American Academy of Physician Assistants

Certification Maintenance and CME FAQ

 

Important Notice about Recertication


 

In late 2015, NCCPA proposed significant changes to the PANRE process. Get informed at the AAPA News Center: NCCPA’s PANRE Proposal, where you'll find resources, the latest AAPA actions and updates and suggestions about how to stay engaged and take action.

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Requirements

What are the requirements for Certification Maintenance?

In 2014, The National Commission on Certification of Physician Assistants (NCCPA) began transitioning certified PAs to a 10 year certification maintenance process. NCCPA certification maintenance currently requires that a PA:

1. Take a recertification exam every 10 years.

2. Earn 100 CME credits every two years, including at least 50 Category 1 CME credits. 

3. Pay a certification maintenance fee to NCCPA every two years.

When NCCPA originally announced the transition to a 10-year recertification testing cycle, the certification maintenance process included self-assessment and performance improvement CME (PI-CME) requirements. However, on August 11th NCCPA announced that effective immediately self-assessment CME and PI-CME are no longer required.

Acknowledging the evidence detailing self-assessment and PI-CME’s positive impact on outcomes, NCCPA also announced new incentives for completing self-assessment and PI-CME activities: PAs will receive an additional 50% weighting for self-assessment credits logged with NCCPA and the first 20 PI-CME credits logged during every two-year cycle will now be doubled when logged with NCCPA.

Many PAs have questions about these changes, how and when it will affect them, and how it relates to them and their own career path. Below you will find answers to the most common questions.

When do I transition to the 10-year certification maintenance process?

Sign in to your dashboard at www.nccpa.net to find out. Practicing PAs who recertified in the 2014, 2015, or 2016 have already transitioned to the 10-year certification maintenance process. All other PAs will transition after successfully passing next PANRE. For example, if a PA recertified in 2012, s/he will not transition to the 10-year certification maintenance process until 2018 when their current six-year recertification cycle ends and they successfully pass PANRE. The following table details how all PAs will eventually transition to the 10-year certification maintenance process.



Previous
PANRE or PANCE


Next
PANRE or initial 
PANCE
Certification Maintenance Cycle
First CME cycle*
 
Second CME cycle* Third CME cycle* Fourth CME cycle* Recertification PANRE
2008 2014 2014 - 2016 2016 - 2018 2020 - 2022 2022-2024 2024
2009 2015 2015 - 2017 2017 - 2019 2021 - 2023 2023-2025 2025
2010 2016 2016 - 2018 2018 - 2020 2022 - 2024 2024-2026 2026
2011 2017 2017 - 2019 2019 - 2021 2023 - 2025 2025-2027 2027
2012 2018 2018 - 2020 2020 - 2022 2024 - 2026 2026-2028 2028
2013 2019 2019 - 2021 2021 - 2023 2025 - 2027 2027-2029 2029

 

Do I need to earn self-assessment or performance improvement credits?

All PAs may participate in self-assessment and PI-CME credits and take advantage of the additional credit weighting incentives applied by NCCPA when loggin those credits for certification maintenance purposes. However, PAs are not required to participate in or complete self-assessment and PI-CME activities.

I’m planning to regain my certification. Do I need to earn self-assessment or PI-CME?

Yes, however by January 1, 2017, there will no longer be a requirement for self-assessment or PI-CME as part of the process for regaining certification. Please see NCCPA’s website for further information. 

Self-assessment

What are self-assessment activities?

Self-assessment is the process of conducting a systematic review of one’s own performance, knowledge base or skill set, usually to improve future performance, expand knowledge or hone skills.

Self-assessment activities, in their most common form, are simply an in-depth medical knowledge test that provides feedback on your performance and the opportunity to learn from the experience. A well-known example is the American College of Physicians Medical Knowledge Self-Assessment Program® (MKSAP®).

Importantly, self-assessment activities are not like taking PANCE or PANRE, where you have one chance per test to get a passing score. Instead, this is exactly what it says – a “self-assessment.” Most activities allow you to take the self-assessment as many times as you like in order to gauge where your own personal knowledge gaps exist. It helps you identify where you need CME or additional self-study to improve your knowledge. Self-assessment activities are meant to help you better recognize gaps in your own knowledge, so that you can better serve your patients.

In recognition of the value of self-assessment and its role in continuous profressional development, NCCPA is now offering an additional incentive to encourage PA participation in self-assessment activities. For all activities approved for AAPA Category 1 Self-assessment CME credit, NCCPA will now apply an additional 50% weighting when those self-assessment credits are logged for NCCPA certification maintenance purposes. In other words, if a PA logs 20 AAPA Category 1 Self-assessment CME credits with NCCPA, they will count as 30 of their total 100 credit requirements for that 2 year CME cycle.

PAs should be aware that the extra weighting for self-assessment activities is only relevant to NCCPA certification. States that require CME for license renewal purposes do not apply any additional weighting for self-assessment and PAs must claim those credits exactly as awarded on their CME certificates.

