Tips to get the most for your continuing medical education spending.
Continuing education is taking on greater importance amid new quality measures, but it comes at a time when practices already are having to budget for pricey new electronic health record and technical upgrades called for under health reform. Getting the most bang for the buck when it comes to continuing medical education (CME) is critical.
The pressures on physicians go beyond just keeping up with the pace of knowledge expansion. New requirements to demonstrate quality of care that can be documented and quantified, observers say, further drives up demand for CME.
âWith the movement from volume to value it has become imperative for physicians to perform at a higher level, and CME will become even more important,â says Michael Romano, MD, chief medical officer for Nebraska Health Network, a health system with 1,300 providers. Romano last year won an award from the Accreditation Council for Continuing Medical Education (ACCME) for his work on broad CME initiatives that improved physician performance and patient care.
In a 2011 paper for the American Clinical and Climatological Association, Peter Densen, MD, a professor at the University of Iowa, discussed estimates that the doubling time of medical knowledge fell from 50 years in 1950 to 3.5 years in 2010, with a forecast of just 73 days by 2020.
âKnowledge is expanding faster than our ability to assimilate and apply it effectively,â Densen wrote. âClearly, simply adding more material and/or time to the curriculum will not be an effective coping strategyâfundamental change has become an imperative.â
1. New CME can be lower cost
The good news from a financial perspective, say physicians and other CME experts: Some of the most effective learning opportunities are coming from lower cost, informal and often online channels. And even in the live world of medical conferences, there are ways to stretch a CME budget.
âWhen people used to say âCME,â I would think of lecture halls, dark rooms and a sage on the stage, much the way I was educated in medical school,â says Graham McMahon, MD, an internist and president and chief exrcutive officer of ACCME in Chicago. âNow thatâs anachronistic and thereâs such a variety of approaches that are more engaging, interesting and accessible.â
Hospitals are boosting investments in continuing education as a way to satisfy quality initiatives, and physicians themselves are attending a much broader array of programming than they did even just a few years ago, McMahon says.
Rather than simply attending a specialty societyâs annual conference, more physicians are participating in local, informal case presentations and online learning.
âThe currency of education today is not necessarily information exchange, but getting together to problem solve, develop cognitive skills or learn a specific new technique in a hands-on way,â McMahon says.
Rather than going back to the same conference every year, physicians are thinking about a specific skill they need to develop this year, and finding that activity or course that delivers that, McMahon says.
Clearly, lecture-style education taught at live conferences still has its place.
2. Get involved
Imparting new research information quickly is better suited to more didactic teaching styles, for example, and informal learning through face-to-face interaction with colleagues is still valuable, experts say.
âMy sense is that physicians really enjoy going to meetings for the social aspects,â says Daniel Carlat, MD, a psychiatrist in Newburyport, Massachusetts, and publisher of the Carlat CME Institute, which advocates for CME that is free of conflicts of interest from drug companies and healthcare industry entities.
âItâs easier to sit in a chair and view slidesâ than to engage in pro-active case studies or learning groups, he says.
For some applications, however, newerâand often cheaperâmethods can work better. The trick, experts say, is choosing which method is best for each continuing education opportunity.
3. Avoid âcredit shoppingâ
When training budgets are tight, itâs tempting to choose a CME course by picking the lowest-cost course per credit hour. Experts urge physicians to think about the actual value a given course generates, however.
âThe key to stretching the CME dollar is to be much more deliberative about choosing courses,â McMahon says. He recommends physicians avoid âcredit shopping,â or basing course selection on the lowest cost per credit hour delivered. Instead, think about the ongoing education benefits of any CME opportunity.
Repeated engagement with a subject over time can often drive much higher performance improvements than traditional one-off didactic lecture sessions, experts say.
4. Find the gaps
Another way to stretch the CME dollar is through self-assessment tools, typically online through individual specialty associations that can identify the most critical areas physicians need to improve. In other words, physicians should skip CME programs that simply reinforce knowledge they already have.
