I. Participating as an Institution/Healthcare Organization
Some diplomats may have the option of participating in intra-system and system-wide quality improvement (QI) projects within their healthcare institution. These programs are characterized by physician champions, effective participant training, dissemination of QI principles, establishment of a culture of improvement, investment in key personnel and infrastructure, and demonstration of outcomes. As opposed to individual or specialty group PQI projects outlined above, institutional PQI projects are characterized by engagement of “teams” of healthcare providers across multiple specialties within the institution in a common project of mutual interest and potential benefit. Engaging groups of healthcare professionals in practice-relevant QI projects that meet specified criteria and simultaneously fulfill MOC Part IV requirements is a potentially powerful way to advance healthcare quality and safety, while leveraging resources to reduce the burden on diplomates, administrative support staff, departments, and institutions. Coordination, documentation and awarding of MOC IV credit for multiple specialties within a single PQI project can be complex and time-consuming, involving multiple ABMS Member Boards. Programs are now available to assist institutions that support physician involvement in quality improvement and MOC across multiple specialties with this process. The purpose of such programs is to offer an institution or larger organization that supports multiple well-designed QI efforts involving physicians from multiple disciplines, a streamlined approach to work with multiple ABMS Member Boards to grant MOC Part IV credit to physicians who actively participate in those QI efforts.

II. Multi-Specialty MOC Portfolio Approval Program
One such program is the Multi-Specialty MOC Portfolio Approval Program. Over 500 QI projects have been approved through this program with more than 3,250 physicians having received MOC Part IV credit via this pathway for participation in quality improvement that were already ongoing at their organization. A joint effort with the ABMS boards, the Multi-Specialty MOC Portfolio Approval Program requires that the institution where the PQI project is being performed (or sponsored) be pre-approved as a Portfolio Sponsor and that the individual ABMS Member Boards are Portfolio Participants (ie, ABTS).

• Over 30 healthcare organizations are already approved Portfolio Sponsors and over 50 additional organizations have applied. Approval of an organization as a Portfolio Sponsor for each two-year term involves a significant investment of time and resources by the institution, including application, participation/renewal fees, the establishment and maintenance of an internal review body, and the means to adjudicate disputes, track and report physician completion, and submit progress reports on approved QI projects. Once approved, Portfolio Sponsors are approved to develop, monitor and approve local quality improvement efforts at their institution for MOC Part IV credit and this credit will be recognized by the participating ABMS member boards such as the ABTS. Despite this complexity, there are several advantages to both you and your institution for fulfilling your MOC IV requirements via this pathway.
• Physicians can earn MOC Part IV credit for participating in healthcare QI efforts within your local organization, which is an added incentive to improve patient care in the workplace while aligning with your organization’s mission, vision and goals.
• Reduces effort of applying to multiple ABMS Member Boards for approval, including diplomates that have more than one ABMS Member Board certification
• Portfolio Sponsors are able to approve their own QI efforts for MOC Part IV credit from the ABTS.

It is important to note that individual diplomates cannot apply for approval via this program directly, but rather they must be eligible for MOC Part IV credit and they must be employed or contracted by an organization or organization’s health system/network that is an approved Portfolio Sponsor. Eligible Portfolio Sponsors include hospitals, health systems, academic medical centers, medical societies, health plans, payers, and accountable care organizations (ACOs). A list of currently approved Portfolio Sponsors can be found here: http://mocportfolioprogram.org/approved-portfolio-sponsors/.

If your institution has elected to become a Portfolio Sponsor and you wish to participate in this pathway, please contact the person responsible for clinical process improvement at your institution. He or she can provide more information about how to participate in currently approved QI projects or how to submit new QI projects for their approval, prior to initiating your QI initiative as there are specific processes, approvals and forms which must be completed to meet the necessary institutional documentation for this pathway. In order to earn MOC Part IV credit for participating in approved QI efforts through this program, ABTS diplomates are required to:

• Be enrolled in the ABTS MOC program at the time that credit is claimed
• Completion data must be received in the same calendar year as when credit was earned
• Completion date must be within the period that spans the current certification cycle or MOC Part IV stage
• Attest to the Portfolio Sponsor that they have meaningfully participated in the QI effort on an Approved QI project. This includes documentation of:
• Active collaboration in the design and/or implementation of the project through team meetings (more than 3 meetings are required), data analysis, implementation training, etc.
• Collection, submission and review of project data
• Implementation of interventions to improve care within the approved project
• Completion of the minimum duration of participation as established by the QI project and project leader
• Have the attestation co-signed by the local project leader
• Provide written reflection on the QI effort

• The initiation of a multidisciplinary collaborative with critical care staff to decrease the number of adverse drug events. (Nationwide Children’s Hospital)
• Development of a pilot program that identifies Quality Improvement Projects that are relevant to clinical practice and are more patient and quality focused. (Mayo Clinic)
• Creation of QI documentation that allowed physicians to apply structured, systematic processes to QI initiatives, thus improving understanding of QI practice and improving care. (University of Michigan Health System, Ann Arbor)