Where can I find self-assessment activities?

AAPA's self-assessment Web page displays all the self-assessments available to you. Activities are listed in alphabetical order by provider.

If you’d like to search by topic, or if you want to print a simple list, you may wish to download this approved self-assessment activities spreadsheet (PDF). This PDF file intentionally includes expired activities so that it can be used as a reference tool. We recommend that you not store paper copies of the PDF list of self-assessments as it gets out-of-date quickly. A link to the PDF list of self-assessments is found on the very bottom of AAPA’s self-assessment Web page.

How do I know if I will receive the additional credit weighting from NCCPA when logging a self-assessment activity?

Only activities approved for AAPA or PI-CME credit will qualify for the additional incentive within the NCCPA loggin system. 

Do I have to take self-assessments related to my current specialty?

Not at all. There is no requirement to take self-assessments in your current specialty area. In fact, self-assessments provide a great opportunity to expand your knowledge of areas that will be included in your recertification exam or to gauge your interest in a different specialty area. AAPA continues to work with several physician organizations, PA specialty organizations and PAs in different clinical areas to gather and develop options for self-assessment activities in a wide range of clinical specialty areas.

Can I complete a self-assessment more than once?

Yes, as long as the activity is completed in different two-year logging cycles AND the activity provider allows this. PAs cannot claim credit for the same activity more than once in the same two-year logging cycle. Be sure to check with the provider of the CME activity if you intend to do an activity more than once, as some providers allow this and others do not.

Do the start and completion dates both have to be within the 2-year cycle in which I am logging self-assessment credits?

No, only the completion date has to be between the start and end dates of the two-year cycle in which you are logging the credit. In other words, it is OK to start a self-assessment activity in one cycle and complete it in the next cycle, as long as you log it during the cycle in which you completed it.

Performance Improvement

What are performance improvement (PI-CME) activities?

PI-CME activities are a unique chance to earn CME while reflecting on your role in team-based care and how you might improve patient outcomes by altering your own approach or methods. PI-CME is a structured process for evaluating the evidence-base for your own behavior and making carefully considered adjustments accordingly. The activity has 3 phases:

  • Stage A – Compare your current practice in a specific clinical area against recognized, evidence-based standards. Assess your current performance, identify performance gaps and discover opportunities for improvement.
  • Stage B – Develop and implement a plan to improve your practice. For example, you might decide to take a class about a specific procedure, develop new patient education material, change the sequence in which you approach routine tasks, or make a simple process change.
  • Stage C – Reassess your practice to evaluate the effects of your improvement plan. If you were able to improve, what factors facilitated your success? If you were not able to improve, what barriers did you encounter that prevented a successful outcome? What would you do differently next time? 

Acknowledging the evidence detailing PI-CME's positive impact on outcomes, NCCPA has announcing a new incentive for completing PI-CME activities: The first 20 PI-CME credits logged during every two-year cycle will now be doubled when logged with NCCPA.

PAs should be aware that the extra weighting for PI-CME activities is only relevant to NCCPA certification. States that require CME for license renewal purpose do not apply any additional weighting for PI-CME and PAs must claim those credits exactly as awarded on their CME certificates.

Where can I find PI-CME?

PI-CME activities are listed on the performance improvement Web page. The popular patient safety activity, available to PAs in any specialty, is shown at the bottom of this page.

Do I need to document improvements in patient outcomes to successfully complete performance improvement activities?

No. It’s important to understand that improving patient outcomes is not the goal of PI-CME activities and is not required in order to earn credit. In the course of the activity you will likely discover information, resources, methods and/or tools that will help you improve your practice and, ultimately, improve patient outcomes. Even so, the primary goal of a PI-CME activity is to achieve proficiency in evaluating and improving a particular aspect of your own clinical practice.

One reason PI-CME activities intentionally separate the evaluation and improvement process from outcome measurement is that this permits PAs the freedom to tackle truly challenging issues where improvements in outcomes may be incremental at best. It can be particularly fruitful to focus your attention on an area where you see significant room for improvement yet you suspect any gains may be difficult to achieve (perhaps due to poor patient compliance, cost considerations, institutional resistance or something else).

Can you give me some examples of issues I could address in performance improvement CME activities?

Engaging in PI-CME will help you to identify and address issues like these:

  • How can we better serve a particular subset of our patients who are not faring as well, who are less likely to take prescribed medications or who are less likely to return to our practice to be seen when needed?
  • What can we do to increase patients’ adherence to post-op instructions in our surgical practice?
  • What elements should be included in a truly multidisciplinary approach to caring for patients with uncontrolled diabetes (or some other chronic condition)?
  • How could we improve the quality of “handoffs” and of communication related to prescribing?
  • Are our protocols for determining when and how to use diagnostic testing evidence-based and congruent with current recommendations in the literature?
  • How could we improve follow-up related to patient referrals?
  • How efficient are our discharge procedures? How could we improve in this area?

