The number of providers placed on probation by the nonprofit that regulates continuing medical education has more than doubled this year, from 15 to 35. Out of the 35 organizations placed on probation, an analysis shows 14 (40%) appear to be small physician associations.
As to why more small physician groups are in jeopardy of losing their accreditation to offer CME than any other provider, these groups say their struggles stem more from scant resources and expertise than from willful mishandling of commercial support. The smaller the association, the fewer the resources and CME expertise they have.
Robin Kimbrough-Melton, executive officer of the American Orthopsychiatric Association, which sponsors 26 activities a year, said: “The major issue for organizations that are small like Ortho is that it is very difficult to meet the guidelines without a significant staff. It really requires a full-time staff to implement the process and maintain the documentation.”
Kimbrough-Melton added that Ortho is weighing whether to submit additional progress reports, which are required of those on probation. “We are leaning against it.”
Of the 704 organizations listed as having ACCME accreditation, the number on probation as of this year is about 5%. Last year the percentage was closer to 2%, assuming the same number of providers. The larger numbers reflect growing pains as providers struggle to comply with policies now in place emphasizing quality, while leaving little room for bias.
The ACCME released the names in May as part of a combined list of providers reviewed against its 2006 accreditation criteria since November 2008. The providers have two years to demonstrate compliance with the criteria, during which they can continue offering CME. The fact that an inordinate number of these are small associations highlights the challenges these groups face in keeping their educational arms afloat. Some may be slow on the uptake, and ACCME is not going easy on them.
At a Senate hearing last year Dr. Murray Kopelow, executive director of ACCME, said 15 providers had been placed on probation, with reasons ranging from failing to implement the criteria, to recidivism (being found in non-compliance four years previously and attempting to correct the problem and then being found in non-compliance again), to failing to address some parts of ACCME's standards for commercial support.
“These causes for probation are still applicable,” Kopelow told MM&M
One of the criticisms Kopelow faced at the hearing was the need to shorten the time it takes to move from a finding of noncompliance to a change in accreditation status that would be made public, such as being placed on probation. That timeframe is 18 to 24 months, he said.
Since 2008, aggregate data show that the highest levels of noncompliance among ACCME constituents involve commercial support issues. Associations on probation, however, told MM&M
that they are having the most trouble with criteria related to performance gaps.
Andi Bartolomeo, director of education and meetings, American Medical Group Association, said her group has processes in place to keep commercial support and education separate but, “The hardest part for organizations such as ours is being able to demonstrate that learning has taken place—how can we prove that a session attended by physician leaders has made a positive impact on patient care when our activities focus on the business of medicine?”
Asked whether it will submit progress reports, Bartolomeo said AMGA, which sponsors two CME activities a year, has “submitted follow up reports, and ACCME has been very helpful in trying to assist us with this process.”
“Typically, the small societies are run by volunteers with minimal or no staff whose administrative responsibilities include ACCME compliance,” said the education director at another small association on probation, who wished to remain anonymous. “The large societies and institutions have entire departments solely dedicated to compliance."