Policy and Medicine

ACCME Launches International Academy for CPD Accreditation and other ACCME News

This month, the Accreditation Council for Continuing Medical Education (ACCME) has been busy with a number of activities and announcements.  Below is a summary of some of the events, activities, and other information regarding the CME industry and stakeholders contained in their March 2013 newsletter. 

International Academy for CME/CPD Accreditation Leaders 

The ACCME and the Royal College of Physicians and Surgeons of Canada have joined together to create the International Academy for CPD Accreditation. The purpose of the Academy is to provide an opportunity for interchange for leaders serving in continuing medical education (CME) and continuing professional development (CPD) accreditation systems and for those seeking to establish CME/CPD accreditation systems. 

The Academy aims to support networking, facilitate mentoring, promote innovation, and enhance the development and implementation of CME/CPD accreditation systems internationally. Accreditation leaders will have the opportunity to learn about each other’s values, principles, and metrics; explore educational and ethical accreditation standards; and to foster evaluations to assess the effect of CME/CPD accreditation systems on physician learning, competence, health care team performance, and health care outcomes. 

The Academy has invited accreditation leaders from around the world to join. Currently, the Academy includes members from the US, Canada, Hong Kong, Oman, and Australasia. The inaugural meeting of the Academy will be held via webinar on May 23. 

ACCME Invited to Join World Federation of Medical Education Standards Revision Task Force 

The World Federation of Medical Education (WFME) has invited the ACCME to participate in the revision of its standards for postgraduate medical education and continuing professional development.  Murray Kopelow, MD, ACCME President and CEO, will serve on an international task force to prepare the draft revision. 

WFME’s mission is to strive for better health care for all people.  Its primary objective is to enhance the quality of medical education worldwide, through the promotion of the highest scientific and ethical standards in medical education.  The ACCME said it is pleased to participate in the initiative as part of its commitment to supporting collaboration within the global CME community. 

ACCME Workshop Includes Public Health Imperatives Forum 

The ACCME has added a new session to its 2013 CME as a Bridge to Quality™ Accreditation Workshop, which is scheduled for April 24-26 in Chicago.  The two-part “Public Health Imperatives Forum” will feature representatives from several federal government agencies. The following agencies have accepted our invitation to participate: the National Institute on Drug Abuse (NIDA), the National Human Genome Research Institute (NHGRI), and the Office of the National Coordinator for Health Information Technology (ONC).  In the first part, the government representatives will discuss how CME can be a strategic partner in addressing public health priorities.  A breakout session will follow, giving participants the opportunity to engage directly with federal representatives about collaboration opportunities to address public health priorities. 

New Videos: How CME Can Support Health Care Professionals’ Continuing Professional Development 

In three new videos, Murray Kopelow, MD, ACCME President and CEO, discusses the role of CME as a strategic asset to health care professionals’ continuing professional development. 

• Accredited Continuing Medical Education as an Educational Home to Support Continuing Professional Development
• Can your CME Program support accredited continuing education for the health care team?
• What are the biggest misconceptions that physicians may have about CME? 

Additional Compliance Examples Posted for Accreditation with Commendation Criteria 

The ACCME added new examples of compliance with the criteria for achieving Accreditation with Commendation to the Examples of Compliance and Noncompliance: Findings Based on the ACCME Accreditation Criteria. Here is the list of new examples. 

• Criterion 16: Compliance Examples 10–26
• Criterion 17: Compliance Examples 12–23
• Criterion 18: Compliance Examples 10–19
• Criterion 19: Compliance Examples 10–16
• Criterion 20: Compliance Examples 10–22
• Criterion 21: Compliance Examples 11–23
• Criterion 22: Compliance Examples 8–14

The Examples of Compliance and Noncompliance: Findings Based on the ACCME Accreditation Criteria enables providers and CME stakeholders to learn from each other and to understand how the ACCME determines compliance and noncompliance with its requirements.  Examples of compliance and noncompliance with each of the Accreditation Criteria, drawn from the accreditation review process, are included. The ACCME created a PDF of the Examples, with the new examples highlighted. 

AMA Selects 31 Medical Education Proposal to Continue Next Phase in $10 Million Initiative

As we noted back in February, the American Medical Association (AMA) announced a $10 million competitive grant initiative to attract bold, innovative projects to transform the way medical schools train future physicians.  Consequently, the AMA announced in late March that it had selected 31 innovative proposals from the initial pool of 119 applicants to move forward in the AM’s $10 million Accelerating Change in Medical Education initiative aimed at transforming the way future physicians are trained. 

“More than 80 percent of U.S. medical schools submitted brief letters of intent outlining their ideas to redesign medical education – an outstanding response that demonstrates medical schools are ready and willing to implement bold, transformative and innovative ideas,” said AMA President Jeremy A. Lazarus, M.D.  “We’ve narrowed these initial applications down to 31 exciting ideas, and we look forward to reviewing the full proposals in the coming months to find the ones that can best align with the changing needs of our health care system.” 

The schools selected will develop a more comprehensive proposal outlining the specifics of their innovations and must submit their full proposals by May 15. The AMA, with the help of a national advisory panel, will select 8-10 grant awardees to be announced in June at the AMA's semi-annual policymaking meeting in Chicago. 

Performance Improvement CME Improves ADHD Clinical Outcomes 

At the recent 2013 Alliance for CE in the Health Professions Conference, CME research was presented on a performance improvement (PI) CME activity designed to improve primary care providers diagnosis and management of adults with attention deficit/hyperactivity disorder (ADHD).  The target audience was HCPs in primary care.  The activity followed the American Medical Association’s 3-stage methodology for PI CME.  

In Stages A and C, the pre-assessment stage and post-assessment stage, participants evaluated their practices with respect to performance measures to diagnose and treat adults with ADHD.  They completed a self-assessment survey, answered questions from chart reviews of adult patients with ADHD in their practice, and selected one or more Quality Improvement Plans (QIPs) to implement in their practice to improve care given to adults with ADHD. 

In Stage B, the action stage, participants were supplied with educational material (National Association of Continuing Education Adult ADHD Toolkit) designed to inform them about caring for adults with ADHD and to help them implement their chosen QIP(s). Performance change was measured by comparing data sets from their self-assessment surveys and patient chart reviews obtained at Stages A and C. 

A total of 92 participants completed the self-assessment surveys and 926 chart reviews prior to and after Stage B. Analysis of the self-assessment survey data gathered indicated that participants more frequently used the performance measures and that they reported feeling more confident in evaluating and treating adults with ADHD at Stage C than they did in Stage A. As a result of the PI CME intervention, medium to large positive effect sizes were found in participants’ utilization of the measures and their confidence in applying the measures with study patients.  

With respect to practice behavior as indicated in the chart reviews, compared to Stage A, participants who completed the PI CME activity were significantly more likely (P < .001) to execute comprehensive initial assessments (91% vs. 97%) and use rating scales (71% vs. 90%) to evaluate adults with ADHD in their practice during Stage C.  Also, more participants confirmed symptom severity using corroborating evidence, recommended pharmacologic and psychosocial treatments, and provided follow-up after establishing a treatment plan. 

Based on these findings, this study concluded that the participants of the PI CME activity often selected more than one QIP to implement in their practice, made improvements across key performance measures that would serve to enhance their practice and improve clinical outcomes for their adult patients with ADHD, and reported increased confidence in providing care to adults with ADHD.  The data derived from the activity, combined with participants’ comments about the value of the educational materials and the instructional format used, validated the educational effectiveness of this 3-stage performance improvement mode of instruction.

ACCME and ACGME: Next Accreditation System

The Accreditation Council for Continuing Medical Education (ACCME) recently announced a new four-part video interview series that discusses how the ACGME’s Next Accreditation System (NAS) supports physicians’ continuous professional development and explores opportunities for medical education accreditors and hospital leaders to collaborate to improve health care safety and quality.  The interview series is with Timothy P. Brigham, MDiv, PhD, Chief of Staff and Senior Vice-President, Department of Education, Accreditation Council for Graduate Medical Education, (ACGME). 

As Brigham explained, the NAS moves away from a catch them being bad model to a quality improvement model.  In other words the ACGME is moving away from torturing the really good programs to find the toxic ones to one where we celebrate and reward the really good ones and everybody, the ACCGME, the ARCs within the ACCGME and the good programs work to help the programs that are struggling a little bit to move up.  A fundamental building blocks of that are the CLER visits, which CLER stands for Clinical Learning Environment Review, where the ACGME visiting every institution , every sponsoring institution in the country, every 18 months to ascertain how the residents are integrated into the safety and quality movements of the hospital.  

And that has all kinds of ramifications from duty hours to supervision to handovers to seeing how the residents are involved, all of the residents not just one or two who are on a committee of safety, are really integrated into learning about safety and quality and helping their institutions become a safer place.  In most institutions, ACGME found there’s a bit of parallel play going on, where the residents are doing one thing, taking care of most of the patients and there’s this sort of rigorous robust safety and quality movement that does not engage them at all.  So, they’re not learning, they’re not contributing to it and the hospital’s struggling because the residents are doing a lot of the patient care if not most of it.  

The second piece of the next accreditation system if you move from the CLER as sort of the foundation, making sure that the institution has all those qualities that the ACGME wants to see in an institution that will be educating our residents, future physicians , is a model of continuous improvement.  Accordingly, the RRCs instead of episodically biopsying the program, will be getting information on an annual basis that they can look at and say, this indicates that the program is going along in a fine way or there may be something going on in here and we’re going to have to take a look at it.   