âYou want to identify gaps in yourself and then search for activities that plug that gap,â McMahon says.
Further financial reading: What do physicians owe their kids?
Finding true knowledge gaps can be tricky, however. While board certification exams often give physicians feedback on what questions were missed, for example, the length of time between exams (often a decade) make them impractical as an ongoing learning guide, notes Elizabeth Grace, MD, medical director for the Center for Personalized Education for Physicians in Denver, Colorado, which offers re-entry programs for physicians coming back to practice after a hiatus and those who have been placed in performance improvement programs. In addition, CME credit courses will often have a pre-test, but that is to demonstrate before-and-after knowledge on a very narrow topic, she says.
Physicians are sometimes blind to the gaps in their own knowledge and skill base, she says.. And the more deficient a physician is, the less likely he is to know he needs help. Physicians tend to choose CME programs that focus on content they already like and feel comfortable with, as opposed to where they see a real need, she says. As more medical associations develop programs to assist with quality-based practice measures, however, that will change, she says.
Competency-based education, with defined benchmarks for skill development, will make it easier for physicians to inventory their strengths and work on weaknesses, she says. She advocates educational programs that address topics of importance to physiciansâ patient population as a way to acquire skills that can be immediately put to use in practices and demonstrate value to payers.
5. Donât go all-in for online
Online education can certainly save costs on airfare, hotels and restaurantsâand evidence suggests younger physicians tend to prefer online to live meetings anyway âbut having the ability to engage in impromptu conversations around the buffet line canât be overlooked as a way to boost the perceived value of attending a conference.
âYou want to balance online with peer learning,â McMahon says. Both are valuable to a physicianâs life-long education, he says.
The face-to-face interaction with colleagues from within a given specialty is still critical, and can help alleviate pent-up career stress, which can in turn prolong careers, says Romano, a family physician also certified in hospice and palliative care.
âWhat gets lost in the conversation [about online alternatives and budget shortfalls] is the collegial interaction with colleagues from the same specialty, and thatâs a very important part of these activities. As we deal with physician burnout, the ability to take a week, go to a vacation spot and unwind for a week is really helpful in avoiding some of these burnout issues,â he says.
Thatâs an investment worth making, he says.
Increasingly, experts say, physicians are evaluating CME as it relates to an overall practice. Some of the newest courses, for example, involve teams of nurses, physician assistants, pharmacy professionals and doctors. Coursework centers on, among other things, how to function better as professionals.
âThis one will take awhile to develop, but everyone recognizes this is important,â Romano says. âMore gatherings will begin to include the entire team.â
7. Skip the conflicts
Carlat advocates skipping conferences that are labeled as CME but are sponsored by drug or device makers, though industry-funded CME is rarer today than it was a few years ago, he says.
âA lower percentage of CME is financed by corporations, but itâs still an issue,â he says.
Commercial funding accounted for 25% of CME investment in 2014, down from 37% in 2010, according to ACCME.
Carlat also suggests taking advantage of CME that can also serve as part of a physicianâs maintenance of certification (MOC) requirements. Increasingly, CME providers have dovetailed their offerings to serve both goals, experts say.
âThere can be some sticker shock involved with maintenance of certification, so anytime you can make it do double-duty, thatâs good,â he says.
The American Board of Internal Medicine and ACCME inked a deal in 2015 to streamline the process for using approved CME coursework as part of the MOC process. (A list of joint programs can be found at bit.ly/ABIM-ACCME-courses. )
As part of that agreement, accredited CME providers can use a single, shared system for registering CME and MOC activities, among other areas of interoperability, the groups say.
Another example is thinking about leveraging CME as a career advancement tool.
âIn talking with hospital CEOs about the value of CME, one thing we recognized is that CME is rarely used strategically,â says John Combes, MD, an internist and chief medical officer for the American Hospital Association. âThereâs a need to develop physician leaders and this is an activity to engage physicians and also get a benefit to organizations,â he says.
