Coalition for Healthcare Communication CME Committee

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1. The Macy Foundation Summary Report recommending a five year phase out of commercial support by industry and the systematic exclusion of accredited commercial providers dominated conversation from start to finish.
   
   Here is the link to the report:
   http://www.josiahmacyfoundation.org/index.php?section=home 
   
   The joint statement by the Coalition and NAAMECC was circulated widely at the meeting. Access at:
   www.cohealthcom.org
   
   Several participants in the meeting that developed the recommendation made presentations at the sessions, but there was little support among meeting attendees for the primary recommendations to kill commercial support and limit provider types to medical schools, not-for-profit professional societies, select health care organizations and professional journals. Moreover, both the leadership of the Alliance and ACCME, made it clear that they did NOT support the full recommendations in the Report Summary.
   
   Perhaps the most poignant remark was made at the end of the closing panel where Mike Saxon of Pfizer noted that if the CME community decided to eliminate commercial support, there would be little resistance by many heads of pharma companies.
   
   Although many thought this report was simply a repetition of a familiar theme from limited group of academicians in and outside of the CME community, Coalition leaders at the meeting were concerned that this may well be a part of a much larger push by academic physicians and many elite policy groups to advance this agenda ahead of the 2008 elections. Indeed, the Institute of Medicine (IOM) held a meeting in Washington the day following the meeting focusing on conflicts of interest, and many expect that the ideas in that report were discussed.
   
   Find more on the IOM Conflict of Interest Sessions at:
   http://www.iom.edu/CMS/3740/47464.aspx
   
   Marty Cearnal, Brad Bednarz and Mark Schaffer will be studying the issues and making recommendations for further Coalition action at our next meeting on March 18. These Coalition leaders will be coordinating with the CME Subcommittee members and working closely with NAAMECC to gather additional intelligence and develop a strategic plan to address this latest threat.
   
   Meanwhile, virtually all provider types expressed concern about decreasing commercial support, the increased overhead created by increasing paperwork required by ACCME standards, and the increasingly complex process of applying for CME grants.
   
   
2. Murray Kopelow’s Hot Topics session on January 20, "ACCME Announces Strategic Imperatives to Address Senate Finance Committee Inquiry into Accreditation and Oversight Processes"
   
   ACCME Chief Executive, Dr. Murray Kopelow announced five strategic imperatives to address the Senate Finance Committee's request to demonstrate how its processes mitigate the risk of influence and bias from commercial entities that fund CME. However, in this and other meetings, Dr. Kopelow appeared to resist calls for the ACCME to do more enforcement (but see aggressive NAAMECC action below).
   
   The first three themes generated a great deal of discussion leaving no time in the session to explore the last two. The five themes are:
   
   
   1. Enhancements to the collection, analysis, application, and dissemination of data and information. This could include such things as real time data reporting, direct reporting by learners and trained observers, information from providers on bias ratings and activity outcomes.
      
      
   2. Changes to the process that ACCME uses to administer the Standards for Commercial Support. This may include such things as more explicitly defined guidelines for content validation and conflict of interest resolution and enhanced sensitivity of accreditation measurement tools. Dr. Kopelow suggested that serious problems may warrant a quick and more visible response by ACCME.
      
      
   3. Review of the management of commercial support. This may include exploration of alternative funding models such as pooled funding with intermediary dispersal of funds; limited funding for single activities unless the needs identification comes from public health sources; and perhaps no commercial support at all.
      
      
   4. ACCME's education and outreach programs. This includes exploring and clarifying boundaries between promotion and CME.
      
      
   5. Collaboration, cooperation, and communication. Dr Kopelow promised a variety of forums and venues where all stakeholders can share information.
      
      Access the ACCME's Call to Action Booklet "CME as a Bridge to Quality" that includes these five themes at:
      http://www.accme.org/index.cfm/fa/news.detail/News/.cfm/news_id/79e6296e-5037-4908-ae85-dbe22c4d73c9.cfm
   
   
   
3. NAAMECC Funds Independent Audit to Assess Bias in CME
   
   The NAAMECC Board, at its meeting during the Alliance annual meeting, approved collaborative funding of up to $20,000 to conduct random audits of a statistically significant number of certified CME activities across multiple provider types.  NAAMECC invited several CME stakeholder organizations to share in the funding and reporting of this initiative to assess the prevalence of bias in CME. The Coalition CME Committee will be reviewing this program and will consider financial and other support for this program.
   
   Access the press release and more information at the NAAMECC site:
   www.naamecc.org
   
   
4. Mark Schaffer and Melinda Steele circulate document outlining common problems with Letters of Agreement (LOA) and call for adoption of a more uniform set of provisions.
   
   The Schaffer/Steele LOA document was widely circulated and discussed in multiple sessions at the meeting. Several leaders from across provider types, including MECCs, Specialty Societies and academic providers, agreed that proposal reflects common and serious issues with the standard form letters, particularly problems arising from the legal teams of commercial supporters.
   
   The Coalition will pursue strategies to circulate the current proposal among industry lawyers, and otherwise support this initiative.
   
   Access the document here:
   http://www.sacme.org/index.cfm?newsid=100&pagepath=News_Events&id=1018
   
   
5. National Commission for Certification of CME Professionals (NC-CME) launched the development of its certification exam which should be available by Mid-2008.
   
   Individuals and groups interested in sponsoring the program or in cooperating in the "beta test" of the test, can find additional information at the NC-CME website:
   http://www.nccme.org/index.asp?dbSection=welcome
   
   
6. Additional Notes
   • Despite or because of the controversy, the Alliance meeting continues to grow attendance. This meeting was the largest ever with over 2,100 attendees.
   • The meeting evidenced a substantial increased interest in international activity. 68% of respondents to an Alliance membership survey said they wanted more information in this area, specifically with interest on Europe.
   • The Alliance has agreed to become much more visible on matters of public policy, including the hiring of a public policy/public relations consultant.
   • All provider types expressed concern about possible reduction or loss of commercial support because decisions by pharma in the face of decreasing revenues and criticism by medical and public policy leaders.
   • The Coalition/NAAMECC button and table cards “Certified CME is Different” were seen throughout the meeting, and stimulated discussion of the need for significant education.
   • John Kamp provided an “Inside-the-Beltway” perspective at two sessions. His power point presentation is on the Coalition website: www.cohealthcom.org