1. CME UPDATE
April 19, 2009

2. Presented by:
Dina L. Gonzales American College of Emergency Physicians Manager, Accreditation and International Relations Susan P. Tyler, M.Ed., CMP Director, Continuing Medical Education College of Medicine University of Cincinnati

3. Discussion Topics: CME Process Chapter Relations Staff Requirements
CME Handbook
Joint Sponsorship (Form 1)
CME Application Process
Enduring Material Application Process
Activity Follow Up, Evaluation, and Outcomes
NER Handbook
National Education Representatives
Accreditation Oversight Subcommittee
Chapter Relations
Staff Requirements
ACCME Updated criteria
Moving Forward

4. CME Handbook Regular Updates On-line access Number pages by section
Recommendation
Action
Regular Updates
On-line access
Number pages by section
Communicate additions, deletions, and revisions
Checklist of requirements
Annually and as needed to address ACCME/ACEP changes or clarifications
Available August 2008
Will be incorporated into pending revision
Via Chapter e-list outlining changes and corresponding page numbers
Currently available in handbook – working on reformatting

5. CME Handbook, continued
Recommendation
Action
On-line templates
CME planning responsibilities
Communicate new requirements
All existing forms are being reformatted
CME Handbook, on-line application process, Joint Sponsorship agreement in lieu of General application
Chapter e-list and quarterly Chapter updates

6. Joint Sponsorship (Form 1)
Recommendation
Action
Review Requirement
Update Form
Educational Opportunity
Attestation
Developing Joint Sponsorship Agreement in lieu of current General Application
Working in conjunction with ACEP legal counsel
New agreement will outline Chapter responsibilities and reference materials to be reviewed
New agreement to include attestation statement

7. CME Application Process
Recommendation
Action
On-line application forms
submission for missing elements
NER approval
Accreditation decisions
All existing forms are being updated
Will be allowed on a go-forward basis
NER will communicate approval to CME coordinator via
Already utilizing an approval letter template; will communicate via and follow-up with hard copy

8. CME Application Process, cont.
Recommendation
Action
On-line application process
confirmation of receipt
Electronic tracking system
Best practice examples
Currently working with IT department (Jan-Feb 2010)
Has been implemented
Will be incorporated into pending CME handbook revision

9. CME Application Process, cont.
Recommendation
Action
Expedited review of application for ACEP Category I only
Pending statement for ACEP Category I credit only
45 business day review period for live meeting applications
Allowable under existing guidelines
Will be incorporated into pending CME handbook revision

10. CME Application Process, cont.
Recommendation
Action
Increase application fees for Chapter meeting applications to $275
Activity fee for multiple presentations of same content ($10 per occurrence for 2-20 with maximum of $200
Rush fee - $500
Will be incorporated into pending CME handbook revision

11. Enduring Material Application Process
Recommendation
Action
Additional NER’s for enduring material applications
Renewal reminders
Approval gaps
Will review in conjunction with Accreditation Oversight Subcommittee
Will establish a tickler system and issue reminder to Chapters
No credit available during lapsed approval periods; will clarify policy in pending CME handbook revision

12. Enduring material application process, cont.
Recommendation
Action
90 business day review period for enduring material applications
Review pricing structure; current fees are low
Will be incorporated into pending CME handbook revision
Increase to $350/5 CME hours; will be incorporated into pending CME handbook revision

13. Activity Follow up, evaluations, and outcomes
Recommendation
Action
Request financial summaries for each activity
Level 3 outcome evaluations
Activity files
Will be incorporated into pending CME handbook revision
Will be incorporated into pending CME handbook revision/Joint Sponsorship Agreement
Maintained by Chapters and National ACEP

14. NER Handbook Update NER orientation In progress
Recommendation
Action
Update
NER orientation
In progress
Conference call pending handbook update

15. National Education Representatives
Recommendation
Action
Remove requirement that NER be involved with planning committee/process (available for consults)
Replace with requirement that an active emergency physician member of ACEP be integrally involved in the planning of the activity to ensure that content is appropriate for the specialty; will be incorporated into pending NER handbook revision

