SACME session

At the SACME fall meeting Nov. 6 in Boston, the AMA s PRA policy head Charles Willis talked about the AMA s performance improvement pilot, which started in August 2001. The project s point is to find out how docs can efficiently and effectively accrue AMA PRA category 1 credit for PMI activities basically, how to integrate QA activities into CME activities.

Five organizations participated in the pilot (University of Pittsburgh Medical Center; U.S. Department of Veterans Affairs, Employee Education System; Accreditation Association for Ambulatory Health Care, Inc.; Iowa Foundation for Medical Care; and American College of Physicians), which aimed to:

* Find flexible operating definitions that describe performance improvement activities.

* Leverage provider expertise in developing educational materials that support physician performance measurement and improvement.

* Keep it simple: AMA PRA credit system guidance must work for both the physician and the diverse CME provider communities.

Challenges to overcome

Among the challenges participants faced were retaining a link to "the exposure model for physician learning (i.e., study of appropriate guidelines)." They also had to figure out how to allocate credit. Should it be based on an incremental scale as they complete the process? Where does the physician learning fit into the stages of the performance improvement cycle?

In the process, participants found that electronic medical record systems still are nowhere near able to serve as the performance improvement panacea. Willis said that AMA and CMS staff have met with EMR companies to address the problem.

Defining PI in stages

After settling on what to call it PI activities and simplifying the process to three stages that focus on the PI components, they issued the final guidelines, which are available at AMA s Web site. Docs get five credits for completing each stage: learning from current practice assessment; learning from the application of performance improvement to patient care (an intervention has to take place in this stage); and learning from the evaluation of the PI effort.

"Performance improvement is something that happens over time. It s not a one-time event like traditional CME," said Willis, which is why a time metric isn t used to capture learning. But if a doc does complete PI activities as an organic whole, he or she will be able to earn a maximum of 20 credits. It s up to providers to develop the learning materials, but it s up to the docs to make sure their documentation is good enough that they can use it to check against for future progress, Willis said. They don t have to start at the first stage and move through the stages chronologically, since that s not always how things work in practice, he added. But, while it s not mandatory, providers do have the option of only awarding credit for those who complete the full cycle.

"It may be bumpy along the way, but this project, along with the Internet CME project, will buttress traditional CME," Willis said.

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