After many months of speculation, the Accreditation Council for Continuing Medical Education has announced the final list of new criteria that will define the CME providers deserving of the coveted status of accreditation with commendation. The good news is that the new menu offers metrics that are actually achievable, with the proviso that each CME provider desiring to reach this status starts now to choose menu options and put a plan in place to implement them.

Highlights of the final rule will affect all nationally accredited CME providers as well as ACCME-recognized state medical associations that accredit local CME organizations, although the state-accredited organizations may take a longer time to implement the new criteria. While most of the criteria are essentially the same as when they were originally released for comment, the final release provides definitive information on the menu of choices associated with the new criteria as well as the metrics for determination of compliance.

New Criteria Highlights

Here are some highlights of the new criteria and their compliance metrics:

• There are 16 new criteria—C23-36—which are divided into five siloed categories:

1. Promotes Team-Based Education

2. Addresses Public Health Priorities

3. Enhances Skills

4. Demonstrates Educational Leadership

5. Achieves Outcomes

• To achieve accreditation with commendation, CME providers need to demonstrate compliance with any seven criteria of their choice from any category, plus one criterion from the Achieves Outcomes category (encompassing relevance, value, and impact of CME)—for a total of eight criteria out of 16.

• CME providers do not need to achieve compliance with the new criteria to achieve regular accreditation status. Still unclear is whether CME providers will have to complete the chapter containing C23-38 even though compliance with that chapter is not required to achieve a basic four-year accreditation.

• There will be a transition phase from accreditation decisions starting in November 2017 and continuing through accreditation decisions in November 2019—during which time providers can choose old criteria 16-22 (now called “Engagement with the Environment”) or the new commendation criteria 23-38. Providers must select either the old or the new criteria; they may not mix them. After the November 2019 cohort, providers will have to demonstrate accreditation with commendation by addressing only Criteria 23-38.

• Importantly, these new criteria are not being implemented for providers accredited through Joint Accreditation for Interprofessional CE (or those intending to become Joint Accredited).

Standards for measuring compliance are either activity-based or program-based, and there is a sliding scale for some criteria based on individual program size—all of which is indicated uniquely for each of the new criteria in the table below.

Sliding scale metrics are stipulated by program size by activities per term of accreditation, as follows: S (small): <39; M (medium): 40 -100; L (large): 101-250; XL (extra-large): >250

• CME providers can document compliance in three ways:

1. Attestations: Providers will need to attest to meeting the criterion in 10 percent of activities during the accreditation term—this percentage is the same for all providers. The ACCME will provide a simple mechanism for attestation during the accreditation process.

2. Submitting evidence at review: Providers will need to submit evidence to show how they met the criterion. The number of activities for which CME providers will submit evidence is based on the number of activities reported during the accreditation term in the ACCME’s Program and Activity Reporting System, or PARS. It may be possible to meet multiple criteria with one activity.

3. Examples and descriptions: For the program-based criteria, the standards state that providers will need to demonstrate compliance with examples or descriptions. This will involve submitting brief explanations as part of the self-study report, and the new outline for this chapter of the self-study report will be issued by the ACCME later this fall.

The New Criteria, Their Rationale, Critical Elements

Category and Criterion

Rationale

Critical Elements to Demonstrate Compliance

Standards for Measuring Compliance

CATEGORY 1: Promotes Team-Based Education

C23—

Members of interprofessional teams are engaged in the planning and delivery of interprofessional CE (IPCE)

Interprofessional continuing education (IPCE) occurs when members from two or more professions learn with, from, and about each other to enable effective interprofessional collaborative practice and improve health outcomes. This criterion recognizes accredited providers that work collaboratively with multiple health professions to develop IPCE.

 

·    Includes planners from more than one profession (representative of the target audience) AND

·    Includes faculty from more than one profession (representative of the target audience) AND

·    Activities are designed to change competence and/or performance of the healthcare team

·    Attest to meeting this criterion in at least 10% of activities (but no less than two) during the accreditation term.

·    At review, submit evidence for this many activities: *

Sliding Scale: S=2; M=4; L= 6; XL=8

C24—Patient/public representatives are engaged in the planning and delivery of CME

Accredited continuing medical education (CME) is enhanced when it incorporates the interests of the people who are served by the healthcare system. This can be achieved when patients and/or public representatives are engaged in the planning and delivery of CME. This criterion recognizes providers that incorporate patient and/or public representatives as planners and faculty in the accredited program.

·    Includes planners who are patients and/or public representatives AND

·    Includes faculty who are patients and/or public representatives

·    Attest to meeting this criterion in at least 10% of activities (but no less than two) during the accreditation term.

