Life Science Compliance Update

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April 05, 2013

CME's Critical Role in Improving Quality and Outcomes

CME Course 12
Over the years, we have emphasized the critical role continuing medical education (CME) provides to improving patient outcomes, reducing healthcare costs, and enhancing the overall quality and efficiency of the U.S. healthcare system—both in terms of more education and proficient physicians and through serving as a conduit for medical progress and innovation.   

CME covers a number of topics and disease areas, and has been proven to improve patient outcomes in areas such as multiple sclerosis, hypertension, COPD, ICU patients, improved taking of family history by physician assistants, Sepsis, healthcare-associated infections, reduction in CT scans, and several other areas.  

Interestingly, a recent article published in the Journal of the American Medical Association (JAMA) called for new steps to educate physicians about the inefficiencies that cause billions in lost healthcare dollars every year.  More work is needed to ensure doctors are aware of “program integrity” -- a term payers use to refer to losses due to inappropriate payments or exploitation, Shantanu Agrawal, MD, medical director for the Center for Program Integrity at the Centers for Medicare and Medicaid Services (CMS) in Baltimore, and colleagues wrote, as reported by MedPage Today. 

“While federal and state governments are vital participants, leaders in medical education, licensure, and specialty certification would ideally work together to ensure that all physicians have sufficient awareness to safeguard public and private healthcare programs, patients, and themselves,” the authors wrote.  Waste accounts for 30% of overall healthcare costs.  “Few physicians intentionally abuse or defraud the healthcare system, but nearly all contribute to waste,” they said.  For example, CMS found insufficient documentation, lack of medical necessity, and coding errors contributed to nearly $30 billion in fee-for-service overpayments in 2011. 

“Despite the enormous resources at stake, physicians receive little education in how to manage and steward finite resources, making formal education of physicians in ‘program integrity’ an essential component of medical professionalism,” the viewpoint stated. 

To handle this costly situation, physicians could receive program integrity training during residencies and fellowships.  “Training could be specialty-specific, and trainees may be more likely to internalize the material if it comes from trusted educators,” the authors wrote.  Only 44% of medical schools and 68% of institutions supporting graduate medical education offer any instruction in program integrity, they said. 

“States could specify that a certain amount of continuing medical education (CME) be earned in program integrity as a condition for licensure,” the authors wrote.  State medical boards could develop their own courses and encourage doctors to participate regularly.  “Similarly, specialty boards could require competence to claim diplomate status and maintenance of certification requirements.  Such education could be specialty-specific,” they suggested. 

Currently, there are few opportunities for education in program integrity.  “CMS does not mandate such education to participate in Medicare and Medicaid,” Agrawal and colleagues wrote.  “To our knowledge, no state medical board requires program integrity education for licensure, and no specialty board requires it for board certification.” 

Need for CME to Update Physicians on Drug Alerts 

In addition for the potential need for CME regarding billing, a recent article from Medpage Today highlighted the need for CME regarding caring for epilepsy patients and the drugs they receive.  Specifically, a recent online survey of American Academy of Neurology (AAN) members showed that roughly 20% of healthcare professionals caring for epilepsy patients were not aware of major electronically reported FDA drug safety warnings for anti-epileptic medicines, such as valproate, according to Sarah Bell, of Johns Hopkins University, and colleagues.  Of those who were aware of the safety alerts, as few as 23% said they remembered specific knowledge of the risks presented in a given alert, Bell presented during an oral session at the AAN meeting. 

Such shocking findings underscore the importance of CME programs and events that can educate physicians about such updates and new clinical and safety data.   

Secondarily, they also emphasize the importance of physicians speaking with sales representatives to learn about these updates at least initially, so that the physician can request more information or know whom to contact for questions.  We previously noted that physicians who fail to meet with sales representatives are even less likely to know about such safety updates, including the addition of an FDA black box warning.  The AAN survey, however, did not ask whether such members see drug reps. 

The FDA issues medication safety warnings via email and through postings on its website. However, these updates are only emailed to participants signed up to receive Drug Safety Communications and MedWatch Alert emails.  These emails are also communicated to healthcare professionals through physician specialty organizations, black box warnings or “Dear Healthcare Provider” letters, as well as in published articles on company and third-party websites. 

“FDA drug safety warnings are not being systematically delivered to neurologists,” she explained, highlighting not only the disparities in knowledge acquisition, but in the variety of sources where healthcare professionals received information from. 

Web-based CME and Pediatric Surgeons 

In other CME news, MedCity reported that doctors from across the globe are getting specialty medical training via a studio tucked inside Akron Children’s Hospital by participating in a web-based CME conference offered by GlobalCastMD.  Dr. Todd Ponsky, a pediatric surgeon who joined the staff of Children’s last year, is co-founder of GlobalCastMD, which offers low-cost, virtual medical conferences to surgeons throughout the United States and internationally.   

Recently, about 1,200 doctors logged onto a secure website to watch Ponsky and leading experts from as far away as England and France share updates about treating childhood traumas. P articipants were able to chat with each other and ask questions of the experts while watching the five-hour virtual conference.  “People can call in and talk to these key opinion leaders and see like they're there,” Ponsky said. 

The webinar concept is a “quick and efficient” way to provide doctors worldwide with details about the latest approaches to treating patients, said Dr. Wayne Meredith, chair of the Department of Surgery at Wake Forest University and executive director of the Childress Institute for Pediatric Trauma.  The nonprofit institute -- which co-sponsored Thursday’s conference -- raises awareness, supports research and provides education about pediatric injuries worldwide. 

Immediately after a similar conference last year, Meredith said, he heard back from a participant who said he learned techniques that saved a child’s life.  “The benefits of this could be huge,” he said. 

Dr. Fayza Haider, a pediatric surgeon at Salmaniya Medical Complex in Bahrain, has participated in 19 virtual conferences organized by Ponsky on topics ranging from urologic surgery to adolescent obesity.  In an email interview, Haider said the GlobalCastMD conferences let her learn about medical advances without traveling -- or changing out of her PJs. 

Through her participation, she said, she has learned surgical techniques that she has been able to use on her patients in Bahrain.  “It gives me a chance to discuss live with the experts and interact with other attendees from all around the world,” she said.

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