• Understanding the ACGME Milestones: Applications and Opportunities for Accredited CME (Part 2 of 4)  
• Clinical Learning Environment Review (CLER) Visits: A Meeting Point for GME and CME (Part 3 of 4) 
• Knitting the Continuum Together: Seizing the Opportunity to Improve Medical Education (Part 4 of 4)

ACCME Updates : CME Providers Submit Year End Reporting By March 29, 2013

The Accreditation Council for Continuing Medical Education (ACCME) continued along with a number of important activities, announcements and updates for continuing medical education (CME) providers and stakeholders, according to their monthly newsletter.  As we previously noted, ACCME recognized that the Centers for Medicare & Medicaid Services (CMS) final rule implementing the Physician Payment Sunshine Act recognized the value of ACCME Standards for Commercial Support.   

As a reminder, ACCME-Accredited Providers must complete their Year-End Reporting by March 29, 2013.  So far, 488 ACCME-accredited providers have entered 32,039 activities into PARS for the 2012 reporting year.  The Program and Activity Reporting System (PARS) is always open and ACCME encourages CME providers to start entering 2012 activity data now in anticipation of the year-end reporting deadline.  Providers are welcome to enter basic information about an activity before it has taken place and complete the entry after the activity.  ACCME also provided several tips to support data entry: 

Enduring Material Activities: Who Counts as a Participant?  When reporting the number of physician and nonphysician participants for an enduring material activity, whether it is Internet-based, printed, or another format, you should count all learners who completed all or a portion of the activity and whose participation can be verified in some manner.  The ACCME would not consider individuals who only downloaded or received the activity but did not actually complete all or a portion of it to be participants. 

Regularly Scheduled Series: Is This an RSS and — If so — How Do I Report it?  First determine if your “series” is an RSS.  The ACCME considers an RSS to be planned as a series with multiple sessions, planned to occur on an ongoing basis (offered weekly, monthly, or quarterly), and planned and presented primarily to the accredited organization’s professional staff.  Examples of RSS activities include grand rounds and tumor boards.  Organizations that provide RSS activities should report each series (not session) as one activity in PARS.  Click here for more info on how to report RSS in PARS. 

ACCME Reports on Strategic Discussions with Stakeholders about CME’s Future 

The ACCME Board of Directors engaged in strategic planning in 2011 to discuss the future of the ACCME system and the role of accredited CME in supporting practice-based learning and health care quality improvement.  Through this process, the Board identified three strategic imperatives: 

1. Foster ACCME Leadership and Engagement
2. Evolve and Simplify the Accreditation Standards, Process, and System
3. Explore and Build a More Diversified Portfolio of ACCME Products and Services 

The Board incorporated feedback from stakeholders to identify these priorities, and then, throughout last year, the ACCME continued engaging with stakeholders about how to fulfill them.  The ACCME convened more than 20 focused discussions about the strategic imperatives with more than 1,100 stakeholders including member organization liaisons, ACCME volunteers, Recognized Accreditors, ACCME-accredited providers, and intrastate providers.  These discussions were held in a range of national, regional, and state forums, including accreditation workshops, town halls, volunteer meetings, Recognized Accreditor conferences, and events for intrastate CME providers.  A summaryof Key Themes from Stakeholder Conversations included: 

• Clarity: The ACCME should communicate its expectations clearly. It will be a lot easier for providers to do what the ACCME asks if they can easily understand the ACCME’s expectations. Commercial support requirements could be restructured to more easily apply to various scenarios such as activities that are commercially supported, those that are not commercially supported, and those that do not include advertising and exhibits.
• Fewer criteria may suffice: Some expectations are redundant (for example, Criterion 4, scope of practice); some are not readily measured (Criterion 5, choice of educational format); and some could be collapsed into one (Criteria 12-15, self-assessment and improvement).
• Criteria 16 and 22 are too easy: Stakeholders pointed out that providers were de facto in compliance with Criteria 16 and 22 by virtue of the organization existing and producing CME designed to change performance.
• Evolve the Commendation Criteria: Providers want to retain a criterion-referenced system for Accreditation with Commendation, but they want more attributes to be recognized as commendable. They like the concept of a menu of options, from which they could choose a certain number to fulfill in order to achieve Accreditation with Commendation.
• Maintain high expectations: Stakeholders do not want the ACCME to lower the bar. They value the Plan-Do-Study-Act approach combined with the Standards for Commercial Support.
• Push providers to higher level outcomes: Stakeholders feel that the ACCME should evaluate whether CME providers cause change—not just measure change—in learners. This should be an ACCME measurable, if not an actual requirement. Also, while stakeholders recognize that learners’ achievement of knowledge and competence are necessary steps in the change process, some stakeholders believe these objectives may no longer be adequate outcomes, if the accredited CME system is positioning itself as a strategic asset for initiatives to improve health care and public health.
• Keep pushing stakeholders: Stakeholders expect and want the ACCME requirements for the accredited CME enterprise to be drivers for their organizations’ change and improvement–—so that their CME programs are in fact relevant and serve as strategic assets to initiatives to improve health care and public health.
• Require organizational competence and-buy-in: It may be time to reintroduce requirements that organizations explicitly demonstrate their commitment to CME. (This expectation was specified in previous ACCME requirements.) Examples could include expecting CME staff to meet certain qualifications, evidence of direct, hands-on oversight by CME leadership, explicit involvement of senior organizational leadership.
• Retain three-part reaccreditation process: Providers see the triad of self-study report plus performance-in-practice review plus interview as a valuable process that should be retained, although they offered suggestions for improvement. One suggestion was to make interviews optional. To ease documentation requirements, providers suggested that the ACCME develop a structured abstract for providers to use when verifying performance-in-practice, which would take the place of labels and facilitate the process of submitting activity files.
• Retain verification by documentation: Providers feel that creating and maintaining adequate documentation of compliance is a lot of work—but that the ACCME’s random selection of activities for performance-in-practice verification is critical to the credibility and overall validity of the accredited CME enterprise in the eyes of our customers. The providers have asked that the ACCME examine how documentation requirements can be reduced while maintaining the important benefits of performance-in-practice verification.
• Templates: Providers want the ACCME to develop (optional) tools, instruments, and resources for providers to use in order to streamline the reaccreditation process and to promote compliance findings.
• Formative feedback: Providers want information about their compliance during their term of accreditation, as opposed to every four or six years. They want to know how they are doing in real-time and they want the opportunity to make mid-course adjustments, so as to avoid noncompliance findings.
• Engage leadership: Stakeholders believe that their institutional leadership and the leadership of the health care system in general is not engaged with continuing professional education—and this engagement must be developed in order to realize the full value of CME. They want the ACCME’s help in achieving this engagement.
• Regulatory alignment: Stakeholders believe that it is critical to achieve a congruence of values and expectations across regulatory systems.
• Validation by MOC and MOL: Stakeholders believe that the accredited CME enterprise needs explicit validation from the emerging systems of Maintenance of Certification^® (MOC) and Maintenance of Licensure (MOL) in equal measure.
• Support MOC and MOL: Stakeholders believe that the accredited CME enterprise must fulfill the needs and expectations of the emerging systems of MOC and MOL. In addition, and perhaps more important, the accredited CME enterprise must fulfill the needs and expectations of those directly involved in improving health care or population health. 

Video Interview Series: ACGME’s Next Accreditation System 

In a four-part video interview series, Timothy P. Brigham, MDiv, PhD, Chief of Staff and Senior Vice-President, Department of Education, Accreditation Council for Graduate Medical Education, (ACGME), discusses how the ACGME’s Next Accreditation System (NAS), supports physicians’ continuous professional development and explores opportunities for medical education accreditors and hospital leaders to collaborate to improve health care safety and quality.  This series is part of ACCME’s efforts to support alignment across the medical education continuum. 

• An Introduction to the ACGME's Next Accreditation System (NAS) (Part 1 of 4)
• Understanding the ACGME Milestones: Applications and Opportunities for Accredited CME (Part 2 of 4)
• Clinical Learning Environment Review (CLER) Visits: A Meeting Point for GME and CME (Part 3 of 4)
• Knitting the Continuum Together: Seizing the Opportunity to Improve Medical Education (Part 4 of 4) 

The ACCME has also produced the following video interviews focusing on the strategic value CME brings to graduate medical education. 

• Case Study: Integrating CME and GME—Jane Nester, DrPH, Executive Director for Medical Education/AHEC at Moses Cone Hospital, describes how she demonstrates the strategic value of CME to graduate medical education.
• Using CME to Engage Community Physicians in Quality and Teaching—Rani Gereige, MD, Director of Medical Education, Miami Children’s Hospital, discusses CME as a bridge between practice improvement, graduate medical education faculty development, and institutional goals. 

Registration Open for April 2013 CME as a Bridge to Quality™ Accreditation Workshop 

Registration is now open for the ACCME's 2013 CME as a Bridge to Quality™ Accreditation Workshop scheduled for April 24-26 in Chicago. A second workshop will be held July 31-August 2.  ACCME has invited providers whose next accreditation decisions are scheduled for July 2014, November 2014, and March 2015. 

ACCME Hosts Luncheon Discussion for Accreditation Surveyors 

The ACCME hosted a luncheon and discussion for ACCME accreditation surveyors during the Alliance for Continuing Education in the Health Professions (ACEHP) Annual Meeting.  The event was attended by more than 60 stakeholders, including ACCME accreditation surveyors; members of the ACCME Board of Directors, Accreditation Review Committee, and Committee for Review and Recognition; and staff and volunteers representing Recognized Accreditors. 

Murray Kopelow, MD, President and CEO, ACCME, discussed the accomplishments surveyors made during the previous year.  Thanks to surveyors’ contributions, the ACCME made 161 accreditation and reaccreditation decisions in 2012.  To support this decision-making, 107 surveyors conducted accreditation interviews. 