16. National education representatives, cont.
Recommendation
Action
Determine which activities can be reviewed and approved in-house by ACEP CME staff
ACEP staff review/approval of simple, repeat, or ACEP Category I only activities
Simple, repeat, or ACEP Category I only activities; to be considered at a later date
To be considered at a later date; not an option based on current staff workload and knowledge

17. National education representatives, cont.
Recommendation
Action
Shorten NER review process
The following procedures have already been implemented: complete application packages to NER via FedEx 2 day; NER will communicate approval to CME Approval Coordinator via ; approval to Chapter via and hard copy

18. National education representatives, cont.
Recommendation
Action
Questionable or complex activities to NER for review
NER evaluation process
NER evaluation of accreditation process
Covered under existing guidelines
To be addressed as part of the NER handbook revision
Annual survey to NER’s to evaluate accreditation process

19. National education representatives, cont.
Recommendation
Action
Query NER’s regarding their desire to continue appointment
NER training/update on ACCME/ACEP policies/procedures
Annual expressions of interest - to be addressed as part of the NER handbook revision
Annual conference call - to be addressed as part of the NER handbook revision

20. Accreditation oversight subcommittee
Recommendation
Action
Policy, oversight, and appeals board
Selected on rotating schedule (every 3 years) based on CME experience/knowledge
Annual orientation
CME staff involvement
Allowable under existing guidelines
Annual committee appointment; focus will be placed on CME knowledge/experience beginning with 09/10 appointments
To be conducted during annual face-to-face meeting at SA

21. Chapter relations
Recommendations
Actions
Allow global overall learning objectives for LLSA and Board review courses
Chapter orientation - ACCME accreditation process and AMA PRA requirements
Chapter orientation - ACEP CME accreditation process (additional requirements)
To be addressed as part of the CME handbook revision
ACCME presentation at SA 2009; will consider future AMA speaker
Two face-to-face meetings per year (SA and LAC); quarterly CME update

22. Chapter relations, cont.
Recommendation
Action
Annual CME educational session
Chapter role in joint sponsorship
Requirements for national ACEP activities
SA and LAC
New Joint Sponsorship agreement will outline Chapter responsibilities
Existing guidelines hold national ACEP activities to higher standards of design and planning; joint sponsorship is offered as a member service and is not an entitlement

23. Chapter Relations, cont.
Recommendation
Action
Annals listings
Current guidelines provide for an Annals/Master Calendar listing for live activities upon receipt of CME application; CME hours are updated upon receipt of approval (15th of month publishing deadline – eg. April 15th for June 1 issue)

24. Chapter Relations, cont.
Recommendation
Action
Monthly or quarterly online newsletter
Post frequently asked questions online
Quarterly CME updates will be provided following completion of pending CME handbook revision
Available in CME handbook; will be updated as part of pending CME handbook revision

25. Staff requirements Add CME staff
Recommendation
Action
Add CME staff
ACEP staff review/approval of simple, repeat, or ACEP Category I only activities
Rebuild Chapter relationships
To be considered at a later date
To be considered at a later date; not an option based on current staff workload and knowledge
New CME Approval Coordinator

26. Staff requirements, cont.
Recommendation
Action
Chapters as educational partners
ACEP staff as teachers/coaches
Joint Sponsorship Agreement (contract)
Focus on customer service
Two live sessions annually; quarterly CME updates; explanations and guidance upon request
Developing Joint Sponsorship Agreement in lieu of current General Application to include attestation

27. ACCME Updated Criteria
CME paradigm shift
From emphasis on physician learning to a focus on improvements in physician competency, performance, and patient outcomes
ACCME’s expectation is that CME providers will design and implement CME activities that will yield measurable outcomes
Emphasis on physician learner “gap analysis”
Educational programs should be designed to address specific “gaps” in EP knowledge and skills
Identify gap and determine/show cause of gap. Why is there a gap?
Identify the barriers to overcoming the gap?
Identify type of gap? Performance, competency, patient outcomes

