification Maintenance Process

Certification Maintenance Process

• 100 CME credits every two years

– 50 Category 1 credits

– Self-assessment CME and PI-CME are now optional

• PANRE every 10 years

Reasons for the Latest Changes

• NCCPA heard the concerns from PAs about the burdens of the certification maintenance process

• Conducted an in-depth review of existing SA/PI activities with particular emphasis on the gaps in availability of practice-relevant options for so many PAs

– Found inadequate coverage of self-assessment in 31 specialty areas and of PI-CME in 13 specialty areas.

– That means we ran the risk of PAs pursuing CME activities with little or no relevance for them just to meet this NCCPA requirement – never what we intended.

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Reasons for the Latest Changes

• Based upon those findings, the NCCPA Board voted to make changes:

– SA and PI-CME are no longer required – now optional

– SA and PI activities are valuable, so NCCPA will begin awarding additional credit – weighting SA and PI-CME more heavily than regular Category 1 CME

Some Specifics

• All approved self-assessment CME activities will be awarded 50% bonus credits by NCCPA

• In each 2-year CME cycle, the first 20 PI-CME credits logged will be doubled

• The weighting will be applied by NCCPA and will be retroactive

• You will see these changes on your certification dashboard later this year

• Weighting will apply to all PAs who complete (or have completed) SA/PI activities – whether on the 6-year cycle or the 10-year cycle

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What Is Self-Assessment (SA)?

• Self-assessment is the process of conducting a systematic review of one’s own performance, knowledge base or skill set for the purpose of improving future performance, expanding knowledge, or honing skills.

• 2012 study concluded that more than 20% of core information guiding clinical practice is changed within one year based on new evidence or guidelines.

What Is Performance Improvement (PI) CME?

PI-CME is a process of active learning and the application of learning to improve your practice and ultimately to enhance patient care

What is Performance Improvement (PI) CME?

• A traditional, approved PI-CME activity includes three stages for which you can earn CME credit:

– Stage A - Identify evidence-based measure and assess practice (5 PI-CME credits)

– Stage B - Intervention(s) (5 PI-CME credits)

– Stage C - Re-measure; document improvement (5 PI-CME credits)

• Completing all 3 stages (bonus of 5 PI-CME credits)

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Finding Self-Assessment and PI-CME Activities

• Currently over 200 Self-Assessment and over 50 PI-CME activities in many different specialty areas (with more under review)

• Prices range from FREE to $400 depending on the sponsor and the number of credits offered. Ongoing efforts to ensure lowest cost possible

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More on PI-CME

• Can be done in partnership with PAs, physicians, and others in your practice

– Most board-certified physicians also have this requirement

• What are the options for identifying a PI-CME activity for me?

1. A traditional PI CME activity (like METRIC or EQIPP)

2. An activity or project that has been developed by an employer or institution and approved by AAPA (e.g. Cleveland Clinic, MD Anderson) -- could also be a QI activity that a PA is already doing

3. An activity or project that has been developed by an individual PA or group of PAs and approved by AAPA

Hospital and Health System Quality Improvement

• Allows PAs to organize QI activities in their own practice settings, or formalize their involvement in existing QI projects and receive PI-CME credits

• Requires official involvement with organization’s QI Department

– Define project goals and quality measures used

– Define team and resources

– Define criteria for meaningful participation

– Submit data package in specified format

• Separate application type on AAPA CME application site – institutional fee is $250, no charge to individual PAs

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AAPA’s PI Builder

• Allows an individual PA to customize her/his own PI-CME module by selecting clinical measures from a library

• Process facilitated online

• 3 options for participation

– Option 1: Choose measures from a measure library

– Option 2: Submit your own measures for approval

– Option 3: Document your involvement in a completed QI project

• $75 for AAPA members, $150 for non-members

PI-CME on Patient Safety

• Johns Hopkins-developed online certificate course

• Approved for 20 PI-CME Category 1 credits

• Can be completed by PAs in any specialty or practice area

• Can also be completed by PAs who are not in clinical practice at all

• Given the recent NCCPA BOD action, completing this activity would count for 40 Category 1 credits

Latest on Potential Changes to PANRE

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NCCPA’s Responsibility

• It is critical to NCCPA’s mission to provide a certification/recertification program that is:

– meaningful and relevant– provides assurance for patients, employers, state

licensing boards, and others regarding PAs’ knowledge and skills

• To do this, NCCPA must continuously monitor and evolve the certification process because things change:

– advances in technology – rapid changes in medicine– changes in the PA profession

© 2016 NCCPA. All rights reserved.

Why Consider Changes to PANRE?

• PA practice has changed (more than 70% practicing in specialties other than primary care)

– Are we still most effectively fulfilling our obligation to the public with the current format for PANRE?

• PAs have asked for change

– Desire to be tested on content relevant to their current role

– Questions about the difficulty of PANRE

– Cost and time required to prepare for today’s PANRE

Key Messages from the Public Comment Period

• PAs are very concerned about maintaining their ability to change specialties and do not want to see that threatened

• PAs are very concerned about the cost and time required to maintain certification (CME and exam requirements)

• If they must take an exam, PAs would prefer one that is more relevant to their practice than today’s PANRE

• Exams matter to the public and to state medical boards (other stakeholders not yet surveyed)

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Challenges for NCCPA

• Maintain the generalist nature of the PA-C

– Protect PAs’ flexibility to change specialties (seen by most PAs as a very important aspect of the profession)

• Improve the relevance and value of the exam by addressing its content and its educational value

– Should facilitate lifelong learning

• Maintain the integrity and appropriate rigor of the process

– Validity in the eyes of external stakeholders to the certification process

Our Response Thus Far

• Analyzed the availability and cost of self-assessment and PI-CME, found the options lacking, and eliminated those requirements

• Launched an effort to define “core medical knowledge” so we can increase PANRE’s focus on assessing core knowledge that is foundational to all PA practice

• To strengthen our position that the PA-C should continue to be viewed as and relied on as a generalist credential:– We are considering a “core medical knowledge” exam

as the capstone event of the 10-year cycle.– We are exploring other ways to integrate “practice-

related” elements into the process

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The Current Controversy

• Some are arguing for the elimination of the recertification exam, saying it has no real value

• In fact, evidence shows that recertifying by exam…

• Supports knowledge retention

• Illuminates areas of knowledge deficiency that many are unable to self-identify

• Improves practice to a greater degree than CME alone

• Matters to the public and other stakeholders

• Represents the high standards of the PA profession that have contributed to the profession’ssuccess for > 40 years

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Consider the Consequences

• No one likes exams, but if there was no PANRE, how would state licensing boards, employers, insurers, payers and patients view that lowering of standards?

– Would the profession be more credible or less credible?

– Would PAs do a better or worse job at keeping up to date on medical knowledge?

– Would it be easier or harder for PAs to change specialties?

– Would our malpractice insurance rates be lower or higher?

– Would the fight for full practice authority be easier or harder?

– Would patients be safer or less safe?

For More Information …

• Read NCCPA News, our monthly e-newsletter

• Visit our website --- specifically:

– https://www.nccpa.net/panre-model

• Bibliography of references:

– http://www.nccpa.net/Uploads/docs/TheEvidenceBase.pdf

Thank You!Questions?

www.nccpa.net