Study says CME leads to million-dollar savings

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It's always been assumed that certified CME brings value to clinical practice. But researchers have not really tied the roughly $2 billion spent annually on CME specifically to dollar savings. A recent study by med-ed company CMEology shows that CME can trim substantial costs from the healthcare system, authors say, even if just a few doctors change their practice as a result of an activity.

To gather real, patient-level data on cost savings as a result of an educational activity would be quite expensive. Instead, the researchers came up with a model.

Looking at surgical outcomes, they predicted that for every bleeding-related complication or botched surgery cardiologists were able to avoid after taking an educational activity, healthcare costs should be cut by a mean of $1.5-$2.7 million.

The hypothetical cost savings yielded by CME-related learning are “substantial,” authors said. They also hailed the study for its ability to frame CME in an economic light—something that's important as the reimbursement model aligns increasingly with quality.

“With the changing nature of healthcare economics, there was a need to communicate the benefits of CME, and everyone understands costs,” said CMEology's Dana Ravyn, PhD, MPH, scientific director and senior analyst, who presented the results in May at the Annual Meeting of the International Society for Pharmacoeconomics and Outcomes Research (ISPOR).

Two CME symposia, sponsored by Baxter, were held in early 2012 and 2013 encouraging practices that prevent bleeding-related complications of cardio-thoracic surgery, such as hemorrhage, transfusion and reoperation. Clinicians were surveyed at the time of the activity and one year after, to gauge commitment to change. Authors' base case predicted that three out of 10 learners would implement the blood-saving practices.

Then, they estimated costs from a database of cardiac and cardiothoracic surgeries: Any bleeding-related complication (BRC) or reoperation for bleeding (RFB) would cost $12-$15,000 each. Finally, a computer model predicted that every BRC or RFB cardiologists are able to avoid after taking an educational activity should result in mean healthcare savings of $1.5-$2.7 million.

“In the bigger scheme of healthcare, that may be a drop in the bucket,” said Jack Kues, PhD, associate dean for continuous professional development, professor emeritus of family medicine, University of Cincinnati College of Medicine, “but if it costs $50,000, for example, to produce the seminar, but it saved $20-$30 million, then that's a good value for that activity.”

Because such economic-impact studies have not really been done, said Brian McGowan, PhD, chief learning officer & co-founder of med-ed firm ArcheMedX, the research is “groundbreaking” and represents “the future of CME assessment.” Stakeholders can use the data to better allocate resources and evaluate educational program outcomes, he said in a statement.

Indeed, “There are quite a few studies within CME that have shown changes in physician behavior and in patient outcome,” said Kues, who was not associated with the study. “What we've typically not seen is what that actual cost is.”

In response to a reporter's questioning, Kues said he approves of the authors' modeling approach and said their logic is sound. “I find it really a very valuable exercise that I would like to see more of within CME,” he said, “just as a way of aligning itself more with where healthcare reimbursement is going in general.”

Then again, what the authors don't do is “close the loop,” said Kues, and tell us what the motivation is for the physician to want to do such an activity. In other words, the study predicts that attending a CME conference, making some commitment after it, and implementing a change will result in lower healthcare costs. Logically, the people who would like that the most are those who are saving the money, he said.

But that begs the question: who is it that's saving the money? It could be insurers, including the federal government, or hospitals. In the past, the motive for physicians to change behavior was increased income, he said, but this study does not appeal to physicians directly--savings accrue to the health system. Altruism? Perhaps, but then why translate savings into dollars.

The bottom line: projecting million-dollar savings from relatively modest participation in CME gives the profession new ammunition to justify expense in an environment of scarce resources. Industry CME budgets were down last year, although advertising/exhibit fees and fees paid by participants were up, and a survey fielded earlier this year among pharma CME directors as part of the Industry Alliance for Continuing Education (IACE) Summit forecasts future budgets will remain flat.

“For me, this kind of modeling and doing it in dollars allows CME to come to the table and get to talk about healthcare costs in a way where they have numbers,” said Kues. “We've not really done that before…This allows CME to participate in the conversation.”

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