Medical Education News

Below are some upcoming continuing medical education (CME) events being offered by NAMEC members.

Medscape Education
NASH: The Epidemic Is Here, Are You Ready?
San Diego, CA - Manchester Grand Hyatt – Harbor Room Ballroom A/B/C
May 18, 2019 @ 6:15 pm

Nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH), relatively unknown just 2 decades ago, are now the most common causes of chronic liver disease worldwide, affecting an estimated 25% of the world's population. The collective epidemic of NAFLD and NASH closely parallels the epidemics of obesity and type 2 diabetes mellitus. As the prevalence of these conditions continues to increase, predictions are that the prevalence of NAFLD and NASH will also increase, creating an unprecedented clinical and economic burden. Early disease can be managed with modification of risk factors in some individuals. There are no approved drug regimens to treat NASH, but the clinical trial pipeline is very active. A panel of leading experts will emphasize the importance of early detection and diagnosis as a means to halting the epidemic through either preventing progression of disease or in the future, treatment.

Learn More

Paradigm Medical Communications, LLC
Every Breath You Take: A Case-based Approach to Improving Diagnosis, Treatment, and Management of Patients with COPD
Online Activity available through May 31, 2019

Learning Objectives
Upon proper completion of this activity, participants should be better able to:
Identify early signs and symptoms of chronic obstructive pulmonary disease that warrant further evaluation with guideline-recommended tools and tests.
Describe evidence-based tools and strategies for determining the severity of chronic obstructive pulmonary disease, including their utility in directing appropriate therapy.
Select treatment options for chronic obstructive pulmonary disease by applying information about agent, patient, and disease characteristics.
Choose a medication delivery device for patients with chronic obstructive pulmonary disease that accords with patient needs, preferences, and capabilities.

Learn More

Academy for Continued Healthcare Learning (ACHL)
Kansas City Heart Rhythm Symposium 2019
Overland Park, KS - Sheraton Overland Park Hotel
August 17-18, 2019 

The purpose of this symposium is to update medical practitioners in the greater Midwest region on the future of cardiac electrophysiology (EP), and on new diagnosis and treatment guidelines in the care and management of patients with arrhythmias, heart failure and other issues impacting the electrical system of the body. Participants will learn about advances in ablation techniques, device management, appropriate use criteria, and survey new developments in guidelines and recommendations. A review of clinical trials that have helped change the clinical practice of EP will also be held. Participants in this symposium will examine the latest trends in Left Atrial Appendage (LAA) treatment options and gain a greater understanding of anticoagulation and stroke prophylaxis.

Learn More

North American Center for Continuing Medical Education, LLC (NACCME)
Mitigating the Cost Burden of PAH: Evaluating the Value of Timely Treatment with Effective Therapy
Online Activity available through March 10, 2020

After participating in this activity, participants should be better able to:
Quantify the clinical and economic burdens associated with the delayed diagnosis, suboptimal treatment, and consequent hospitalization of patients with PAH
Evaluate clinical data regarding the PAH-specific therapies as well as their mechanism of action, efficacy, safety, and implications on mitigating healthcare utilization and costs
Develop diagnostic, treatment, and follow-up protocols for PAH that reflect guideline recommendations and current clinical evidence and support individualized PAH care
Inform formulary placement and benefit design decisions with the latest cost data, treatment guidelines, and optimal PAH management strategies

Learn More

A recent Senate Committee on Finance hearing called the "Medicare Physician Payment Reform After Two Years: Examining MACRA Implementation and the Road Ahead" included representatives from the American Medical Association (AMA), American Academy of Family Physicians (AAFP), American College of Surgeons (ACS), American Medical Group Association (AMGA), and the Brookings Institution. 

-What is MACRA & MIPS?- 

MACRA was generally regarded as a positive direction for redirecting the system for how physicians are paid but there were calls for changes in the program.  

MACRA is a landmark regulation that breathed new life into the value-based reimbursement transition. The program is tying a significant portion of Medicare payments to patient outcomes, care quality, and costs.

