“Wow, an ACCME lovefest has broken out,” tweeted @theCMEguy, otherwise known as CME consultant Derek Warnick, during a webinar put on by the Accreditation Council for Continuing Medical Education last week. The webinar addressed changes the ACCME recently proposed that are designed to streamline its accreditation process. The proposals came about as ACCME is implementing the strategic imperatives identified by its board in 2011, one of which is finding ways to simplify and evolve its standards, process, and system.

From the responses to callers on the webinar, Twitter chatter, and the CME LinkedIn group, it appears that the ACCME has in fact hit a sweet spot with its proposals, which cover general accreditation, accreditation with commendation, Standards for Commercial Support, and other policies. (Here’s a link to the full proposal and related ACCME documents, and here’s a link to a discussion of the proposed changes by Medical Meetings columnist Steve Passin, of Passin and Associates.)

Among the responses that prompted Warnick to declare said lovefest? “I’ve been in the CME community for about 12 years and I want to commend whoever thought of this because it’s great…I want to commend you for trying to hear us and trying to simplify this,” said one caller.

“This is one of the most exciting things I’ve seen from ACCME in a long time, so thank you, Dr. Kopelow and the board for this kind of leadership and imagination and creativity to our field,” said another. Another said simply, “You’ve restored my faith that things can be changed in large organizations across the nation and I greatly appreciate it and look forward to seeing all the changes that are upcoming.”

While the majority were supportive of the proposed changes, it wasn’t all rainbows and unicorns. As one person noted during the Twitter chat, “These changes may be simplified but they are not simple.” Another said, “Have to ask: What is changed in the past year to lead to these [proposed] changes? Community wanted this 5+ years ago.”

Even though the proposals are now public, those who have been waiting will have to wait a bit longer before the changes go into effect. During the webinar, ACCME’s president and chief executive, Murray Kopelow, MD, pointed out that the proposed changes need to go through an informal call for comments and further discussion before the board of directors makes its decision. As Kopelow said, “Nothing is changing today about our expectations of you.”

"We Heard You”

That the initial response was so positive may be because the ACCME based its proposals on feedback from 1,145 CME stakeholders, from ACCME surveyors and recognized accreditors to CME providers working in the trenches. Among the messages received were that “we need to communicate our expectations as clearly as possible,” said Kopelow during the webinar. “We also heard that the community wants us to maintain our expectations. The stakeholders do not want us to lower the bar … but they did say, ‘Would fewer criteria hurt?’” Stakeholders also told the ACCME that it should retain the three-part self-study report, documentation review, and interview process, but that it could perhaps be streamlined to help reduce the costs associated with documentation. “Can we somehow find a simpler and a cost-efficient way to do it while maintaining the benefits of the verification of performance and practice?”

The idea to evolve the accreditation with commendation criteria also came from stakeholder feedback, said Kopelow. No one wanted to return to the days when the criteria were based on creativity and innovation, though. “They wanted it to be clear about what it was that people needed to do and that we would reward and recognize people for it,” he added. The idea the ACCME grabbed onto was to create a longer list of criteria, with some of the current criteria and some new ones, that providers could pick and choose from. “I like the idea of menu of options for accreditation with commendation,” one person tweeted, since allows for some individuality, though another added, “If it means filling out more forms or creating new documentation, then blech.”

People also said they wanted templates they could use to implement the requirements. The idea to replace the performance-in-practice labels with a structured abstract form also was a big hit, prompting Twitter responses including, “More descriptive … Less labeling. Me like.”

Other ideas that were, Kopelow said, “harder for us to address simply and quickly, but very important,” include aligning the various accreditation systems, giving providers more informative feedback than just an accreditation decision, and how to address the issues of holding U.S. providers to a higher level of outcomes. Also on the ACCME’s radar is involving provider leadership in the accreditation process, and continuing to engage with and support maintenance of certification and maintenance of licensure.

Some Questions Remain

During a Q&A session after the formal webinar, several people called in with questions about the proposed changes. Among them:

• Has ACCME discussed the proposed changes with other accreditors, such as the American Nurses Credentialing Center and the Accreditation Council for Pharmacy Education? What about CME provider organizations such as the Alliance for Continuing Education in the Health Professions?

Kopelow said, “Our partners in nursing and pharmacy have been working with us continuously through our revolution, our evolution, and in our changes … anything that we do we have to do in step with our colleagues.” ACCME did not, however, specifically reach out to ACEHP, the Society for Academic CME, or the National Association of Medical Education Companies, though “we will certainly now work with the organizations that represent providers and with providers directly,” he said.

• What’s the timeline for implementation?

The informal call for comment period is open until July 2 (here’s a https://accme.wufoo.com/forms/accme-simplification-and-evolution/survey link to the survey), and the ACCME board of directors will discuss the feedback at its meeting July 11-12. If the board decides not to make a decision at that time, the board likely will pick it up at its fall meeting. Once the board makes a decision, it goes to the ACCME’s member organizations for review and it goes out for a formal call-for-comment period of 45 days. The earliest providers can expect to implement the changes would be in April 2014, said Kopelow.

• One of the proposed changes involves a removal of the monitoring system for regularly scheduled series. Is it being replaced with something else?

“We’re replacing it with the rest of the criteria,” said Kopelow. There will no longer be separate rules for RSS. “We haven’t diminished the expectation,” he said. “It’s just that we’ve removed it from self- distinguishing it from every other kind of activity.”

• For meetings with a large number of speakers, do you have to provide a professional practice gap for each presenter, or can you just provide an umbrella professional practice for the seminar as a whole?

“Having a professional practice gap for every lecture might be appropriate if every lecture is unrelated to the lecture before,” Kopelow said. However, having one identified gap might be sufficient as long as each lecture focuses on the same gap, even though each lecture might be addressing different aspects.

• Can the period of receiving accreditation with commendation be lengthened beyond the current six-year term?

“Like for life, you mean?” asked Kopelow. “Well, the way that conversation usually goes is continuous accreditation where you have accreditation and it’s yours to lose.” However, he pointed out that the idea of a longer accreditation with commendation term is a good suggestion to bring up to the board.

• How do you envision strengthening the position of CME programs by further engaging organizational leadership?

Kopelow pointed to several initiatives the ACCME is already undertaking to engage institutional leadership in involving CME at a national level to improve health, including working with the American Hospital Association to bring their leadership into conversations on how to use CME in their organizations. ACCME also was invited to a meeting with the National Human Genome Research Institute to co-present about the role of medical education in increasing physician literacy about the use of genomics science. While it hasn’t yet been addressed by ACCME, one suggestion that has been raised was that “the ACCME … make a rule that says, ‘Your CEO needs to be out serving or there needs to be a demonstration from your board of directors of your organization that they are involved and committed,’" said Kopelow.

• Is there some way to encourage further education within the CME community as part of the accreditation criteria—perhaps as a criteria for accreditation with commendation?

“It could be a position that we take,” Kopelow said, that “a commitment to the professional development of the people in CME is a manifestation of organizational commitment. … It’s an area we haven’t addressed yet.” It is, however, something that the ACCME board finds very important, he added.

• On the CME LinkedIn group, there was a question about the change to not allow corporate logos, as a form of corporate branding, to be used in educational materials, disclosure, and acknowledgment of commercial support. Could providers still use logos on acknowledging exhibitors and supporters in the expo hall?

Kopelow answered, "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.”