ACCME: Proposal for Simplifying and Evolving the Accreditation Requirements and Process for CME

This week, the Accreditation Council for Continuing Medical Education (ACCME^®) announced a “Proposal for Simplifying and Evolving the Accreditation Requirements and Process.”  The proposed changes seek to streamline the accreditation process and requirements and to strengthen support for continuing medical education (CME) as a strategic asset to health care improvement initiatives.  

The proposal is based on the ACCME Board of Directors’ strategic planning, the ACCME’s experience evaluating providers under the 2006 Accreditation Criteria and analysis of accreditation data, and feedback from stakeholders.  

The ACCME is asking stakeholders to review the proposal and submit their feedback. The proposal, supporting materials, and a survey have been posted here.  Feedback, which can be submitted here, is due by July 2, 2013. 

The ACCME will also hold a free webinar today, May 23, from 1:00 to 2:00 PM, EST, to explain the proposal and answer stakeholders’ questions. 

The proposal builds on the success of accredited CME providers in achieving the ACCME’s expectations under the current accreditation requirements.  These requirements have been in place since 2006 with no substantive changes.  When the ACCME released the 2006 Accreditation Criteria, its goal was to position CME as a strategic asset to US health care quality improvement efforts.  “Accreditation data shows that providers are facilitating practice-based education that supports health care professionals’ commitment to lifelong learning.”  Accredited CME providers are partnering with quality initiatives within their institutions, health systems, and communities.  Accredited providers have successfully demonstrated that CME is a Bridge to Quality™. 

 “This proposal demonstrates the commitment of the ACCME and its stakeholders to continuous improvement. Since its founding in 1981, the ACCME has focused on setting and maintaining accreditation requirements that are relevant to health professionals’ lifelong learning needs and responsive to changes in the health care environment. The proposed changes build upon this strong foundation and continue the evolution of the ACCME accreditation system,” said James F. Burke, MD, Chair, Board of Directors, ACCME.  

“The ACCME and its stakeholders believe that it is important to simplify the accreditation requirements and process while maintaining high standards and continuing to respond to the evolving health care environment. There is a growing momentum in the ACCME accreditation system and we want to foster this evolution of accredited CME. We look forward to stakeholders’ responses and our continued dialogue about shaping the future of our CME system,” said Murray Kopelow, MD, President and CEO, ACCME. 

“The proposed simplification of the requirements and process will make a real and positive difference to accredited providers.  The changes will facilitate the development of CME that matters to patient care,” said Billie Dalrymple, Director, CME Department, Texas Medical Association (TMA). TMA is an ACCME Recognized Accreditor. (Recognized Accreditors are state or territory medical societies that accredit intrastate organizations offering CME.  All CME providers within the ACCME accreditation system follow the same requirements). 

Standards for Commercial Support 

The ACCME made several proposed updates to its Standards for Commercial Support (SCS).  Specifically, the ACCME proposed edits to Standard 4.3 and the related edits to Standard for Commercial Support 6.4 and the Commercial Support Acknowledgment Policy.  The ACCME is proposing that:  

SCS 4.3: Educational materials that are part of a CME activity, such as slides, abstracts and handouts, cannot contain any advertising, corporate logo, trade name or a product-group message of an ACCME-defined commercial interest. 

SCS 6.4: ‘Disclosure’ must never include the use of a corporate logo, trade name or a product-group message of an ACCME-defined commercial interest. 

Explanation: In 2011, the ACCME decided to prohibit the use of corporate logos of ACCME-defined commercial interests in commercial support acknowledgment. The ACCME issued a formal call for comment, as required by the ACCME’s Rule-making Policy.  The Board deferred implementation of the policy change while the ACCME was engaging in discussions with stakeholders regarding simplifying and evolving the accreditation requirements and process.  Now that these discussions have progressed, the ACCME is planning to take the necessary steps to ensure that corporate logos, as a form of corporate branding, will not be included in educational materials.  With this change, the corporate logos of ACCME-defined commercial interests could not be used in educational materials, disclosure, and acknowledgment of commercial support. 

Several CME stakeholders asked for clarification about whether in an exhibit area, a CME provider may use corporate logos on signs thanking exhibitors and supporters.  In response,  Dr. Murray Kopelow, ACCME Chief Executive, told Sue Pelletier at Meetings.net, that

“Nothing in the
exhibit hall can be, or is, part of the program of accredited CME. No
sign in the exhibit hall fulfills any ACCME CME requirement. Nothing in
the exhibit hall is overseen by the ACCME. As a result, no sign in the
exhibit hall would ever be reviewed for compliance with the ACCME’s
requirements nor be allowed to fulfill an ACCME requirement. Signs in an
exhibit hall announcing, or reporting, commercial support is not an
ACCME-required acknowledgement of commercial support.”

