ACCME plan for limited transparency draws support

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Comments to a recent ACCME proposal formed a clear consensus: Accredited med ed providers who break the rules should not be identified, unless changes in their accreditation status occur.

After a six-week comment period that ended March 8, the ACCME yesterday posted the responses, along with a preliminary analysis, on the “Calls for Comment” section of ACCME.org. Responses came out overwhelmingly in favor of ACCME's January proposal to keep CME providers' names confidential during the Complaints and Inquiries Process, which the council uses to investigate criticisms lodged against activities, including issues about commercial bias.

Even when allegations of noncompliance with ACCME rules are found to be true, the council proposed to identify the provider only if changes in its accreditation status are made, although it didn't specify which changes. All other results would remain confidential.

Some who backed the ACCME confidentiality proposal said it would prevent providers from lodging frivolous claims that could damage a competitor's reputation. Another said it would keep ACCME's Complaints and Inquiries Process from being “played out in blogs and the media.”

Most respondents agreed that discretion—not full disclosure—is appropriate. Out of a total of 50 responses, 41 (80%) favored confidentiality even after verifying a violation. One grantor, Eli Lilly, also backed the plan. Seven views were classified as “mixed,” supporting aspects of the plan but voicing concerns.

Only one comment opposed the proposal, voting for full disclosure. “For those providers who struggle each and every day to ‘do the right thing,' it is unfair to let those who bend the rules, do what they want, take enormous sums from pharmaceutical companies and then pretend not to be influenced,” the respondent wrote, adding, "Why should a provider who has been found to be in non-compliance with the criteria be allowed to hide?"

Several comments to the ACCME proposal also stressed the importance of establishing a timeline for adjudicating complaints. In 2008 during a Senate Aging Committee hearing on CME, some said the ACCME was not moving swiftly enough to address compliance concerns.

In explaining the wording of the proposal back in January, ACCME chief executive Dr. Murray Kopelow said some stakeholders had asked for more transparency, some less, so ACCME sought a balance between the two. Publicizing accreditation status but retaining individual criteria findings as well as findings from the activity review—a similar process used during the accreditation-review process—helps strike that balance, he said.

He also said that single activity reviews, while useful as a source of feedback, do not “rise to the level where making it public would be of value.”

One pro-confidentiality respondent, identified only as an accredited provider, echoed that notion, writing that its contemporaries “should be judged by their complete body of work, not by a single activity.”

Also among those who agreed with more confidentiality were medical associations, such as the American Academy of Family Physicians, as well as state medical societies, including those of Texas and Illinois. The Wisconsin Medical Society, which supported the overall plan, said some information should be made available on a “need-to-know basis,” but cautioned against using it to “embarrass or demean a CME provider for competitive reasons.”

The Association of American Medical Colleges agreed on confidentiality but noted, “On the other hand, when a provider's status has changed as a result of a full accreditation review, public release of that information is crucial to transparency.” And Eli Lilly called for “transparent reporting of egregious non-compliant activities.”

Whether the proposal becomes official policy will be decided in July, when the ACCME board of directors meets to discuss the issues and responses. The ACCME said it plans to continue communicating the status of these discussions with providers and stakeholders.

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