When organized CME was in its infancy, we viewed it as the professional responsibility of a physician to keep up in those areas that would benefit the care of patients. In other words, the end result was to improve knowledge and skills based on self-identified needs. Funding came from medical societies and hospitals, with support from the pharmaceutical industry.
The “new CME” in America has now gone well beyond this simple structure. The Accreditation Council for CME (ACCME) in a new statement requires providers to include in their mission statements “expected results articulated in terms of changes in competence, performance or patient outcomes.”
In addition, the CME provider must “utilize non-education strategies to enhance change” and “identify factors outside the provider's control that impact on patient outcomes.” These are no small tasks.
Currently the pharmaceutical industry is funding more than 50% of the cost. But there may be a reduction in pharma funding because of the reorganization of the CME grant-making process. When the Office of Inspector General of HHS forced separation of education from marketing, companies shifted control of CME funding from marketing managers to medical education managers. This new breed of funders is expected to function independently of marketing objectives. Marketing managers, however, still control the bulk of the funds and may be reluctant to relinquish control while still responsible for sales results.
What's more, the distribution of CME funding is now concentrated in the hands of a few medical education managers reporting to a single manager or “czar” who is inundated with grant requests that used to be spread across scores of marketing managers.
Medical education and communications companies (MECCs) have been receiving about half of all pharma grant funding. That may not continue. According to one pharma medical education manager, “MECCs can no longer consider pharma companies as clients; academic medical centers are now their clients.” Another manager will no longer accept any grant application from an MECC, whether that organization has been accredited by ACCME or not. And a third concluded that “MECCs in general are mediocre at CME; maybe they can function as meeting planners for medical schools or societies.” This despite 2005 grants of $595 million to MECCs.
Consider the following:
• Who is responsible for improving physician performance? Government? Employers? Health care systems? CME providers?
• Are educators qualified to measure performance improvement or patient outcomes?
• Are the data sets available, particularly in ambulatory care, to measure competence, performance or patient outcomes?
• Is there clear evidence that competence leads to improved patient outcomes?
• Are academic medical centers and specialty societies capable of carrying out the innovation necessary to implement the new requirements? And do they want to?
• Are pharma companies willing to support performance improvement regardless of the impact on sales?
Before CME goes off the track, perhaps we should consider returning to the earlier definition of CME as the means to improve physician knowledge and skills, instead of holding the CME community responsible for improving physician performance.
Lewis A. Miller is principal, WentzMiller & Associates. A version of this article also
appears on www.wentzmiller.org