CME UPDATE April 19, 2009

Presented by: Dina L. Gonzales American College of Emergency Physicians Manager, Accreditation and International Relations Susan P. Tyler, M.Ed., CMP Director, Continuing Medical Education College of Medicine University of Cincinnati

Discussion Topics: CME Process Chapter Relations Staff Requirements CME Handbook Joint Sponsorship (Form 1) CME Application Process Enduring Material Application Process Activity Follow Up, Evaluation, and Outcomes NER Handbook National Education Representatives Accreditation Oversight Subcommittee Chapter Relations Staff Requirements ACCME Updated criteria Moving Forward

CME Handbook Regular Updates On-line access Number pages by section Recommendation Action Regular Updates On-line access Number pages by section Communicate additions, deletions, and revisions Checklist of requirements Annually and as needed to address ACCME/ACEP changes or clarifications Available August 2008 Will be incorporated into pending revision Via Chapter e-list outlining changes and corresponding page numbers Currently available in handbook – working on reformatting

CME Handbook, continued Recommendation Action On-line templates CME planning responsibilities Communicate new requirements All existing forms are being reformatted CME Handbook, on-line application process, Joint Sponsorship agreement in lieu of General application Chapter e-list and quarterly Chapter updates

Joint Sponsorship (Form 1) Recommendation Action Review Requirement Update Form Educational Opportunity Attestation Developing Joint Sponsorship Agreement in lieu of current General Application Working in conjunction with ACEP legal counsel New agreement will outline Chapter responsibilities and reference materials to be reviewed New agreement to include attestation statement

CME Application Process Recommendation Action On-line application forms E-mail submission for missing elements NER approval Accreditation decisions All existing forms are being updated Will be allowed on a go-forward basis NER will communicate approval to CME coordinator via e-mail Already utilizing an approval letter template; will communicate via e-mail and follow-up with hard copy

CME Application Process, cont. Recommendation Action On-line application process E-mail confirmation of receipt Electronic tracking system Best practice examples Currently working with IT department (Jan-Feb 2010) Has been implemented Will be incorporated into pending CME handbook revision

CME Application Process, cont. Recommendation Action Expedited review of application for ACEP Category I only Pending statement for ACEP Category I credit only 45 business day review period for live meeting applications Allowable under existing guidelines Will be incorporated into pending CME handbook revision

CME Application Process, cont. Recommendation Action Increase application fees for Chapter meeting applications to $275 Activity fee for multiple presentations of same content ($10 per occurrence for 2-20 with maximum of $200 Rush fee - $500 Will be incorporated into pending CME handbook revision

Enduring Material Application Process Recommendation Action Additional NER’s for enduring material applications Renewal reminders Approval gaps Will review in conjunction with Accreditation Oversight Subcommittee Will establish a tickler system and issue reminder to Chapters No credit available during lapsed approval periods; will clarify policy in pending CME handbook revision

Enduring material application process, cont. Recommendation Action 90 business day review period for enduring material applications Review pricing structure; current fees are low Will be incorporated into pending CME handbook revision Increase to $350/5 CME hours; will be incorporated into pending CME handbook revision

Activity Follow up, evaluations, and outcomes Recommendation Action Request financial summaries for each activity Level 3 outcome evaluations Activity files Will be incorporated into pending CME handbook revision Will be incorporated into pending CME handbook revision/Joint Sponsorship Agreement Maintained by Chapters and National ACEP

NER Handbook Update NER orientation In progress Recommendation Action Update NER orientation In progress Conference call pending handbook update

National Education Representatives Recommendation Action Remove requirement that NER be involved with planning committee/process (available for consults) Replace with requirement that an active emergency physician member of ACEP be integrally involved in the planning of the activity to ensure that content is appropriate for the specialty; will be incorporated into pending NER handbook revision

National education representatives, cont. Recommendation Action Determine which activities can be reviewed and approved in-house by ACEP CME staff ACEP staff review/approval of simple, repeat, or ACEP Category I only activities Simple, repeat, or ACEP Category I only activities; to be considered at a later date To be considered at a later date; not an option based on current staff workload and knowledge

National education representatives, cont. Recommendation Action Shorten NER review process The following procedures have already been implemented: complete application packages to NER via FedEx 2 day; NER will communicate approval to CME Approval Coordinator via e-mail; approval to Chapter via e-mail and hard copy

National education representatives, cont. Recommendation Action Questionable or complex activities to NER for review NER evaluation process NER evaluation of accreditation process Covered under existing guidelines To be addressed as part of the NER handbook revision Annual survey to NER’s to evaluate accreditation process

National education representatives, cont. Recommendation Action Query NER’s regarding their desire to continue appointment NER training/update on ACCME/ACEP policies/procedures Annual expressions of interest - to be addressed as part of the NER handbook revision Annual conference call - to be addressed as part of the NER handbook revision

Accreditation oversight subcommittee Recommendation Action Policy, oversight, and appeals board Selected on rotating schedule (every 3 years) based on CME experience/knowledge Annual orientation CME staff involvement Allowable under existing guidelines Annual committee appointment; focus will be placed on CME knowledge/experience beginning with 09/10 appointments To be conducted during annual face-to-face meeting at SA

Chapter relations Recommendations Actions Allow global overall learning objectives for LLSA and Board review courses Chapter orientation - ACCME accreditation process and AMA PRA requirements Chapter orientation - ACEP CME accreditation process (additional requirements) To be addressed as part of the CME handbook revision ACCME presentation at SA 2009; will consider future AMA speaker Two face-to-face meetings per year (SA and LAC); quarterly CME update

