Strategic Linkage Between ABIM & Bridges to Excellence (BtE) - Frequently Asked Questions
- A product to assess overall physician clinical performance does not currently exist in the market. Why not?
- How will ABIM decide which measures to include in the Comprehensive Care PIM. Will all the measures be treated similarly?
- What process will ABIM use to develop its scoring recommendations? Will it apply to other products?
- How will BtE determine performance thresholds for payment? What input will ABIM provide, if any?
- Beyond payment, will physicians receive any other kind of recognition for meeting the performance standards of the Comprehensive Care PIM?
- What will the ABIM audit involve? Will ABIM start auditing performance measures with its other products?
- How will ABIM assure that its standards for reliability and validity are met with this product?
- Why has ABIM decided to link with P4P programs? Does this suggest a new strategic direction for the Board?
- How does the agreement between ABIM and BtE compare to existing arrangements?
- How does ABIM and boards in general differ from medical specialty societies?
A product to assess overall physician clinical performance does not currently exist in the market. Why not?
Largely because of the current state of measurement science, including the complexity involved in assessing multiple clinical domains; the lack of valid, reliable measures in acute care; and statistical issues, e.g., in most physician practices there are small numbers of patients with a given condition.
Nevertheless, given ABIM's long history of evaluative work and the public and the profession's desire for an assessment of internists' performance across multiple conditions, the Board is ready to take on this important challenge.
How will ABIM decide which measures to include in the Comprehensive Care PIM. Will all the measures be treated similarly?
ABIM, with the input of an outside expert committee, is reviewing preventive, chronic, and acute care measures embedded in its existing products and measures in use elsewhere. All the measures considered have met national standards, and decisions related to inclusion will be based on clinical importance and other criteria. ABIM is also reviewing measures from its practice infrastructure assessment and patient satisfaction survey.
Some of these measures will "count" towards performance thresholds. Others that do not meet reliability/validity tests, will be included in order to provide feedback to physicians for quality improvement purposes, such as patient education and communication.
What process will ABIM use to develop its scoring recommendations? Will it apply to other products?
In addition to the advice from experts in the field of measurement science, ABIM will analyze performance measurement data from its existing practice improvement products, and a future field test of the Comprehensive Care PIM to be conducted in Spring, 2006.
This analysis and input will enable the Board to decide if proposed measures can be generalized across physicians, provide sufficient precision to discriminate performance between physicians, and of course, meet standard tests for validity and reliability. At this point, ABIM does not have plans to apply its recommended scoring framework to its other Maintenance of Certification performance assessment products.
How will BtE determine performance thresholds for payment? What input will ABIM provide, if any?
ABIM will provide BtE and any other payers with its scoring recommendations, but will not be setting the payment amount. In addition to ABIM's input, BtE will also receive guidance from Towers Perrin as it establishes performance "cut points" for payment. BtE expects such thresholds to evolve over time.
Beyond payment, will physicians receive any other kind of recognition for meeting the performance standards of the Comprehensive Care PIM?
ABIM is committed to recognizing physicians who have fulfilled its comprehensive and rigorous requirements—that include an assessment of knowledge, diagnostic acumen, clinical judgment, and performance in Internal Medicine and its subspecialties—through maintenance of certification. As such, it is not issuing recognition based solely on performance which is one, albeit important, dimension.
What will the ABIM audit involve? Will ABIM start auditing performance measures with its other products?
Because ABIM's evaluation will reflect performance and may be linked to payment, the organization has decided to incorporate an audit mechanism to assure data veracity in this program. The details of the audit program are still in development. ABIM continues to reserve the right to audit data associated with its other products but has no immediate plans to do so.
How will ABIM assure that its standards for reliability and validity are met with this product?
ABIM will apply the high standards for rigor/validity that it has established with its portfolio of assessment products over the last 70 years. These standards include review of the literature, field testing, analysis of existing product data, and outside, expert input. The organization will also apply its standard continuous quality improvement process in order to provide ongoing enhancement of the Comprehensive Care PIM over time.
Why has ABIM decided to link with P4P programs? Does this suggest a new strategic direction for the Board?
ABIM is committed to enhancing physician quality and sees linkage of its program with P4P as a potential for extending its established public mission. ABIM is equally committed to reducing measurement redundancy for physicians, and sees such an association with P4P programs as an important mechanism to do so. That said, such linkages are voluntary for physicians who pursue ABIM Maintenance of Certification
How does the agreement between ABIM and BtE compare to existing arrangements?
The ABIM seeks to engage in a range of strategic partnerships to advance the quality of patient care. The relationship with BtE builds upon existing relationships with quality organizations but differs in that it provides a broader, more comprehensive assessment of seven to 10 conditions rather than specifically focusing on one condition.
How does ABIM and boards in general differ from medical specialty societies?
The ABIM, part of the spectrum of health care oversight organizations, sets the standards and certifies the knowledge, skills and attitudes of physicians who practice in Internal Medicine and its subspecialties. Its primary audience is the public. Medical specialty societies work to enhance the quality of health care by providing their physician members with educational resources that foster excellence and professionalism, and they seek to influence public policies that affect their membership. The ABIM and its many related medical specialty societies partner on a range of initiatives to enhance the quality of patient care.
For more than 75 years, certification by the American Board of Internal Medicine (ABIM) has stood for the highest standard in internal medicine and its 19 subspecialties and has meant that internists have demonstrated – to their peers and to the public – that they have the clinical judgment, skills and attitudes essential for the delivery of excellent patient care. ABIM is not a membership society, but a non-profit, independent evaluation organization. Our accountability is both to the profession of medicine and to the public. ABIM is a member of the American Board of Medical Specialties. For additional updates, follow ABIM on Facebook and Twitter.