·    At review, submit evidence for this many activities:*

Sliding Scale: S=2; M=4; L= 6; XL=8

C25—

Students of the health professions are engaged in the planning and delivery of CME

This criterion recognizes providers for building bridges across the healthcare education continuum and for creating an environment that encourages students of the health professions and practicing healthcare professionals to work together to fulfill their commitment to lifelong learning. For the purpose of this criterion, ‘students’ refers to students of any of the health professions, across the continuum of healthcare education, including professional schools and graduate education.

 

 

 

 

 

 

·    Includes planners who are students of the health professions AND

·    Includes faculty who are students of the health professions

·    Attest to meeting this criterion in at least 10% of activities (but no less than two) during the accreditation term.

·    At review, submit evidence for this many activities:*

Sliding Scale: S=2; M=4; L=6; XL=8

CATEGORY 2: Addresses Public Health Priorities

C26—

The provider advances the use of health and practice data for healthcare improvement

The collection, analysis, and synthesis of health and practice data/information derived from the care of patients can contribute to patient safety, practice improvement, and quality improvement. Health and practice data can be gleaned from a variety of sources; some examples include electronic health records, public health records, prescribing datasets, and registries. This criterion will recognize providers that use these data to teach about health informatics and improving the quality and safety of care.

 

 

 

 

·    Teaches about collection, analysis, or synthesis of health/practice data AND

·    Uses health/practice data to teach about healthcare improvement

Demonstrate the incorporation of health and practice data into the provider’s educational program with examples from this number of activities:*

Sliding Scale: S=2; M=4; L= 6; XL=8

C27—

The provider addresses factors beyond clinical care that affect the health of populations.

 

 

This criterion recognizes providers for expanding their CME programs beyond clinical care education to address factors affecting the health of populations. Some examples of these factors include health behaviors; economic, social, and environmental conditions; healthcare and payer systems; access to care; health disparities; or the population’s physical environment.

·    Teaches strategies that learners can use to achieve improvements in population health

·    Attest to meeting this criterion in at least 10% of activities (but no less than two) during the accreditation term.

·    At review, submit evidence for this many activities:*

­­ Sliding Scale: S=2; M=4; L=6; XL=8

C28—

The provider collaborates with other organizations to more effectively address population health issues

Collaboration among people and organizations builds stronger, more empowered systems. This criterion recognizes providers that apply this principle by building collaborations with other organizations that enhance the effectiveness of the CME program in addressing community/population health issues.

·    Creates or continues collaborations with one or more healthcare or community organization(s) AND

·    Demonstrates that the collaborations augment the provider’s ability to address population health issues

·    Demonstrate the presence of collaborations that are aimed at improving population health with four examples from the accreditation term.

 

CATEGORY 3:  Enhances Skills

C29—

The provider designs CME to optimize communication skills of learners

Communication skills are essential for professional practice. Communication skills include verbal, nonverbal, listening, and writing skills. Some examples are communications with patients, families, and teams; and presentation, leadership, teaching, and organizational skills. This criterion recognizes providers that help learners become more self-aware of their communication skills and offer CME to improve those skills.

 

 

 

 

 

 

·    Provides CME to improve communication skills AND

·    Includes an evaluation of observed (e.g., in person or video) communication skills AND

·    Provides formative feedback to the learner about communication skills

At review, submit evidence for this many activities:*

Sliding Scale: S=2; M=4; L= 6; XL=8

C30—

The provider designs CME to optimize technical and procedural skills of learners

Technical and procedural skills are essential to many aspects of professional practice, and need to be learned, updated, reinforced, and reassessed. Some examples of these skills are operative skill, device use, procedures, physical examination, specimen preparation, resuscitation, and critical incident management. This criterion recognizes providers that offer CME to help learners gain, retain, or improve technical and/or procedural skills.

·    Provides CME addressing technical and or/procedural skills AND

·    Includes an evaluation of observed (e.g., in person or video) technical or procedural skill AND

·    Provides formative feedback to the learner about technical or procedural skill

·    At review, submit evidence for this many activities:*

Sliding Scale: S=2; M=4; L=6; XL=8

C31—

The provider creates individualized learning plans for learners

This criterion recognizes providers that develop individualized educational planning for the learner; customize an existing curriculum for the learner; track learners through a curriculum; or work with learners to create a self-directed learning plan where the learner assesses their own gaps and selects content to address those gaps. The personalized education needs to be designed to close the individual’s professional practice gaps over time.

