Pay for Performance: The Role of Continuing Medical Education

1. Pay for Performance: The Role of Continuing Medical Education October 28, 2006 Kenneth Fink, MD, MPH Chief Medical Officer, Region X Centers for Medicare and Medicaid Services Norman B. Kahn Jr., MD Vice President, Science and Education American Academy of Family Physicians

2. “It is CMS’s belief that the PVRP also aligns with CME’s goals of assisting clinicians in their pursuit of maintaining clinical knowledge that leads to better healthcare outcomes.” Barry M. Straube, MD CMS, November 2005

3. From Pedigree to Performance: the evolution of CME

4. Continuing Professional Development Medical Resident Licensed Specialist Credentialed Practice Student We share some responsibility in the ‘continuum’ . . . . (ACCME) Maintenance of Licensure (Requirements by members of FSMB) Achieving Licensure Maintenance of Certification (Requirements by members of ABMS) Achieving Certification Under Graduate Graduate • Continuing Medical Education • Provider accreditation by ACCME • Activity accreditation by AAFP • Credit systems by membership organizations • (ex: AMA, AAFP) Medical Education Medical Education (Accreditation by ACGME) (Accreditation by LCME)

5. 1948 - 2004 CME communicates to the profession and the public that physicians are keeping up with medical advances.

6. Traditional CME • “Wants” assessment vs. needs assessment • Presenter-centered teaching vs. physician-centered learning • Evaluation of the presentation vs. measuring change in practice or in outcomes of care

7. “. . . these observations call for a learner-centered model of CME, one that supports the professional development of individual physicians who confront questions derived from practice . . . CME, built on practice-based need, identified through practice measurements, designed to facilitate individualized change.” Regnier K. et al. Accreditation for learning and change: quality and improvement as the outcome. J Contin Educ Health Prof 2005; 25(3): 174-182.

8. New CME Formats • Evidence-based CME • Point-of-care CME • Performance improvement CME

9. What Is Evidence-Based Medicine? “The integration of current best research evidence with clinical expertise and patient values.” David Sackett, 2000

10. Graded Evidence Levels of Evidence • N of 1 • Systematic review/meta analysis • Randomized controlled trials • Cohort studies • Case control studies • Multiple time series • Expert consensus statements

11. Evidence-Based CME • Evidence-based practice recommendations • Approved EBM sources • Strength of recommendations taxonomy (SORT) • Foundation for POC and PI CME

12. AAFP EB Credit Awarded

13. Point-of-Care CME • N of 1 needs assessment (physician question regarding care of patient, real time) • Electronic clinical information resources (approved) • Documentation of clinical question, review of evidence, implementation decision • CME credit – 1/2 per inquiry < 15 credits per year

14. Performance Improvement CME • Assess practice (chart audit – physician practice behaviors and patient status) against evidence-based performance measures • Learn and intervene (change practice behavior) • Reassess practice (document change) • AAFP METRIC, AAP e-QIPP, ACP-ABIM PIM’s • CME credit – 5 per stage, 20 (total) for completion

15. Performance Measures Ambulatory Care Quality Alliance Implement Measures Develop Measures Endorse Measures NCQA AMA PCPI National Quality Forum

16. The New CME “Links” • Research generates evidence for incorporation into clinical practice guidelines and practice performance measures • New educational formats (point-of-care learning) facilitate implementation into patient care • PI cycle formats (performance improvement CME) measure performance and document improvement

17. 2005- CME now has the potential to communicate that physicians (through self-assessment) are measurably improving the quality of care they provide to patients.

18. A Culture of Improvement • Research: Creating new knowledge • CME: Disseminating new knowledge • QI/PI: Implementing new knowledge

19. A Culture of Improvement “Practice performance will be enhanced through educational interventions that measurably change physician practice behaviors in ways that are linked by the evidence to improved patient outcomes.”