May 4, 2013

OPPE, FPPE, MOC, MOL .... Slurping the Alphabet Soup of Physician Assessment

A couple of months ago I drove past fertile vineyards and took in the not-so-sweet scent of dairy farms, en route to a small community hospital in California's Central Valley. I had been 
invited to present a continuing medical education session on The Joint Commission's requirements for clinician evaluation.

As a board-certified practicing pediatrician, I am all too familiar with my own relatively new requirements for re-certification. The American Board of Medical Specialties recently introduced a Maintenance of Certification (MOC) process much more extensive than what was required in the past. I now need to pass a periodic closed book examination, demonstrate ongoing learning and participate in quality improvement projects.

The Joint Commission has its own set of evolving acronyms, OPPE and FPPE, designed to provide oversight for clinicians applying for or maintaining hospital privileges. In 2010, the Federation of State Medical Boards' Maintenance of Licensure (MOL) process specified that physicians demonstrate continuous professional development in order to renew their medical license.

I am all for greater oversight. Who would want sub-standard care for their patients, let alone for them, their friends and family members.

In an ideal world, this system of monitoring would produce better and safer care and not be significantly burdensome to hospitals or clinicians. However, the current state of clinician evaluation may at best be inadequate and at worst be detrimental to actual value and quality improvements.

There are a number of issues with our current ways of evaluating clinicians. Evidence supporting the effectiveness of MOC in improving clinical practice and patient-level outcomes is starting to trickle in, but is far from conclusive.

Multisource feedback (input from peers and patients) has its own set of limitations in assessing a clinician's ability to practice medicine. Studies advise exercising caution when using peer and patient feedback since it may be subject to biases. For example, physician assessments are frequently influenced by personal characteristics, rather than by professional performance.

Providing patients reassurance that the clinician or hospital treating them follows certain standards is a worthwhile goal. However, making sure that these plethora of requirements really translate to better, safer and more cost-effective care is an even more worthwhile one.

- Ulfat Shaikh

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