Thursday, April 10, 2014

Resistance to MOC and MOL now expands to other professions-CRNAs

I copied this from the CRNA FB page and am re-posting it here because I thought it was worth sharing. Any thoughts? Input? Anyone get this email?
IPGE, Inc.
April 8, 2014
We are contacting you as a concerned coalition of CE Providers.
In 2016 the CPC Program created by the NBCRNA will go into effect and replace the current CE Program. It will require you to earn a new type of credit referred to as the "assessed credit". These credits are earned on-line or at AANA prior approved programs that provide an end of event evaluation. The evaluation may take the form of a ten question quiz following each lecture, or it may take the form of a skills demonstration such as evaluating placement of an endotracheal tube or using ultrasound for vascular access or regional anesthesia. 15 assessed credits will be required each year of a 4-year cycle.
You will also need to earn 10 non-assessed credits called "PAU's" each year of the four-year cycle. These credits are self monitored and can be earned in a variety of non-traditional ways. These would include but not be limited to writing a book or a book chapter, attending non-prior approved seminars, presenting a lecture, providing volunteer missionary work, assuming department management roles, etc. These credits are subject to periodic audit by the NBCRNA.
Every other cycle (every 8 years) a re-certification exam must be taken and successfully passed.
Another requirement is the establishment of "Competency Modules" that will provide 5 assessed credits. You will need to complete one module each year of the four-year cycle, BUT you may earn all of your 15 annual assessed credits by completing these modules. The modules will only be available on-line for the present time. So it is possible for you to complete all of your assessed CE requirements by computer for an indeterminate period of time. We estimate it will take 5 hours to complete a Module if current standards are applied to the modules. Now this doesn't sound so bad does it? The problem is that the creation of modules by CE Providers has been made so exceedingly difficult and expensive by the NBCRNA that it appears the only provider that will be able to do it is the AANA. Certainly state associations could not meet the requirements. So this means that the AANA could conceivably become the only provider of credits for you to become re-certified. This monopolization of CE will force all other providers out of business and it will spell the end of the live seminar that has been the traditional backbone of our CE since the inception of the profession. It may also cause the demise of State Associations since without a CE format there is little need or incentive to spend the necessary funds or take the time to attend a state meeting. Should this happen, states may not be able to recruit enough members for a quorum to conduct business. Do you suppose that the ASA is watching this with eager eyes and legislative ears. Once unorganized, states will not be able to meet challenges put forth by organized ASA members and you can only imagine what that might mean for your practice.
Furthermore, it has been rumored that the AANA may provide the required modules to you at no cost as a benefit of membership. Although this has not been confirmed, if it does happen, this will more than likely mean the end of your CE funding in lieu of payment of your AANA dues. Once employers learn that you can be re-certified by sitting at home on a computer they will jump at the chance to rid themselves of providing meeting costs as a benefit.
Please be assured that we, as Providers of Traditional CE are not opposed to change or periodic review of our standards of credibility. On the other hand we are very much in favor of this type of activity, however, we are also of the very strong opinion that anything that could produce such a radical change in the requirements and delivery of our professional CE should be done with complete transparency and openness to those it will affect. Also, any new program should be sent to the community of interest, all CRNA's, and others with an opportunity for comment. This being accomplished, comments should then be assimilated and carefully considered for every change outside the current CE process. Finally, a cost analysis for provider and the individual CRNA should be clearly stated before any new CE process is implemented. None of these criteria were met in the establishment of this CPC Program. From its very inception to the ultimately botched roll-out, the process was conducted in secrecy and in a dictatorial manner. Now we find ourselves in the dilemma of having to squash it before it squashes us.
To summarize, we are of the opinion that this CPC program has the very real potential to destroy the infrastructure of our specialty as we know it. To allow this to happen is professional suicide. We urge you to contact your state president, the AANA President and Board of Directors and express your opinion of this program. It is not too late to put in place a moratorium and replace this program with something more rational and less threatening to all CRNA's.
Below is a Resolution Proposal that we hope to introduce at the AANA Meeting in September. We welcome your signature as a concerned CRNA. To indicate your support of the resolution simply reply to this email by typing
YES in the subject line no later than April 27, 2014. Also, feel free to forward this email in order to share this information with your colleagues who will also be affected.
Thank you so much for your attention and support.
Bernie Kuzava, CRNA
Sandy Ouellette, CRNA
Larry Hornsby, CRNA
Peter Strube, CRNA
Paul Hilliard, CRNA
2014 Resolution On Proposed Continued Professional Competency Requirements for Recertification
Whereas, the National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA) has moved forward to establish new recertification requirements as defined in the Continued Professional Certification (CPC) Program that will significantly impact the community of interest such as the members through CRNA forums at state, regional, hospital departmental grand rounds and national meetings, the AANA Continuing Education Committee and continuing education meeting sponsors and managers;