 

 

 

 

·    Tracks the learner’s repeated engagement with a longitudinal curriculum/plan over weeks or months AND

·    Provides individualized feedback to the learner to close practice gaps

·    At review, submit evidence of repeated engagement and feedback for this many learners:*

Sliding Scale: 25; M=75; L=125; XL=200

C32—

The provider utilizes support strategies to enhance change as an adjunct to its CME

This criterion recognizes providers that create, customize, or make available supplemental services (e.g., reminders) and/or resources (e.g., online instructional material, apps) that are designed to reinforce or sustain change.

·    Utilizes support strategies to enhance change as an adjunct to CME activities AND

·    Conducts a periodic analysis to determine the effectiveness of the support strategies, and plans improvements

 

·    Attest to meeting this criterion in at least 10% of activities (but no less than two) during the accreditation term.*

·    At review, submit evidence for this many activities:

Sliding Scale: S=2; M=4; L=6; XL=8

CATEGORY 4: Demonstrates Educational Leadership

C33—

The provider engages in CME research and scholarship

Engagement by CME providers in the scholarly pursuit of research related to the effectiveness of and best practices in CME supports the success of the CME enterprise. Participation in research includes developing and supporting innovative approaches, studying them, and disseminating the findings.

 

 

 

 

 

 

 

 

 

 

·    Conducts scholarly pursuit relevant to CME AND

·    Submits, presents, or publishes a poster, abstract, or manuscript to or in a peer-reviewed forum

·    At review, submit description of at least two projects completed during the accreditation term and the dissemination method used for each.

C34—The provider supports the continuous professional development of its CME team

 

 

The participation of CME professionals in their own continuing professional development (CPD) supports improvements in their CME programs and advances the CME profession. This criterion recognizes providers that enable their CME team to participate in CPD in domains relevant to the CME enterprise. The CME team are those individuals regularly involved in the planning and development of CME activities, as determined by the provider.

·    Creates a CME-related continuous professional development plan for all members of its CME team AND

·    Learning plan is based on needs assessment of the team AND

·    Learning plan includes some activities external to the provider AND

·    Dedicates time and resources for the CME team to engage in the plan

·    At review, submit description showing that the plan has been implemented for the CME team during the accreditation term.

 

C35—

The provider demonstrates creativity and innovation in the evolution of its CME program

This criterion recognizes CME providers that meet the evolving needs of their learners by implementing innovations in their CME program in areas such as education approaches, design, assessment, or use of technology.

·    Implements an innovation that is new for the CME program AND

·    The innovation contributes to the provider’s ability to meet its mission.

·    At review, submit descriptions of four examples during the accreditation term.

CATEGORY 5: Achieves Outcomes

C36—

The provider demonstrates improvement in the performance of learners

Research has shown that accredited CME can be an effective tool for improving individuals’ and groups’ performance in practice. This criterion recognizes providers that can demonstrate the impact of their CME program on the performance of individual learners or groups.

·    Measures performance changes of learners AND

·    Demonstrates improvements in the performance of learners

·    Demonstrate that in at least 10% of activities the majority of learners’ performance improved.

C37—

The provider demonstrates healthcare quality improvement

CME has an essential role in healthcare quality improvement. This criterion recognizes providers that demonstrate that their CME program contributes to improvements in processes of care or system performance.

·    Collaborates in the process of healthcare quality improvement AND

·    Demonstrates improvement in healthcare quality

·    Demonstrate healthcare quality improvement related to the CME program at least twice during the accreditation term.

C38—

The provider demonstrates the impact of the CME program on patients or their communities

Our shared goal is to improve the health of patients and their families. This criterion recognizes providers that demonstrate that the CME program contributed to improvements in health-related outcomes for patients or their communities.

·    Collaborates in the process of improving patient or community health AND

·    Demonstrates improvement in patient or community outcomes

·    Demonstrate improvement in patient or community health in areas related to the CME program at least twice during the accreditation term.

 

Start a Conversation at Your Organization/Make Strategic Choices

 

It is time to convene the leadership for every CME provider to review the new criteria and begin to make choices on which of the new criteria each provider will strive to meet. Strategic planning is the key to having the results that you want and enjoying a result of accreditation with commendation.

For providers that seek and use commercial support, it is expected that those supporters will place a value on CME providers that can demonstrate accreditation with commendation.

Once decisions have been made on which criteria will be implemented, then new policies, procedures and practices will need to be identified that will facilitate having the critical elements to demonstrate compliance.

Steve Passin is president & CEO of Steve Passin & Associates, based in Newtown Square, Pa. Contact Steve at passin@passinassociates.com.