The Joint Commission Provides Recognition for NBPAS

Eric Seaborg
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The National Board of Physicians and Surgeons (NBPAS) apparently received another boost toward wider acceptance of its recertification program when The Joint Commission added the organization to its list of “designated equivalent source agencies” in its accreditation manuals.

The NBPAS was founded in 2015 in reaction to what its founders saw as the expensive and onerous maintenance of certification requirements of the American Board of Medical Specialties (ABMS) and the American Osteopathic Association. The NBPAS process is designed to provide “physicians with a choice in board recertification that is clinically rigorous, evidence-based, less burdensome, and nationally accepted,” according to its website.

“This is another important milestone for the National Board of Physicians and Surgeons,” said NBPAS Founder and President Paul Teirstein, MD, who is chief of cardiology at the Scripps Clinic in San Diego. “Hospitals and health systems look to the The Joint Commission standards as important benchmarks for accreditation.”

However, ABMS immediately objected to any assertion of “certifying body equivalency” by NBPAS. NBPAS does not provide original board certification, only what it terms “recertification” of physicians board-certified by ABMS, and only in their original specialties. NBPAS recertification is based on submission of continuing medical education credits, with no testing requirements.

“ABMS strongly disagrees with the persistent and misleading assertions that the NBPAS recertification process provides a means of continuing ABMS board certification or is equivalent to ABMS board certification,” ABMS responded to the news in a statement on its website. “Claims of equivalence to ABMS certification or that NBPAS is a means to maintain ABMS member board certification are misleading to the profession, and most importantly, to the public who depend upon the strength of ABMS board certification.”

Designated equivalent source

A letter from The Joint Commission Executive Vice President David W. Baker, MD, MPH, to NBPAS says: “NBPAS will be added to the list of designated equivalent source agencies in The Joint Commission's glossary for the Ambulatory Care, Behavioral Health and Human Services, Critical Access Hospital, Hospital, and Office-Based Surgery accreditation manuals effective July 2022.”

The Joint Commission website defines a “designated equivalent source” as an agency that has “been determined to maintain a specific item(s) of credential(s) information that is identical to the information at the primary source. The glossary of the accreditation manual provides examples of such sources.” Primary sources are used “for confirming that an individual possesses a valid license, certification, or registration to practice a profession.”

A Joint Commission spokesperson responded “no comment” to repeated requests for clarification or information, particularly for an explanation of how NBPAS could be considered to have “information that is identical to the information at the primary source” when the primary source of certification—ABMS—maintains that NBPAS recertification is by no means equivalent to ABMS maintenance of certification.

NBPAS apparently received another boost toward wider acceptance of its recertifi cation program…

NBPAS Associate Director Karen Schatten, MLS, said in an email to Kidney News: “NBPAS engaged in discussions with the Joint Commission, which agreed that NBPAS met their standards for designated equivalent source agencies. The Joint Commission added NBPAS as part of its regular standards update process.”

Will hospitals react?

The Joint Commission itself does not control the credentialing of hospital personnel; hospitals decide what credentials to require and accept. The NBPAS website lists some 200 hospitals that “accept NBPAS diplomates,” which is a relatively small number of the 6000 hospitals the American Hospital Association says exist in the United States.

“Now is a good time for hospitals and health systems to update their bylaws and add NBPAS as an option for physician credentialing and privileging requirements,” said NBPAS’ Teirstein.

“With the addition of The Joint Commission, NBPAS also meets national accreditation standards for hospitals and health plans that also include Det Norske Veritas, the National Committee [for] Quality Assurance, and the Utilization Review Accreditation Commission,” according to an NBPAS press release.

ABMS’ response says: “NBPAS has recently been listed as a sample source of information regarding a candidate physician's educational attainment for hospital or health plan credentialing services. However, to be clear, neither The Joint Commission nor the National Committee for Quality Assurance has rendered any [judgment] about the equivalency of NBPAS’ certificate to an ABMS member board certification.”

ABMS questions equivalence

“ABMS questions the rigor of NBPAS’ process for ensuring the professionalism of its members,” the statement continues. “ABMS has identified a number of physicians whose certificates were revoked by ABMS member boards and who are certified by NBPAS. The reasons for these revocations range from sexual harassment to mis-prescribing controlled substances and other professionalism issues. This type of physician behavior places patients at risk yet they maintain their NBPAS certificates.”

ABMS and its member boards such as the American Board of Internal Medicine first adopted maintenance of certification requirements in 2000, with 10-year recertification exams and other requirements. Widespread dissatisfaction with these requirements—especially the high-stakes periodic examination—has led to extensive re-consideration of the process, with NBPAS’ Teirstein not being alone in calling the maintenance of certification process “onerous, time-consuming, time-wasting, and expensive.”

The ABMS statement notes that it has responded to physician dissatisfaction by completing a “comprehensive, transparent, and collaborative process” to review continuing certification processes to ensure they are “both relevant and supportive of diplomates’ learning and improvement needs while providing the public with a reliable and dependable credential.”

These reforms may have come too late for some physicians who agree with an NBPAS press release that “recertification through NBPAS offers physicians a less burdensome pathway to maintain board certification and is a tangible solution to burnout and the growing national physician shortage.”