Senate Committee on Finance Investigates a Specialty Society

The United States Senate Committee on Finance (Committee) has jurisdiction over the Medicare and Medicaid programs. As you are probably aware, for several years Senator Grassley, Chairman of the Committee, and the Committee has been investigating the pharmaceutical industry, including industry funding for Continuing Medical Education.

Now, Senator Grassley is examining issues related to non-profit organizations for what he calls a concern about “the strong ties between the pharmaceutical industry and non-profit charities”. He is of the opinion that money from the pharmaceutical industry “shapes the practices of non-profit organizations which purport to be independent in their viewpoints and actions. Specifically, it is alleged that pharmaceutical companies give money to non-profits in an attempt to garner favor in ways that increase sales of their products”.

What does this have to do with those of us in CME? The good Senator has requested an accounting of industry funding that pharmaceutical companies or foundations established by these companies have provided to the American College of Cardiology (ACC) and its foundation, the American College of Cardiology Foundation (Foundation). He wants to know about any transfer of value from a pharmaceutical company, including but not limited to grants, donations, and sponsorship for meetings or programs, etc.

I would almost be willing to conjecture that this is not the only specialty society the Committee on Finance decides to examine.

 

if you would like to see the Grassley letter to ACC go to:

http://finance.senate.gov/sitepages/grassley.htm

Floyd Pennington, PhD

Director CME

American Society of Transplantation

Macy Foundation Chairman’s Executive Summary

Wow. The Josiah Macy, Jr. Foundation Chairman’s summary of the “Continuing Education in Health Professions:Improving Healthcare Through Lifelong Learning” sure created some furor during the recent meeting of the Alliance for Continuing Medical Education – some reasonable and some downright irrational.

Some stakeholders in CME have already drawn conclusions about the credibility of the report. Some have developed a litany of of reasons as to why the report is not to be taken seriously. Others have tried to distance their organizations from the report and the recommendations. I am aware of only one organization indicating they intend to learn from what is in the report and use it to inform them about how they can improve their services.

What has been released is not the final report, so it seems imprudent to draw any final conclusions about the report or about the reports recommendations. We need the final report so we can carefully examine the substance of the papers and the data that purportedly supports the groups recommendations. But that doesn’t mean we just sit and wait. The Chairman’s summary includes a number of actionable items and suggestions that can be addressed right now. Why wait?

In responding to reports presented by those in attendance at the Macy Foundation meeting, Mike Saxton challenged the group to do something now and not wait until the full report. I think Mike is right.

Many of the issues discussed in the report have been vetted for years. It is time for action. The question is who will lead the effort.

Any suggestions?

What should the CME professional know for the year 2012?

Just before the 2008 annual meeting of the Alliance for Continuing Medical Education I was contactnig by Shelly Putterman. Here is what he asked:

“In preparing a presentation for the 33rd Annual Alliance meeting, “Envisioning the Future: What You Need to Know for 2012,” I went back to my records of the 4th and 5th meeting of 1979 and 1980. You are memorialized as an attendee and I wonder if you have any comments to make for this year. I would love to add your comments to mine.”

What an opportunity. Here is my response:

We should know these things might happen:

• Maintenance of certification time periods will shrink
• All physicians will be required to be board certified
• Competency based licensure and re-licensure will be based on maintenance of certification
• Pay for Performance will be a fact of life for physicians
• Physicians will be discriminating consumers of learning resources focused on practice improvement efforts.
• Mandatory CME will be abolished as a requirement for licensure or re-licensure and replaced by a competency- based requirement.
• The CME accreditation system, if it survives, will be completely transformed, requiring all ACCME accredited providers to perform at the currently defined Level 3.
• The number of accredited CME providers will be drastically reduced
• CME professionals will be expected to be certified
• Pharma will give funding preference to organizations who employ certified CME professionals

We should know that in the future, to designate a CME activity for AMA PRA Category 1 Credit ^TM the activity will have to be:

• Based on data measuring something related to health care delivery in a specific setting.
• Address a practice improvement initiative based on the assessment data.
• Have learning objectives linked to specific practice improvement initiative.
• Utilize content directly related to the knowledge, skill, attitudes, or system changes required to be successful in the practice improvement initiative.
• Employ evaluation mechanisms that measure practice improvement.
• Physicians will be required to participate in a specific number of AMA PRA Category 1 Credit ^TM, activities that meet these criteria – thus linking CME directly to outcomes.
• Other learning resources provided by ACCME accredited providers will be included in the definition for AMA PRA Category 2 Credit ^TM.

We should know these might be the results:

• Practice improvement based CME will move from relative obscurity to the center of the CME enterprise making the return on investment for CME measurable.
• AMA PRA Category 1 Credit TM activities will be directly linked to the priority health care initiatives of the individual or organizational health care provider— thus tying CME to the business needs of the practice or organization
• There will be a dramatic increase in the number of patient care improvement initiatives across the country. Physicians will be the center of these efforts—thus reclaiming some control of improvement in the delivery of health care.
• ACCME accredited organizations not in close proximity to the delivery of health care will work in collaboration with organizations that are to grant AMA PRA Category 1 Credit ^TM for their initiatives.
• Some organizations currently accredited by ACCME might find it difficult to meet the ACCME level three accreditation criteria and may no longer find accreditation an attractive option and will leave the business.

What to you think the CME professional will need to know in the year 2012?