MIPS was generally viewed as burdensome. There were some calls for it to be completely eliminated. 

John Cullen, MD, president of the American Academy of Family Physicians, testified that MIPS 'has created a burdensome and extremely complex program that has increased practice costs and is contributing to physician burnout.' Further, Cullen observed that "understanding the requirements and scoring for each MIPS performance category and reporting data to CMS is a complex task and detracts from physicians’ ability to focus on patients.”

Another statement was critical of MIPS achieving its set goals.

Research examining the structure of the Merit-Based Incentive Payment System (MIPS) and experience with similar programs suggest that MIPS is unlikely to improve the quality or efficiency of patient care. But MIPS is creating substantial administrative costs.

Additional coverage of this hearing:

• https://revcycleintelligence.com/news/as-macra-implementation-turns-2-industry-leaders-call-for-change
• https://insurancenewsnet.com/oarticle/chairman-grassley-issues-statement-at-hearing-on-medicare-physician-payment-reform#.XNWCfqR7mUk
• https://www.healthdatamanagement.com/news/physician-groups-voice-frustrations-with-quality-payment-program
• https://www.brookings.edu/testimonies/medicare-physician-payment-reform-after-two-years/
• https://www.medpagetoday.com/publichealthpolicy/medicare/79708
  

Patient-Centered Outcomes Research Institute (PCORI) Funding Announcement (PFA), PCORI aims to fund studies that address high-priority methodological gaps in patient-centered outcomes research (PCOR) and comparative clinical effectiveness research (CER). 

Letters of Intent are due Wednesday, May 29, 2019, by 5:00 p.m. ET.

Those selected to submit a full application will be notified by Monday, June 24, 2019.

Full applications will be due Wednesday, September 4, 2019, by 5:00 p.m. ET.

All of the bullet points below are available - including to submit your application - at this link. 

Applicant Resources

Write Your LOI

• Methods PFA
• Methods Application Guidelines
• Methods LOI Template
• Sample Methods LOI Template
• Applicant FAQs
• Methods PFA FAQs
• PCORI Online: Pre-Award User Guide for Research Awards
• Tips for Preparing a Responsive Letter of Intent (LOI)

Submit Your Application

• Methods PFA
• Methods Application Guidelines
• Methods Application Checklist
• Applicant FAQs
• Methods PFA FAQs
• PCORI Online: Pre-Award User Guide for Research Awards

Required Application Templates

• People and Places Template
• Leadership Plan Template (Only required if proposed project is dual-PI)
• Methods Research Plan Template
• Methodology Standards Checklist
• Methods Milestones Template
• Subcontractor Detailed Budget Template
• Budget Justification Template
• Letters of Support Table

If you are Resubmitting Your Application

• Resubmission Letter Template

Additional Applicant Resources

• PCORI Methodology Report and Standards
• Policy on Submission of Research Contract Applications
• Glossary
• Ambassador Center
• Engagement Rubric
• Engagement in Research
• Budgeting for Engagement Activities
• Compensation Framework
• Cost Principles: Description of Allowable Direct Costs under a PCORI Award
• PCORI Merit Review Criteria
• Standard Contract for Funded Research Projects

FROM PCORI: 

What & Who We Fund

Research Focus

Comparative Clinical Effectiveness Research (CER)

Studies that compare outcomes to determine the effectiveness, including risks and benefits, of two or more approaches to health care

CER Methods and Infrastructure

Studies to improve the methods available for patient-centered CER

Development of a large, highly representative electronic-data infrastructure, called PCORnet, for improving the conduct of patient-centered CER

Conditions Studied

We pay particular attention to:

• Conditions that affect large numbers of people across a range of populations
• Conditions that place a heavy burden on individuals, families, specific populations, and society
• Rare diseases, which are difficult to study

Populations of Interest

We pay particular attention to a number of populations in making research funding decisions:

