Over the past 15 years there has been an increasing emphasis on the credentialing of physicians from hospitals, insurance companies, and practice plans. As a result, obtaining board certification for a subspecialty discipline from the American Board of Internal Medicine (ABIM) has become critical to the success of subspecialty physicians, including hematologists. Starting in the year 1990, maintenance of certification in a subspecialty of internal medicine required completion of a certification program every ten years. This entailed passing modules that assessed medical knowledge or physical diagnosis skills in addition to a secure examination in that discipline.
Beginning in 2004 ABIM added additional modules that are required for maintaining certification called practice improvement modules (PIMs). PIMs are Web-based self-evaluation tools that guide physicians through chart abstraction, patient survey, and practice system inventory to establish a practice performance assessment for a chronic condition or preventive service. Initially, the physician abstracts data from the charts of at least 10 patients and compares his/her management of a specific clinical condition to guidelines set forth by national accrediting agencies or medical societies. Areas of deficiency are noted, and a plan is put in place to correct these deficiencies. The PIM is completed when the effect of the plan has been measured and the diplomate reports the results to ABIM. In addition to Maintenance of Certification credit, physicians who complete a PIM earn 20 CME credits.
Many large group practices already use this approach to evaluate whether their practice’s performance adheres to national guidelines for the treatment of chronic diseases. Previously, multiple guidelines were available for physicians managing patients with chronic illnesses such as hypertension, diabetes mellitus, and asthma, or for the assessment of procedural-based competence. However, completing a PIM in a subspecialty such as hematology for an academic physician was difficult in the past, as it required either querying patients or colleagues via a questionnaire regarding communication skills or a self-directed module that the physician had to generate on his/her own for a specific area of hematology. I’m happy to report that this is no longer the situation.
To assist hematologists, ASH has generated PIMs that assess the management of patients with multiple myeloma, idiopathic thrombocytopenic purpura, and myelodysplastic syndromes. I recently completed the PIM on multiple myeloma. It focused on multiple areas in the management of patients with multiple myeloma — whether or not one’s practice always obtains markers predictive of response to treatment such as beta 2-microglobulin prior to therapy; which staging system is employed by the practice and how that system is used in deciding on medical care; and whether patients are given bisphosphonates using accepted guidelines for efficacy and safety. The questions for this PIM take about two to three hours to complete for the minimum number of patients (10) that are queried. However, the entire process took me seven months to complete, as it required implementing and reporting the effect of the changes mandated for completion of the PIM. For our group, this centered on the need to use the same staging system for all of our investigators and a consistent approach to treatment based on that system. In the future, this should allow for more uniform management of patients with multiple myeloma by the physicians at our center.
These ASH PIMs allow hematologists the ability to compare their practice performance with national guidelines and to correct areas of deficiency. However, please remember that the PIM is not completed until a report is generated describing how the changes implemented affected care. I recommend that physicians who need to recertify make sure that they start the PIM at least one year prior to the expiration of their certificates.