Comment on the Alliance response to the Macy Foundation Chairman’s Summary: “Continuing Education in Health Professions:Improving Healthcare Through Lifelong Learning”

Congratulations to the Alliance for Continuing Medical Education for quickly commenting on the Josiah Macy Jr. Foundation, Chairman’s Summary report of the conference “Continuing Education in Health Professions:Improving Healthcare Through Lifelong Learning”. I understand the necessity of making the Alliance membership aware that the organization had no role in the meeting or framing the report. However, I read the comments on behalf of the Alliance as dismissive of the report. I certainly hope that is not the case. Some impressive people who have shaped the field of CME are involved in this effort. A look at the roster of people involved in the conference include several Alliance past presidents. In addition, there are CME scholars and other leaders in the field of CME joined by very thoughtful people.

The Alliance comment on the report states:

“This report reflects the individual views of a selected number of people who conducted a two and a half day session out of the country last fall.”

Let’s be honest here.

• A large number of people in CME concur with much of what is included in the report. These are not only the views of a selected group of people.
• What difference does it make that the meeting occurred out of the country? Does that diminish its value in some way?

The comment states:

“The report includes broad generalizations of divisive issues that have not been vetted …..”

You have to be kidding.

• Most of these issues have been vetted for years by many individuals and groups the CME world, in the literature, in regulatory agencies, and some even in the Congress of the United States.

The comment further states:

“………and we believe may not be in the best interests of the CME community at large.”

Do we not believe it is in the best interest of the CME community to:

• acknowledge legitimate observations about the current CME system and implement many of the features mentioned?
• do all we can to ensure independence for commercial bias n our CME activities?
• address the failures of the current accreditation system?
• implement the principles put forward by the group to guide continuing education of health professionals?
• embrace the suggested fundamental purposes of continuing health professional education?
• acknowledge that maintaining professional competence is a core responsibility of each health professional and that systems of care profoundly affect patient care?
• acknowledge that traditional single intervention lecture-based CME activities are largely ineffective in changing health professional performance?
• see the importance of practice based learning and improvement as a promising approach to improve the quality of patient care?
• recognize that information technology is essential to practice based learning?
• embrace engaging approaches to teaching in CME?

If not in agreement with the contents of the report then what is the position of the Alliance Leadership on these issues?

• Should practice based learning emerge as a primary form of CE?
• Should we seek support to develop technology that facilitates point of care learning including easy access to clinical decision support resources?
• Should we encourage the development of life-long learning skills at all levels of formal health professions education.
• Should we encourage a national initiative that advances the science of CE addresses the proposed charges to such an institute?
• Should we continue due diligence in ensuring that the CE of health professionals is based on the best science available, independent of commercial influence, using the best learning resources available. Can we do this with commercial support?
• Should we limiting the kinds of organizations that can become accredited providers? Should any organization that can meet the accreditation standards be excluded? If so on what grounds?
• As a matter of convenience and cost containment, is a single accreditation organization for nursing and medicine is a good idea?
• Why not incorporate information technology and interactive scenarios into CME activities?
• Should CME to do its part to encourage the development of practice-based learning skills and make every effort to help health professionals maintain those sills throughout the professionals’ career.

I found I agreed with much – not all – of what was in the report. Is there not something in the report that the leadership of the Alliance finds in the best interest of its membership and the field of CME? I sure hope so. If not our society is pushing itself closer to the brink of irrelevance.

I am looking forward to publication the proceedings that will provide a rich background on how this group arrived at its position. Then perhaps we can comment in a more thoughtful and balanced way.

 

What do you think?

Certification for CME Professionals?

Yes! Certification for CME professionals. There is group working on this right now and it is likely that a certification process for CME professional will be launched in the very near future.

The effort is not without distractors. Some ask if there a body of knowledge unique to the field of CME that can be used to establish a viable set of knowledge and performance expectations. Some wonder who will acknowledge a credential earned through a certification process. Others challenge the need for an independent certifying body suggesting it is the responsibility of professional societies in CME to “train” people in the filed and to determine what competencies should be expected of people working in their sector of the CME enterprise.

The people behind the idea of certification for CME professionals say it is time to step up, set expectations for competence and performance for people the field, and establish a process by which those expectations can be demonstrated. And they are going about it very carefully following national guidelines for establishing a certifying body and a certification process. They will likely be nationally recognized as a certifying body in the field of CME. They will be independent of the special interests of the CME Professional societies. They will have a carefully constructed certification process that is likely to include a rigorous written examination.

I can imagine hospitals and health systems coming to expect that the people they employ in CME hold a certificate. I would not be surprised to see pharmaceutical companies require that agencies receiving grants and contracts employ certified CME professionals. Hmmmmm. What if the ACCME added a requirement that at least one person employed by an accredited CME provider had to be certified? Far-fetched?

If positioned effectively and developed correctly, certification of CME professionals may change the field. If you are interested in more information about the effort to establish a certification for the CME professional visit www.NC-CME.org. I recently interviewed Dr. Judy Ribble, the Executive Director of the National Commission for Certification of CME Professionals. You can download that podcast at:

http://www.ctlassoc.libsyn.com/index.php?post_id=297488

What do you think?

Conversations in CME — What It is About

There is a constant barrage of issues arising that impact the field of Continuing Medical Education. Funding issues challenging the independence of the content of industry supported CME offerings. Concerns that the CME accreditation system may be too complex and ineffective in influencing accredited CME providers link their efforts to physician competence or performance, patient safety, team care, or improvement initiatives. The emergence of a certification process for CME professionals. Independent reports that suggest major changes in how CME is funded, establishing a national focus on improving CME, and suggestions for the kinds of groups that should ( and by exclusion) should not be accredited CME providers. Just to mention a few.

Conversations in CME is a place to weigh in on these issues and your issues. It is a community of colleagues free to present and debate their opinions, make suggestions, and express concerns. From time to time there will be links to podcasts presenting “conversations” with informed leaders and stakeholders in CME. I want to make these learning opportunities for the CME professional.

Perhaps through these discussion, we can find ways to shape the future of CME from the perspective of the CME provider.

Join in and let your thoughts be known.