• Racial and ethnic minorities
• Older adults
• Low-income
• Residents of rural areas
• Women
• Children
• Individuals with special healthcare needs, including individuals with disabilities, individuals with multiple chronic diseases, individuals with rare diseases, and individuals whose genetic makeup affects their medical outcomes
• Patients with low health literacy/numeracy and limited English proficiency
• Lesbian, gay, bisexual, transgender (LGBT) persons
• Veterans and members of the armed forces and their families

Eligibility

Private Sector

• Nonprofit research organizations
• For-profit research organizations

Public Sector

• Universities and colleges
• Hospitals and healthcare systems
• Laboratories and manufacturers
• Units of state, local, or federal government

US Organizations

Must be recognized by the Internal Revenue Service

Foreign Organizations and Nondomestic Components of US Organizations

May apply if:

• There is demonstrable benefit to the US healthcare system, and the essential scientific needs will be met by conducting the study outside the United States or having the study conducted by non-US research organizations
• US efforts in the area of patient-centered research can be clearly shown, and the engagement plans include US patients and stakeholders, and are relevant to US healthcare system

Individuals: Not permitted to apply

What is Quality Improvement CME?

Some have proposed defining it as the combined and unceasing efforts of everyone—healthcare professionals, patients and their families, researchers, payers, planners and educators—to make changes that will lead to better patient outcomes (health), better system performance (care) and better professional development. This definition arises from a conviction that healthcare will not realise its full potential unless change making becomes an intrinsic part of everyone's job, every day, in all parts of the system. Source.

Why is this important to CME specifically?

Clearly, improving outcomes is important. But on a very practical level for an individual physician, Medicare will reward physicians who complete 'quality improvement' CME as part of the Merit Based Incentive Payment System (MIPS). MIPS was created as part of the Quality Payment Program created by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).

Per the ACCME, "accredited CME providers can support their clinician learners in several ways: you can help clinicians understand how to identify Improvement Activities, facilitate those activities, and then assist clinicians in attesting to their participation; and you can plan and present CME activities that will count as Improvement Activities." The ACCME has a webinar that explains how CME can qualify for MIPS.

In addition, the American College of Physicians has a program designed to coach organizations and physicians in improved patient care called ACP Advance.  This program, launched in 2019 "will provide subscribed individuals and organizations with a 12-month tailored coaching program that includes a curriculum and access to online training courses and resources."

Another valuable resource is the repository of case studies where you can "Learn from other hospitals about successful strategies to create safe, reliable health care processes and deliver high-quality care to patients."

To meet the criteria for Improvement Activities in the Merit-Based Incentive Payment System (MIPS) of QPP, accredited CME providers need to implement activities that:
- Address a quality or safety gap that is supported by a needs assessment or problem analysis, or support the completion of such a needs assessment as part of the activity;
- Have specific, measurable aim(s) for improvement;
- Include interventions intended to result in improvement;
- Include data collection and analysis of performance data to assess the impact of the interventions; and
- Define meaningful clinician participation in their activity, describe the mechanism for identifying clinicians who meet the requirements, and provide participant completion information.

Additional resources that may prove useful:

• The National Committee for Quality Assurance's FAQ.
• The ACCME's MIPS FAQ.
• 10 FAQs About the Merit-based Incentive Payment System (MIPS)
• CMS MACRA Guide and FAQ.

MACRA Funding Announcement [Excerpt]

Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) Funding Opportunity: Measure Development for the Quality Payment Program

Cooperative agreement awardees
On September 21, 2018, we selected 7 applicants to receive cooperative agreement awards through the “Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) Funding Opportunity: Measure Development for the Quality Payment Program.”
The cooperative agreements give financial and limited technical support to:
    Develop
    Improve
    Update or
    Expand measures to use in the Quality Payment Program.
Measures for consideration include:
    Outcome measures such as patient-reported outcome and functional status measures.
    Patient experience measures.
    Care coordination measures.
    Measures of appropriate use of services.
We’re committed to advancing quality measures that:
    Minimize burden on clinicians.
    Improve outcomes for patients.
    Drive value in care.
It's critical that we leverage the expertise and insight of those on the front lines to develop measures that make the most sense and contribute to building a truly value-based healthcare system. We look forward to partnering with these organizations.

