CME body revamps accreditation, outlines 2-year transition

The Accreditation Council for Continuing Medical Education (ACCME) has revamped its accreditation model, setting a two-year deadline for providers to change the way they plan and deliver activities. The new model, released last week on the ACCME Web site, ties accreditation to the practice of medicine by requiring providers to demonstrate that their activities improve quality, from an efficacy and safety standpoint—a model similar to the one being adopted by those who fund education. The new rules outline three ascending levels of accreditation—provisional, accreditation, and accreditation with commendation—based on a provider’s ability to meet an entry level set of updated standards, plus additional criteria. The new rules are scheduled to take effect by 2008. In the meantime, many are wondering what effect the new standards will have on the review process. “This is ACCME getting into the quality-improvement business,” noted Walt McDonald, MD, chief executive, Council of Medical Specialty Societies (CMSS). As providers digested the changes, many wondered about the effect on accreditation review. Many of the practical details of implementation have yet to be addressed. As was the case when ACCME revised its Standards for Commercial Support in 2004, “ACCME is probably going to be fairly liberal in their interpretation,” McDonald said. “As always, the manner of implementation is the decision of the leadership of each provider,” said Murray Kopelow, MD, ACCME chief executive. He said ACCME and others will provide workshops and resource materials to assist providers. Meanwhile, providers should engage in self-assessment, reflecting on how, or if, they might be meeting the criteria already. This involves “asking questions like, ‘Where does our program already facilitate change in competence, performance or patient outcomes? How do we know? What could we do differently? What will be our expected results?’ When providers begin this process of self-assessment they are, in fact, beginning their implementation of the updated criteria,” Kopelow said. ACCME called on providers to phase in the system over the next two years, making it effective with those receiving initial and re-accreditation in November 2008. The group implored providers to start taking steps right away. “It is important to the validity and impact of CME that all providers move expeditiously to implement the revised model and the updated criteria,” ACCME said in the nine-page document. In a statement, Kurt Boyce, president of the North American Association of Medical Education and Communications Companies (NAAMECC), questioned whether a more subjective evaluation of providers would emerge. Nevertheless, he said NAAMECC “fully endorses ACCME’s efforts” and called the model “a major step forward.” Indeed, the criteria may well “release [providers] a little bit from the administrative and bureaucratic aspects of traditional CME,” said Jack Kues, PhD, head of CME, University of Cincinnati. Kues added that, by focusing more on outcomes, patient or healthcare improvements, learning and practice, the new standards “are going to be very good for academic medical centers.” McDonald expressed concern as to whether small medical societies would have the resources to carry out the new directives. “The big societies have lots of resources,” he said. “While they may struggle with it, I think they can carry it out. The little ones that have small CME offices—I worry about whether they will be able to do the need assessment that this calls for and whether they will be able to analyze changes in learners in terms of competence, performance or patient outcomes.” Subtitled “CME as a Bridge to Quality,” the revised model rewards accredited providers for moving through levels of accreditation while changing and improving their practice of CME. Basic criteria include creating a mission statement focusing on changes in competence, performance or patient outcomes and assessing the degree to which learners met those goals through the activity. To reach the next level, providers must meet such conditions as choosing appropriate educational formats. Level three adds other criteria such as collaborating with other stakeholders. It’s not clear how these criteria will be evaluated, though. “I can understand people’s fears,” Kues said. “ACCME has not said exactly how they’re going to define and evaluate peoples’ criteria. If you’re a provider, that can be frightening because you want to…know what they're going to look at in the accreditation process, and none of that is available right now.” To fill in the details, NAAMECC and CMSS have scheduled meetings with Kopelow. NAAMECC’s is scheduled for Sept. 18, and CMSS has invited Kopelow to discuss the criteria in November. “There’s a lot of work in here for CME providers…to ensure they’re moving their activities in the right direction,” said Marty Cearnal, EVP, chief strategy officer, Jobson Medical Information. “Even though the full implementation of this is two years away…we’ll start to see changes in the system very soon.”