In this month’s Continuing Physician Professional Development (CPPD) report, the American Medical Association (AMA) discussed a number of topics related to continuing medical education (CME), including the results of a recent survey, actions from the AMA House of Delegates, “Get the Facts Campaign!” factsheet, and CME-related events. A number of these activities and actions, including changes to the AMA PRA credit system, were previously reported.
At the 2009 Annual Meeting of the House of Delegates (HOD), the AMA heard concerns, as articulated in Resolution 302 (A-09), that the number of state-accredited continuing medical education (CME) providers may be declining. One of the reasons cited for this decline was the burden and costs to maintain accreditation as a result of changes in accreditation requirements and fee increases by the Accreditation Council for Continuing Medical Education (ACCME).
In response to this resolution, the AMA conducted a survey in July 2009. The purpose of the survey was to gain understanding from intrastate accredited CME providers’ about the impact of proposed ACCME fee increases and to determine whether proposed changes to the ACCME accreditation criteria and rules would affect CME providers’ willingness or ability to continue being accredited.
The survey results were summarized as part of a comprehensive report, CME Report 14 (A-10) that was presented to the AMA-HOD at its 2010 Annual Meeting. Accordingly, the AMA CPPD report summarized and shared the results of the CME provider survey. The survey had responses from 549 intrastate providers, which included all 46 states that had ACCME recognized accreditation programs.
AMA analyzed the providers who responded by size of the CME program, years in operation and type of CME organization. The report indicated that none of these variables had an impact on the response patterns. AMA also pointed out that when evaluating each issue (staff resources, fee increases, fluctuations in enrollment, scope of course offerings, etc.), the items were more intertwined and had an impact on each other. As a result, AMA looked at how the collective weight of ACCME criteria had synergistic consequences beyond any one requirement.
Hospital and health care systems provided the majority of responses (75 percent) and state specialty societies (9 percent). The providers that responded to the survey report that they serve audiences of physicians ranging in size from 12 to 50,000, with an average of about 1,000 physicians. In 2008, these providers produced, on average, 45 activities for 348 hours of instruction. Important findings included:
- 86 percent of respondents indicated that it was “very important” to their organization to be able to provide AMA PRA Category 1 Credit™
- Almost 60 percent of respondents indicated that the new ACCME criteria would make it more difficult to provide quality CME activities.
- Only 17 percent indicated that the new criteria would help their institution provide quality CME.
- Of the 15 percent that answered “other” to this question, several comments indicated the new ACCME criteria would lead to a decrease in the number of activities the provider would be able to produce.
Providers were asked to indicate the degree of ease or difficulty their organization might have in documenting compliance with each of the 22 ACCME criteria. While the majority of providers rated six criteria as being “very easy” or “somewhat easy” to document, 15 criteria were rated as being “somewhat difficult” to document, and one criterion was evaluated by the majority as being “very difficult” to document.
Another interesting finding was that over 40% of providers responding said that lack of commercial support was likely or somewhat likely a factor that might cause their organization to consider not being accredited in the future. That is over 200 providers saying that lack of commercial support may lead them to discontinue offering accredited CME. Think about the impact that will have on doctors.
It will create geographic accessibility concerns and may result in overcrowding of other CME programs. What is also disturbing about a finding like this is that given all of the ongoing criticism and strict scrutiny of industry funded CME, the number of providers may begin to decrease. Evidence of this was clearly shown by the AMA, which reported that 34 percent of these intrastate providers report that their organizations are currently “discussing whether or not to maintain CME accreditation.”
This would correlate directly with the continued decrease in commercial support as was reported by ACCME earlier this year. Moreover, over 55 percent of providers reported that the new ACCME criteria and fees are considered problematic. Coupled with decreasing commercial support, the AMA asserted that if these issues are left unresolved, there likely will be a further reduction in the number of intrastate CME providers and in the number of CME activities certified for AMA PRA credit to serve physicians at the local level.
As a result, AMA-HOD reviewed this data and other information that was included in CME Report 14 (A-10), and directed the AMA to work with the ACCME to:
- Reduce the financial burden of institutional accreditation and state recognition
- Reduce bureaucracy in the accreditation and recognition processes
- Improve CME
- Show that the updated criteria improve patient care
- Mandate meaningful involvement of state medical societies in policies that affect state recognition; and
- Reconsider the fee increases for intrastate accredited CME providers.
The complete text of the official actions of the AMA-HOD may be found online.
Get the Facts Campaign!
Started by the National Task Force on CME Provider/Industry Collaboration in 2009, the “Get the Facts!” campaign is a national effort to disseminate information on issues important to CME community. This includes addressing and preventing misinformation and misunderstandings about independent CME by providing accurate, objective information about certified CME to those inside and outside the CME community. Part of the campaign is to issue Fact Sheets. Recently, the Task Force issued a new fact sheet on the topic of on-label and off-label usage of prescription medicines and devices. The fact sheet explained that off-label use of a prescription drug or device “refers to the ability of licensed health care providers to prescribe or use the drug for indications, conditions, patients, dosages or routes of administration not yet evaluated and approved by the FDA.”
The new fact sheet then went on to recognize that “Off-label discussion of product use is permitted within Certified CME activities when there is sufficient evidence for the off-label use and it is accepted within the medical profession as having adequate justification for the proposed use.” There is also a requirement that “discussion must be at the discretion of the CME presenter without influence by the manufacturer or activity supporter.”
The fact sheet further emphasized that a presentation of an off-label indication within the context of a CME activity is intended to provide healthcare providers with the most current clinical evidence for all available treatment options and when other therapies are not available or have not benefited the patient.
As a result, AMA asserted that such off-label “discussion must be evidence-based, should be strictly limited to the discretion of the accredited provider within the activity, and cannot be positioned to encourage or promote off-label use for commercial purposes. Sufficient evidence and a balance between a product’s safety and efficacy must be presented to permit providers to make informed decisions when considering off-label drug use.”