ABNS Report ABNS 14 Directors AANS 4 CNS

ABNS Report

• • • ABNS 14 Directors – AANS (4) – CNS (4) – Senior Society (4) – Academy (1) – NSA (1) 6 year terms 8 committees – Bylaws – Credentials – Educational Requirements and Subspecialization – Finance – MOC – Oral Exam – Professional practice data and Technology – Written Exam

ABNS Retiring Directors TAE SUNG PARK: SNS CHARLES BRANCH: AANS

ABNS New Directors AL COHEN -SNS CHRIS SHAFFREY-AANS

ABNS New Officers Secretary Vice Chairmen Chairman

Diplomate Count • • • Active Retired Deceased Revoked Non-participation MOC 3612 191 female (5. 28%) 1554 1063 26 7 Total 6262

Residency Stats • • 1194 residents tracking toward certification. 171 are women (14%). 75 out of 97 programs have one or more female residents. 162 residents completed training in 2010.

Females YEAR 05 -06 06 -07 07 -08 08 -09 09 -10 10 -11 # / PROGRAMS • • • 93 / 69 88 / 59 127 / 62 142 / 69 150 / 70 171 / 75

Primary Exam March 12, 2011 697 examinees at 98 test centers 219 for certification 478 for self-assessment 375 questions, 40% newly written or revised

Oral Exam Changes Change from 4 point to 5 point grading scale. Establish minimum pass grade for each of three sections. Intermingle the 3 separate sections of exam. Using more standard questions. Change from 2 to 3 failures before remediation.

Maintenance of Certification Ø Ø Ø ABNS program is fully implemented. Time limited certificates first issued in 1999. Discussion and early action on using MOC for a variety of different efforts. Ø PFP Ø Hospital credentialing Ø MOL Ø PQRS Care. First (BCBS program in Maryland) to provide 7% increase for participation in neurosurgery MOC. ABMS language in health care bill as optional pathway for CMS PQRS.

MOC Cognitive Exam Candidate Group 2007 2008 2009 2010 2011 Pediatric 2 3 10 General 16 52 76 88 68 Spine 9 21 63 52 42 Total 27 76 142 150 120

MOC Cognitive Exam Failure rate Candidate Group 2007 2008 2009 2010 2011 Pediatric 0 0 0 General 0 0 0 Spine 0 0 1. 6 3. 8 0

COMPONENT Professionalism Lifelong Learning and Self-Assessment ABNS-MOC ASSESSMENT METHODS FREQUENCY Unrestricted License Chief of Staff Questionnaire CAHPS Peer Communication Survey CME (150 Credits 60 Cat I; 90 I/II); SANS (24 Credits) Patient Safety Module Every 3 years Knowledge Performance in Practice 2/22/2021 Every 3 years Every 10 years Written Exam (NBME) SANS Every 3 years Consecutive Key Cases Chief of Staff Questionnaire SANS CAHPS Peer Communication Survey Every 3 years

UPDATE ON MOC INITIATIVES Patient Safety Module Hunt Batjer/Larry Chin PQRS/MOC Program Incentive CAHPS/Press. Ganey MOC 5 -year in-depth review

ABNS Board Eligibility 4 years to get application in 5 years take oral exam 1 year to re-take Thereafter, not “board eligible” “Board eligibility” for 7 years maximum

ABNS Office Relocation Mary Louise Sanderson announced intent to retire at 2011 Winter meeting. Houston office lease expires June 30 th. Move to New Haven proposed. Business plan created to explore costs.

ABNS Office Relocation Benefits Mary Louise agrees to stay 3 years Allows time for legitimate search Allows time for mentorship Kind gesture to one who has served the organization Detractors Potential expense Poor location for oral exams Potential loss of valued colleagues

ABNS Office Relocation ABNS office and oral examination site need not be the same. Urology—Charlottesville and Dallas ENT--Houston and Rosemont Ortho—Chapel Hill and Chicago Orals should remain geographically central. Office should be attached to a major medical center. Will remain in Houston for at least next exam while exploring other options.

Canadian Neurosurgeons Originally allowed to take ABMS exams if FRCS (C). Eliminated in 1996. Now required to repeat significant amount of training.