The ACCME asks providers to complete evaluations regarding their experience with the accreditation process and uses this feedback to analyze its current practices and make improvements.  Kate Regnier, MA, MBA, Deputy Chief Executive and COO, ACCME, presented data reflecting feedback from each of the three 2012 cohorts, which showed that providers reported positive experiences with surveyors and the accreditation interviews.  Dion Richetti, Director, Accreditation and Recognition Services, ACCME, reviewed the feedback, which showed that 95% or more of surveyors had a positive experience with the interview process.  Mr. Richetti also presented surveyor feedback regarding the Accreditation Compliance Review System (ACRS), which was implemented last year in order to simplify and streamline the process for accredited providers and accreditation surveyors.  The data shows that 97% of surveyors found the ACRS easy to use. 

CE Accreditors Meeting Focuses on Interprofessional Education 

The ACCME and its colleague accreditors, the Accreditation Council for Pharmacy Education (ACPE) and the American Nurses Credentialing Center (ANCC), hosted “Interprofessional Accreditation in Support of Interprofessional Education: An Exploratory Meeting of Accreditors” in February at the ACCME’s offices in Chicago.  The inaugural meeting brought together continuing education accreditors from a variety of health professions to identify areas of alignment among the accreditation systems and opportunities to support interprofessional collaborative practice. 

ACCME Hosts Commercial Supporters Forum 

The ACCME hosted a commercial supporters forum in January at its Chicago offices. ACCME executive staff and commercial supporters discussed current and emerging issues related to the health care environment and accredited CME, including the Food and Drug Administration (FDA) Risk Evaluation and Mitigation Strategy (REMS) for extended-release and long-acting opioid analgesics.  Participants discussed the importance of the ACCME Standards for Commercial Support: Standards to Ensure Independence in CME and explored strategies for supporting accredited CME that is independent from commercial influence. 

The ACCME hosts commercial supporter forums on occasion to provide an opportunity for participants to address emerging issues related to the health care environment and accredited CME funding and to reinforce their commitment to ensuring that commercially supported CME advances public health and serves the public interest. 

Genomics Medicine Conference Highlights Physician Education 

The National Human Genome Research Institute, National Institutes of Health, convened “Genomic Medicine IV: Physician Education in Genomics” in January in Dallas.  One of the goals of the conference was to identify ongoing efforts and needs related to physician education in genomics. 

Mira Irons, MD, Associate Chief, Division of Genetics, Boston Children’s Hospital; and member, ACCME Board of Directors, gave a presentation explaining that genomics education must move beyond general rules and principles and focus on providing physicians with relevant, practical information about how genomics applies to their scope of practice and their patients. 

The ACCME and the Accreditation Council for Graduate Medical Education (ACGME) were invited to discuss the roles of CME and GME in the medical education continuum. Thomas J. Nasca, MD, MACP, CEO, ACGME, addressed the importance of a multipronged approach to genomics education, which encompasses developing clinical proficiency in genomics in each specialty and includes practitioners and faculty. Murray Kopelow, MD, President and CEO, ACCME, described the scope of the ACCME accreditation system and the role of accredited CME as a strategic partner in efforts to advance physician education and practice related to genomics.  He explained how information about physician practice informs the medical education continuum, including undergraduate, graduate, and continuing medical education.  More information about the conference, including links to presentation slides and videos, is available here.

ACCME Updates December and January

The Accreditation Council for Continuing Medical Education (ACCME) recently discussed several important announcements in its December 2012 and January 2013 newsletters.  The newsletters noted that to meet year-end reporting deadlines, ACCME-accredited providers must complete entering data for 2012 activities and complete 2012 program summary by Friday, March 29, 2013. 

The Program and Activity Reporting System (PARS) is always open and providers can enter basic information about an activity before it has taken place and complete the entry after the activity.  So far, 414 ACCME-accredited providers have entered more than 24,340 activities into PARS.  For more information about reporting, ACCME has several web pages for assistance. 

ACCME Clarifies Management of Payments to Reserve Space for CME Activities Held in Conjunction with Other Organizations’ Meetings 

In response to questions and input from accredited providers, the ACCME has issued a clarification concerning the management and reporting of payments to reserve space for accredited CME activities (sometimes called satellite symposia) held in conjunction with other organizations’ meetings. 

• All funds that originate from an ACCME-defined commercial interest and are paid to reserve space to hold accredited CME activities are considered commercial support.
• As with all commercial support, these funds must be paid directly to the accredited provider responsible for the activity or to a designated nonaccredited joint sponsor. 

The accredited provider responsible for the activity that is held in the reserved space must manage and report the funds as commercial support, in accordance with ACCME commercial support requirements (Standards for Commercial Support and related policies). 

Accredited providers are expected to comply with this clarification when planning and implementing future activities.  ACCME does not expect accredited providers to comply with this clarification retroactively.  Accredited providers do not have to revise agreements or plans that are already underway or resubmit or re-categorize financial information that has already been submitted into the Program and Activity Reporting System (PARS).  ACCME has provided a Q&A in support of this clarification.  

Executive Summary of November 2012 ACCME Board of Directors 

At the November 2012 Board of Directors meeting, the ACCME ratified 54 accreditation and reaccreditation decisions, including 14 providers (26%) that received Accreditation with Commendation.  The Board ratified 28 progress report decisions.  Of those, 20 (71%) progress reports demonstrated compliance with all ACCME requirements previously found in noncompliance.  Eight progress reports (29%) did not yet demonstrate compliance in all requirements and the providers are required to submit another progress report.  

The ACCME ratified decisions for two providers receiving joint accreditation: Creative Educational Concepts, LLC; and Duke University Health System.  The decisions have also been ratified by the Accreditation Council for Pharmacy Education (ACPE) and the American Nurses Credentialing Center (ANCC).  

As of November 2012, there are 701 ACCME-accredited providers.  This number includes 16 initial applicants that successfully achieved Provisional Accreditation from the ACCME in 2012.  There are 1,330 providers accredited by ACCME Recognized Accreditors (state or territory medical societies that accredit local organizations offering CME). 

The ACCME elected James Burke, MD, and Carlyle Chan, MD, as the 2013 Chair and Vice-Chair of the ACCME at the annual meeting of its Board of Directors, held November 29-30, 2012, in Chicago.  The ACCME also elected the following new Board members: 

• Shannon K. Bolon, MD, MPH, Primary Care Medical Education Branch Chief, Health Resources and Services Administration, Rockville, MD
• Galicano F. Inguito, Jr., MD, MBA, Associate Residency Program Director, Family Practice Residency Program, St. Francis Hospital, Wilmington, DE
• Victor I. Reus, MD, Professor in Residence, Department of Psychiatry, University of California, San Francisco
• Michael Romano, MD, MHA, Vice-President of Medical Affairs, Jennie Edmundson Memorial Hospital, Council Bluffs, IA
• David A. Swankin, JD, President and CEO, Citizen Advocacy Center, Washington, DC 

Video Interviews: Improving Your CME Professional Practice 

The ACCME produced two video interviews providing practical strategies for improving CME professional practice. 

• Empowering Staff to Facilitate Content Planning—Marilyn Peterson, MA, CCMEP, Director, CME, Texas Health Research & Education Institute, discusses how her staff became curriculum development specialists, enhancing their engagement with faculty, clinical content planning committees, and health system leadership, and improving the quality and value of the CME program.
• From the Ground Up: Creating Your CME Program—Jane Nester, DrPH, Executive Director, Medical Education/AHEC at Moses Cone Hospital, shares the strategic approaches she used to create a transformative CME program. 

The ACCME also produced a video interview series focusing on the strategic value CME brings to graduate medical education. 

• Case Study: Integrating CME and GME—Jane Nester, DrPH, Executive Director for Medical Education/AHEC at Moses Cone Hospital, describes how she demonstrates the strategic value of CME to graduate medical education.
• Using CME to Engage Community Physicians in Quality and Teaching—Rani Gereige, MD, Director of Medical Education, Miami Children’s Hospital, discusses CME as a bridge between practice improvement, graduate medical education faculty development, and institutional goals. 

The CME Accreditation Statement: What It Means for You 

The ACCME has published a new Web page, The CME Accreditation Statement: What It Means for You, which explains the value and benefit of the accreditation system.  The Web page is part of ACCME’s ongoing efforts to communicate the value of accredited CME to health professionals and other stakeholders. Accredited providers are welcome to use this content to support their communications with stakeholders. 

ACCME Convenes Discussions on Interprofessional Education 

The ACCME Board of Directors convened discussions with invited guests about advancing interprofessional continuing education in support of interprofessional collaborative practice.   

James M. Galloway, MD, Assistant US Surgeon General, US Public Health Service, and Regional Health Administrator, US Department of Health & Human Services, Region V, discussed his experience working with the Indian Health Service and the National Native American CVD Prevention Program as an example of how interprofessional education and team-based care can address health care disparities. 

Kathleen Mudd, MBA, Vice-President for Product Delivery, National Committee for Quality Assurance; and Rowan K. Zetterman, MD, Dean, Creighton University School of Medicine, discussed their experience as jointly accredited providers, describing successful examples of interprofessional continuing education. 

Karen Drenkard, PhD, RN, Executive Director, American Nurses Credentialing Center; and Peter H. Vlasses, PharmD, DSc (Hon.), Executive Director, Accreditation Council for Pharmacy Education, joined with Murray Kopelow, MD, MS(Comm), ACCME President and CEO, to discuss their experience modeling interprofessional collaborative practice through the joint accreditation initiative. 

Registration Now Open for April 2013 CME as a Bridge to Quality™ Accreditation Workshop 

Registration is now open for the ACCME’s 2013 CME as a Bridge to Quality™ Accreditation Workshop scheduled for April 24-26 in Chicago. A second workshop will be held July 31-August 2.  