95% of eligible clinicians participated in the first year of the Merit-based Incentive Payment System!

[Excerpt] MIPS participation in year 1 nets 95% of eligible clinicians

In terms of quality measures selected and reported, the most prevalent was controlling high blood pressure, an intermediate outcome measure, according to the report. The rest of those in the top 10 were process measures. Among them were tobacco screening and intervention, breast cancer screening and pneumococcal vaccine status in the elderly.

The most reported improvement activity was providing 24/7 access to a patient's medical record, a key ingredient in ensuring timely and coordinated care. Rounding out the top five were use of decision support and standardized treatment protocols, patient-centered medical home attestation, engagement of patients through implementation of improvements in a patient portal, and collection and follow-up on patient experience and satisfaction data on beneficiary engagement. [Source]

The Outcomes Standardization Project has a web site.

http://outcomesince.org/glossary/ is now available for those that may be interested in standard terms and definitions in the profession of continuing medical education/continuing education. 

Terms that definitions have been made available include Participant, Learner, Intended Reach, Learning Actions, Completion Rate, Assessment, Evaluation, and more.  Click the link above to view the list. 

If you are not familiar with why this is available, what the purpose of it is, etc.  you may want to review the webinar available at https://youtu.be/Qt6kxjCWPtc

You can also view this video below:

The Accreditation Council for Continuing Medical Education (ACCME) has shared the following press release for your review:

The ACCME is pleased to release Advancing CME to Optimize Care: 2018-2019 Highlights from the Accreditation Council for Continuing Medical Education (ACCME(R)). The year-in-review report describes the ACCME and continuing medical education (CME) community's initiatives to advance quality learning for healthcare professionals the drives improvements in patient care.

* Through collaborations with state medical society accreditors, the ACCME provides education and resources to sustain local CME and a vibrant state-accreditation system.

* The ACCME expanded collaborations with accreditors, certifying boards, licensing boards, and government agencies, enabling clinicians to engage in education that counts for multiple requirements, reducing burdens and increasing flexibility.

* Joint Accreditation for Interprofessional Continuing Education (TM) welcomed four more professions, giving jointly accredited organizations the option to offer team-based education for seven professions without needing separate accreditations.

* By participating in national public health initiatives, the ACCME and the educator community leverage the power of accredited CME to address the opioid crisis.

With its new website, international collaborations, research opportunities, and more advanced data system, the ACCME aims to promote an even more dynamic CME enterprise that is ready to adapt to the changing educational needs of clinician-learners today and in the future.

The ACCME published Advancing CME to Optimize Care, as part of its effort to build visibility for the CME community and communicate the value of accreditation and accredited CME.

"I look forward to our continued collaborations and growth, as we work together toward realizing our vision of a world where our community of educators supports clinicians in delivering optimal healthcare for all." - Graham McMahon, MD, MMSc, ACCME President and CEO

Download the report here (http://www.accme.org/publications/2018-2019-highlights-report).

ACCME

The Accreditation Council for Continuing Medical Education (ACCME(R)) is a nonprofit organization based in Chicago, responsible for accrediting organizations that offer continuing medical education (CME) and for recognizing state medical societies as accreditors of local CME programs.

The ACCME sets standards for CME that reflect the values of the educator community and aim to accelerate learning, inspire change, and champion improvement in healthcare. These standards ensure that accredited CME is designed to be relevant to clinicians' needs, evidence-based, evaluated for its effectiveness, and independent of commercial influence. Through participation in accredited CME, clinicians and teams drive improvement in their practice and optimize the care, health, and wellness of their patients.

