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February 21, 2011

ABMS MOC CME New System of CME Accreditation: Eliminating or Reducing Commercial Influence or Commercial Support?

Picasso207 
The recent American Board of Medical Specialties (ABMS) Maintenance of Certification (MOC) white paper is more like a Picasso than a Rembrandt.   It seems as if everyone who reads the document comes up with different conclusions as to what the writers mean.  This is often the case for documents written by a committee, but this document more than most recent statements on continuing medical education is subject to different interpretations.

The ABMS Task Force on MOC created a Joint Working Group on MOC CME with members from both ABMS/ACCME, one of the topics for discussion was commercial support of continuing medical education.

The Joint Working Group explored the role industry should play in MOC CME and suggested that “the public’s perception concerning commercial funding of CME for physicians is not positive.” However, the white paper does not include any citations to support this claim. In fact, they do not even offer any articles from the press or citations to congressional hearings. More importantly, they do not offer a shred of evidence showing specifically that Americans are concerned about commercial support of CME. We are not aware of any survey that asked participants if they were concerned about commercial support of CME specifically.

Instead, the white paper collectively groups together MOC CME and CME with commercial speaking, marketing, lawsuits, and other industry abuses or mistakes that have caused the public’s trust in industry to erode. While it is always possible in any area of business that commercial support may influence business, this suggestion is frequently misstated in CME, where numerous safeguards are already in place to ensure that content of programs are of the highest integrity.

Perhaps what is most perplexing about the white paper is that while they clearly acknowledge the numerous benefits of commercial support in their findings, yet they include in their recommendations “eliminating or reducing, to the extent possible, influence exerted by commercial entities.” While the language might indicate that the Joint Working Group only wanted to reduce or eliminate influence and not the actual funding or support of such programs, it would be naïve to think this way.

When one thinks about eliminating or reducing to the extent possible your mind goes to examples such as alcohol consumption, though many enjoy drinking beer wine and spirits.  Eliminating or reducing implies one has a problem.

The reality is commercial influence in CME is almost non-existent today, especially given recent ACCME policies, OIG guidance, PhRMA Code, and other guidelines from industry, academia, institutions, and the government.

With that in mind, it still remains a mystery why the Joint Working Group would want to “reduce or eliminate” the influence exerted by commercial entities when commercial support provides a positive role and is in the public’s best interest. For example, as the Joint Working Group recognized in their findings but not in their recommendations, commercial support may:

  • Facilitate affordable access to CME activities for physicians (especially physicians in rural and/or underserved areas);
  • Accelerate the translation of new science and technologies into clinical practice and drive practice change (the importance of this aspect for equipment dependent specialties such as surgery and radiology was emphasized);
  • Promote multi-center or multi-provider group activities; and
  • Encourage educational innovation. Commercial support may become less of an issue if educational content is relevant to practice, evidence-based, practice-based, and includes core competencies.

If we are to reduce or eliminate commercial support of CME, we will be eliminating the positive role it has in educating physicians. And eliminating commercial support will not make it easier for CME providers to manage bias or disclose information, which require significant time and resources.

In looking at the positive role commercial support of CME provides, exactly how and why is the Joint Working Group proposing to reduce or eliminate influence of commercial support? All of their reasoning and support seems to be from “public concern,” however they provide no evidence of the public’s distrust. As a result, it seems as though the Joint Working Group is taking a proactive stance against commercial influence. While this approach may be reasonable, it is crucial that CME stakeholders and the Joint Working Group create guidelines and establish an understanding that emphasizes the positive role commercial support of CME provides as identified above.

Improving the transparency and integrity of commercially supported CME is an ongoing and challenging process. CME providers, staff and faculty constantly strive to ensure that ACCME guidelines are met to their fullest and that programs are free from bias, industry control, independently reviewed, and objective. Accordingly, CME stakeholders should work with the ABMS and MOC Committee to ensure that their final recommendations keep commercial support of CME in place, while continuing to balance the high level of objectivity, independence and integrity that CME providers practice.

At a time when patient outcomes are suboptimal, more Americans are developing chronic disease, and the population is becoming older, we need to be encouraging more collaboration between industry and the medical community to address these challenges. CME stakeholders should be focused more on ways to ensure collaboration instead of worrying about how to separate potential influence that is overwhelmingly nonexistent.

We are encouraging everyone to read the white paper for themselves and submit comments to the ABMS by March 1st to ABMS at

ABMS_MOC_Support_Program@abms.org.

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