Is ABMS proposal a threat to the CME system?

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The American Board of Medical Specialties (ABMS) issued a white paper examining how CME can support its Maintenance of Certification (MOC) requirement in the future. But the paper raised hackles among some who saw it as a call for new credit systems, added administrative burdens on education providers and yet another attack on the beleaguered concept of commercially supported CME.

MOC is the four-part process that board-certified physicians use to re-certify. It includes performance assessment, not simply attending lectures or completing online activities. The criteria for the performance aspect of MOC includes a CME requirement, so the two programs are beginning to work together, and the white paper, titled “CME for MOC,” was an early effort for the ABMS to determine whether CME can be of sufficient quality to help its members improve practice and maintain certification.

ABMS's certifying boards lack a general understanding of all the requirements of CME, explained Dr. Nancy Davis, an expert in MOC CME invited by ABMS to contribute to discussions, “so the whole purpose…is to help [ABMS], not create new requirements and accreditation systems, [but] in fact to help them understand how the system we have can support MOC.”

Others foresaw harsh consequences. The ABMS “is considering recommending to their 24 member boards to set up additional accreditation systems” for CME to meet MOC requirements, wrote Tom Sullivan, on his popular blog Policy and Medicine. While the goal of improving physician education is a laudable one, if adopted, he continued, such systems could require “at the very least multiple sets of paperwork, creating multiple systems of compliance standards,” and hospitals and health systems would be required to track more than one CME accreditation for their physicians.

Sullivan also voiced concern that physicians would be forced to choose between “getting CME from annual meetings and learning new science” and attending events that are “MOC only.” That could decrease meeting attendance.

Dr. Murray Kopelow, chief executive of the Accreditation Council for CME (ACCME), countered that notion. ACCME was also part of the joint working group whose discussions led to the white paper. The term “MOC CME” appearing throughout the document, instead of the clearer “CME for MOC” used in the paper's title, “generated a reaction in people that we're going to make a new CME,” he said.

While the paper does propose development of a “standard currency” for MOC CME that would “ensure interchangeability of programming between member boards” (the third of four recommendations), Kopelow told MM&M that, “There is no such intention by the ABMS or the ACCME to put the AMA PRA or the AAFP credits or the osteopathic credits—all created by groups of physician organizations for their members—to put all of that out of business.”

MOC is analogous to the AMA's PRA Category 1 Credit system, he said, and the ABMS white paper, which spells out what CME for MOC should look like, actually recommends the same kinds of attributes that CME has had since the ACCME revamped its accreditation criteria in 2006 to focus on changes in competency, performance and patient outcomes.

The member boards do retain the right to create their own parallel accreditation systems and their own educational activities, which they sell to diplomats. “It's our impression that those were created by boards who wanted to get moving with MOC,” Kopelow said.

As to Sullivan's contention that the paper “could lead to exclusion of commercial support from MOC CME,” the ABMS actually proposes removing commercial influence in order to inspire public trust (recommendation three).

During discussions, representatives from the American Medical Association (AMA) and specialty societies “definitely spoke loudly against another accreditation system, but the message was also loud and clear that CME needs to be of high quality, it needs to be performance-based, evidence-based and free of commercial bias,” said Davis, citing recommendations one and two.

All of this is what the ACCME is asking providers to do today, continued Davis, who is president of the National Institute for Quality Improvement and Education (NIQIE). The challenge, she said, is how can the board be sure that's actually what's being delivered?

For instance, the standard AMA format for performance improvement (PI) CME makes it possible for a physician to demonstrate practice improvement. “But,” she said, “there is a gap in terms of the quality of PI CME being developed.”

The ABMS invites interested individuals to submit comments to the white paper's four recommendations by March 1.

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