What Are OPPE and FPPE?

Ongoing Professional Practice Evaluation (OPPE) and  Focused Professional Practice Evaluation (FPPE) Rahul K. Shah, MD  George Washington University School of Medicine, Children’s National Medical Center, Washington, DC The legitimacy of a concept or term can be ascertained by how successful your Internet search is when you begin to research the topic. A couple of years ago, it was difficult to find information on  Ongoing Professional Practice Evaluation (OPPE) and Focused Professional Practice Evaluation (FPPE). Today, a search of such reveals pages of websites that define OPPE, teach us about the term, help medical staff strategize in using OPPE, and even offer consultants for OPPE. What is OPPE? The Ongoing Professional Practice Evaluation is a standard from the Joint Commission (JC) that requires medical staff to collect and distribute to physicians specific data regarding the core competencies and quality improvement. Fortunately, the core competencies are now second nature to residents as their program evaluations use this structure and they have become accustomed to these from the American Board of Medical Specialties (ABMS) and the Accreditation Council for Graduate Medical Education (ACGME). The six core competencies are: patient care, medical/clinical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, and system-based practice. This Ongoing Professional Practice Evaluation will be a continuous process in which physician-specific metrics will have to be disseminated, and if needed, quality improvement initiatives can be targeted to deficient areas. One of the strengths and potential pitfalls of the OPPE is that the metrics are defined by the institution or service chiefs. This is a tremendous amount of latitude and can be an issue if the metrics are the same for a head and neck surgeon and an otologist. The metrics are derived from a multitude of sources: patient satisfaction surveys, morbidity and mortality conferences, infection rates, compliance to guidelines, participation in CME activities, 360-degree evaluations, etc. Many had issues with the first iteration of OPPE because of the light scrutiny by regulatory agencies on compliance with this standard and institutions struggling to grasp the concept and usefulness. Now, there are many institutional, computer-based, and consultancy resources to use in creating OPPE metrics and scorecards that undoubtedly have raised the bar of scrutiny, and the standard is higher. In this column, we have written a few times that physicians and institutions should concentrate efforts on defining metrics that are reasonable for their practice patterns and, most importantly, define metrics that matter. If a metric shows no distribution among physicians and is not particularly amenable to perhaps quality improvement strategies for outliers, then it is not a robust OPPE metric. For example, post-tonsillectomy bleed rates certainly will vary from physician to physician, but the range is tight and the intervention on how to deal with outliers with a bleed rate of 3.5 percent compared to a practice average of 2.75 percent escapes me. Discussion of OPPE often involves FPPE, which we will discuss in greater detail in future columns. FPPE also comes from the Joint Commission and is an acronym for the Focused Professional Practice Evaluation. This evaluation tool helps monitor physician performance and outcomes if there is concern about one’s practice patterns. Otolaryngologists are going to have to work diligently to define OPPE metrics that demonstrate the value and quality of the care we give, yet provide opportunity for improvements.  This is much easier in other venues in the hospital, such as ICUs, where the central line infection rates or compliance with clinical pathways can be measured. The OPPE is another level of transparency for physician performance and outcomes that is now a regulatory requirement. Many institutions are currently working through the process. We expect  many Academy members will need to begin this process. By sharing our efforts and knowledge, we hope we will be able to confidently define metrics that matter. References 1. http://med.stanford.edu/shs/update/archives/FEB2007/president.htm, accessed, July 11, 2011. 2. http://www.compass-clinical.com/hospital-accreditation/2011/06/oppe-measuring-for-healthcare-quality-not-just-compliance/, accessed July 11, 2011.   We encourage members to write us with any topic of interest. We will try to research and discuss the issue. Members’ names are published only after they have been contacted directly by Academy staff and have given consent for their names to be used. Email the Academy at qualityimprovement@entnet.org to engage us in a patient safety and quality discussion that is pertinent to your practice.