By Ann Lichti
Alliance National Learning Competencies
Competency Area 1.1: Apply adult learning principles in CEhp activities/interventions and overall program planning.
Competency 2.1: Implement CEhp activities/interventions to address healthcare professionals’ practice gaps and underlying learning needs
Competency 4.2: Collaborate with external stakeholder groups and key partners that can help maximize the impact of CEhp activities/interventions and meet the CEhp mission.
Points for Practice
- Support collaboration among accredited providers, medical boards, accreditation organizations, and member specialty societies.
- Encourage accredited providers to develop CME activities that are aligned with MOC criteria from various medical boards.
- Develop a value proposition statement for internal and external stakeholders.
Note: This article was reported from Graham McMahon, MD, MMSc’s workshop, “Promoting Engagement, Opportunity and Strategic Value through Accredited CME,” presented on Jan. 26, 2017.
“Please be our friend.” These words of encouragement started Dr. Graham McMahon’s standing-room-only session at the Alliance 2017 Annual Conference as he encouraged attendees to connect with ACCME via their various social media channels (LinkedIn, Facebook and Twitter). Social media is becoming an increasing communication tool between ACCME and its almost 1,900 accredited providers. Using the hashtag #ACCMEQuickTip, ACCME has tweeted multiple links to resources and videos covering a wide range of topics, including:
- Commendation criteria
- COI resolution
- Addressing ACGME/ABMS competencies
- ABIM MOC
- The effectiveness of accredited CME
- Registering REMS activities
The theme that resonated throughout McMahon’s session was that ACCME encourages accredited providers to have a continuous dialogue with them through multiple communication avenues.
Challenges and Opportunities in Our Current Environment
McMahon discussed how he has traveled across the country meeting with the leadership of the diverse group of providers in ACCME’s system of accreditation. What he has heard is that “CME/CE is underappreciated, undervalued and underresourced, but it delivers.” ACCME has a responsibility to ensure accredited providers are adhering to ACCME policies and Standards for Commercial SupportSM but also promote excellence in continuing medical education and encourage the professional growth of accredited providers’ staff. ACCME’s goals are to support providers and help build value in the CME system, which will ultimately help providers “do more and deliver more.”
McMahon stressed that learners and their expectations for their education are changing. Physicians are requesting more simulation and hands-on skills development, and they want to learn in the workplace. They want continuous learning and want to learn with their peers in real time. While online learning continues to be a draw, it is more than just a convenient way of “obtaining knowledge in their cellphones.” Physicians are using online education as a way of connecting with peers to help them solve complicated problems, and share wisdom and problem-solving skills. They are also searching for highly relevant material that’s efficient and helps drive changes in their practice and thinking. Physicians are looking beyond credits to find rewarding education. Therefore, providers need to think about what they are selling: Is it credit or education? Physicians are seeking education, and providers must be thoughtful about how they are positioning their services and their value proposition for their stakeholders.
Educational Activities 2.0: Moving Beyond Credit
Continuing medical education is an evolution. It is no longer episodic. Providers must look to develop curriculum-based activities. Instead of offering CME activities that connect with learners “15 minutes every once in a while, providers should seek to develop a relationship with learners and build up their skills over time.” CME is incorporating more learner feedback mechanisms, and providers are offering education that is demonstrating higher levels of outcomes. Providers are no longer emphasizing attendance metrics as a measurement of the success of their educational activities. Outcomes from providers are instead showing that physicians can think and problem solve around complex patient cases. Blended learning, collaborative learning, personalized programming, social media-based formats, and use of reflective statements versus post-testing are all regularly being integrated into today’s CME activities. CME can also be used to discuss controversial topics or unorthodox cases. This is where physicians discuss and share what they hear and see and what their patients are asking them about. However, the activities should still provide balanced, evidence-based treatment recommendations.
ACCME’s system is trying to move with providers to allow for greater innovation. The goal is to reduce the number of forms, required signatures and long, laborious processes that prevent providers from hearing about a problem in the morning and developing education that solves it the same afternoon. “We want you to be nimble.” McMahon added that “we tend to over-regulate ourselves.” ACCME is committed to reducing bureaucracy for providers by simplifying requirements and eliminating some of the criteria. If an activity is likely to be evidence-based and balanced, meets real needs and includes problem solving, is assessed appropriately with a practice statement and is commercially independent, then it counts as an accredited/certified activity. Whenever learning is happening, accredited CME is there. “Conversations that happen spontaneously meet real clinical needs if they begin to solve complicated problems in a bigger dimension.” Providers can use a variety of methods (notes/emails) to easily document this process, and ACCME’s website1 has resources to help providers along these lines.
ACCME’s objective is to help providers spend more time on educational development and demonstrating value and less time completing documentation. ACCME continues to work with AMA to have aligned, set criteria. This collaboration seeks to simplify expectations, create a greater alignment with ACCME’s requirements and offer a shared glossary of terms. Providers will benefit from a regulatory system that is more flexible to meet learners’ needs instead of a system that leaves providers feeling restricted by perceived barriers within the accreditation system.
