The Next Accreditation System

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The Next Accreditation System
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Aims of the Next Accreditation System

• Enhance the ability of the peer-review system to
  prepare physicians for practice in the 21st
  Century
• To accelerate the movement of the ACGME toward
  accreditation on the basis of educational
  outcomes
• Reduce the burden associated with the current
  structure and process-based approach

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Competencies/MilestonesPast Decade

• Competency evaluation stalls at individual
  programmatic definitions
• MedPac, IOM, and others question
• the process of accreditation
• preparation of graduates for the future health
  care delivery system
• House of Representatives codifies New Physician
  Competencies
• MedPac recommends modulation of IME payments
  based on competency outcomes
• Macy issues two reports (2011)
• IOM 2012-2013

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The Next Accreditation System Background and
Rationale
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How is Burden Reduced?

• Most data elements are in place
• Standards revised every 10 years
• No PIFs
• Scheduled (Self-Study) visits every 10 years
• Site visits may be requested by the Review
  Committee in-between the 10-year Self-Study
  visits
• Internal reviews no longer required

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The Next Accreditation System

• Instead of biopsies, annual data collection, that
  may include, but are not limited to
• Trends in annual data
• Milestones, Resident, Fellow and Faculty Surveys
• Scholarly activity template
• Operative and Case Log Data
• Board pass rates
• PIF replaced by Self-Study
• High-quality programs will be free to innovate
  Requirements have been re-categorized (Core,
  Detail, Outcome)

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The Conceptual Change fromDo this or else...

• The Current Accreditation System

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What is Different?
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The Next Accreditation System
Continuous Observations
Promote Innovation
Assess Program Improvement(s)
Identify Opportunities for Improvement
Program Makes Improvement(s)
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Terminology
Core Requirements Statements that define
structure, resource, or process elements
essential to every graduate medical educational
program.
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Terminology
Outcome Requirements Statements that specify
expected measurable or observable attributes
(knowledge, abilities, skills, or attitudes) of
residents or fellows at key stages of their
graduate medical education.
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Terminology
Detail Requirements Statements that describe a
specific structure, resource, or process, for
achieving compliance with a Core Requirement.
Programs in substantial compliance with the
Outcome Requirements may utilize alternative or
innovative approaches to meet Core Requirements.
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Terminology

• Each requirement labeled
• Core All programs must adhere
• Outcome All programs must adhere
• Detail Programs with status of Continued
• Accreditation may innovate

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Decisions on Program Standing in the NAS
Continued Accreditation
Application for New Program
Accreditation with Warning
Probationary Accreditation
10-15
75-80
2-4
STANDARDS Outcomes Core Process Detail Process
lt1
Withdrawal of Accreditation
1. NAS No Cycle Length 2. All programs with 1-2y
cycles in the old system placed in Continued
Accreditation with Warning Status 3. Percentages
represent approximations based on accreditation
status received by programs in the past
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Data Collection in the Next Accreditation System
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Annual Data Review ElementsPolicy 17.61 Review
of Annual Data

• Continuous Data Collection/Review
• ADS Annual Update
• Resident Survey
• Faculty Survey
• Milestone data
• Certification examination performance
• Case Log data/Clinical experience
• Hospital accreditation data
• Faculty member and resident scholarly activity
  and productivity
• Other

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Other Data (Episodic)

• ACGME complaints
• Verified public information
• Historical accreditation decisions/citations
• Institutional quality and safety metrics

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Curriculum Vitae
Except for the program director, faculty CVs
will no longer be collected
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Core Faculty

• For core programs, only physicians can count as
  Core Faculty
• Only faculty members who spend 15 or more hours
  per week working on the residency program
  (including clinic work, didactics, research, and
  administration) are counted as Core Faculty
• Core Faculty complete Scholarly Activity template
  in ADS
• Core Faculty complete Faculty Survey

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Core Faculty

• Examples of faculty members that meet the
  definition of Core Faculty
• A physician who works in the ICU with
  responsibilities that include clinical
  supervision of residents, who is a member of the
  Clinical Competency Committee, runs simulation,
  who helps write resident curriculum
• A physician scientist who spends most of his time
  conducting clinical outcomes research, with only
  four weeks per year of clinical time, but in
  addition, spends 15 hours or more supervising
  residents in their research projects and writes
  and provides didactics related to scholarship
  writes the curriculum for scholarship (i.e.,
  statistics), and conducts evidence-based journal
  club.

