Posts filed under ‘CME Issues’

CME – Who Gets the Assignment

I recently visited a small community hospital to talk to them about PI CME. Like  in many  small settings.  responsibility for coordinating the CME program is an add on role. The person assigned the responsibility has other responsibilities. They have no training in CME. They may or may not have experience in education. They may or may not have clinical experience.

One person at the session had just been given the responsibility for CME and was in the Marketing Department. This person had no idea what was required of CME providers. No idea what it means to be an accredited CME provider. Absolutely no knowledge or understanding of what is required by the ACCME, AMA,  etc.  All they know is that the setting in which they work wants to offer the physicians  “CME’s” Whatever CME’s are.  What a learning curve.

In situations like this the person assigned responsibility for the CME Program should get together with the Quality Improvement people and ride the quality improvement initiatives like a tight saddle on a bucking bronco. in fact the CME program should probably be assigned to the QI people in these settings. They have they data. They can learn the CME rules and regulations. They can link  CME to quality initiatives  that make a difference to the patients in that setting.

All approved CME activities have to be evaluated in improvement terms.  Improvement in competence, performance or patient outcomes. Lets put CME where the people have the skills to assess these improvements. Quit screwing around with CME as part of marketing or even the medical affairs office. Enhance the educational skills of some of the the improvement people. Enhancing the improvement  skills of  the CME people doesn’t seem to be working. Let’s try another way to link education to physician competence and performance. Especially if they have patient outcomes data.

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May 10, 2012 at 11:48 pm 1 comment

Revisit…….Why Fund CME?

NOTE: I have published this blog before but had the urge to do it again when I heard this.  In a side conversation at the recent meeting of the National Task Force on CME/Provider/Industry Collaboration someone said that an employee in one of the grants offices in industry was told by the higher ups that they were not sure the company was going to continue supporting independent CME. One of the reasons was a reaction to the recent CEJA  report calling for “limitations” on corporate support for CME. So here is what I mused before.

Suppose I own a pharmaceutical or medical device manufacturing company. You know what? I am going to shed providing support for accredited CME and I am doing it right now. My company does not need the extra hassles.

Please understand. I see how my company’s support for CME adds value to the relationships we have with our customers. And, in my opinion, this support is not as “evil” as some in organized medicine are making it out to be. But you know what? There are too many in the CME enterprise, the physician community, and government questioning that any value can come from my business supporting CME. Do you think I need that kind of press? What about the exposure coming from the federal government? And I really don’t need a bunch (although a minority) of boisterous customers and organizations that supposedly represent my customers shouting to the world that my company should not be supporting their CME. Nope. No thanks. Nada.

I don’t need the extra costs of staffing the CME function in my company. Grant applications. Grant application reviews. Compliance officers. Compliance reviews. LOA’s. Check requests and disbursements. Project reconciliation processes.   Why pay the overhead to house these functions. I don’t need the costs of educating my employees about the CME rules and regulations. I have to pay a lot to monitor employee performance to be sure they don’t get my company in trouble by breaking some inconsequential CME rule or regulation. I really don’t like the entitlement attitude some physicians and physician organizations have that suggests my company owes it to them to support their pet CME project because they use my company’s products. On and on.

I don’t need the hassles and intimidation the federal regulators put on my company to insure compliance with their requirements. Who wants to be looking over your shoulder all of the time for fear the feds will come calling.

I don’t want to wonder if the money my company puts into the CME enterprise is having an impact on health care delivery. I don’t want to have to wonder if the money I put into CME is having and impact on patient health status. You know what? If my company puts money into the CME enterprise my shareholders want to know what impact the money is having on the delivery of evidence based patient care and to the extent possible patient health status in clinical areas of interest to my company. And yes, my stockholders want to know if the investment in CME is having a positive impact or any added value for our customers and the company – bottom line included but not exclusively.

Am I going to put the money I have been allocating to support CME into a big ole pot and let someone outside of my company decide how to spend that money with no accountability back to my shareholders? Are you crazy?

People in my company can’t even talk to CME providers about areas of mutual interest. Like I am going to give money to someone my company representatives can’t even engage in a significant and appropriate dialogue. Right!

So what about the notion that the money my company puts into CME impacts the cost of drugs and thus the cost to the patient. Of course it does. My company is not a charity. I have to recoup those costs. Removing my support for CME will not reduce those costs. If health care providers have to bear the costs of their own CME who is ultimately going to pay? The patient of course. Health care costs might actually go up when I  take what I have been spending to support CME and spend it on something that will add value to my relationships with my customers. And I assure you I will find a way to do that.

And by the way the CME enterprise will save money when we stop funding CME. No need for the AMA to spend money on the annual Task Force meeting. ACCME can cut the accreditation application and review process in half by eliminating all of the questions and documentation required related to commercial support for CME. Wow. CME providers might be able to say they are part of the “Green Movement” with all of the paper saved. The Alliance can reduce the number of days needed for its annual meeting saving its members travel and lodging costs to attend the meeting. The CME enterprise won’t need the new “Faculty Development” initiative to teach physicians who speak at CME events the difference between CME and marketing (oh please).  CME providers can save money on going to all of the meetings they think they can’t miss because they need to get the latest information on how to effectively beg for bucks. CME providers won’t have to spend all of that time writing grants chasing support. Our sector won’t have to spend the money on all of the high cost conferences that try to address the maze of rules and regulations imposed on our support to the CME enterprise.  Wow. What a savings for everybody. Everybody except the physician and patient of course. Physicians will still have to engage in CME and to pay for that CME. Physicians will pass those costs on to their patients.