ACCME Presents at CME Provider Meetings in New Mexico, South Carolina, Washington State 

The ACCME participated in several CME events in New Mexico, South Carolina, and Washington State during the last few months: 

• Steve Singer, PhD, ACCME Director, Education and Outreach gave presentations at the New Mexico Accredited CME Providers Annual Training Conference held by the New Mexico Medical Society in October and the South Carolina Medical Association CME Provider Workshop held in November.
• Murray Kopelow, MD, ACCME President and Chief Executive, led a session at the 2012 Washington State Medical Association CME Provider Conference held in December.  

ACCME Participates in ABMS, AHA, CMSS Meetings 

The ACCME participated in the following meetings during the past few months as part of its ongoing collaboration with member organizations.  

• Carlyle Chan, MD, member, ACCME Board of Directors, attended the Fall 2012 ABMS Board Congress, held by the American Board of Medical Specialties in September in Chicago. Kate Regnier, MA, MBA, ACCME Deputy Chief Executive and COO, participated in an American Board of Medical Specialties Maintenance of Certification® Committee meeting held in December in Chicago.
• Kate Regnier, MA, MBA, ACCME Deputy Chief Executive and COO, participated in a meeting of the Lifelong Physician Development Stakeholder Workgroup convened by the American Hospital Association (AHA) in October in Chicago.
• Ms. Regnier also participated in the Council of Medical Specialty Societies (CMSS) 2012 Annual Meeting, held in November in Washington, DC. The CMSS is an ACCME member organization. 

CE Accreditors Meeting Focuses on Interprofessional Education, Joint Accreditation 

The ACCME and its colleague accreditors, the (ACPE) and the (ANCC), held a meeting to discuss interprofessional education and the joint accreditation process developed by the three organizations.  The meeting focused on how accreditors could advance interprofessional continuing education in support of interprofessional collaborative practice.  

In February 2013, the three accreditors will host a meeting at the ACCME’s offices in Chicago, Interprofessional Accreditation in Support of Interprofessional Education: An Exploratory Meeting of Accreditors. The inaugural meeting will bring together continuing education accreditors from a variety of health professions to identify areas of alignment among the accreditation systems and opportunities to support interprofessional collaborative practice.  Representatives from the ACCME, ACPE, and ANCC will describe how the joint accreditation process supports interprofessional education and collaborative practice. 

European CME Forum Includes ACCME Presentation 

Murray Kopelow, MD, participated in a panel discussion at the Fifth Annual Meeting of the European CME Forum, held in November in London.  Joining him on the panel were Dr. Edwin Borman, Secretary-General, European Union of Medical Specialists (UEMS)–European Accreditation Council for Continuing Medical Education (EACCME), and Pam Montgomery, PhD, Director, Fellowship & Standards and Deputy CEO, Royal Australasian College of Surgeons.  

The panelists discussed their visions and perspectives of accreditation and CME, based on their experience in their respective countries. Engaging with the audience, they discussed issues including the importance of rigorous accreditation standards, strategies for managing commercial support and conflicts of interest, cross-border recognition of CME, and how to raise the quality of CME.  The ACCME participated in the European CME Forum as part of its ongoing efforts to support collaboration in the global CME community. 

ACCME-Accredited Providers: 2013– 2014 Fee Schedule Posted 

The 2013–2014 fee schedule for ACCME-accredited providers is now available here. Accredited providers should note the following: 

2013 Fee Increases: The ACCME Board of Directors approved 2013 fee increases for services including pre-applications, progress reports, extensions, and conference call accreditation surveys. 

2014 Fee Structure Change: As we previously announced, in 2014, the ACCME is eliminating the reaccreditation fee.  In 2014, the ACCME-accredited provider annual accreditation fee will increase from $3,300 to $5,300. We will continue to assess separate fees for one-time and as-needed services, including pre-applications, initial accreditation, joint accreditation, survey team expenses, extensions, and progress reports. 

2012 ACCME State/Territory Medical Society Conference Concludes a Year of Engagement and Collaboration

The 2012 ACCME State/Territory Medical Society Conference: A Conference of Leaders, held December 12-13 in Chicago, was the culmination of a year of engagement and collaboration between the ACCME and Recognized Accreditors.

The conference addressed strategic opportunities for participants to reposition their CME enterprise as an educational home that provides the resources to support the continuing professional development of their physicians—in alignment with the expectations of physician licensure, certification, and health care reform.  Sessions also provided hands-on training to support state medical society CME accreditation, interpretation, and decision-making under the ACCME Markers of Equivalency and Accreditation Criteria. 

ACCME Participates in Coalition for Physician Accountability Meeting 

Members of the ACCME Board of Directors and executive staff participated in a meeting of the Coalition for Physician Accountability held January 7–8 in Dallas. James F. Burke, MD, Chair, and Carlyle Chan, MD, Vice-Chair, ACCME Board of Directors; and Murray Kopelow, MD, ACCME President and Chief Executive, participated in the meeting, which was hosted by the Federation of State Medical Boards (FSMB). 

The Coalition for Physician Accountability comprises members from the national organizations responsible for the oversight, education, and assessment of medical students and physicians throughout their medical careers. Its purpose is to strengthen the professional self-regulation system through continuous improvement of medical education, assessment, and practice.

ER-LA Opioid REMS CME Critics and the ACCME’s Vigorous Response

Although many praised the Food and Drug Administration (FDA) for releasing its long-awaited Risk Evaluation and Mitigation Strategy (REMS) for extended-release (ER) and long-acting (LA) opioid analgesics, there has been some criticism about the program.   

A REMS is a risk management plan that goes beyond requirements in the drug prescribing information to manage serious risks associated with a drug.  The Food and Drug Administration Amendments Act (FDAAA) of 2007 gave FDA the authority to require companies to develop and implement a REMS when necessary to ensure that the benefits of a drug or biological product outweigh its risks.   

In a recent “Viewpoint” article published in the Journal of the American Medical Association (JAMA), Lewis S. Nelson, MD, of New York University School of Medicine and New York City Poison Control Center, and Jeanmarie Perrone, MD, of the Perelman School of Medicine in Philadelphia, Pennsylvania, asserted two problems with drug companies to provide educational materials to doctors on opioids.   

Background 

The REMS is part of a federal initiative to address the prescription drug abuse, misuse, and overdose epidemic.  The REMS introduces new safety measures designed to reduce risks and improve the safe use of ER/LA opioids, while ensuring access to needed medications for patients in pain.  FDA is requiring a REMS for ER/LA opioid analgesics because FDA has concluded that there is a disproportionate safety problem associated with these products that must be addressed. 

One cause for the opioid problem is that while they used to be prescribed for “severe pain — terrible postoperative pain, terrible preoperative pain of a surgical illness — everything that was related to being close to a hospital and needing a lot of care,” today, opioid analgesics are a “panacea for everything that hurts you.” 

A separate REMS for transmucosal immediate-release fentanyl (TIRF) products was announced in December 2011 and was implemented in March 2012.  Moreover, the latest FDA's long-acting opioid REMS plan runs contrary to the fentanyl product REMS, which mandates education for prescribers, pharmacies, distributors, and patients, they wrote. 

All ER/LA opioid analgesics will be required to have a REMS.  The new ER/LA opioid REMS will affect more than 20 companies that manufacture these opioid analgesics.  Under the new REMS, companies will be required to make education programs available to prescribers based on an FDA Blueprint.  It is expected that companies will meet this obligation by providing educational grants to accredited continuing education (CE) providers to offer training to prescribers at no or nominal cost.  These CE activities must cover the content and messages of a blueprint developed by FDA for this purpose. 

The REMS also will require companies to make available FDA-approved patient education materials on the safe use of these drugs. The companies will be required to perform periodic assessments of the implementation of the REMS and the success of the program in meeting its goals. The FDA will review these assessments and may require additional elements to achieve the goals of the program. 

Debate on Opioid REMS 

Dr. Perrone and Dr. Nelson raised concern about the REMS requirement that manufacturers of ER/LA opioids provide educational materials about the appropriate use of these drugs.  “The propriety of having the pharmaceutical industry develop unbiased education for prescribers and patients is debatable,” they asserted.  This concern is misplaced because the education will be created by independent, accredited, CME providers.  Ignoring all of the CME regulations and firewalls that prevent bias or undue influence, the authors are still concerned about the “financial motivations and creative risk/benefit messaging.” 

They also maintained that while education was a “crucial element of safety, medication guides and related warnings have generally been ineffective in educating patients about the risks associated with certain medications,” the authors add.  This point failed to understand that the central piece of the REMS is education is for doctors prescribing opioids, not patients.   

The fentanyl REMS, on the other hand, requires a patient-prescriber agreement that requires patient education. 

Karen Drexler, MD, associate professor of psychiatry at Emory University in Atlanta, Georgia, maintained that “A black box warning might have more impact.”  Another potential problem identified was the voluntary nature of the REMS for healthcare providers.  “An advisory committee expressed concern that a voluntary process would not likely provide sufficient assurance of knowledge dissemination and retention and instead recommended linking certification, through mandatory testing, to renewal of a prescriber’s Drug Enforcement Administration registration,” the authors write.  While this argument has some merit, there are several states that require opioid-related education or physicians to maintain their licenses.  This argument, however, is problematic, because it is the individual states that must mandate doctors to take pain education, and the goal of FDA’s REMS is for states and CME providers to hopefully incorporate these principles into their state laws, regulations, programs, and requirements.   

The authors cite a recent study that showed that 13.4% of 259 practicing family physicians reported that they would no longer prescribe an opioid if they were required to obtain 4 to 8 hours of training and 2 hours of continued medical education every 2 years, although they would be tolerant of lesser requirements (Slevin et al, J Opioid Manag 2011:7;109-115).  “Mandatory training is something I'm sure most physicians are not going to be happy about,” Dr. Drexler added. 

