CME as a Bridge
To Quality
Presentation to
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© 2008 ACCME
ACCME Board of Directors
R. Russell Thomas, Jr., DO, MPH
Chair
Barbara E. Barnes, MD
Vice-Chair
Susan Bailey, MD
Treasurer
Arnold Berry, MD, MPH
S. Kalani Brady, MD
Peter Coggan, MD, MSEd
Claudette Dalton, MD
Jerilyn Glass, MD, PhD
Federal Government
Ruth Horowitz, PhD
Public
James Liljestrand, MD
John D. Marler, Jr., PhD
© 2008 ACCME
Karla Matteson, PhD
Debra G. Perina, MD
William W. Pinsky, MD
Henry Pohl, MD
Harold J. Sauer, MD
Susan Spaulding, Public
Ronald Wade, MD
Sterling Williams, MA, MD
ACCME Member Organizations
American Board of Medical Specialties
American Hospital Association
American Medical Association
Association for Hospital Medical Education
Association of American Medical Colleges
Council of Medical Specialty Societies
Federation of State Medical Boards of the US, Inc.
© 2008 ACCME
Bridging the Gap
“It is not realistic to think one can solve all the
problems in health care delivery. None of the popular
models for improving clinical performance appear
superior… therefore bridges must be built and
models must be integrated to be truly effective.”
In Building Bridges to Quality, Grol, JAMA, 2001;286:2600-2601.
© 2008 ACCME
ACCME’s Role
Accredited CME is an essential component of
continuing physician professional
development in the eyes of the ACCME
member organizations
For almost 30 years, the ACCME system for
accredited continuing medical education has
provided standards, criteria, and policies that
define what it means to be a provider of CME
© 2008 ACCME
ACCME Recognizes…
US health care is at a crossroads and
Accredited CME is being asked to
provide solutions.
It is a critical time for CME to
address the competency and
performance gaps of physicians…
© 2008 ACCME
Gaps are Evident
“All adults in the United
States are at risk for
receiving poor health
care, no matter where
they live; why, where,
and from whom they
seek care; or what their
race, gender, or financial
status is.”
Rand, 2006 National Report Card
© 2008 ACCME
Accredited CME
• Connects current practice to best practice
• Is one of our nation’s strategic assets for
improving care
• Is an important partner for change to your
physicians and your community of practice
• An essential link between the life-long learning
of physicians and State and Federal
requirements for physician licensure and
Maintenance of Certification™
© 2008 ACCME
You Need to Understand
Your stakeholders need to understand just how
important this role of CME is to the healthcare
mission of your organization
It is a critical time for CME to make absolutely sure
that it is widely known what CME,
– is doing
– will be doing
– is capable of doing
© 2008 ACCME
It’s a Critical Time
It’s time to call a meeting to discuss…
CME as a
Bridge to Quality
© 2008 ACCME
Cementing the Construct…
© 2008 ACCME
Meeting Agenda
Accredited CME…
• Linked to practice and focused on quality gaps
• Supports Maintenance of Certification®
• Requirement of maintenance of licensure
• Fostering collaboration to address QI
• Addressing interdisciplinary teams
• Independent of commercial interests
Education that matters to patient care
© 2008 ACCME
Background
Is CME effective?
– Highest level of
research evidence says
“yes”
– 2007 Metasynthesis
from US Agency for
Healthcare Research
and Quality
Rand, 2006 National Report Card
© 2008 ACCME
CME AS A BRIDGE
TO QUALITY
Accredited CME is linked to
practice and focused on
healthcare quality gaps.
© 2008 ACCME
Synonymous with Practice-Based
Learning and Improvement
• Activities are linked to practice-based needs
(Updated Criterion 2)
• Content of CME matches the scope of the learner’s
practice (Updated Criterion 4)
• Measurements of change in competence,
performance or patient outcomes will be available
(Updated Criterion 11)
© 2008 ACCME
Practice Improvement
16. The provider operates in a
manner that integrates CME
into the process for
improving professional
practice.
19.
17. The provider utilizes noneducation strategies to
enhance change as an
adjunct to its
activities/educational
interventions (e.g.,
reminders, patient
feedback).
20. The provider builds bridges with other
stakeholders through collaboration and
cooperation.
18. The provider identifies factors outside the
provider’s control that impact on patient
outcomes.
© 2008 ACCME
The provider implements
educational strategies to
remove, overcome or
address barriers to physician
change.
