Expert Insights: What's Next in CME?

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Five key players look at what's in store for the future of med ed and how changes to the way it's regulated will impact the profession, if at all


Bob Addleton, EdD, LPC, CCMEP,
EVP,
Physicians' Institute for Excellence in Medicine


Which funding alternatives being explored have the best chance of achieving real funding balance?

First, metrics need to be accepted by the CME Community about what constitutes “funding balance?” Given that, it is reasonable to expect that physicians will have to pay more for their CME. I do not think that pharmaceutical companies will contribute to a pooled fund over which they have no control. Foundations, insurance companies, and the government might.

Will ACCME's enhanced monitoring and oversight efforts help the CME profession move beyond the issues of commercial support?
The efforts of the ACCME are necessary but insufficient. The “issues” are largely perceptual rather than regulatory-related. All who are involved in producing and consuming CME must ensure that the best interests of the patient are foremost in their efforts. When this is done, most of the issues will go away.

How do you define quality improvement/performance improvement CME now and how do you expect it will evolve?
Right now, performance improvement (PI) CME is an effort to improve that addresses gaps in recognized clinical guideline performance. Well and good, but there is no emphasis on the tools and processes that are used to determine the improvement, as well as inadequate attention to holding the gains. Eventually, PI CME will adopt the tools of the quality improvement and six sigma movements.


Marty Cearnal,
EVP, chief strategy officer,
Jobson Medical Information


Which funding alternatives being explored have the best chance of achieving real funding balance?
“Funding Balance” is an interesting concept. The idea that too much funding from a single source is problematic deserves serious analysis especially in an area like CME where there are so many external and internal system controls.  I think in the near-term “funding balance” will be achieved in a manner detrimental to patient care, which is by a significant reduction in funding from commercial supporters.  Long-term physicians will pick up a larger share of the cost.

Will ACCME's enhanced monitoring and oversight efforts help the CME profession move beyond the issues of commercial support?
ACCME's monitoring will provide increased assurance of compliance, but that “good news” is not “news” in a climate where only negatives make headlines. CME providers need to launch a campaign to explain to everyone from politicians to patients that, “What your doctor doesn't know can hurt you!” We need to publicize the good that CME does if we are to change perceptions.

How do you define quality improvement/performance improvement CME now and how do you expect it will evolve?     
Making improvements in the impact of CME in these challenging times is a daunting task.  Most providers use practice gap analysis and outcomes research to bookend at least some of their CME activities.  Standardized electronic medical records could, in the future, greatly enhance PI CME by providing low-cost access to accurate and timely data for planning and assessment.


Maureen Doyle-Scharff, MBA, FACME,
Senior director, medical education group,
Pfizer


Which funding alternatives being explored have the best chance of achieving real funding balance?
A model that takes the ultimate decision of who receives individual grants away from industry and puts it in the hands of capable providers focusing on narrowing professional practice gaps, supporting quality improvement initiatives and improving the health and care of patients is a viable option. Companies, including Pfizer, have adopted a “block grant” model that allows for strategic discussion and cooperation with providers in a way that ensures everyone's interests, especially patients, are being appropriately served.

Will ACCME's enhanced monitoring and oversight efforts help the CME profession move beyond the issues of commercial support?
Continuous improvement to the systems in which the CME enterprise functions, especially those elements that focus on quality and independence, is welcome and necessary for the profession to grow and evolve.

How do you define quality improvement/performance improvement CME now and how do you expect it will evolve?
QI/PI CME is education that is linked to practice-based needs, matches the scope of a learner's practice and most importantly measures change beyond knowledge and/or skill. QI/PI CME will continue to evolve and grow in importance as MOC and MOL become more mainstream, where the focus will be less about what a physician knows and more about how they apply knowledge to practice to improve the health and well-being of their patients.
 

Karen M. Overstreet, EdD, RPh, FACME, CCMEP,
President,
Indicia Medical Education, LLC


Which funding alternatives being explored have the best chance of achieving real funding balance?
Although no one has solved this problem yet, many models are being evaluated. Pooled funding, if intended to replace the current system, simply won't work. Having multiple supporters sounds great but is very difficult to operationalize because grantors have such disparate requirements and timelines. But independent “block” grants have worked well and deserve more attention.

Will ACCME's enhanced monitoring and oversight efforts help the CME profession move beyond the issues of commercial support?
I certainly hope so! The CME community has been distracted for far too long on issues that add no value to what we do as educators. Enhanced monitoring, if it identifies noncompliance and facilitates remediation, will allow good providers to focus on the important issue: helping clinicians help their patients.

How do you define quality improvement/performance improvement CME now and how do you expect it will evolve?
I believe QI/PI is the future of CME. Many providers are talking about PI education, but few have figured out how to implement it effectively. Having recently launched a pilot PI activity, I can't wait to see the results! I'm hopeful that innovative approaches like PI will replace ineffective “one-off,” didactic ones.


Tom Sullivan,
President and founder,
Rockpointe Corporation


Which funding alternatives being explored have the best chance of achieving real funding balance?
There is a belief in some sectors that alternative funding for CME is standing ready on a moment's notice.  Given the state of the overall economy, that scenario has not played out. Right now we are exploring several options for additional support, from governmental sources, insurers, hospitals and companies not directly involved in the sale of “healthcare” products. The jury is still out on whether those sources will eventually rise to any significant level.

Will ACCME's enhanced monitoring and oversight efforts help the CME profession move beyond the issues of commercial support?  
Let's hope so. Now that the ACCME is increasing their enforcement of the Standards for Commercial Support we should be able to move beyond this debate. Let's not forget that there is no evidence that commercial support creates bias. It's all about the appearance of conflicts. Accredited CME providers have safe guards to ensure that CME content is fair balanced and free of commercial bias. Unfortunately, few people appreciate the work that goes into this process. We send all content out for external review prior to presentation or publication in addition to a series of procedures to manage and mitigate faculty conflicts of interest.  

How do you define quality improvement/performance improvement CME now and how do you expect it will evolve?
PI CME is based upon performance measures. It takes the concept of needs based education which is the current practice to another level. PI CME will evolve with the uptake of electronic medical records from the current level of 8%. Education has always been at the core of quality improvement. I'm pleased to see this trend to recognize the importance of CME in systems improvement. I think quality/performance improvement CME is in early development. It reinforces the importance of CME and gives us a better seat at the table for healthcare reform.

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