CME: A Retrospective and Prospective

By Lewis A. Miller, MS, CHCP

Editor’s Note: This speech was delivered on Jan. 28, 2017, at the Alliance Annual Conference Award
Ceremony. Lewis Miller was one of the two recipients of the 2017 Lifetime Achievement Award.

Allow me to lead you through a brief trip down memory lane: How many of you were in the CME field in 1970? Please raise your hands (and keep them in the air). And in 1975? In 1980?  Yes, we have a few veterans besides Dennis and myself. How many of you remember the prevailing definition of CME in those days? It was “the professional responsibility of each physician to keep up to date for the benefit of patient care.”

My Beginning

I started in this field in 1968, as editor of Patient Care, a primary care journal. I had been applying some innovative concepts to article development without knowing they formed the basics of CME. Doctors didn’t submit articles; we surveyed practitioners to identify needs and developed content from multiple sources. We also measured readership.

I was delighted when my good friend and editorial board member, Ralph Sanchez, a family doctor in Metairie LA, and part-time dean of CME at LSU, invited me to join a handful of academic center CME deans for periodic informal meetings discussing where CME was going.

It was the right time to get involved.

A Change in CME

The 1970s and early 1980s revolutionized the simple framework that had existed in CME.

Mandatory CME rapidly spread from state to state, until some 90 percent of all physicians were required to present evidence of the number of CME hours attended per year. As a result, medical school departments of CME multiplied, supplementing the activities of medical societies. So did medical education companies, and pharmaceutical company support grew exponentially.

Soon after, CME credit approval shifted from AMA approval of individual CME programs to accreditation of providers by the new Accreditation Council for CME, a multi-organization body.

I realized in 1975 that the CME field had no forum for cross-disciplinary discussions to improve the scope and quality of everyone’s efforts. To address this, I convened in New York City a one-day “no-speeches” invitational session including 46 representatives of medical societies, medical schools, federal health officers, practicing physicians, hospitals and pharmaceutical companies. We made sure each person had at least 30 minutes of interaction with each other, discussing the broad theme of “Whither Continuing Medical Education?” Thus, we began to understand each other’s perspective.

This was the beginning of the Alliance, and from that small beginning came this membership, now numbering somewhere around 2,000.

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Predictions

With those anchors in the past, let’s shift to the future.

If the ’70s and ’80s were a period of upheaval, our current decade is even more so. CME no longer fits the original definition, nor does the healthcare system resemble that of 40 years ago. We are in the grip of a multi-trillion dollar federal-state bureaucracy that is challenging CME’s very need to exist.

Our role in CME needs assessment. Measurement of patient care improvements that result from our efforts are being displaced by big data on a major scale. For example, my daughter Kathy obtained a $14 million grant five years ago under the Affordable Care Act to build a Regional Health Information Organization (RHIO) in the Bronx, New York. The RHIO now collects and analyzes care data on some 2 million patients served by some 300 providers. To date, that initial investment has been recouped in elimination of duplicate services — and soon can move on improving quality of care.

Healthcare delivery is changing. Hospitals and accountable care organizations are swallowing smaller, independent medical practices. Teams, including patients, are more responsible for the delivery of care than ever before.

The federal government, through CMS, ACA and to some extent the FDA, demand changes in healthcare quality, delivery and cost management. Thirty percent of physician remuneration is now based on measures of value, not fee for service.

Where We Go from Here

How will we reshape our profession and demonstrate our value so that we do not become a minor cog in the healthcare machinery?

Thankfully, the Alliance and ACCME recognize many of these challenges. But, if we are to be a leader, rather an increasingly small cog, we need to change dramatically.

My vision for the future:

The Alliance must no longer be simply for continuing education. Let us become part of a new Alliance for Healthcare Quality and Delivery Improvement. Let us be a change agent devoted to:

  1. Improving the ability of healthcare professionals and their patients to bring America to the top of the list for healthy living and longevity;
  2. Improving systems of healthcare delivery from hospitals to nursing homes to clinics to home care so as to contribute to these goals;
  3. Building into our programs the concepts of value that will control costs in a manner that justifies the value we bring as change agents.

Are these feasible goals?

Yes, they are, but only if we collaborate with other organizations and professionals in healthcare delivery and quality. We must be an integral part of the process of change, lest we lose our relevance.

Thank you.

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