What if I can’t find performance improvement activities that apply to what I do?

Participating in PI-CME activities is entirely optional. However, if you would like to participate in PI-CME but are having trouble finding activites related to your practice, you have several options, including:

  • Use PI Builder, AAPA’s new online tool that enables you to build a personalized PI-CME activity using measures that are relevant to your practice and improvement interests. See below for more information.
  • Take an approved patient safety course.
  • Check to see if you can receive AAPA Category 1 PI CME credit for quality improvement activities in which you already participate. If not, consider approaching your employer’s Quality Improvement department to suggest that they apply for AAPA accreditation of an existing program in which more than one PA participates.

AAPA continues to work to insure that performance improvement activities are available to PAs practicing in a wide variety of clinical settings and specialties. AAPA works with physician organizations, PA specialty organizations and PAs in different clinical areas to this end. 

What is PI Builder?

PI Builder is an online tool that allows an individual PA to build his or her own PI project by selecting from a library of approved measures. PAs can either:

  • Choose measures from the measure library
  • Submit measures that you would like to use for approval
  • Request credit for an institutional quality improvement activity that you have already completed, so long as the project was completed while you were in your current logging cycle, and you are able to demonstrate meaningful participation in the project.

I don’t have continuity of care. How can I participate in performance improvement activities?

It is not necessary to have ongoing responsibility for the care of patients to participate in PI-CME. If you have access (or can collect) data about a process or activity that impacts the quality of patient care, you can participate in performance improvement activities. Current topics for PAs who do not have continuity of care include assessing and improving the quality of “handoffs” and of communication related to prescribing. Potential topics include proper indications for diagnostic testing, patient safety practices, follow-up related to patient referrals, efficiency of patient care delivery and timely delivery of discharge.

Another option is to take an approved patient safety course.

Can I complete a performance improvement activity more than once?

Yes, as long as the activity is completed in different two-year logging cycles AND the activity provider allows this. PAs cannot claim credit for the same activity more than once in the same two-year logging cycle. Be sure to check with the provider of the CME activity if you intend to do an activity more than once, as some providers allow this and others do not.

Do the start and completion dates both have to be within the 2-year cycle in which I am logging credits?

No, only the completion date has to be between the start and end dates of the two-year cycle in which you are logging the credit. In other words, it is OK to start a performance improvement activity in one cycle and complete it in the next cycle, as long as you log it during the cycle in which you completed it.

What is AAPA doing to increase the diversity of PI-CME offerings?

PAs practice across the entire spectrum of medicine and surgery, making it a challenge to address every PA practice setting simultaneously. We are aware of gaps and are working with individuals and organizations to stimulate the development of new activities. The following are current initiatives aimed at stimulating new PI-CME activity development:

  • AAPA developed PI Builder, an online tool which allows PAs to create their own performance improvement activity or submit for credit quality improvement programs that they have already completed.
  • Tool Kit: AAPA is working with a group of volunteers to develop a Tool Kit for PI-CME activity developers. This Tool Kit is intended to function as a “how-to” guide for organizations and educators interested in developing original PI-CME activities. The Tool Kit will be published online during the summer of 2014.
  • Specialty Organization Outreach: PA specialty organizations are in the best position to understand the needs of PAs who practice in the specialty they represent. AAPA is working directly with a number of specialty organizations to help them address some of the current gaps.

Does PI-CME require statistical expertise? Will I need to write a final paper?

No, there is no statistical expertise or specific research skills required. In fact many activities facilitate the analysis of your data. There is no requirement to write an essay. The emphasis is on the process itself rather than outcomes or final products.

Will I need to get institutional review board approval to perform my PI-CME activity?

No, PI-CME and quality improvement are exempt from IRB review. Only those who may want to publish the results of their improvement effort are advised to check with their IRB manager, as an IRB exemption letter may be required by a journal editor.

In 2011, the Institute of Medicine published a discussion paper, “The Common Rule and Continuous Improvement in Health Care: A Learning Health System Perspective,” to help inform the discussion around IRB review for QI/QA projects and initiatives.

The IOM developed the vision of a learning health system as one that “…gets the right care to the right people when they need it, and captures the results for making improvements.” Collecting information about a provider’s performance as it relates to patient care is thus necessary and should be considered a normal routine activity of any healthcare organization.

To facilitate practice improvement activities, the IOM developed a framework for a “Common Rule” in continuous improvement, which states that unless you are evaluating something other than what is already accepted practice or posing more than minimal risk, the IRB process for human subject research should not be warranted.

For further information you can access the IOM paper here. In addition, you can follow up with your local or a central IRB. Often, they will provide information related to QI/QA activities and may provide a flow chart for determining if an activity is considered human subject research.

For more information, call 703-836-2272 or email cme@aapa.org