Proposed: A CME funding model that could reduce the perception of bias.
The continuing medical education community needs a funding model that specifically addresses the issues involved in industry support: the potential for influence when content andare supported by a single grantor, the lack of equity in the granting opportunities available to different provider types, and an increasing difficulty in securing an adequate source of funding.
A commercial-support/advocacy consortium, or CSAC, model would allow CME providers to easily find multiple supporters and funding at levels needed to provide effective performance-improvement CME and meaningful outcomes measurements. It also would make the process more transparent by listing on a consortium-specific Web site funding amounts, specific dollar amounts received by each collaborating education partner, and summaries of results-driven improvements in practice and patient care. Here’s an overview of how it would work.
Filling the Funding Pool
In this model, all commercial supporters interested in a particular disease state or condition would form a consortium. Commercial supporters could participate in any number of consortia within their therapeutic interests.
To begin, each commercial supporter would contribute the same amount of money (e.g., $3 million x 3 years = $15 million) in total the first year. The money would be used for grant funds and developing the consortium Web site and Web site content (including a grant submission portal, grant disclosure posting, performance and patient care outcomes summaries, and stipends for those serving on and chairing the advisory and advocacy boards).
The money would not be returned for any reason, including dropping out of the consortium, and if proposals aren’t funded, the money would remain in the pool. Any funds remaining at the end could be used for a grant via request for proposal(RFP) for patient education tools/materials in the consortium’s stated disease or condition. These materials would be available for every future activity and/or offered to every related association/society for posting on their Web sites (at no additional charge to the consortium). Leftover funds also could be used to improve the consortium Web site (funds used for this purpose only once in the 3 year cycle); or consortium members could elect to roll the funds over to the next year provided that there are insufficient funds to provide patient education tools/materials or the one-time Web site improvement.
Five groups would compose the CSAC’s grant review committee: a CME group, a medical affairs group, a legal/compliance group, an advisory group, and an advocacy group. Each CSAC member company would contribute one representative from their organization to the CME, medical affairs, and legal/compliance groups.
The advisory board would be made up of external CME advisers, one recommended by each supporter. This person may be a member of the organization’s existing external CME advisory board. The CME group and the advisory board would elect a member of the advisory board as chairperson (the nominee must win more than 50 percent of the vote) for a term of three years. The chairperson would serve as chair of the Grant Review Committeee as well. Duties would include: conducting meetings via any method and frequency that is efficient and effective—e-mail, conference call, online, or live. The grant-review committee chairperson also would ensure that evaluation criteria are developed and used appropriately. This includes verifying that each organization’s compliance needs are met, and that the criteria are objective and pertinent, and adhere to all standards, policies, regulations, and codes. The grant review committee chairperson also would meet with appropriate parties to resolve any internal and external disputes.
The advisory board chairperson would reach out to the pertinent advocacy groups for representative(s) to serve on the advocacy board. Depending upon the number of advocacy groups, the board could be composed of a minimum of three to a maximum of seven members.
The Advocacy board also would elect, with a more than 50 percent majority, a chairperson from among its members. This person would conduct the board's grant review meetings and serve as liaison to the Grant Review Committeee.
The grant-review committee and advocacy boards, in separate meetings, would review and rank the proposals according to the metrics (highest number of votes, highest scores, etc.) determined by the consortium. The chairpersons of these boards would compile the final proposal rankings.
The consortium could elect to secure a third-party entity to manage the finances and administrative duties, or rotate that decision among the consortium members. Members also could elect a CME rep, from among their members, to provide update reports on activities and outcomes to all consortium members.
The Granting Process
In this model, all provider types would be eligible to submit a grant proposal to the consortium. Amounts would be set at no less than $1 million, and there would be a minimum of two collaborators for each submission. One collaborator must be either an association/society or university center of excellence, regardless of the provider type submitting the proposal. The CSAC Web site would include a portal for online grant submission and the posting of provided grants (with specific amounts noted for both the CME providers and each collaborator who receive the grant). It also would have a section to describe each initiative, the outcomes in practice and patient-care improvement, and the number and type of healthcare professionals educated per activity.
Proposals would be required to include a multifaceted initiative with outcome data plans that demonstrate objective improvement in both physician practice and patient care; a patient-education component or tools for practice; and an indication of how local and or community agencies will be educated (e.g., block grants). If any proposal is declined due to questions about a provider’s reputation, it would have to be fully documented, and any compliance issues would be reported to the Accreditation Council for CME.
The grant review committee and the advocacy board would conduct the initial review of the proposal and give a specific rationale for an up or down vote. All proposals would have to be approved unanimously. If a proposal doesn’t receive unanimous approval, the grant-review chairperson would have the discretion to invite further discussion. Any proposal that was not unanimously approved after discussion would be declined.
The advocacy and advisory board chairpersons then would rank the proposals for funding based on the established metrics.
Worth the Work
The CSAC model would provide multiple support sources, more thorough and effective initiatives for educating healthcare providers, more objective and comprehensive PI activities, and meaningful outcomes data regarding patient health improvement. It also would significantly reduce the perception of bias. The unanimous voting and the inability to reduce or return monies to individual supporters would decrease the likelihood of furthering the specific interests of a particular organization. With the advisory board, and chairpersons paid by the consortium and elected by the members, disputes would not be resolved at the level of any particular commercial supporter.
This model would require hard work, determination, persistence, tact, and diplomacy. It would require an investment of time, personnel and other resources, and it would require passionate champions to see it through. Anything worthwhile requires nothing less.
Would this be the magic bullet to cure all that ails CME today? No. But it would be an opportunity to reaffirm that CME can continue to result in improved practice and patient care. n
Barbara Fuchs, MS, CCMEP, CPHQ, is president of EPIQ Services LLC, specializing in CME consulting. She has held leadership positions across the healthcare industry as an accredited provider, commercial supporter, and in clinical nursing). Her expertise includes case/quality management and performance improvement.You can reach her at bfuchs@firstname.lastname@example.org.