What will happen in the CME field when money from the pharmaceutical and device sector is gone? The requirements of physician participation in CME are not going away. In fact, those requirements are becoming more rigorous and narrowly focused. Look at maintenance of certification requirements and the  proposed rules for maintenance of licensure.

Pharmaceutical and device companies still have the obligation of educating those who purchase and use their products. They must continue to support education of physicians. This will be a bit easier in the absence of the accredited CME hassles.

Every system is perfectly designed to get the results it gets. If the CME system is not getting the results it wants then that system has to change. Pharma and device manufacturers support for CME can and probably will be stopped. The CME system will change as a result of that decision. Will that be the magic bullet that will enable CME to reach its full potential in impacting patient outcomes? Forgive me. I am a skeptic and I approve this question.

Tell me again why pharma and device manufacturers should support accredited CME? I seem to have lost my interest in doing so.

September 28, 2011 at 11:38 pm Leave a comment

Can I Improve What I Don’t Measure?

Someone once said, “If you can’t measure something, you can’t understand it. If you can’t understand it, you can’t control it. If you can’t control it, you can’t improve it.”

As a CME professional wanting to improve individual CME activities my organization offers and my overall program I have to have points of measurement of value to me, my learners, and my organization. Things I want to measure to see if we are improving and to show my learners and my organization that we are having a mission focused impact.

Continue Reading September 1, 2011 at 12:04 am Leave a comment

Do We Have a Problem with our Problem Solving Behaviors?

In our drive to design CME activities that we hope will demonstrate impact or improvement on a professional practice gap we often jump to potential causes or even solutions before we fully understand the real nature of the gaps that give rise to presumed educational needs.

Continue Reading August 30, 2011 at 2:14 am 2 comments

Physian Performance and Quality – No Relationship?

“Performance improvement” CME

I found on a Blog called Trusted MD. It is syndicated by R. W. Donnell | Mon, 04/18/2011

It is a response to a comment by Daniel Carlat a few days ago.
about the emerging importance of PI CME.

He says, “I knew we were moving in this direction but I was not aware that “PI CME” was official. Dan Carlat blogged this yesterday. As one would expect he’s mainly concerned about industry getting in on the trend, but between the lines of his post I read a measure of concern about the whole idea of PI CME. I’m concerned too. Performance has little to do with quality, or good doctoring by any definition.”

Unbelievable!  What physicians do – their performance – has little to do with quality, or good doctoring”? I completely understand there are many determinants of quality and good “doctoring”. To assert that what physicians do -their performance- in patient care has no impact on quality is unfathomable to me.

April 19, 2011 at 8:18 pm Leave a comment

Why PI CME?

PI CME is gaining traction but there are still few physicians taking advantage of this learning format. Some physicians still say they have no idea what PI CME is. Others say they are too busy to engage in this form of CME because takes too much time or it is too much trouble. So why should we be diligent in offering PI CME and trying to increase the number of physicians engaging in this dynamic learning format? I can think of a number of reasons.

  • Improvement is a part of the fiber of the practice of medicine. Every physician I have ever met is continuously seeking ways to provide optimal patient care. They are constantly looking for ways to improve the outcomes their patients can achieve.
  • PI CME is physician centric. Yes it is “All about me”. Me as a learner. My practice. My patients,
  • PI CME is data driven. Physicians are scientists. Data are important. Data derived from their own practice and compared to “best practices” is informative and challenging. You change what you measure.
  • Engaging in practice improvement activities is required for Maintenance of Certification and is in the framework for Maintenance of Licensure. Accredited hospitals must engage physicians in improvement efforts in their own settings. Some third party payers are offering incentives for engaging in improvement initiatives that can demonstrate better patient outcomes.
  • PI CME is aligned with sound adult learning principles – physicians learn by solving problems. They have a need to know. This, among other principles, is core to adult learning. .

The AMA has a framework for offering PI CME credit. One of the best things the CME profession could do to support PI CME is to adopt a systematic, sustainable, repeatable approach to guide PI CME initiatives. With the emergence of Lean Healthcare and one of its central tools – A3 Problem Solving- we have a framework that is effective and efficient. We should embrace it as a new way of doing our PI CME business.

Integrating CME and Improvement – The New Normal

February 4, 2011 at 11:07 pm Leave a comment

Communities of Practice – A Framework for Learning and Improvement

One of the sessions at the 2011 annual meeting of Alliance for Continuing Medical Education that I was supposed to participate in was to report on the work of a “Community of Practice”. The session was canceled because an attempt to get a community established failed to materialize. So what are these things called Communities of Practice (COP)? Take a look at the graphic. It provides a good description of a COP.

COP’s are usually comprised of a group of individuals who find they have a common area of interest or a common concern. They build a trusted relationship with each other around the area of common interest and begin to share their unique knowledge and experience related to the issue. By doing so they soon develop a shared understanding and approach to the issue and build a collective knowledge base which informs their practice guiding how they approach the common area of concern. The end result is that the experience of the COP builds in each member a collective knowledge base that, when applied, improves their individual performance and can have a dramatic impact on improving the issue they were drawn together to address.

Think of all of the things happening in CME that might benefit from COP’s forming to explore issues, develop deeper levels of understanding, produce resources for all of us to use. Things like Maintenance of Certification, Maintenance of Licensure, Integrating QI and CME, PI CME, Utilizing Social Media in Healthcare and Physician Learning – and this just scratches the surface of possibilities.

COP’s are engaging, intellectually stimulating, and fun. Find one or start one. You’ll be glad you did.

Integrating Education and Quality Improvement – The New Normal

February 4, 2011 at 2:19 am 7 comments

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