Whereas, the requirements for two of the proposed components of the CPC program - the competency modules and the assessed CE units -- have significant and far reaching ramifications which may threaten the continuing ability of State Associations and CE sponsors to offer quality post graduate and continuing education programs for CRNAs which have been a long standing hallmark of this profession;
Whereas, requirements for assessed CEs and competency modules can serve to incentivize online learning over participation in live meeting events that may have the unintended effect of harming not only AANA State Association's ability to convene their business meetings due to lack of sufficient numbers of members but also networks of CE providers by the inability to implement the logistics required;
Whereas, should the NBCRNA online only competency modules policy proceed, it can create a disincentive for CRNAs to pay costs (as well as for employers to offer this benefit to CRNAs) for attending live, in person continuing education meetings in the future as all 4 planned web based competency modules can be taken by a CRNA in one year and can also be counted as assessed credits;
Whereas, there are open market concerns should AANA be a vendor for the competency modules for members that could be offered at a significantly lower fee or no fee than could be offered by other CE vendors creating a competitive disadvantage to all other meeting sponsors; now, therefore, be it
Resolved, the AANA Board of Directors support a moratorium on the proposed CPC to be implemented January 1, 2016; and
Resolved the AANA Continuing Education Committee evaluate the CPC program components of competency modules and assessed CEs and formulate recommendations for modifications as provided in the AANA bylaws, and, if evidence demonstrates that there is value for some other form or variation of the currently proposed plan that can be determined to positively impact the profession that the alternative plan be proposed and opened to the community of interest for comment inclusive of all CRNA's before adoption;
Resolved that once given the support of the CRNA community for any proposed new plan for recertification that it be pilot tested, validated and shown to be reliable in demonstrating competency before it is implemented
The current CPC proposed plan incentivizes online learning over live meeting involvement where many would argue that psychomotor skills and competencies might be better taught and assessed. Additionally, web only competency modules can discriminate against many CRNAs who may be older and less interested in technology. While some CRNA's prefer this format, others do not and many avenues for continuing education should be available. There is strength in diversity. Presently the requirement for assessed units could be obtained annually by taking 3 of the 4 web-based competency modules online alone with no timeline for other methods of delivery.
Since AANA intends to be a vendor, there is a competitive disadvantage to other program sponsors to offer these modules. This can serve to disenfranchise many if not most other CE providers, the majority of which are state associations and department grand rounds. Since the modules require content development, validity and reliability of assessed items, pilot testing and a plan from the developer of how credits will be transferred to NBCRNA, a fee to NBCRNA for transfer, a non-refundable fee of $10,000 to NBCRNA for review of 4 modules and possible selection and a site to launch the web based activity, the cost is not within reach of most vendors. The estimated cost would be for anyone willing to do this could approach $100,000.00 and in addition, hiring information technology (IT) personnel to oversee and manage the program. Vendors must also provide reports of reliability every 6 months to NBCRNA, must provide a financial statement indicating financial ability to provide the modules, and must resubmit the modules, for a fee, to NBCRNA and AANA for reevaluation.
The power of the AANA as an organization rests in the ability and encouragement of its members to meet, network, discuss and debate political issues and discuss clinical challenges. It is at the district and state meetings that future AANA leaders are developed and any initiative, even if well intended, that may result as a consequence of enactment reduce or diminish the need for these meetings can disrupt the very fabric that has made AANA the pacesetter in all of advanced practice nursing. If a significant portion of required credits after 2016, or 4 modules and 60 assessed credits in 4 years, are obtained on line, there will be no need for CRNA's to attend meetings. This can serve to incentivize CRNA employers currently reimbursing for continuing education to withdraw that benefit and harm will be done to the AANA and all members. State associations that depend on meeting revenue to support critical operations will be disadvantaged by low attendance and it is unlikely CRNAs will see the continued value of AANA membership when they become even more isolated from their peers.
This resolution, if adopted by the members will allow needed time for all stakeholders to address these concerns and support plans to meet the same goals set forth for all professions striving to ensure that its members maintain competency in their practice. There are many different forms of assessment and practice based evaluations that are worthy of study without creating unnecessary hardship on professionals and disrupting a professional association's culture in the course of accomplishing it. The large community of interest before implementation can do this with a program that is based on evidence, is developed in collaboration with AANA, is pilot tested and involves comment. The makers of this resolution are NOT opposed to changes in recertification but are opposed to the implementation of CPC until a more thorough study and evaluation of the impact and ramification of this program has been conducted.
Sandra M Ouellette, CRNA
Tafford Oltz, CRNA
LaRayne Oltz, CRNA
Peter Strube, CRNA
Bernie Kuzava, CRNA
Larry Hornsby, CRNA
Mike Fallacaro, CRNA

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