Dr. Peronne also expressed the need for short-acting opioids REMS that gives warnings about the addictive nature of the drugs even in short-term prescriptions.  “For unclear reasons, a REMS for short-acting opioids has not been publicly proposed despite data suggesting that this opioid formulation is widely associated with nonmedical use,” the authors write.  While Dr. Drexler agreed that the strength of the REMS is that it addresses a whole category of drugs rather than addressing each individual drug, one of its weaknesses is that “it singles out the [ER/LA] opioids and leaves out other members of the opioid analgesic class.”  FDA, however, maintained that it took this approach due to the disproportionate problem with the long-acting opioids. 

Response from the ACCME 

Dr. Murray Kopelow, Chief Executive of the Accreditation Council for Continuing Medical Education (ACCME), respectfully responded to this editorial by noting that the opinions on CME “should be based on the best available information.”  He asserted how accredited CME “providers are required to meet rigorous standards designed to ensure actual—not ostensible— independence.  Providers must comply with the ACCME’s Standards for Commercial Support when offering any accredited activities, including those related to the REMS for long-acting and extended-release opioid analgesics. 

He explained how these Standards “require CME providers to design activities that are independent, free from commercial bias, and based on valid content. Providers must ensure that all content- related decisions are made free of the control of commercial interests.  The ACCME believes that CME can receive commercial support from industry without receiving any advice or guidance, either nuanced or direct, on the content of the activity or on who should deliver that content.” 

Kopelow also recognized how accredited CME providers “have more than 20 years of experience managing the boundary issues created by commercial support,” and the Standards “have become a national model” for numerous other health professional groups.   

He also reiterated how FDA’s ER/LA REMS requires opioid manufacturers to offer accredited continuing education (CE) grants to produce education based on the blue print, and “explicitly state[s] that manufacturers are prohibited from having any input or influence over educational design or curriculum.”  Further, he points out how the blueprint says that “accrediting bodies and CE providers will ensure that the CE activities developed under this REMS will be in compliance with the standards for CE of the Accreditation Council for Continuing Medical Education (ACCME) or another CE accrediting body.” 

Martin Grabois, MD, and Lynn R. Webster, MD, the president and president-elect of the American Academy of Pain Medicine, respectively, also responded to the Viewpoint.  They recognized that while there is a potential for bias in industry funded CME, the current system includes only two sources for funding: government and industry.   

However, we are completely unaware of any kind of funding from the government to provide CME whatsoever.  If any such funding exists, it is likely extremely limited and probably has significant restrictions and administrative burdens.  In fact, we noted last year that the Department of Defense had to close its CME office.   

Nevertheless, Grabois and Webster are correct in recognizing that the authors “did not advocate for pragmatic solutions.”  Instead, they went for the low-hanging fruit of critizing industry support, when as Grabois and Webster correctly note, it is “the best idea to come forward because for now it is the only idea to come forward.”  Given the issues America faces funding numerous aspects of health care reform, and the complete absence of any mention of continuing education in the Affordable Care Act, it is highly likely that no funding for government for CME, or specific to opioids will ever emerge.  

Congress and FDA have negotiated for 25 years now regarding user fees to help expedite the drug approval process, and every five years included new requirements and added regulations to ensure safety.  This process of industry-funded agencies has largely succeeded, and perhaps the only true way to get more education is establishing in the next User Fee negotiations a more formal CME funding process. 

Problems for Psychiatrists  

Dr. Drexler noted that while the REMS is for all prescribers, for psychiatrists, it presents “additional challenges.”  For example, “one of the directions to prescribers is to make sure that you do a thorough history and physical examination and that you really understand the source of the pain and individualize the treatment before you prescribe any of these [ER/LA] opioids.”  But most psychiatrists don’t have an examination room in theirr office suite, and it may have been years perhaps since they have done a thorough physical examination, Drexler said.  She noted that frequently, patients ask psychiatrists to write prescriptions for opioids if they are having pain and haven't been able to see their internist or pain medicine specialist.  These are the cases where psychiatrists must be “especially cautious” to prescribe opioids without all the information they need.   

The other caution for psychiatrists, said Dr. Drexler, is to be aware of what other medications patients are taking.  “We do prescribe sedative hypnotics that can combine with opioids [and that can] lead to overdose deaths.  Adequately screening as best we can for high-risk alcohol use is also important because alcohol can combine with opioids and sedative hypnotics and lead to overdose deaths.” 

Dr. Perrone and Dr. Nelson also believe now is an ideal time to “inventory the evidence” for the efficacy and risks associated with opioid drugs for chronic non-cancer pain and moderate pain and to revise existing labeling to reflect the current clinical science and risk-benefit profile. 

It will also be important to “minimize the burden on physicians and the health care system by implementing a REMS that does not compromise patient care,” write Dr. Perrone and Dr. Nelson.  “For example, physicians may avoid prescribing a drug if they are unwilling or unsure of how to meet the REMS requirements.  This may result in increased prescribing of drugs that are not part of a REMS,” they add. 

Despite these concerns, the authors were “optimistic that the [REMS] is the first of several steps needed to enhance safe prescribing of these powerful drugs.”  

A better option, Nelson and Perrone wrote, would be to tie opioid education to certification via mandatory testing for renewal of a physician's DEA registration.

Although Nelson and Perrone assailed the FDA's recent action, they also cautioned that if the REMS is too restrictive, it may lead prescribers to choose other drugs not part of a REMS -- such as short-acting opioids like Vicodin, a hydrocodone combination product. 

The best option is to see how this first REMS works out before we go on a giant hunt to find alternatives to a program not yet tried.

AMA CEJA: AMA House of Delegates Passes Clarification to Align with ACCME Standards for Commercial Support

The American Medical Association (AMA), held it’s Interim Meeting, where the House of Delegates discussed, debated, and voted on several important recommendations.

Of importance to our readers and stakeholders in  continuing medical education (CME) community, the house also clarified the AMA’s ethical guidance on CME—the Council on Ethical and Judicial Affairs (CEJA) Report 1-A-11.  Specifically, CEJA recommended that Opinion E-9.011, which was last updated in 1996, be amended because “CME has evolved substantially, as have standards for the conduct of CME providers, such as those of the ACCME.”  In addition, CEJA pointed to its 1-A-11 Report, adopted in June 2011 and subsequently Opinion E-9.0115, as “developments” that led to updating E-9.011.  

The revisions to E-9.011 were made to ensure consistency among Opinions in the Code of Medical Ethics, to avoid unnecessary repetition of guidance set out in AMA policies and other standards for CME.  Revisions were developed in consultation with the Council on Medical Education.  The majority of the recommendations and changes made are consistent with the CEJA Report 1-A-11 from June 2011, and are also consistent with ACCME Standards for Commercial Support. 

The Guidelines for physician-attendees were edited for clarity, including replacing cross-references to E-8.061, “Gifts to Physicians from Industry,” with explicit guidance regarding subsidies for expenses of attending CME activities.  

Specifically, the modified position urges physicians to “decline any subsidy offered by a commercial entity other than the physician’s employer to compensate the physician for time spent or expenses of participating in a CME activity.” 

As a point of clarification this is already the practice for CME providers in certified CME.  While industry support of CME may allow physicians and health care providers to attend CME events for reduced registration costs—CME programs with commercial support are prohibited from using funds to fund a physician’s travel or expenses for a CME activity.  The Accreditation Council for Continuing Medical Education (ACCME) Standards for Commercial Support explicitly prohibit such activities, Specifically, Standard 3.12 states that: 

The [CME] provider may not use commercial support to pay for travel, lodging, honoraria, or personal expenses for non-teacher or non-author participants of a CME activity. The provider may use commercial support to pay for travel, lodging, honoraria, or personal expenses for bona fide employees and volunteers of the provider, joint sponsor or educational partner.  

In addition, Standard 3.9 states that “No other payment shall be given to the director of the activity, planning committee members, teachers or authors, joint sponsor, or any others involved with the supported activity.  Standard 3.10 states that “If teachers or authors are listed on the agenda as facilitating or conducting a presentation or session, but participate in the remainder of an educational event as a learner, their expenses can be reimbursed and honoraria can be paid for their teacher or author role only,”—thus their participation cannot be reimbursed.    

Industry trade codes, such as those by PhRMA and AdvaMed, as well as many professional medical associations, also have similar policies. 

Moreover, if a CME company who received support from a pharmaceutical company for an educational grant, paid for the travel or expenses to attend an activity, the federal government could view such payments as a “kickback” to the physician that induces him or her to prescribe the company’s drugs.   

What may be problematic about this newly adopted position is continuing education or training for medical devices.  As we have covered several times, the training of physicians on medical devices is highly technical and requires physicians to sometimes travel to a manufacturer to obtain the best form of education—often by the creator or innovator that invented the device.  If this newly adopted position does not provide flexibility for medical device training, the education of physicians may suffer due to the prohibitive costs that travel and lost patients may have.   

Other Recommendations  

Guidelines for faculty and sponsors were also updated to remove specific references to guidance from other entities (e.g., Accreditation Criteria, Standards for Commercial Support and related policies of the ACCME; Guidance on industry-supported educational activities from the FDA; and Code on Interactions with Healthcare Professionals of PhRMA). 

CEJA acknowledge that “Physicians should strive to further their medical education throughout their careers, to ensure that they serve patients to the best of their abilities and live up to professional standards of excellence.” 

Participating in formal CME activities is “critical to fulfilling this professional commitment to lifelong learning.”  As attendees of CME activities, physicians should: 

a)    Select activities that are of high quality and are appropriate for the physician’s educational needs.

b)    Choose activities that are carried out in keeping with ethical guidelines and applicable professional standards.

c)    Claim only the credit commensurate with the extent of participation in the CME activity.

d)    Decline any subsidy offered by a commercial entity other than the physician’s employer to compensate the physician for time spent or expenses of participating in a CME activity. 

