For the first time, the Accreditation Council for CME is initiating a review of the commercial support system that will include considering a full range of options — from leaving the process intact, to setting up a centralized grants repository, to limiting — and even prohibiting — pharmaceutical industry funding of CME.

“It's hard to believe that we could be talking about not having commercial support — we wouldn't have talked about that 10 years ago,” says Murray Kopelow, MD, ACCME chief executive. “It doesn't mean that any one of those [choices] needs to be the outcome, but we do have to talk about them.”

The plan for a system review was outlined in an August 3 letter the ACCME sent to the U.S. Senate Committee on Finance to address the committee's concerns about CME.

After a nearly two-year investigation into pharmaceutical industry funding of CME, the SFC issued a report in April, and then it sent a letter to the ACCME expressing concern that the agency's oversight of CME was insufficient to guarantee that programs are independent of drug company influence.

While the ACCME's letter says that it recognizes that CME providers can receive financial support from industry without undue influence, it adds that “the future role of industry in CME, including that of a funder, will be evaluated in the context of independence.”

Bias Prevention

In response to the SFC's concern that the ACCME relies on providers' self-reported data about activities rather than direct observation, the ACCME will also explore establishing a system for monitoring activities for commercial bias. Asked whether the ACCME is considering instituting random, unannounced monitoring and direct reporting by learners and observers, as many CME professionals have suggested, Kopelow responded, “Everything is on the table for consideration and discussion. The added value and the unintended consequences [of monitoring] all have to be part of the discussion.”

Steel Hand

The letter also said that ACCME would consider strengthening the steps required for obtaining and maintaining accreditation. For instance, says Kopelow, the ACCME might shorten the timeframe providers are given to correct compliance problems. The ACCME could also impose more stringent consequences for noncompliance, depending on the infraction. Providers that fail to follow disclosure guidelines at 20 percent of their activities would have the opportunity to correct the problem, but “if we find that a provider is promoting a product and not improving healthcare, maybe that would be a cause for immediate probation. We could put people on probation and say that unless you come into line to a certain degree within a certain length of time, you lose your accreditation — that's more than we've ever done before.”

The ACCME's approach, he says, will be “a steel hand in a velvet glove. We believe strongly that this isn't a question of catching providers, but rather of identifying compliance issues and giving everyone the opportunity to come into compliance.”

All Hands on Deck

Everyone involved in the CME enterprise can contribute to discussing the issues and developing strategies, says Kopelow. In the press release accompanying the letter to the SFC, the ACCME said that the “implementation of this action plan will engage the entire CME enterprise in the development of solutions.”

“This isn't something we're going to do in secret. This is something we're going to do in collaboration; this is something we're going to do in the open, with multiple small advisory groups, discussion groups, and forums,” Kopelow clarifies.

The Alliance for CME, the Council for Medical Specialty Societies, and the North American Association of Medical Education and Communication Cos. have offered to help, he says.

As for the time frame, “We're going to begin the discussions over the next few weeks and months. It will peak in the next 12 months,” he says. “This will be an incredibly healthy [process]. We've got our work cut out for us. We're going to roll up our sleeves.”

Asked how the system changes would be funded, he says that the most obvious solution would be for the revenue to come from providers who are receiving additional service from the ACCME, those who receive commercial support and use faculty who have conflicts of interests. There are several ways to fund new approaches, Kopelow says. “I don't think money will be the problem,”