Accredited CME facilitates engagement with physicians and healthcare teams where they live, learn, and work. There are approximately 1,800 accredited CME providers within the ACCME System, across the country and internationally, representing a range of organizations including medical schools, hospitals/health systems, government/military agencies, specialty societies, and insurance/managed-care companies. Accredited providers offer about 163,000 activities each year, comprising more than one million hours of instruction and including more than 28 million interactions with physicians and other healthcare professionals.

The Indiana State Medical Association (ISMA) has a new mobile app, available for free, that gives physicians that may prescribe controlled-substance access to opioid-related education.  The Richard M. Fairbanks Foundation provided a grant to fund this new app.  This education is required by Indiana law - Indiana Senate Enrolled Act 225 which passed in 2018.

The app can help physicians fulfill the 2 hour required continuing medical education every 2 years. The app uses video, webinars and podcasts to transmit the education.

The educational requirement takes effect July 1. ISMA's web site notes that they are the largest physician organization in Indiana. 

The name of the app is ISMA Online.

Physicians’ Education Resource® to Present Two Satellite Symposia at the 2019 AUA Annual Meeting in Chicago.

The  two innovative live educational activities will be presented at McCormick Place West in Chicago, Illinois, on May 3 and 4, 2019 as part of the 2019 AUA Annual Meeting.

• Transforming Treatment Paradigms in Renal Cell Carcinoma: Understanding the Role of Risk Stratification and Emerging Data in the Adjuvant Setting, will be held as a breakfast symposium on Friday, May 3, from 8-9:30 a.m. in W375B on level 3. The program will be chaired by Robert A. Figlin, M.D., FACP, Steven Spielberg Family Chair in Hematology-Oncology, director of the division of hematology/oncology, deputy director of integrated oncology service line and a professor of medicine and biomedical sciences at Cedars-Sinai Medical Center. During this program, a multidisciplinary panel of renowned experts in renal cell carcinoma (RCC) will guide attendees through an in-depth, up-to-date review of risk assessment in the early-stage RCC setting; surgical standards-of-care and challenges; patient selection for adjuvant systemic therapy; evidence from clinical studies of adjuvant therapy for RCC; and overall multidisciplinary care planning. To register, click here.
• Bladder Cancer Working Group: Practical Application of Immunotherapeutic Strategies to Optimize Patient Outcomes, Next Steps to Move the Field Forward, will be held as a dinner symposium on Saturday, May 4, from 6-8 p.m. in W375A on level 3. The program will be chaired by Daniel P. Petrylak, M.D., professor of medicine and urology, co-director of the Signal Transduction Research Program, Yale Cancer Center, Yale School of Medicine. During this program, a multidisciplinary faculty of renowned experts in urology, medical oncology and immunotherapy will review practice-changing data and discuss their impact on patient care. Brief didactic presentations will be followed by real-world clinical case presentations and discussions to facilitate interpretation and application of the evidence. The faculty will also share their forward-looking perspectives on the bladder cancer treatment horizon based on recently reported and anticipated clinical trial data. To register, click here.

MDMag covered the issue of patient sleep quality for overall health in a recent article. Paul P. Doghramji, MD, Karl Doghramji, MD, and David N. Neubauer, MD each questioned why patient sleep is not considered as a commonly-accepted measure of a patient’s health, similar to blood-pressure tests.  

"Studies have shown that at least 50% of all primary care patients experience insomnia at some point. Only 1 in 3 will present the issue to their doctor, Doghramji said, and just 1 in 20 will seek therapy for it."

The topic was discussed during a continuing medical education symposium supported by Eisai Inc and Imbrium Therapeutics during the 2019 American College of Physicians (ACP) Internal Medicine Annual Meeting in Philadelphia, PA. Risk factors from sleep issues are distinguishable and the discussion should continue and perhaps help improve patient care. 

Join us on Facebook to share news, pictures and posts, even share your continuing medical education events. Our Facebook page, created on April 26, 2019, is https://fb.me/namecassn - we hope you join us!