Physicians should strive to further their medical education throughout their careers, for only by participating in CME can they continue to serve patients to the best of their abilities and live up to professional standards of excellence.  Fulfillment of mandatory state CME requirements does not necessarily fulfill the physician’s ethical obligation to maintain his or her medical expertise. 

Attendees.  

Guidelines for physicians attending a CME conference or activity are as follows: 

(1)  The physician choosing among CME activities should assess their educational value and select only those activities which that are of high quality and appropriate for the physician’s educational needs.  When selecting formal CME activities, the physician should, at a minimum, choose only those activities that

(a)  are offered by sponsors accredited by the ACCME, the American Academy of Family Physicians (AAFP), or a state medical society;

(b)   contain information on subjects relevant to the physician’s needs;

(c)  are responsibly conducted by qualified faculty;

(d)  conform to Opinion 8.061, “Gifts to Physicians from Industry.”

(2)  The educational value of the CME conference or activity must be the primary consideration in the physician’s decision to attend or participate. Though amenities unrelated to the educational purpose of the activity may play a role in the physician’s decision to participate, this role should be secondary to the educational content of the conference.

(3)  Physicians should credit commensurate with only the actual time spent attending a CME activity or in studying a CME enduring material.

(4)  Attending promotional activities put on by industry or their designees is not unethical as long as the conference conforms to Opinion 8.061, “Gifts to Physicians from Industry,” and is clearly identified as promotional to all participants. 

Faculty. 

Guidelines for physicians serving as presenters, moderators, or other faculty at a CME conference are as follows: 

(1)  Physicians serving as presenters, moderators, or other faculty at a CME conference should ensure that

(a)  research findings and therapeutic recommendations are based on scientifically accurate, up-to-date information and are presented in a balanced, objective manner;

(b)  the content of their presentation is not modified or influenced by representatives of industry or other financial contributors, and they do not employ materials whose content is shaped by industry. Faculty may, however, use scientific data generated from industry-sponsored research, and they may also accept technical assistance from industry in preparing slides or other presentation materials, as long as this assistance is of only nominal monetary value and the company has no input in the actual content of the material.

(2)  When invited to present at non-CME activities that are primarily promotional, faculty should avoid participation unless the activity is clearly identified as promotional in its program announcements and other advertising.

(3)  All conflicts of interest or biases, such as a financial connection to a particular commercial firm or product, should be disclosed by faculty members to the activity’s sponsor and to the audience. Faculty may accept reasonable honoraria and reimbursement for expenses in accordance with Opinion 8.061, “Gifts to Physicians from Industry.” 

Sponsors 

Guidelines for physicians involved in the sponsorship of CME activities are as follows: 

(1)  Physicians involved in the sponsorship of CME activities should ensure that

(a)  the program is balanced, with faculty members presenting a broad range of scientifically supportable viewpoints related to the topic at hand;

(b)  representatives of industry or other financial contributors do not exert control over the choice of moderators, presenters, or other faculty, or modify the content of faculty presentations. Funding from industry or others may be accepted in accordance with Opinion 8.061, “Gifts to Physicians from Industry.”

(2)  Sponsors should not promote CME activities in a way that encourages attendees to violate the guidelines of the Council on Ethical and Judicial Affairs, including Opinion 8.061, “Gifts to Physicians from Industry,” or the principles established for the AMA’s Physician Recognition Award. CME activities should be developed and promoted consistent with guideline 2 for Attendees.

(3)  Any non-CME activity that is primarily promotional must be identified as such to faculty and participants, both in its advertising and at the conference itself.

(4)  The entity presenting the program should not profit unfairly or charge a fee which is excessive for the content and length of the program.

(5)  The program, content, duration, and ancillary activities should be consistent with the ideals of the AMA CME program.

 

ACCME Video Strategies for CME to Make a Difference

Accreditation Council for Continuing Medical Education (ACCME) recently released a short video describing how CME providers can improve their outcomes.  The video, which included ACCME Chief Executive Murray Kopelow, discussed ACCME Criteria 18, 19, and 20 as opportunities to ensure CME makes a difference.   

In Criteria 18, CME providers are asked to identify factors outside their control that impact on patient outcomes.  Kopelow said that providers need to ask what is causing the outside factors; in other words, what else besides what the doctors know or the doctors do is causing this?  

Criteria 19 says, providers implement educational strategies to remove, overcome or address barriers to physician change.  Kopelow noted several questions CME providers must ask: 

• What is blocking your effectiveness?  
• What is it that is out there that’s preventing your educational intervention of getting these docs, who now know how to do something, to go out and change?  
• What is it that we need to remove, overcome or address so that the doc can go out and care for the patients the way we are teaching them to?  

In response to these questions, he noted that one strategy to overcome these challenges is Criteria 20: building bridges with other stakeholders through collaboration and cooperation.  He said that CME providers should go out and find people in organizations that can help CME do better, that can help CME help the physicians provide better care.  

In summary, he noted three questions and three Criteria. 

• Criteria 18: What else is causing our problems and preventing changes in patient outcomes?
• Criteria 19: What’s blocking our effectiveness, so, what other educational strategies can we put into place to remove barriers to physician change? and
• Criteria 20: find people in organizations that can help us, can help CME do a better job.

ACCME July 2012 Board of Directors Meeting Summary

The Accreditation Council for Continuing Medical Education (ACCME) recently released its August 2012 newsletter.  The newsletter addresses a number of important topics for continuing medical education (CME) providers and stakeholders including, but not limited to: 

• A summary of the ACCME Board of Directors July 2012 Meeting;
• Simplified requirements for communicating information in Internet CME activities and Enduring Materials; and
• The Food and Drug Administration’s (FDA) issuance of a final Risk Evaluation and Mitigation Strategy (REMS) for Extended-Release/Long-Acting Opioid Analgesics 

July 2012 ACCME Board of Directors Meeting 

Held July 26-27, the Board ratified 61 accreditation and reaccreditation decisions, including 20 providers (33%) that received Accreditation with Commendation, which confers a 6-year term of accreditation—this included the Potomac Center for Medical Education (PCME).   As of July 2012, there are 702 ACCME-accredited providers and 1,338 providers accredited by ACCME Recognized Accreditors (state or territory medical societies that accredit local organizations offering CME).  In addition: 

• Twenty-three (38%) received Accreditation; 18 of these providers (30%) are required to submit progress reports; 5 (8%) do not need to submit progress reports.
• Nine providers (15%) were placed on Probation and are required to submit progress reports.
• All of the 9 initial applicants received Provisional Accreditation (15% of the total; 100% of initial applicants). 

The Board ratified 28 progress report decisions.  Of those, 23 (82%) progress reports demonstrated compliance with all ACCME requirements previously found not in compliance, and were accepted.  Four progress reports (14%) failed to demonstrate compliance in all requirements and the providers are required to submit another progress report. One progress report decision (4%) was deferred. 

For those who criticize CME providers, particularly those that accept commercial support, this summary should provide sufficient evidence that the ACCME not only has appropriate firewalls to protect against undue influence or bias, but that the ACCME also engages in significant oversight of providers and enforces its rules and regulations, including its Standards for Commercial Support (SCS).  With 15% of providers being placed on probation and another 30% being required to submit progress reports, it is clear that the ACCME takes compliance very seriously.   

The Board also convened conversations with leadership from the recognized state/territory medical society CME accreditation system to discuss the evolution, standards, expectations, obligations, challenges, and opportunities facing accredited CME.  The Board asked participants about the value their accreditation program brings to their state, about the value of ACCME support and services, and how the ACCME can continue to support their accreditation programs.   

Participants included ACCME member organization liaisons; members of the Committee for Review and Recognition (CRR); and CEOs, executive leadership, and staff from 38 recognized state/territory medical societies. The conversations were part of the Board’s ongoing process for facilitating the implementation of the ACCME 2011 strategic imperatives: Foster ACCME Leadership and Engagement; Evolve and Simplify the Accreditation Standards, Process, and System; Explore and Build a More Diversified Portfolio of ACCME Products and Services. 

Internet-based CME and Enduring Materials: Modifying Communication Requirements  

In response to questions from accredited providers and technological advancements, the Board re-examined its requirements regarding the communication of information to learners as described in the Internet CME and Enduring Materials policies.  The Board agreed to simplify its interpretation of the requirements because of the evolution of technology and learners' increasing familiarity with technology.   

The Internet CME and Enduring Materials policies require providers to communicate to learners information such as the activity’s principal faculty and their credentials, estimated time to complete the activity, hardware/software requirements, the providers' privacy and confidentiality policy, and other information. The policies state that this information must be communicated to learners prior to the activity.  Previously, the ACCME has interpreted “prior to the activity” to mean that learners must be made to pass through the information.  The ACCME did not consider it acceptable for providers to use optional links in electronic CME activities that allowed learners to go directly to the CME content and bypass the information required by the Internet CME and Enduring Materials policies. 

ACCME will now be acceptable, in effect immediately, for providers to choose from various electronic means, such as tabs, links, “click here” buttons or rollover text, or other electronic means to make the required information accessible.  The Board recognized that the use of tabs or links to disseminate information is now the online standard.   

For CME activities in which the learner participates electronically (e.g., via the Internet), all required information specified in the ACCME’s Enduring Materials: Definition and Requirements Policy and the Internet CME Policy must be made accessible to the learner prior to the learner beginning the CME activity.  

