ACCME proposals draw calls for parity from stakeholders

Commercial CME providers say a proposed rule change could do more harm than good and that they should be treated on equal footing with other providers, such as insurers and hospitals. The controversial proposal, one of two issued last month, suggests rewording the definition of a “commercial interest” to include any commercial CME provider having a promotional or publishing arm or other separate organization. Commercial interests are the group whom, under Accreditation Council for CME (ACCME) rules, may not plan or deliver CME. So worded, the proposal could bar joint sponsorship—the logistic and implementation support that many universities, hospitals and not-for-profits use medical education and communication companies (MECCs) for. That change could have a “chilling effect,” said the Coalition for Healthcare Communication (CHC), as most sponsors are not structured to provide such services. “Right now the language has got this kind of ‘throw the baby out with the bath water’ character to it and can be interpreted so broadly that it does things that the ACCME did not intend,” said Marty Cearnal, one of several who helped draft a set of comments CHC sent to ACCME last week. The semantic brouhaha over the first proposal has almost overshadowed a second ACCME proposal, which suggests changing the limits on what can and cannot appear in a letter of agreement (LOA) between a grantor and a CME provider. (CHC said that that change also is open to misinterpretation and has asked ACCME to explain its rationale and intent.) MECCs say the ACCME does not intend to marginalize them, although the reason ACCME is seeking to redefine a commercial interest remains unclear. Nevertheless, they are uncomfortable being singled out for having possible conflicts of interest. NAAMECC, the group which includes some 80 organizations, wants rules ensuring independence, such as firewalls which many already have in place, applied more evenly across the provider community. “We fairly believe in the principle of equity,” said NAAMECC President Karen Overstreet. The group supports a “firewall policy that clearly delineates what creates separation and independence in all types of organizations,” NAAMECC stated in comments sent last week to ACCME. But changes in policy “should not single out specific entities for exclusion based on organization type or tax status.” A more constructive proposal, say representatives, would be one that includes all providers as commercial interests, including insurers, medical practices and for-profit hospitals. It boils down to what is the appropriate way to make it clear to everyone that education developed by CME providers is unbiased? Because the proposed wording “has a high probability for multiple interpretations,” CHC stated, “we strongly recommend that ACCME provide more direction…on its intent.” The deadline for comments is this Friday. Both the CHC and NAAMECC are encouraging all members to respond individually. So far there has been no official deadline extension, although some say ACCME may consider comments received after March 30. The coalition is sponsoring a conference call tomorrow to discuss the proposals. Based on the ACCME’s call for comment, “the language will be refined so that it achieves the objective while avoiding the unintended consequences,” said Cearnal, Jobson Medical Information EVP and chief strategy officer.