Support for Today’s CME Professionals
CME professionals have a critical set of skills and are able to connect the learner community; deliver evidence-based, independent education; and help with maintenance of certification (MOC), licensure, and credentialing along with the education. CME professionals are adept at
- educational strategy;
- accreditation standards;
- process improvements;
- credit management;
- data retrieval; and
- process improvements.
While physician learners might not fully understand and appreciate the expertise CME professionals possess, ACCME does. McMahon elicited a warm response from the audience when he said, “ACCME loves you. We want you to be able to exercise those skills to have the kind of impact you want to make on your learners.”
ACCME’s Overall Compliance Findings: Positive Trends
ACCME’s 2008-2016 data from 1,316 providers shows progressive growth with an increasing number of providers demonstrating commendation and fewer providers on probation. The primary areas for provider noncompliance are with the Standard for Commercial SupportSM related to inappropriate use of commercial supporters’ employees within CME, disclosing/resolving COI and providing unscientific/ unbalanced clinical recommendations. ACCME’s updated commendation criteria focus on promoting team-based education, addressing public health priorities, achieving outcomes, enhancing physicians’ skills and demonstrating educational leadership. Achieving accreditation with commendation shows the excellence of accredited providers, and ACCME is encouraged by the growing group of providers who are attaining this level of accreditation.
Joint Accreditation, Maintenance of Certification (MOC) and Expanded Partnerships
Joint accreditation is a single pathway for continuing education (CE) providers to be able to be jointly accredited by pharmacy, nursing and physician education and offer multiple types of credit in one packaged program. Joint accreditation establishes the standards for education providers to deliver continuing education planned by the healthcare team for the healthcare team2. About as many non-physicians as physicians are engaging in education not to receive credit, but to address clinical needs. These interprofesional continuing education activities (IPCE) help create a culture of respect for teams who work and learn together.
Providers can be a resource to the hundreds of thousands of physicians who continue to engage with CME activities that are aligned with MOC. There are approximately 20,000 clinicians who are ABIM diplomates. The value of MOC for physicians is that they can use the CME activities in which they already participate to fulfill MOC requirements. ACCME encourages providers to register their activities for ABIM MOC points. Currently, there are 5,799 ABIM MOC activities, 288 American Board of Anesthesiology (ABA) MOC activities and 68 American Board of Pediatrics (ABP) MOC activities registered in ACCME’s PARS system. While encouraging, ACCME would like providers to increase the number of these activities. McMahon said that providers should not be concerned about ACCME’s mandatory audit process of ABIM MOC activities. The rules are simple and straightforward, and ACCME encourages providers to ask questions about the overall process.
A larger opportunity for ACCME is working with the Centers for Medicare & Medicaid Services (CMS). It has a new reimbursement system for clinicians across the country (MIPS/MACRA legislation), which are are part of planned changes to the health system that continues to encourage healthcare professionals to engage in practice improvement. Healthcare providers (physicians, physician assistants, nurse practitioners, clinical nurse specialists, and certified registered nurse anesthetists), can use quality measures from improvement activities to avoid downward payment adjustments3. Accredited CME/CE is being considered as part of practice improvement principles. If adopted as part of rules — that accredited CE that is approved for performance improvement principles counts for MIPPS/MACRA credit — this could be transformative for the CME/CE industry. ACCME continues to serve in an advocacy capacity to demonstrate the value of accredited education to improve clinical performance. Similarly, the FDA has expectations for clinicians to engage in safe opioid prescribing practices. The REMS program has led to the development of 750 REMS activities with approximately 181,000 completions. ACCME continues to play a role in keeping education at the forefront to tackle national health crises. These expanded partnerships between stakeholders will allow the CME industry to continue demonstrating the alignment between both accredited and non-accredited continuing education, physicians’ lifelong learning and quality improvement.
Supporting Providers to Demonstrate Value
McMahon closed with a powerful call to action: “Talk to your doctors. Talk to your QI directors. Talk to your dean or CEO. Make those connections so that you’re actually meeting the real needs in your environment, not just doing what you’ve always done because it’s comfortable. You have to be more. You have to be vigilant or you will be essentially, irrelevant.”
- Accreditation Council for Continuing Medical Education. www.accme.org.
- By the Team for the Team: Evolving Interprofessional Continuing Education™ for Optimal Patient Care. Report from the 2016 Joint Accreditation Leadership Summit. ©2016 by Joint Accreditation for Interprofessional Continuing Education™.
- Centers for Medicare & Medicaid Services. CMS Quality Measure Development Plan: Supporting the Transition to the Merit-based Incentive Payment System (MIPS) and Alternative Payment Models (APMs). Baltimore, MD: Centers for Medicare & Medicaid Services; 2016. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/MACRA-MIPS-and-APMs.html.
The opinions expressed are those of the author and do not constitute the views of Physicians’ Education Resource®, LLC.