“We don't reject or refute [the Senate Finance Committee's] observations,” says Murray Kopelow, MD, chief executive, Accreditation Council for CME. As thesaid in a press release, the report's observations highlight where there could be enhancements to the system that would make CME's independence from commercial interests more distinct, he says. “We plan to open communication channels with committee staff. We're going to integrate [the committee's comments] into our internal assessment process.”
We asked Kopelow for his thoughts on the key issues raised in the committee's letter to the ACCME.
- On monitoring activities
“We are discussing the concept of a compliance-surveillance system, where there is direct observation of the educational activities. The learners could be our trained observers, who could then make their thoughts known about commercial bias in an activity.”
- On the ACCME's policy of accrediting providers if 80 percent of activities are in compliance
“We expect all providers to be compliant all of the time, but we understand that organizations can make mistakes. Improvement must be demonstrated through a progress report. We have a lot of faith in our progress report process, as ACCME data shows it is effective. However, we still need to look at the value and impact of changing [our standard] to 100 percent. Of equal or greater importance is for ACCME, and the CME enterprise, to answer the question: Why is there a consistent percentage of people in every cohort that is out of compliance?”
- On the 24 percent of providers found out of compliance
“We may need to be much more transparent with our accreditation results and information, perhaps by publishing the results of an individual provider or perhaps by publishing the aggregated results. For example, we know that more than 85 percent of that 24 percent that are found in noncompliance become compliant within a year.”
- On the report's focus on problems with MECCs
“The issues that are raised in the report are relevant to all providers. We published the accreditation performance data of all the providers. Clearly, the MECCs were among the most compliant with the Standards for Commercial Support. The data doesn't support the observation that any provider group is the problem. These are systemwide issues.”
- On commercial supporters influencing content
“We're going to have to recognize that perhaps some of the current practices have become obsolete. When a commercial supporter suggests or directs the content of CME, that's an action that undermines, challenges, or removes the [provider's] independence. If a commercial supporter makes a suggestion that is followed because [the provider] wants to get more money next time, even if the provider takes full responsibility for accepting the input, it does not ensure the independence of CME.
“It is probably reasonable to believe that CME can receive money from industry without receiving any advice or guidance, either nuanced or direct, on the activity content or who should deliver it. We need to ask: Can collaboration with industry and independence from industry coexist in CME? The terms industry partners and collaboration with industry imply a relationship that's not consistent with the spirit of the ACCME's Standards for Commercial Support.”