Understanding Maintenance of Certification: Performance in Practice

February 6, 2009


This is the fifth in a series of articles on the requirements of the American Board of Psychiatry and Neurology (ABPN) for Maintenance of Certification (MOC) and how they affect neurologists.

What is the Performance in Practice component of Maintenance of Certification?

The Performance in Practice (PIP) component is a quality improvement program designed to evaluate whether physicians have shown practice improvement over the 10-year MOC cycle by chart review and second-party external review.

When does the Performance in Practice component take effect?

This MOC requirement will be phased in beginning in 2013. Physicians certified in 2004 will be the first required to complete the PIP requirement. When they apply in 2013 to take the MOC cognitive examination in 2014, they will also be required to have one completed PIP unit. Those certified in 2005 will need to complete one unit. Those certified in 2006 will need to complete two units. The program will be fully implemented for those certified in 2007 and beyond, who will need to complete three units.

What does the ABPN require for the Performance in Practice component?

Physicians will be required to complete three PIP units, each consisting of both a clinical module (chart review) and a feedback module (second-party external review). When the program is fully implemented, the first PIP unit must be completed in years one through three of the 10-year MOC cycle; the second unit in years four through six; and the third unit in years seven through nine.

How long will it take to complete the Performance in Practice units?

The ABPN recommends allowing ample time for completion of PIP units. It may take 24 months from the date the original data is collected from patients and/or peers to complete one PIP unit.

What are the clinical modules?

Clinical modules require that physicians collect data from at least five patient cases in a specific category (e.g., diagnosis, type of treatment, treatment setting) obtained from the physician's personal practice over the previous three-year period.

The physician must then compare data from the five cases with published best practices, practice guidelines, or peer-based standards of care (e.g., hospital quality improvement programs), and develop a plan to improve effectiveness or efficiency in his or her clinical activities.

Within 24 months, the physician must collect the same data from at least another five clinical cases in the same specific category to see if improvements in practice have occurred.

What are the feedback modules?

Feedback modules require physicians to solicit personal performance feedback from at least five peers or five patients concerning the physician's clinical activity over the previous three years.

The physician must then identify opportunities for improvement in the effectiveness and/or efficiency in his or her practice as related to the core competencies and take steps to implement suggested improvements.

Within 24 months, the physician is required to solicit feedback from at least another five peers or five patients to see if improvements in practice have occurred. If a physician participates in peer review in his or her clinical setting, that institutional activity may also fulfill the PIP Feedback Module criteria.

What if I don't see patients?

The PIP component is designed for "clinically active" physicians. The American Board of Medical Specialties (ABMS) has issued a new definition of clinically active: any amount of direct and/or consultative patient care, and/or supervision of residents that has been provided in the preceding 24 months. The ABMS requires that all physicians report their status once every 24 months in each area of certification. This information will be available to the public. The ABPN encourages physicians to take the Clinical Activity Status survey.

How will the AAN help neurologists meet the Performance in Practice requirement?

The AAN is developing an online program that will enable physicians to complete clinical and feedback modules for Performance in Practice. More information will be available when the program is finalized.


For more information about MOC, visit the ABPN website. If you have questions regarding the AAN's education offerings related to MOC, contact Susan Rodmyre at srodmyre@aan.com or (651) 695-2725.