This modification does not apply to disclosure information required in the Standards for Commercial Support 6: Disclosures Relevant to Potential Commercial Bias to the learner prior to the beginning of the CME activity.  Learners must be made to pass through the information in order to engage in the CME activity.  The use of tabs, links, or other electronic means that allow learners to go directly to the CME content and bypass the information are not acceptable methods for complying with Standard for Commercial Support 6.  The ACCME has provided Q&A to explain the modified requirements.  

ACCME’s Decision-Making Process: Ensuring Consistency and Accuracy

The Board heard a report from the Quality Improvement Committee about an audit of the ACCME's decision-making process for the July 2012 cohort, which included an analysis of the internal controls the ACCME employs to ensure the consistency and accuracy of decision-making.  The Board agreed that the ACCME’s internal controls are effective in supporting valid and consistent accreditation decisions.  The Board will continue to monitor and improve, where necessary, its internal controls.  This most recent audit builds on the work of the Board of Directors 2010 Monitoring Task Force which spent a year reviewing and analyzing the ACCME’s internal controls and determined that the process for ensuring the consistency and fairness of accreditation decision-making should continue to be a high priority. 

ACCME 2012 Bylaws  

In accordance with ACCME bylaws, the revised bylaws became effective July 22, 2012. The ACCME updated its documents and policies to support implementation of the 2012 bylaws. 

FDA Releases REMS for Extended-Release/Long-Acting Opioids 

As we reported back in July, FDA released its REMS for extended-release and long-acting (ER/LA) opioid analgesics.  The centerpiece of the ER/LA Opioid Analgesic REMS is a prescriber education program about the risks of opioid medications as well as safe prescribing and safe use practices.  The FDA developed and issued a blueprint, which contains the core educational messages. The education will be controlled, designed, and delivered by accredited continuing health care education providers, based on the blueprint.  The first page of the blueprint says that “accrediting bodies and CE providers will ensure that the CE activities developed under this REMS will be in compliance with the standards of the ACCME or another CE accrediting body.” 

The education will be funded by a consortium of opioid manufacturers, the REMS Program Companies (RPC), through educational grants to accredited CE providers, so that it is available free of charge or at nominal cost to prescribers.  “We appreciate that the FDA recognizes the value of accredited education and chose to leverage the CE system to carry out this important public health initiative,” said Murray Kopelow, MD, ACCME President and CEO, in an audio commentary.  “Accredited CME providers can base their activities on the blueprint and be in compliance with the ACCME Standards for Commercial Support.” 

ACCME Participates in AMA, ABMS, AAMC Meetings 

The ACCME participated in several meetings during the past few months as part of its ongoing collaboration with member organizations. Through joint leadership initiatives, the ACCME and member organizations identify and implement strategies for improving physicians' continuing professional development and patient care.  For example, the ACCME participated in a meeting of the Coalition for Physician Accountability held in August in Philadelphia.  They also participated in a meeting hosted by the Educational Commission for Foreign Medical Graduates. The Coalition comprises national organizations responsible for physician assessment, accreditation, licensure, and credentialing.  

ACCME Awards Potomac Center for Medical Education Accreditation with Commendation

The Potomac Center for Medical Education (“PCME”) was awarded Accreditation with Commendation as a provider of Continuing Medical Education (CME) by the Accreditation Council for Continuing Medical Education (ACCME).  PCME, the accredited division of Rockpointe Corporation (“Rockpointe”), is also accredited by the Accreditation Council for Pharmacy Education (ACPE), to provide continuing education to pharmacists and pharmacy technicians.  PCME is a leader in CME and aims to have the highest impact on healthcare by improving physician practice, and subsequently, improving patient outcomes.  This achievement grants PCME accreditation through July 2018. 

“PCME is honored to receive this recognition and we are proud of our role in providing the highest quality continuing education in a number of therapeutic areas,” said Jay Katz, CEO of Rockpointe.   “This recognition underscores PCME’s true mission to change physician behavior and enhance physician knowledge through cutting edge CME programs so that patients can receive better care and healthcare providers remain informed on the latest breakthroughs, clinical information, and treatments.” 

Accreditation with Commendation is earned by a small but growing cadre of applicants, and is ACCME’s highest accreditation award status.  PCME demonstrated compliance across all 22 of ACCME’s accreditation criteria, signifying PCME’s commitment to CME excellence, which underscores the educational programs PCME designs to improve physician knowledge, competence, performance, and patient outcomes.  PCME is one of only a handful of for-profit medical education providers to receive Accreditation with Commendation; the overwhelming majorities are academic medical centers and medical societies.  

In a letter from ACCME Chief Executive Murray Kopelow, M.D., he gratulated PCME on “this significant achievement in CME” and commended PCME for their “commitment to excellence.”  Kopelow recognized that PCME has “demonstrated an engagement with your environment in support of physician learning and change that is part of a system for quality improvement.”  One ACCME reviewer recognized that PCME “integrates into its activities learning strategies and quality assessment tools that aid physicians in translating what they learn into their respective clinical practices” 

In order to be awarded Accreditation with Commendation, accredited providers must demonstrate compliance with the ACCME’s base criteria 1-15, as well as the ACCME’s commendation criteria 16-22.  PCME’s CME program is built on an instructional design process that identifies barriers and through collaboration, engages with the larger healthcare system to improve quality and the professional practice of physicians.  For example, physicians who participated in a live, half-day, case-based, multi-format CME workshop, created by Rockpointe and accredited by PCME, were 50% more likely to provide evidence-based care for chronic obstructive pulmonary disease (COPD) than those who did not participate.  These results were published in the International Journal of COPD and the outcomes were also presented at Chest 2010, the annual meeting of the American College of Chest Physicians. 

Additionally, physicians who attended a live, highly intensive, case-based educational initiative created by Rockpointe and accredited by PCME were 52% more likely to practice guideline-driven and evidence-based medicine for hypertension than those who did not participate in the CME activity.  The outcomes of this successful program were published in the Journal of Clinical Hypertension.  These two programs are just a few examples of how PCME’s programs improve patient outcomes, as well as change physician behavior. 

With more than 15 years of experience ensuring successful program implementation and outcomes measurement, PCME’s CME program employs Best Practice processes that guide design and implementation of CME content that links quality and education to practice improvement.  The education developed is not only interactive and engaging, but rigorously reviewed to ensure objectivity, scientific rigor, and absence of commercial influence.  

PCME’s CME-certified activities have the ability to reach physicians where they practice and treat patients, whether through grand rounds, local and regional meetings, meetings in conjunction with association meetings, or websites and journals (enduring education).  PCME will certify over 500 local meetings in 2012 alone.  PCME is honored to have achieved Accreditation with Commendation and will continue its dedication to excellence with each CME activity and each learner, as they strive to improve clinical behavior, one change at a time.

ACCME Annual Report Data 2011

The Accreditation Council for Continuing Medical Education (ACCME) published its 2011 Annual Report Data, which includes data on the size and scope of the continuing medical education (CME) enterprise nationwide.  

The report shows that in 2011: 

• CME Economy declined by 1.1% to $2,349,580,281
• Commercial support for CME decreased by 11.1%, by $93,776,050 less than 2010
• Commercial support now represents 32% of the total CME funding, down from 46% of total funding in 2007.
• Physician attendance decreased by .05%,72,747 attendees, to 13,741,621
• Non Physician attendance increased by 1.0%, 93,894 attendees, to 9,558,789
• 38% of attendees participated in courses produced by Publishers/MECS, 30% courses by universities and 28% from hospitals.
• 37% of physicians attended regularly scheduled events such as grand rounds, followed by 34% received credit for internet enduring materials, 16% for courses, and 9% for Journal CME.

For the first time, the 2011 Annual Report Data aggregates state and national statistics, including total numbers of accredited CME providers, activities, hours of instruction, and participants.  This data shows that there are more than 2,000 accredited CME providers across the country that offered more than 130,000 activities in 2011, almost a 5% increase from 2010.  Accredited CME providers report that their 2011 activities educated more than 23 million participants including more than 13 million physicians and more than 9 million nonphysician health care professionals.   

In addition, the 2011 Annual Report Data features separate data sets about the CME delivered by ACCME-accredited providers and by state-accredited providers, offering an overview of the CME system at both the national and state levels. 

The ACCME directly accredits providers that offer CME primarily to national or international audiences of physicians and other health care professionals. The ACCME also recognizes state and territory medical societies as accreditors for providers that offer CME primarily to learners from their state or contiguous states. All accredited providers within the ACCME accreditation system are held to the same high standards and are required to report information about their programs that the ACCME collects and analyzes in order to produce annual report data. 

The 2011 Annual Report Data includes an overview of commercial support received by ACCME-accredited providers. The data shows commercial support distribution by numbers and types of activities, hours of instruction, and participants. The ACCME is able to publish this commercial support overview because of the Program and Activity Reporting System (PARS). Launched in 2010, PARS is a Web-based portal designed to centralize and streamline the collection, management, and analysis of program and activity data from accredited CME providers. The structure of PARS and the CME community’s adoption of PARS enable the ACCME to produce new information.  

The 2011 Annual Report Data marks the 14th year the ACCME has been collecting, analyzing, and publishing information about accredited providers, and offers more than a decade-long perspective on the evolution of the ACCME accreditation system. The annual data reports are produced as a service to accredited providers and other stakeholders.  ACCME Chief Executive Murray Kopelow, MD, commented on the release of 2011’s report.  

2011 Report

The ACCME made changes to the way they reported previous year's data to include information from ACCME accredited and state accredited providers.  So earlier versions of our analysis included previously published data from previous year's that is different than the previous years data published in this year's report.  We have subsequently fixed the data to match the ACCME changes. 