In a 2014 report, âContinuing Education as a Strategic Resource,â the association said hospital-provided CME programs account for nearly 40% of credit hours offered. The report urged hospital associations to promote partnerships with medical societies and others on CME, another way to stretch dollars a practice commits to education.
The association also advocates more accommodative policies on accepting project work and other non-traditional activities as CME, another form of âdouble dippingâ that can lower overall CME costs for a given practice.
Replacing time-based credit with performance-based CME should be a key part of adapting new learning methods into physiciansâ ongoing training, the report concludes, while acknowledging some practitionersâ concerns about loosening CME guidelines too much.
Looking forward, be aware that increasingly, CME may be measured more by outcomes than credit hours.
As less formal gatherings for skill development become more popular, look for newer ways of measuring continuing education, experts say.
âHow do you quantify the learning that happens in these less formal engagements? We used to sign up for an activity, fill out an application and collect documentation of attendance. Now education is happening on the fly and itâs difficult to quantify,â Romano says.
Looking at outcomes may be the best indicator, he says, though he acknowledges the dilemma that some outcomes measures take many years to come to fruition. Performance-based measures after CME occasionsâtracking, for example, a physicianâs ordering of mammograms for over-50 patientsâis easier to quantify over a shorter period of time, he says.
And practices can measure evidence-based processes of care that should result in good final outcomes, he says, such as physiciansâ performance on keeping diabetic patientsâ blood pressure and cholesterol under control.
Joining with a few other local practices to tackle issues in a similar format to a grand rounds or a cancer care team review is another way to promote learning in a lower-cost environment.
âThe thing we found most useful is gathering physicians around one table to talk about activities,â Romano says. Physicians informally sharing opinions on treatment plans and discussing clinical cases are the most effective ways of learning, he says.
âWhen you get a group together to talk about patient care, patients definitely benefit. The sharing of the clinical experience is one of the more powerful ways to do education, not to mention the cost savings involved when you can bring a larger group together to lower the administrative costs,â of the meeting, he says.
This can be done even in a more traditional, didactic conference environment, says McMahon. To boost the take-away value of these sessions, he says, consider digging in when a presenter pauses a lecture and asks the audience to pause and think of a case that relates to the topic, says McMahon. Those are great opportunities to turn to a peer and ask how they handled a case, he says.
âIt creates opportunities to become more self-aware and to be honest about not knowing an answer or struggling with a difficult issue,â he says, another way to get more value out of a conference rather than simply absorbing presented information.
Traditional, presentation-based conferences still have value, argues Todd Dorman, MD, FCCM, associate dean for continuing medical education at Johns Hopkins University School of Medicine.
Didactic education shouldnât be seen as weak cousin, he says. âThereâs still a role for live meetings because they provide networking, interacting with experts and being able to ask about the subtleties among clinical colleagues.â He does expect nearly week-long, multi-faceted meetings to constrict down to smaller workshop sessions targeted to engaging physicians on areas of specific expertise.
Already, he says, physicians can extend the value of these sessions by being accountable for their own engagement. Asking questions at the end of presentations and sending follow-up emails to presenters after a conference with more detailed questions are all ways to boost what physicians take away, he says.
âIâve had attendees write me about specific patients after a conference where I have presented and have gladly and happily gotten back to them,â he says.
Itâs important, also, to look for expertise at conferences that brings in knowledge that is a bit outside a physicianâs core specialty, Dorman says.
âIt might mean reaching out for activities that might be put on by other specialists. A pulmonologist might identify a weakness in expertise in certain aspects of kidney disease, for example, so maybe once every few years he might look for a session on that,â he says.
The jury is in on CME in general, Dorman says, noting that CME has proven its value in moving the profession forward. But the issues involving how physicians can learn more and get increased value out of each opportunity are still on the table, he says.
âThe present question is, âCan we learn more about which methods are cost effective under which circumstances?â And, âHow can we be more effective?ââ