Related to this proposed change, the ACCME is also proposing that the “acknowledgement” of commercial support “may not include corporate logos and slogans.” 

In addition, the ACCME is proposing using the term “providership” instead of “sponsorship” with regards to CME activities.  Specifically, the proposal states that the ACCME defines joint providership as the sponsorship of a CME activity by one accredited and one nonaccredited organization.  Therefore, ACCME accredited providers that plan and present one or more activities with non-ACCME accredited providers are engaging in “joint providership.”  Please note: the ACCME does not intend to imply that a joint providership relationship is an actual legal partnership.  Therefore, the ACCME does not include the words partnership or partners in its definition of joint providership or description of joint providership requirements.  

Explanation: In 1998, the ACCME stopped using the term sponsor to refer to accredited providers in the ACCME requirements except when using the term joint sponsorship.  In order to be more consistent with our own terminology and with the terminology used by other accreditors, we propose to modify the wording in our requirements.  The ACCME edited the policy below as an example of this proposed change.  The ACCME proposed updating the terminology using “providership” in several other places as well. 

Other Proposed Changes 

The ACCME also made several other proposed changes. 

CME Activity Formats: the ACCME proposed removing some of the special requirements related to activity formats, which pre-date the current ACCME Accreditation Criteria.  This includes removing language and requirements from

• Enduring Materials
• Internet Material
  
  • The ACCME removed language which stated that all required ACCME information be communicated to the learner prior to the learner beginning the CME activity
  • It also proposed removing information about
    
    • Hardware/Software
    • Provider Contact Informatino
    • Policy on Privacy and Confidentiality; and
    • Copyright
• Journal CME
  
  • The ACCME removed language noting that CME content, post-tests, and education evaluation all be communicated before an activity that is journal based
• Regularly Scheduled Series (RSS)
  
  • The ACCME also proposed removing language about the required monitoring system for RSS 

Application 

The ACCME is proposing to change the application process for initial applicants so that providers seeking accreditation would only be required to have a CME activity reviewed before full accreditation, removing the requirement of a survey of a providers administrative office.   

Performance-in-Practice Review  

In response to requests from the CME community, the ACCME proposed offering an abstract for accredited providers to use when verifying performance-in-practice.  This abstract would take the place of labels and facilitate the process of verifying performance-in-practice.  ACCME prepared a draft version of the abstract for review, which appears on the last page of the new proposal.  It provides instruction and fields to insert narrative; this narrative would replace the submission of additional documentation from activity files.  It also includes specific instructions for submitting attachments that are needed for verification.  The purpose of this abstract is to clarify and simplify the performance-in-practice review process. 

Accreditation with Commendation 

The ACCME proposed removing several criterion (4, 13-16, and 18) to remove redundancies and streamline the Criteria while maintaining the continuous improvement model and the high standards that are essential for designing and implementing independent, effective, and relevant CME. These changes would reduce the number of criteria required for accreditation from 15 to 11.  ACCME proposed the following replacements: 

• The provider routinely demonstrates and promotes interprofessional collaborative practice in the operation of its CME program and in the design and implementation of its educational activities.
• The provider routinely incorporates patient data (for example, data from registries or electronic health records) into the process for identifying professional practice gaps and educational needs.
• The program of CME conducts assessments of the individual’s professional competence and performance and designs and implements individualized learning activities to address the needs that were identified through the assessments 

From these new criterion, the ACCME is proposing the creation of a “menu of options.”  From this list, accredited providers would choose the specific criteria that they would meet in order to be eligible for Accreditation with Commendation.  Different providers could choose different criteria, but all providers would have to meet the same number of criteria.  The purpose of a menu of options would be to reflect the strength of the diverse community of CME providers, offer more flexibility, and promote innovation and creativity.  The ACCME would need to work out the details:  

• how many criteria would be included as options,
• how many criteria would providers have to meet,
• how compliance would be measured.  

The ACCME would need to work out a timeframe for implementation enabling providers to continue to be eligible for Accreditation with Commendation under the current criteria during the transition period.  Accordingly, the ACCME is asking whether CME providers see value in the concept of a menu of options.