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Core Faculty

• Examples of faculty members that do not meet the
  definition of Core Faculty
• A physician who conducts rounds two weeks out of
  the whole year and has no other program
  responsibilities (administrative, didactics,
  research supervision) other than clinical work
  during those two weeks
• A faculty member with a PhD, and who is not a
  physician, who works in the basic science
  laboratory

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Faculty Scholarly Activity Template in ADS
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Faculty Scholarly Activity
Enter Pub Med ID s
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Faculty Scholarly Activity
Enter a number
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Faculty Scholarly Activity
Enter a number
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Faculty Scholarly Activity
Enter a number
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Faculty Scholarly Activity
Enter a number
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Faculty Scholarly Activity
Answer Yes or No
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Faculty Scholarly Activity
Answer Yes or No
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Resident Scholarly Activity
Similar to Faculty Template
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What Happens in My Program?

• Annual data submission
• Self-Study visit every 10 years
• Possible actions following Review Committee
• Clarify information
• Progress reports for potential problems
• Focused site visit
• Full site visit
• Site visit for potential egregious violations

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What Happens in My Program?

• Core and subspecialty programs reviewed together
• Existing Independent subspecialty programs that
  chose to remain independent are subject to
• Program Requirements and program review
• Institutional Requirements and institutional
  review
• CLER visits
• No new independent subspecialty programs allowed
  after July 2013

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What Happens after Review of my Program?

• Citations will still be issued (if necessary)
• Programs have to provide response to citations in
  ADS annually
• Areas of non-compliance
• Citations issued after 7/1/13 (Phase I) and after
  7/1/14 (Phase II) will not be considered resolved
  until the Review Committee determines that they
  have been corrected

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What Happens after Review of my Program?

• Areas in need of improvement
• General concern(s) identified from annual review
• Written response not required
• Will not have to be documented in ADS
• PD, DIO/GMEC should act on these areas

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NAS Whats Different?

• No site visits (as we know them)
• but
• Focused site visits for an issue
• Full site visit (no PIF)
• Self-Study Visits every 10 years

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What is a Focused Site Visit?

• Assesses selected aspects of a program and may be
  used
• to address potential problems identified during
  review of annually submitted data 
• to diagnose factors underlying deterioration in a
  programs performance
• to evaluate a complaint against a program
• 30-day notification given

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What is a Full Site Visit?

• Application for a new core program
• At the end of the initial accreditation period
• Re-applications (withheld or withdrawn)
• Review Committee identifies broad issues/concerns
• Other serious conditions or situations identified
  by the Review Committee
• 60-day notification given
• Minimal document preparation
• Team of site visitors

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Ten-Year Self-Study Visit

• Not to be confused with a focused or full site
  visit requested by the Review Committee after
  annual program review
• Not a traditional site visit
• Implementation
• 2015 for Phase I and some Phase II specialties
• 2016 for most Phase II specialties

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Ten Year Self-Study Visit

• Will review core and subspecialty programs
  together
• Review Annual Program Evaluations (PR-V.C.)
• Response to citations
• Faculty development
• Judge program success at Continuous Quality
  Improvement (CQI)
• Learn future goals of program
• Will verify compliance with Core requirements

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Self-Study and Self-Study Visit

• Self-Study
• Conducted by the program
• Annual Program Evaluation
• Review of program goals and improvement efforts

• Self-Study Visit
• Conducted by ACGME Field Staff members

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Ten-Year Self-Study and Self-Study Visit
AE Annual Program Evaluation
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ACGME Webinars and Other Resources

• ACGME webinars are available at
  http//www.acgme.org/acgmeweb/tabid/431/Programand
  InstitutionalAccreditation/NextAccreditationSystem
  /Webinars.aspx
• CLER
• Overview of Next Accreditation System
• Milestones, Evaluation, CCCs
• Specialty-Specific Webinars (Phase I)
• Phase I Coordinator Webinars (surgical and
  non-surgical)
• Specialty-specific Webinars (Phase II) Nov
  2013-Dec 2013
• Slide presentations for distribution to the GME
  community NAS, CCC, Milestones, Annual Program
  Evaluation/PEC, Updates on Policy December 2013
• Upcoming
• Specialty-specific Webinars (Phase II) Jan
  2014-May 2014
• CLER
• Self-Study (what programs do)
• Self-Study Visit (what ACGME site visitors do)