According to a recent article from Medical Marketing & Media, “state-accredited continuing medical education (CME) providers continue to decrease.”
For example, between 2003 and 2010, the number of providers accredited by state medical societies fell by 18.7% to 1,450. Unabated, this trend could “impede the delivery of cost-effective, quality, accessible certified CME” dealing with local health issues, noted an internal report by the AMA’s Council on Medical Education.
The article noted that, “one reason behind the drop is the annual fee for accreditation, which is slated to go up to $550 by 2013.” Although, AMA has asked the Accreditation Council for Continuing Medical Education (ACCME) to reconsider, Dr. Murray Kopelow, ACCME chief, “said he delayed the hike, though new fees will go up as planned.”
Another reason why we have seen drops in accredited providers may be associated with ACCME’s compliance criteria, updated in 2006. The updated policies require providers to link activities to practice gaps and evaluate for change. “Kopelow said 14% of state providers have left the system the last five years. “But there is a national consensus that this is the CME we want.”
Less CME at Academic Medical Centers
In addition to a shrinking number of state CME providers, academic medical centers are also experiencing difficulty providing CME. For example, last week, Dr. Marschall Runge, Executive Dean at the University of North Carolina School of Medicine, noted that the School of Medicine “has decided to close the Continuing Medical Education (CME) Office on campus, as a result of state budget reductions.”
The letter explained that the School is “reorganizing the way CME credit is offered for SOM faculty members.” Additionally, Runge noted that the School “will also reassign management of large CME events.”
Runge noted that CME activities that have been planned and will take place from now to December 31, 2011, are not affected by this change.
In addition, “Grand Rounds, Mortality and Morbidity Conferences, and other on-campus educational programs that offer CME credit will continue to be offered, provided the sponsoring department is willing to pay for the cost of CME credit on a fee-for-service basis.”
The letter also noted that “School of Medicine departments will now use outside vendors for meeting planning services,” which Runge noted “is common practice at academic medical centers.” He wrote that, “Individual departments will continue to offer off-campus programs to provide educational opportunities for faculty and physicians of North Carolina, because educating practicing physicians is an important part of UNC’s mission.”
Finally, Runge noted how “the budget reductions forced UNC to make extremely difficult decisions, and this is one of them.” He said, “more detailed information about logistics and pricing will be provided to all Associate Chairs for Administration soon.” While he emphasized that CME “is tremendously important,” it was obviously not important or cheap enough to keep at a major medical institution like UNC.
Less CME in Hospitals
Academic medical centers are not alone. “The sluggish economy, major state and federal budget cuts, and looming provider payment cuts have driven more hospitals to consider reducing staff as a way to stabilize their bottom lines.”
According to recent Bureau of Labor Statistics (BLS) data, there were 13 hospital mass layoffs—defined as involving 50 or more employees—in August, resulting in 1,085 initial unemployment benefit claims. If the layoff pace continues, BLS analysts say hospitals in 2011 will post 127 mass layoffs involving 8,257 people, which would give 2011 the third-highest number of mass layoff incidents in the last decade.
For example, Fairfax Virginia-based Inova Health System recently announced plans to cut 606 employees as it moves to outsource environmental services, laundry, and referral management and scheduling. Meanwhile, MetroHealth System in Cleveland recently announced plans to reduce its workforce by 450 employees over the next two months in an effort to handle $30 million in budget cuts and stem 2011 losses.
MetroHealth Chief Mark Moran said that it will be “leaders of the units who are going to have to look at their operations and make decisions.” This will likely mean looking at CME departments and medical education budgets.
Western Connecticut Health Network (WCHN) also recently announced plans to lay off 60 workers, due to the sluggish economy and as a result of state and federal cuts to hospital reimbursements.
In addition to these labor numbers, a recent Moody’s Investor Service report outlined dismal fiscal prospects for not-for-profit hospitals, noting that median operating revenue dropped to a decade low of 4% in fiscal year 2010. Moreover, the American Hospital Association (AHA) earlier this month said hospitals would lose $41 billion from 2013 to 2021 if Medicare payments are cut by 2%.
According to AHA, the 2% cut would cost 92,866 jobs in 2013 and 194,522 jobs by 2021.
Discussion
Ultimately, it is likely that many of these layoffs will affect the CME departments and medical education offices at hospitals and academic centers that have them, particularly in rural areas, non-profit hospitals, and inner cities, which already struggle in these areas. The home of Inova, Fairfax Virginia is the wealthiest county in the country. If wealthy areas are laying off en mass this does not bode well for less fortunate areas.
Hospitals and academic medical centers that may be planning on relying solely on outside CME providers, may run into a problem as well because as noted above, the sources of funding is limited and state CME providers are dropping and commercial support of CME dwindling as well. Both of these factors mean that hospitals and academic medical centers may have even less options to choose from for CME providers, and that does not take into account the frequency of CME, the kind (i.e. topic), and the quality.
Compliance with the CME paperwork is enormous. In light of significant cuts to personnel and funding there is no easy way to keep track of every record and ensure quality education.
As we continue to see changing budgets and a sluggish economy, CME and medical education will face significant challenges. Those who propose cutting even more industry funding should heavily consider the data cited in this article because when it comes to some of these institutions, commercially support CME may be literally the only option they have to educate their healthcare professionals.
I was hired into a new position at one of the oldest, private medical schools in the country in the mid 1980’s, after the school paid an exorbitant fee to a private meeting planner to produce one program. The school realized that it could have an in-house planner, that could produce many conferences and act as a liaison to over two dozen affiliates in a large geographic area, for a little more than what it paid a private company to produce one.
After that position, I was hired into another new position at an Optometry school. Our most significant achievement, in the early 1990s, was creating a course for pending legislation. After it was up and running, and later became a model program, it was “given” to the state society.
At the same time, private companies, offering to coordinate and provide on-site management, proliferated; as managed care and increases in malpractice insurance rates took off.
Medical schools and hospitals are being forced to reduce staff sizes, and CME offices and staff seem to be a target. This is removing the control and public relations benefits to the centers of learning, practice and care; all for the sake of what appears to be spending reductions. The commerical enterprises are making a lot of money at the expense of non-tangible benefits in-house CME provided to the former organizers.