Lewis Miller on the Evolving CME Landscape

Continuing medical education is changing dramatically. To keep up with the changing trends in the delivery of medical care in the U.S., major new directives now include:

  • An expansion in the roles of CME professionals and a shift in their educational mission to team-based education, whence the new concept, continuing education for health professionals.

  • A sharp decline in industry support of CME and CEHP — from more than 50% of total expenditures to less than 30%.

  • The move of CME and CEHP from measuring knowledge after a learning session to determining changes in performance and patient outcomes.

  • Big data and the influence of federal healthcare funding have led CEHP to collaborate to improve quality in hospitals and medical centers.

  • A new approach by the Accreditation Council for Continuing Medical Education, the certifying body for CME providers, has simplified requirements for accrediting organizations.

Let's examine these changes.

FROM CME TO CEHP

The practice of medicine, in hospitals and in offices, is now considered a team effort. Doctors, nurses, nurse-practitioners, physician assistants, pharmacists, and others who provide care now work together for more effective and efficient patient care.

The educational system, from professional schooling to lifelong learning, is similarly evolving to accommodate this team trend. Continuing education accreditation bodies are slowly figuring out how to work together while holding on to their independence. So are CME providers, particularly in hospital settings.

To support the concept of team learning, there is now a Joint Accreditation for Interprofessional Continuing Education, a collaboration of ACCME, the Accreditation Council for Pharmacy Education, and the American Nurses Credentialing Center. This organization establishes standards for education providers to deliver continuing education planned by an education team for a team of healthcare providers. Finally, there is now a certification program for CPD professionals.

INDUSTRY SUPPORT DECLINES

Pharma­ceutical and medical-device firms once played a significant role in shaping physician-directed CME programs. What changed? First, back in the 1990s, the Office of Inspector General of the U.S. Department of Health and Human Services ruled there needed to be a clear dividing line between education and promotion. This led ACCME to tighten its Standards of Commercial Support to prevent companies from influencing content and speakers in CME programs.

Then public and political pressure brought about the Sunshine Act, requiring companies to disclose physician payments. Finally, shifts in priorities by industry — as toward DTC advertising — led to reductions in CME and CEHP funding. What was once more than $1 billion in support has declined to less than $700 million (out of $2.4 billion total).

MORE THAN KNOWLEDGE CHANGE

Does CME make a difference? For years, educational professionals believed that if a course improved what a physician knew, that was good enough.

Now, prodded by federal and other programs mandating quality improvement, CME programs are being measured by changes in physician–healthcare performance and patient outcomes, which are more easily determined owing to the rise of EHRs. There are federal programs that pay bonuses for doctors demonstrating performance change on measures determined by specialty — and there will soon be punitive measures if doctors fail to demonstrate such improvement.

INTEGRATING WITH QUALITY DATA

Increasingly, hospitals are being incentivized or penalized on how care is delivered to Medicare — and now ACA — patients. This led hospitals to set up quality-control departments, which provide data to govern changes in healthcare delivery systems and professional behavior.

CME departments need to work closely with such departments, but turf battles often emerge. In time, collaboration will become a must-have, as opposed to a nice-to-have.

CHANGING ACCREDITATION

ACCME now stresses the need for accredited providers to demonstrate commitment to improving the quality and safety of healthcare in their community. ACCME is also aligning with changing specialty board requirements for doctors to prove Maintenance of Certification.

CME activities have increased steadily in the past five years. Internet educational programs have grown, though their growth is slowing. The evidence points to blended learning and repetition of key points as the best formulas for results.


Lewis Miller is founder of the Alliance for Continuing Education in the Health Professions, the Global Alliance for Medical Education, and WentzMiller Global Services, a consulting firm. 




Photo credit: Medical Advertising Hall of Fame