21. The provider participates within an
institutional or system framework for quality
improvement.
22. The provider is positioned to influence the
scope and content of activities/educational
interventions.
CME AS A BRIDGE
TO QUALITY
Accredited CME supports
physicians’ maintenance of
certification.
© 2008 ACCME
ABMS MOC™ Process
Part I - Professional
Standing
Part III - Cognitive Expertise
Medical specialists must hold a
valid, unrestricted medical license
in at least one state or
jurisdiction in the United States,
its territories or Canada.
They demonstrate, through
formalized examination, that they
have the fundamental, practicerelated and practice environmentrelated knowledge to provide
quality care in their specialty.
Part II - Lifelong Learning
and Self-Assessment
Part IV - Practice
Performance Assessment
Physicians participate in
educational and self-assessment
programs that meet specialtyspecific standards that are set by
their member board.
© 2008 ACCME
They are evaluated in their
clinical practice according to
specialty-specific standards for
patient care. They are asked to
demonstrate that they can assess
the quality of care they provide
Supporting ABMS Member Boards
Regarding your own program of CME….
– How did the content relate to your scope of
practice?
– What competencies did your CME address?
– Did your CME vary in format?
– What professional practice gaps of yours did
your CME address?
– What changed for you, or your patients, as a
result of your program of CME ?
© 2008 ACCME
CME AS A BRIDGE
TO QUALITY
Accredited CME is an essential
requirement for Maintenance of
Licensure.
© 2008 ACCME
FSMB Draft Report 2007
“State medical boards have a responsibility to
the public to ensure the ongoing competence
of physicians seeking relicensure.”
© 2008 ACCME
Recommendations
A. The Board should require the following for license renewal and
require documentation thereof:
Participation in an ongoing process of reflective self-evaluation, self assessment and
practice assessment, with subsequent successful completion of
educational activities tailored to meet the needs or
deficiencies identified by the assessment.
Demonstration of continued competence in the following areas: [ACGME/ABMS
Competencies] and, if applicable, osteopathic philosophy and osteopathic manipulative
medicine; including the knowledge, skills and abilities to provide
safe, effective patient care within the scope of their
professional medical practice. This criterion must be met, in part, by
passage of a valid, secure, proctored examination in the physician’s current practice area.
Demonstration of accountability for performance in practice.
© 2008 ACCME
Guided by the Updated Criteria…
Accredited CME
CME professionals will
provide value to their
providers are
physician community by,
perfectly positioned
– Helping to uncover, measure,
to support physicians
and address important
knowledge, competency, and
as they navigate their
performance-based gaps in
own, personalized
practice
processes of MOC™ and – Aligning educational planning
with their physicians’ scope of
“MOL”
practice
© 2008 ACCME
CME AS A BRIDGE
TO QUALITY
Accredited CME is fostering
collaboration to address quality
improvement.
© 2008 ACCME
ACCME Will Reward Providers That…
• Work towards understanding the
healthcare environment in which their
physicians practice
• Seek solutions beyond their own
boundaries
• Identify and remove obstacles that stand
between current care and best care for
patients.
© 2008 ACCME
Updated Criteria Address Collaboration,
Quality, and Systems-Based Practice
16. integrate CME into process for improving professional practice.
17. utilize non-education strategies (e.g., reminders, patient feedback).
18. identify factors outside the provider’s control that impact on patient
outcomes
19. remove, overcome or address barriers to physician change
20. build bridges with other stakeholders
21. participate in an institutional or system
framework for QI
22. positioned to influence the scope and content of activities and
educational interventions
© 2008 ACCME
ACCME as an example
• Striving to embody the model of learning and
change described in the Updated Criteria by
providing outreach, education, and coordination to
nurture innovation and interaction among key
stakeholders
• In 2007, these efforts have culminated in
productive relationships with multiple healthcare
stakeholders
© 2008 ACCME
Examples
•
•
•
Metropolitan Chicago Breast Cancer Task Force
Five regional members of the CMS Better Quality
Information to Improve Care for Medicare
Beneficiaries pilot program
The White House Office of National Drug Control
Policy
© 2008 ACCME
A Regional Quality Gap….
Chicago Tribune
© 2008 ACCME
Fall 2007
A Regional Quality Gap….
