No Relevant Financial Relationships (i.e., No relationships with ACCME - defined commercial interests related to the content of my presentation)

Transcription

1 Murray Kopelow, MD No Relevant Financial Relationships (i.e., No relationships with ACCME - defined commercial interests related to the content of my presentation)

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3 ACCME s 2004 Position To meet the needs of the 21st century physician, CME will provide support for the physicians' professional development that is based on continuous improvement in the knowledge, strategies and performance-in-practice necessary to provide optimal patient care. Final Report: ACCME Task Force on Competency and the Continuum April 2004

4 Sept 2006 Change in Emphasis Focus on rewarding providers for changing and improving their practice of CME.

5 Sept 2006 Change in Emphasis Focus on rewarding providers for changing and improving their learners professional practice.

6 Accredited CME is Synonymous with practice based learning and improvement Needs derived from professional practice gaps (C2) Activities designed to change competence, performance or patient outcomes (C3) Content of CME matches the scope of the learner s practice (C4) Measurements of change in competence, performance or patient outcomes will be available (C11)

7 The ACCME is Committed to ensuring that physicians have access to quality continuing medical education. Resolute in its efforts to ensure that CME is provided through a valid and credible accreditation system.

8 Validity of CME Content Face Construct Predictive Concurrent About what we do.. Is credible. Is built right Of the right care. In line with others

9 CME providers can receive commercial support from industry. Teachers and authors who have $$ relationships with industry can teach and write in CME. CME providers cannot receive guidance, either nuanced or direct, on the content of the activity or on who should deliver that content.

10 Standards for Commercial Support and the Content Validation Statements are key part of ACCME s overall strategy to ensure validity of CME Based on valid content

11 CME as a Bridge to Quality The ACCME System for Physician Learning and Change Accredited CME is, Independent of commercial interests

12 Framed by the Updated Criteria CME is 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-in-practice Fail the needs of patient care

13 STANDARD 5. Content and Format without Commercial Bias 5.1 The content or format of a CME activity or its related materials must promote improvements or quality in healthcare and not a specific proprietary business interest of a commercial interest.

14 Underlying Issues Accredited CME providers must place a higher priority on the health and well being of the public than on individuals personal economic interests. Some people in CME have personal economic interests derived from financial relationships with commercial interests that create a personal sense of duty or loyalty to the commercial interest. Some financial relationships with commercial interests are important enough to conflict with the person s responsibility to CME learners and to conflict with the public interest. If a person in CME has a conflict of interest, the CME provider must manage the conflict in a manner that is in the best interest of the public.

15 Q: When do relationships create conflicts of interest? ACCME: The ACCME considers financial relationships to create actual conflicts of interest in CME when individuals have both A current financial relationship with a commercial interest and The opportunity to affect the content of CME about the products or services of that commercial interest.

16 At least Two Levels of Conflict of Interest Organizational: Irreconcilable, Managed by Recusal SCS 1.1 A CME provider must ensure that the following decisions were made free of the control of a commercial interest. Identification of CME needs; Determination of educational objectives; Selection and presentation of content; Selection of all persons and organizations that will be in a position to control the content of the CME; Selection of educational methods; Evaluation of the activity. SCS 1.2 A commercial interest cannot take the role of non-accredited partner in a joint sponsorship relationship.

17 2004, 2005, 2007 The ACCME defines a commercial interest as any entity producing, marketing, re-selling or distributing health care goods or services, used by or on patients with the exemption of. 501-C Non-profit organizations Government organizations Non-health care related companies Liability insurance providers Health insurance providers Group medical practices For-profit hospitals For-profit rehabilitation centers For-profit nursing homes

18 At Least Two Levels of Conflict of Interest Personal: Reconcilable, Managed by safeguards SCS 2.1 The provider must be able to show that everyone who is in a position to control the content of an education activity has disclosed all relevant financial relationships with any commercial interest to the provider. The ACCME defines relevant financial relationships as financial relationships in any amount occurring within the past 12 months that create a conflict of interest. SCS 2.2 An individual who refuses to disclose relevant financial relationships will be disqualified from being a planning committee member, a teacher, or an author of CME, and cannot have control of, or responsibility for, the development, management, presentation or evaluation of the CME activity. SCS 2.3 The provider must have implemented a mechanism to identify and resolve all conflicts of interest prior to the education activity being delivered to learners.

19 For Accredited Providers CME This independence from commercial interests is is fundamental to to CME. Non CME $$ Relationships

20 For Accredited Providers CME CME Non CME $$ Relationships (Non aligned) Non CME $$ Relationships (Aligned with CI s)

21 For Accredited Providers CME CME Non CME $$ Relationships (Non aligned) Non CME $$ Relationships (Aligned)

22 CME providers can receive commercial support from industry. CME providers cannot receive guidance, either nuanced or direct, on the content of the activity or on who should deliver that content.

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24 CME Revenue

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26 $3,000 Millions $2,500 $2,000 $1,500 $1,000 $500 $- 75% Providers who receive 10% of CS 90% Providers who receive 25% of CS 96% Providers who receive 50% of CS 100% Providers who receive 100% of CS Comm_Supp Ad_Exh Other_Income 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 75% Providers who receive 10% of CS 90% Providers who receive 25% of CS 96% Providers who receive 50% of CS 100% Providers who receive 100% of CS Comm_Supp Ad_Exh Other_Income

27 $3,000 Millions $2,500 $2,000 $1,500 $1,000 $500 $- 4% Providers who receive 50% of CS 11% Providers who receive 75% of CS 24% Providers who receive 90% of CS 100% Providers who receive 100% of CS Comm_Supp Ad_Exh Other_Income 100% 80% 60% 40% 20% 0% 4% Providers who receive 50% of CS 11% Providers who receive 75% of CS 24% Providers who receive 90% of CS 100% Providers who receive 100% of CS Comm_Supp Ad_Exh Other_Income

28 CME providers can receive commercial support from industry. Teachers and authors who have $$ relationships with industry can teach and write in CME. CME providers cannot receive guidance, either nuanced or direct, on the content of the activity or on who should deliver that content.

29 Identified for action, by ACCME Management of commercial support Across the CME enterprise Funding models and the role of industry in CME. Alternate funding models (e.g., pooled funding, limits, sources) The value, or impact, of no commercial support.

30 Assumptions to Challenge the Validity of CME Content There is commercial bias? Face Can CS ed be credible? Construct Industry cannot pay? Predictive Bias follows from CS? Concurrent Only CME unmanageable? i.e., manageable in research and operations but not in CME?

31 Thank you

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