The total income of the CME industry decreased by $25,314,668, -1.1% to $2,349,580,281 between 2010 and 2011, the total income has decreased by  $335,542,016 and 12.5% since 2007.  Commercial support of CME continued to decline, by $93,776,050, this represents an 11.1% reduction from $846,182,688 in 2010 to $752,406,638 in 2011and a total reduction of a full $496,518,234, -39.8% since 2007.  

Making up for some of this lost income, however, were increases in Advertising/Exhibits (7.0% in 2011 and 8.0% since 2007) and Other Income (3.9% in 2011 and 11.8% since 2007).

According to the ACCME, Other income represents income other than commercial support and advertising and exhibits income; for instance, participant registration fees, and allocations from a provider's parent organization or other internal departments.

 

Commercial support now represents only 32% of the total CME enterprise, a 11.1% decline since 2010 and a 39.8% decline since 2007. 

Publisher/MEC

For publishing/medical education companies, total income increased 2.4%, however, total income since 2007 has decreased 35.3%.  Commercial support declined 8.9% in 2011 and has declined a whopping 58.3% since 2007.  Moreover, whereas commercial support was 71.5% of the enterprise in 2007, it was 46.1% in 2011.  The income has increased minimally in advertising and exhibits (3.2% in 2011) and other income (50.7% in 2011).

 

Medical Schools

For schools of medicine (universities), total income decreased 4% in 2011.  Commercial support declined 13.3% in 2011 and 17.9% since 2007.

Associations/Nonprofits

For Nonprofits (physician membership organizations and other non profits), total income increased 0.7%, however, it has decreased 2.7% since 2007.  Commercial support decline 10.7% in 2011 and has declined 36.9% since 2007.

The number of activities, total hours of instruction, and total physician participants have continued to increase since 2007. 

 

Type of Activity

The grand total types of activities supported directly by accredited CME providers are broken down below: 

• Courses: 49,644 activities, with 287,793 hours of instruction and 1,673,014 physician participants
• Regularly scheduled series: 20,780 activities, with 416,814 hours and 4,403,799 physician participants
• Internet (enduring materials): 18,569 activities, with 39,163 hours of instruction, and   3,568,207 physician participants
• Enduring materials (other): 6,310 activities, with 33,471 hours of instruction and 1,131,683 total physician participants
• Journal CME: 3,537 activities and 883,972 physician participants

Activities by Organization

The total numbers of directly sponsored activities based on type of CME provider and the top three formats of CME offered are as follows:

•  Hospital/health care delivery system: 44,982 activities.  Courses (24,414); Regularly scheduled series (13,784); internet (enduring materials) (3,390)
• School of medicine: 17,100 activities.  Courses (7,769); Regularly scheduled series (6,208); internet (enduring materials) (2,249)
• Publishing/education company: 16,916 activities.  Courses (4,811); internet (enduring materials) (7,980); enduring materials other (3,272)
• Nonprofit (physician membership organization): 12,405 activities.  Courses (5,169); internet (enduring materials) (3,021); enduring materials (other) (1,150); journal CME (2,464)
• Government or Military: 3,362 activities.  Courses (2,511). Most hours as well for courses (22,962).

 Overall, Courses were the most popular format for offering directly sponsored CME (49,644); followed Regularly scheduled series (20,780); internet (enduring materials) (18,569); enduring materials (other) 6,310; and Journal CME (3,537).

Hours of Instruction

Overall, Regularly scheduled series offered the most total hours of instruction for directly supported CME (416,814), followed by courses (287,793); and internet (enduring materials) 39,163.  The breakdown by type of CME provider is as follows:

• Hospital/health care delivery system: 314,214 hours; most hours are Regularly scheduled series (211,633)
• School of medicine: 273,489 hours; most hours Regularly scheduled series (193,045)
• Nonprofit (physician membership organization): 92,417 hours; most hours courses (57,983)
• Publishing/education company: 52,681 hours; most hours courses (23,169); internet (enduring materials) (10,497); enduring materials (other) (14,386)
• Government or Military: 25,435 hours; most hours courses (22,962)
• Non-profit (other) 18,692 – most hours courses (12,190)

Physician Participants

Below is the number of total physician participants attending CME programs based on the provider of the CME. 

• Publishing/education company: 3,776,293 participants; most participants: internet (enduring materials) 2,638,619; enduring materials (other) 812,492; courses (136,312)
• Hospital/health care delivery system: 3,053,328 participants; most participants: Regularly scheduled series (2,194,391); courses (48,532); internet (enduring materials) 150,218
• School of medicine: 2,520,108 participants; most participants Regularly scheduled series (2,090,214); courses (242,817); internet (enduring materials) 158,200
• Nonprofit (physician membership organization): 1,965,699 participants; most participants journal CME (682,359); courses (625,027); internet (enduring materials) 357,280

 For jointly sponsored events, the total physician participants are as follows:

• School of medicine : 911,800 participants; most participants internet (enduring materials) (592,096); Regularly scheduled series (150,420); courses (119,825)
• Publishing/education company: 376,041 participants; most participants journal CME (225,544); internet (enduring materials) 87,856; courses (35,090)
• Nonprofit (physician membership organization): 247,121 participants; most participants courses (151,458); internet (enduring materials) (61,510); Regularly scheduled series (15,158)
• Hospital/health care delivery system: 178,323 participants; Regularly scheduled series (92,041); courses (64,254); internet (enduring materials) (18,518)
• Non-profit (other): 49,480 participants

 

Overall, publishing/education companies have the most physician participants (4,152,334) followed by: 

• School of medicine – 3,431,908
• Hospital/health care delivery system – 3,231,651
• Nonprofit (physician membership organization) – 2,212,820
• Non-profit (other) – 322,585
• Not classified – 170,103
• Insurance company/managed care company – 127,645
• Government or Military – 92,575

 

Commercial Support Reporting

Through 2010, ACCME-accredited and state-accredited providers reported the monetary value of in-kind commercial support they received, and included that amount in their total commercial support numbers.  Beginning in 2011, due to a modification in ACCME commercial support reporting requirements, accredited providers no longer included the monetary value of in-kind support and reported only the dollar values for funds actually received. The nature (required) and source (optional) of in-kind commercial support is now reported qualitatively.  Examples of in-kind commercial support include equipment, supplies, facilities, and other nonmonetary resources provided by a commercial interest in support of the CME activity. Therefore, comparisons between 2011 commercial support numbers and previous years will not be valid.   

The total commercial support with monetary value of in-kind commercial support excluded is as follows:

•  Publishing/education company – $248,015,575
• School of medicine – $201,688,456
• Nonprofit (physician membership organization) – $124,913,669
• Not classified – $64,363,362
• Non-profit (other) – $60,471,672
• Hospital/health care delivery system – $52,568,251
• Insurance company/managed care company – $348,502
• Government or Military – 37,150

 

ACCME-Accredited Providers Only

The following numbers apply only to ACCME-accredited providers.  In 2011, other income made up 53% of total income, commercial support 33%, and advertising and exhibits 13%. Other income has increased steadily over the years with an increase of 4 percent in 2011 from 2010. 

There are 687 ACCME-Accredited providers.  The number of ACCME-accredited providers grew steadily until 2007. The ACCME lost 49 providers (7%) since 2007, including 7 providers (1%) between 2010 and 2011. Most of the loss in numbers has been from the following provider types: nonprofit physician membership organizations, publishing/education companies, and hospital/health care delivery systems. The numbers of schools of medicine, government or military providers, and insurance/managed-care companies has remained fairly steady. There has been a small decrease in nonprofit other providers and a slight increase in the number of not classified organizations. 

When providers voluntarily withdraw their ACCME accreditation, the ACCME ascertains the reason whenever possible.  The most common reason providers give is corporate changes, such as mergers and acquisitions. In addition, smaller providers sometimes withdraw because they have decided to offer CME through partnerships (joint sponsorships) with larger accredited providers.  For that reason, the decline does not necessarily represent a reduction in physicians’ and other health care professionals' access to CME.  The number of physician and nonphysician participants in CME activities has increased steadily over the years, although participant numbers remained virtually flat between 2010 and 2011. The numbers of activities and hours of instruction increased between 2010 and 2011. 

The majority of providers (80%) bring in $1 million or less each year in commercial support, with almost half of providers (48%) bringing in $100,000 or less. One-fifth of providers (20 %) bring in more than $1 million per year in commercial support, with the smallest percentage of those (2%) bringing in $10 million or more. 

Data showed the percentage of revenue that each provider type receives from commercial support, the percentage of activities receiving commercial support by provider type, and the total hours of instruction (with commercial support) offered by provider type, represented by the circle size.  Data showed that nonprofit physician membership organizations receive the smallest percentage of their revenue from commercial support and produce the smallest percentage of commercially supported activities (excluding government or military providers—see note), while not classified providers receive the largest percentage of their revenue from commercial support and produce the largest percentage of commercially supported activities, although they offer fewer overall hours of instruction.  

Medical schools receive about half of their income from commercial support, about 20% of their activities are commercially supported, and they produce the most overall hours of instruction.  Commercial support accounted for fewer than 1% of activities and less than 1% of total revenue for government or military providers.

In 2011, the majority of CME activities (79%) did not receive commercial support, accounting for approximately 80% of physician participants, and 75% of nonphysician participants. Twenty-one percent of CME activities did receive commercial support, bringing in approximately 20% of physician participants, and 25% of nonphysician participants. 

Comment 

The CME Economy is still in a slow decline, which given the current financial circumstances hopefully we may be nearing a bottom.  The trend for the reduction in commercial support by companies fails to take into account that those resources and courses supported by industry may no longer be in existence or available to clinicians.  There is a down side potential for physicians not getting the latest information on therapies that could potentially save patients lives.    

By performance, we can see from this report that the Medical Communication Companies are becoming the engine for this market sector and have been able to reach the largest number of clinicians.