28. ACCME Updated Criteria, cont.
Needs Assessment
The professional practice gap(s) that the activity addresses.
Current practice vs ideal way of managing a clinical problem (based on practice guidelines, best available evidence, etc.)
The educational need(s) that was derived from the professional practice gap(s).
Knowledge, competence, or performance
Evidence that the need(s) was incorporated into the CME activity.
Include sample or example

29. ACCME Updated Criteria, cont.
Planning Process
Activity has been designed to change physician competence, performance, or patient outcomes
Planning notes/minutes
Overall narrative activity description
Individual narrative session/lecture descriptions
Identify match between the content and the scope of your learners’ current or potential scope of professional activities
Describe process used to ensure format is appropriate to objectives and desired results.
Identify desirable physician attribute(s) that was incorporated into the planning process

30. ACCME Updated Criteria, cont.
Disclosure
Provide list of all individuals in control of content of CME activity (name, credentials, institution affiliation)
Provide disclosure forms for all individuals in a position to control the content disclosed relevant financial relationships
Faculty/Authors
Planning committee members
Staff
Individuals who refuse to disclose are disqualified from CME planning and implementation, if applicable

31. ACCME Updated Criteria, cont.
Disclosure, cont.
Describe mechanism to identify conflicts of interest prior to the start of the activity
Describe mechanism to resolve conflicts of interest prior to the start of the activity
Disclosure of relevant (or no) financial relationships was made to learners prior to the beginning of the activity (include sample or example)
Disclosure of source of commercial support was made to learners prior to activity (include sample or example)
Provide list of all Commercial supporters for the activity
Provide copies of all signed written agreements that correspond with the list of all commercial supporters

32. ACCME Updated Criteria, cont.
Faculty or author honoraria and reimbursement are paid in compliance with provider’s policies
Provide copy of policy and final financial (budget) summary for each activity
Provide accurate documentation detailing the receipt and expenditure of commercial support
Provide copy of income and expense statement
Evaluation of changes in learner’s competence, performance, or patient outcomes
Provide copy of evaluation form/mechanism
Provide copy of brochure, meeting announcement, and/or meeting materials with the approved ACCME accreditation statement

33. ACCME Updated Criteria, cont.
Enduring Materials
Demonstrate that the activity is in compliance with the ACCME Policy that is specific to its activity type
Show how the activity complies with the applicable policy
Provide copy of final product
Utilize labels, arrows, highlighting, or other method to make explicit where in the activity there is evidence of compliance

34. Moving forward Revision of ACEP CME Mission Statement
Joint Sponsorship Agreement
Chapter review of all activity files for required requirements/documentation prior to being submitted for review
Live activity, enduring material (print, CD-ROM, monograph, etc.), and Internet require separate applications and cannot be combined into one activity
Internet enduring materials require submission of screen shots of all web pages for activity from start to finish
Third Party communication
Member physicians vs NER involved in planning process
Application Fee Increases
Needs Assessment

35. Moving forward, cont. Measurable Learning Objectives
Standardized Evaluation Forms
Standardized Faculty Disclosure Forms
Application timelines/deadlines
Brochure printing/distribution
No CME provided for activities in which promotional materials have been distributed without approved credit statement
Annals of Emergency Medicine calendar deadlines
Counting CME credits (rounding, welcome/introduction, breaks/lunches, tests, etc.)
Online application process/tracking
CME Audit – Steve Passin & Associates
ACCME Reaccreditation

36. Resources included in notebook
Consultants Report – February 28, 2009
ACCME Accreditation Policies Including Information for Provider Implementation
ACCME Essential Areas and Their Elements
ACCME Self Study Report Tabs – March 2010 Cohort
ACCME Performance in Practice Review Labels – March Cohort
ACCME Examples of Compliance – November 2008
AMA Physician’s Recognition Award and credit system
ACCME website –
AMA website –