CME as a Strategic Asset for
Improving Quality Webinar in Fall 2007
“Applying the ACCME Updated
Criteria while Addressing a Public
Health Imperative”
Chicago Tribune
© 2008 ACCME
Fall 2007
A Regional Quality Gap….
CME as a Strategic Asset for
Improving Quality Webinar in Fall 2007
“Applying the ACCME Updated
Criteria while Addressing a Public
Health Imperative”
A cooperative effort of the
Accreditation Council for Continuing
Medical Education and
The Illinois State Medical Society
Chicago Tribune
© 2008 ACCME
Fall 2007
A Regional Quality Gap….
CME as a Strategic Asset for Improving
Quality Webinar in Fall 2007
David A. Ansell, MD, MPH
“Applying
theMedical
ACCME
Chief
Officer Updated
University
Medical Centera Public
Criteria Rush
while
Addressing
Health Imperative”
Murray Kopelow, MD
Chief Executive Officer
A Accreditation
cooperative effort
the
Counciloffor
ContinuingCouncil
Medicalfor
Education
Accreditation
Continuing
Medical Education and
The Illinois State Medical Society
Chicago Tribune
© 2008 ACCME
CME AS A BRIDGE
TO QUALITY
Accredited CME is addressing
interdisciplinary team practice.
© 2008 ACCME
Institute of Medicine Directive
• Health Professions
Education: A Bridge to
Quality (2002)
– A core-competency that
health professionals
“cooperate,
communicate, and
integrate care in teams
to ensure that care is
continuous and
reliable”
© 2008 ACCME
To Realize This Goal
• Long-term strategic
partnership
ACCME
ANCC
ACPE
© 2008 ACCME
• Three accrediting
organizations of three
professions
• Cooperating,
communicating - and are
integrating their systems of
accreditation
Since 1998/2005
• All three organizations have actively
collaborated to explore areas of synergy
• A statement of shared values and future
collaborative projects, accepted by the
leadership of all three organizations in
2006
© 2008 ACCME
Fruits of Our Collaboration
• Alignment of critical aspects of accreditation
Requirements and Processes for physicians,
nurses, and pharmacists
• Shared commitment to safeguard education from
commercial interests
• Both the ANCC and ACPE adopted the ACCME
Standards for Commercial Support™ in 2007
© 2008 ACCME
Committed to Future Collaboration
• More standardized terminology for
accreditation
• Common or shared approaches for
accreditation processes
• Creation of a special accreditation that
rewards providers who engage in
multidisciplinary education planned for
and by the entire healthcare team
© 2008 ACCME
CME AS A BRIDGE
TO QUALITY
Accredited CME is independent of
commercial interests.
© 2008 ACCME
An Endeavor For Medicine,
By Medicine
When CME fails to be exclusively oriented to
measured gaps in the delivery of care we
cease to be relevant to physicians-inpractice and we fail the needs of patient
care.
© 2008 ACCME
Face Validity
Our most important stakeholder –
the American public – demands that
the CME system provide demonstrable
value without influence from industry
© 2008 ACCME
ACCME Commitment
The ACCME is resolute in its efforts to
ensure that CME is,
– Provided through a valid and credible
accreditation system
– Independent of commercial interests
– Free of commercial bias in all CME topic
selection, planning decision, and presentation
content
© 2008 ACCME
Definition of “Independence”
“The concepts of independence from
industry and collaboration with
industry in the development of [CME]
content are mutually exclusive.”
ACCME Board of Directors, Executive Summary from November 2007 Board Meeting
© 2008 ACCME
“Independence” (Cont’d)
Although commercial interests may provide
commercial support for educational activities
as defined by the ACCME’s Standards for
Commercial Support: Standards to Ensure
Independence… there is no role for ACCMEdefined commercial interests in the
development or evaluation of accredited CME
activities
ACCME Board of Directors, Executive Summary from November 2007 Board Meeting
© 2008 ACCME
You Must Accept
• Commercial interests’ influence erode the public’s
confidence in CME and introduce obstacles for the
ACCME system, accredited providers, and their
stakeholders.
• ACCME will work quickly and effectively to
monitor and remove bias and influence from
accredited CME
• ACCME continues to seek discussion among
stakeholders
© 2008 ACCME
Taking Action
• You have a story to tell
• Accredited CME is aligned to the current
and future needs of medicine
• It is a critical time for CME to make
absolutely sure that it is widely known
what CME
– is doing
– will be doing
– is capable of doing
© 2008 ACCME