REPORT OF COMMITTEE ON CONTINUING EDUCATION
CM-CE Report 1-A-06
Subject: CME Program Report
Presented by: Leslie H. Secrest, MD, Chair
February 2006 Council on Medical Education Meeting Focuses on CME
Reform in CME . The Committee on Continuing Education provided assistance in developing the agenda for the council's February 2006 meeting which focused on trends in continuing medical education at the national and local levels. Marcia Jackson, PhD, senior advisor on education for the American College of Cardiology in Baltimore, MD, addressed the council on the topic of reforming and repositioning continuing medical education. Reform for CME is indicated for the following reasons:
- The public expects and demands up-to-date doctors;
- Deficiencies are in the spotlight;
- The effectiveness and value of CME must be demonstrated;
- Physicians must become lifelong learners with education organized around competencies;
- CME needs to be linked to a change in physician behavior and ultimately to a change in patient outcomes;
- Alternative funding sources are needed.
These reforms have been identified by professional and regulatory bodies, specifically the Institute of Medicine, American Board of Medical Specialties, Accreditation Council for Continuing Medical Education (ACCME), Federation of State Medical Boards, American Medical Association, and Conjoint Committee for CME. Recommendations have been outlined by the Conjoint Committee for CME, a collaboration of 14 stakeholders including all of the aforementioned organizations, to address needed reforms to ensure that patient outcomes are linked to the practice of competent physicians who engage in self-assessment of specific competencies and lifelong learning to maintain competency.
ACCME Response . Dr. Jackson's presentation was followed by the perspective of the ACCME on reform in CME given by Susan Rudd Bailey, MD, member of the ACCME representing the American Medical Association. The ACCME supports the maintenance of certification movement, demonstration of physician lifelong learning, and quality and safety movement. In a move to further these measures, the ACCME recently adopted the Updated Standards for Commercial Support, a set of standards which require that CME is free of commercial bias and based on valid evidence-based content. Dr. Bailey also reviewed recent changes in the AMA Physician Recognition Award which now allows physicians to earn AMA PRA Category 1 Credit™ for new formats of learning including Internet point of care, individual performance improvement activities, test item writing, and manuscript review for journals. These new formats mark the beginning of migration from "CME hours" to "CME credits" and recognize that physician learning occurs in settings other than time in classrooms.
Local Perspective . Finally, Wesley W. Stafford, MD, immediate past chair of the Committee on Continuing Education, presented the local perspective on reform in CME reviewing the response of TMA-accredited CME providers to the ACCME Standards for Commercial Support and to recent voluntary guidelines established by the pharmaceutical and medical device professional associations. Texas CME providers have not experienced less access to speakers with relevant financial relationships, as anticipated, and while most have adopted mechanisms for resolving conflicts of interest of faculty and activity planners, providers are looking to ACCME and TMA to define compliant mechanisms. The most notable change in recent CME practices is the format for applying for and receiving grants from pharmaceutical companies to support CME activities. In 2003, the Office of Inspector issued the General Guidance for Pharmaceutical Companies, which requires that pharmaceutical companies not engage in activities that influence physician treating and prescribing practices for Medicare and Medicaid patients. As a result of this guidance, pharmaceutical companies have established online grant applications, thus removing contact with local representatives who may influence physicians' choices in drugs. CME providers find the online applications difficult to complete with the rate of denials increasing, resulting in less support for educational activities, especially those of small hospital providers.
Update on Intrastate Accreditation Program
Since the committee's report to the House of Delegates in May 2005, 12 organizations have submitted applications or self studies for CME accreditation by TMA. Eleven were granted full accreditation (three of these earned six years accreditation with commendation) and one earned initial provisional accreditation. Tam's Subcommittee on Accreditation, a team of 17 physicians and CME professionals, conducted the onsite surveys and submitted reports to the committee for consideration and accreditation decisions.