Chapter relations, cont. Recommendation Action Annual CME educational session Chapter role in joint sponsorship Requirements for national ACEP activities SA and LAC New Joint Sponsorship agreement will outline Chapter responsibilities Existing guidelines hold national ACEP activities to higher standards of design and planning; joint sponsorship is offered as a member service and is not an entitlement

Chapter Relations, cont. Recommendation Action Annals listings Current guidelines provide for an Annals/Master Calendar listing for live activities upon receipt of CME application; CME hours are updated upon receipt of approval (15th of month publishing deadline – eg. April 15th for June 1 issue)

Chapter Relations, cont. Recommendation Action Monthly or quarterly online newsletter Post frequently asked questions online Quarterly CME updates will be provided following completion of pending CME handbook revision Available in CME handbook; will be updated as part of pending CME handbook revision

Staff requirements Add CME staff Recommendation Action Add CME staff ACEP staff review/approval of simple, repeat, or ACEP Category I only activities Rebuild Chapter relationships To be considered at a later date To be considered at a later date; not an option based on current staff workload and knowledge New CME Approval Coordinator

Staff requirements, cont. Recommendation Action Chapters as educational partners ACEP staff as teachers/coaches Joint Sponsorship Agreement (contract) Focus on customer service Two live sessions annually; quarterly CME updates; explanations and guidance upon request Developing Joint Sponsorship Agreement in lieu of current General Application to include attestation

ACCME Updated Criteria CME paradigm shift From emphasis on physician learning to a focus on improvements in physician competency, performance, and patient outcomes ACCME’s expectation is that CME providers will design and implement CME activities that will yield measurable outcomes Emphasis on physician learner “gap analysis” Educational programs should be designed to address specific “gaps” in EP knowledge and skills Identify gap and determine/show cause of gap. Why is there a gap? Identify the barriers to overcoming the gap? Identify type of gap? Performance, competency, patient outcomes

ACCME Updated Criteria, cont. Needs Assessment The professional practice gap(s) that the activity addresses. Current practice vs ideal way of managing a clinical problem (based on practice guidelines, best available evidence, etc.) The educational need(s) that was derived from the professional practice gap(s). Knowledge, competence, or performance Evidence that the need(s) was incorporated into the CME activity. Include sample or example

ACCME Updated Criteria, cont. Planning Process Activity has been designed to change physician competence, performance, or patient outcomes Planning notes/minutes Overall narrative activity description Individual narrative session/lecture descriptions Identify match between the content and the scope of your learners’ current or potential scope of professional activities Describe process used to ensure format is appropriate to objectives and desired results. Identify desirable physician attribute(s) that was incorporated into the planning process

ACCME Updated Criteria, cont. Disclosure Provide list of all individuals in control of content of CME activity (name, credentials, institution affiliation) Provide disclosure forms for all individuals in a position to control the content disclosed relevant financial relationships Faculty/Authors Planning committee members Staff Individuals who refuse to disclose are disqualified from CME planning and implementation, if applicable

ACCME Updated Criteria, cont. Disclosure, cont. Describe mechanism to identify conflicts of interest prior to the start of the activity Describe mechanism to resolve conflicts of interest prior to the start of the activity Disclosure of relevant (or no) financial relationships was made to learners prior to the beginning of the activity (include sample or example) Disclosure of source of commercial support was made to learners prior to activity (include sample or example) Provide list of all Commercial supporters for the activity Provide copies of all signed written agreements that correspond with the list of all commercial supporters

ACCME Updated Criteria, cont. Faculty or author honoraria and reimbursement are paid in compliance with provider’s policies Provide copy of policy and final financial (budget) summary for each activity Provide accurate documentation detailing the receipt and expenditure of commercial support Provide copy of income and expense statement Evaluation of changes in learner’s competence, performance, or patient outcomes Provide copy of evaluation form/mechanism Provide copy of brochure, meeting announcement, and/or meeting materials with the approved ACCME accreditation statement

ACCME Updated Criteria, cont. Enduring Materials Demonstrate that the activity is in compliance with the ACCME Policy that is specific to its activity type Show how the activity complies with the applicable policy Provide copy of final product Utilize labels, arrows, highlighting, or other method to make explicit where in the activity there is evidence of compliance

Moving forward Revision of ACEP CME Mission Statement Joint Sponsorship Agreement Chapter review of all activity files for required requirements/documentation prior to being submitted for review Live activity, enduring material (print, CD-ROM, monograph, etc.), and Internet require separate applications and cannot be combined into one activity Internet enduring materials require submission of screen shots of all web pages for activity from start to finish Third Party communication Member physicians vs NER involved in planning process Application Fee Increases Needs Assessment

Moving forward, cont. Measurable Learning Objectives Standardized Evaluation Forms Standardized Faculty Disclosure Forms Application timelines/deadlines Brochure printing/distribution No CME provided for activities in which promotional materials have been distributed without approved credit statement Annals of Emergency Medicine calendar deadlines Counting CME credits (rounding, welcome/introduction, breaks/lunches, tests, etc.) Online application process/tracking CME Audit – Steve Passin & Associates ACCME Reaccreditation

Resources included in notebook Consultants Report – February 28, 2009 ACCME Accreditation Policies Including Information for Provider Implementation ACCME Essential Areas and Their Elements ACCME Self Study Report Tabs – March 2010 Cohort ACCME Performance in Practice Review Labels – March 2010 Cohort ACCME Examples of Compliance – November 2008 AMA Physician’s Recognition Award and credit system ACCME website – www.accme.org AMA website – www.ama-assn.org