Canadian Neurosurgeons Ø Ø Training requirements were different. Inability to evaluate quality of training programs. Ø Ø No ACGME or RRC oversight Slippery slope. Mexico Ø Brazil Ø Europe Ø Ø Expense.

Options For ABNS 1. 2. 3. 4. Maintain current ABNS policy Accept Canadian training for ABNS certification Additional review of Canadian Accreditation policies and procedures Develop mechanism for evaluating Canadian training programs: RRC

RRC Ø ABNS Members Ø Ø Ø ACS Members Ø Ø Ø Alex Khalessi Ex Officio Ø Ø Arthur Day Nelson Oyesiku Resident Representative Ø Ø A. John Popp Volker Sonntag (Vice Chairman) AMA Members Ø Ø Ø Ralph Dacey (Chairman) (Selman/Grady) Hunt Batjer (Chair-elect) Fred Meyer Pamela Derstine, Ph. D replaced Larry Sulton.

Society of Neurological Surgeons Ø Ø Ø Matrix Curriculum Milestone Project Cross Fertilization Co. RE Chair attends NBME Ø Subcommittee chairs attend primary exam committee meeting at Academy. Ø ABNS provides ex officio member to SNS council. Ø Ø Chair, Educational Requirements/Subspecialization Committee (Karin Muraszko)

ABMS BOD Chair, Public Health & Policy Task Force ABMS Committee

Transformation of US Medicine US Healthcare is too expensive and its quality too inconsistent. Patients have higher deductibles now than ever before. Market has learned there are no demonstrable correlations between cost of service and quality (opposite may often be true).

Center for Applied Research (CFAR) Outside consultant, hired by ABMS to evaluate it’s future

CFAR Report Questions 1. 2. 3. What is the value of certification and MOC? Will there be an increasing number of substitutes to ABMS certification? Are ABMS and Member Boards in real jeopardy?

The Era of Demand for Physician Assessment and Performance Measurement In parallel to 3 important trends Increasing regulatory behavior Government & Quality Organizations The proliferation of market solutions Disenchantment with the profession The era of “trust us” is over

Publicly available data on physicians: medical school attended, malpractice lawsuit history, specialty board certification poor predictors of their adherence to accepted standards of medical care.

Proliferation of Market Solutions Three Market Players 1. Health systems Developing the means to assess quality & cost of care 2. Insurance companies Many are “tiering” physicians 3. New companies outside healthcare delivery system Reason to believe more profound change will come from outside sectors that provide care.

Proliferation of Market Solutions Companies Outside Care Delivery Systems >200 health-oriented web portals Health-related website traffic is increasing 32 million Americans use it daily. 71 million use Internet for prescriptions.

Danger of Ratings seem to accelerate deprofessionalization- the process by which a high-status profession loses its autonomous claims to set standards. Ratings may not be accurate if driven by poor data.

ROBERT PARKER The Wine Advocate

Smart people who didn’t see it coming “With over fifty foreign cars on sale here, the Japanese auto industry isn’t likely to carve out big slice of the US market for itself. ” Business Week, August 2, 1968

Smart people who didn’t see it coming “Who the hell wants to hear actors talk? " H. M. Warner, Warner Brothers, 1927

Smart people who didn’t see it coming “There will never be a bigger plane built. “ Boeing engineer, speaking on 247, a plane that seats 10

Smart people who didn’t see it coming “I think there is a world market for about five computers” Thomas J. Watson, chairman of IBM, 1943

Smart people who didn’t see it coming “We don’t like their sound. Groups of guitars are on their way out” Decca Recording Co. executive, turning down The Beatles in 1962

The solution should come from within our specialty Training programs ABNS RRC Society of Neurological Surgeons AANS CNS Subspecialty Sections

Neuro. Point Alliance • Organized neurosurgery has been working to create a national infrastructure that allows members to track clinical outcomes and improve quality of care. – – – • • • ABNS MOC PQRS Industry –sponsored registries Specific clinical outcomes research projects Formally incorporated in 2008. In the process of recruiting practice sites to participate in a pilot project to serve as a foundation for a broader National Neurosurgery Quality and Outcomes Database (N 2 QOD). Invitation for ABNS member of BOD. • Chair of Professional Practice Data & Technology Committee