TMA's current roster of CME-accredited organizations includes 62 organizations. The breakdown for type of organization is as follows: 49 hospitals or hospital systems, 3 physician groups, 2 state specialty societies, 2 state agencies, 1 regional health education center, 1 medical education foundation, 1 university student health center, 1 quality improvement organization, 1 education training company, and 1 home health agency.
New Services . The committee's Subcommittee on Accreditation and staff initiated a number of new services to assist TMA-accredited CME providers in provision of quality continuing education and maintaining accreditation. They are as follows:
- Upon TMA's approval of the Updated ACCME Standards for Commercial Support, all primary CME contacts for TMA providers were sent a packet outlining new items in the standards, suggestions for compliance, and sample forms for implementing the standards. This information will be updated as needed.
- In May 2005, a new session , "Preparing for Accreditation," was first offered to organizations seeking reaccreditation in the following six to eight months. TMA staff and one member of the subcommittee serve as facilitators for the teleconference session, which covers timelines and forms used in the reaccreditation process, tips for answering questions in the application and selecting attachments, strategies for conducting a self-study, and expectations related to the new Standards for Commercial Support. Subsequent sessions were held on Sept. 8, 2005, and Nov. 9, 2005. Evaluation by participants has been overwhelmingly positive.
- A mid-year "CME Basics" workshop was first held on Jan. 20, 2006. Response was positive with registration sold out and requests to offer the workshop again in January 2007. In addition, the course is traditionally offered in conjunction with the annual Texas CME conference in June.
- TMA staff will serve as a consultant for TMA-accredited providers that wish to develop performance improvement activities for CME credit as now allowed by the AMA PRA program. TMA, AMA, and Seton Healthcare Network in Austin have begun planning for the initial performance improvement project.
Texas Medical Board CME Rules for New Physician Licenses
Administrative Medical License . The Committee on Continuing Education was called upon to provide guidance to TMA's representative to the Texas Medical Board concerning development of rules to implement the new administrative medicine license. The license, established as part of the new Medical Practice Act approved by the Texas Legislature in May 2005, limits the license holder to the practice of administrative medicine.
In a teleconference meeting in early August, committee members reaffirmed TMA's current policy to support physicians' self assessment of continuing medical education needs and pursue appropriate avenues to meet those needs. (Policy 70.005 Council on Medical Education, p 93, I-92) Further, the committee reaffirmed TMA policy that opposes all mandates for CME in specific subject areas and supports working with relevant medical groups, community groups, and legislators to determine more effective methods of resolving issues which typically lead to mandated subject content. (Policy 70.008 Board of Trustees, p 39C, I-96)
The committee supports use of the current TMB rules for reporting continuing education for registration of the medical license as a model for continuing education requirements for the new administrative medical license. The current requirement calls for 12 hours of formal CME (AMA PRA Category 1, AAFP Prescribed hours, or AOA Cat. 1A) and 12 hours of informal CME to be reported annually. One of the formal hours must be in the area of ethics and/or professional responsibility. The entire requirement can be met with formal hours.
HB 2680 Charity Care by Retired Healthcare Practitioners . The committee reviewed HB 2680 Charity Care, also May 2005 legislation, which allows retired physicians to perform voluntary charity care with reduced license fees and CME requirements. After clarification of "reduced" CME, the committee supports rules that call for a reduction in the number of informal hours only. The 12 formal CME hours will remain the same as for the full license to practice medicine in Texas.
2006 Texas CME Conference
TMA offers an annual two-day conference for physicians and staff who plan and implement continuing medical education activities. The program provides updates on CME issues, trains CME providers to meet accreditation requirements, and provides networking opportunities for CME providers. The 2006 conference will address the updated ACCME Standards for Commercial Support, new AMA PRA guidelines, and physician competency-based CME. Multiple sessions designed for newcomers in the profession also will be offered. The 2006 conference will be on June 21-23 in Austin at the Doubletree Hotel.
TMA House of Delegates: TexMed 2006