Now that I’m over my snit about the Accreditation Council for CME’s lack of responsiveness to my questions about its chief executive’s statements in The New York Times and new potential public disclosures about those found to be noncompliant with the 2006 Accreditation Criteria, I have a deeper appreciation than ever for the difficulty ACCME faces whenever it has something to announce.

Say too much on one hand and everyone goes crazy trying to figure out how a broad statement could play out in the nitty gritty details of real life; say too little and everyone goes crazy trying to figure out what it is you’re not saying. Talk about a no-winner.

Anyway, Dr. Kopelow and I had an interesting conversation shortly after I got all miffy. I really didn’t get a whole lot of definitive answers from him, which is pretty much what I expected (while he’s the spokesman and public face of ACCME, he can’t really speak for the board that’s ultimately making the decisions, so in situations like this one, there’s not much he can say). But I am glad he was able to take the time to speak with me and at least give me enough to put together an article that says a bit more. Really, though, I don’t expect to get much in the way of real answers until after the upcoming December board meeting.

That being said, I’m going to go out on a limb and make a few predictions anyway, based on nothing more than my keen ESP skills, history, and common sense:

1. ACCME isn’t going to release information about activities or providers that have had complaints filed against them until after the investigation is completed. Dr. Kopelow of course didn’t say or even imply this, but in poking around ACCME’s Web site I don’t see anything that remotely would make me think it would be increasing transparency against those accused but not convicted. Look at the wording of the updated Process for Handling Complaints/Inquiries Regarding ACCME-Accredited Providers:

“ACCME reserves the right to make public some information about the ACCME Complaints and Inquiries Process which may include but is not limited to the facts and circumstances involved in the complaint or inquiry, the name of the accredited provider involved, the names of commercial supporters, the names of non accredited joint sponsors and the ACCME’s findings.”

To me, that inclusion of findings tells me that it’s just thinking about the end of the cycle, not the beginning. I know some people have raised the idea of making the info public at the time a complaint is filed, or at least suspending access to enduring materials and online activities during an investigation, but I just don’t see ACCME going in the direction of guilty until proven innocent. I could be wrong, but it just doesn’t appear to be the way it has done things up until now.

2. You will get to make your feelings known about any new disclosure policies that may come out of the December board of directors meeting before they go into effect. Think about it: As far as I can tell, ACCME has not adopted any major policies or made any major announcements without asking for comments since the 2006 Accreditation Criteria (and even then all the preliminary materials were open for discussion. A lot of discussion). Put that together with the policy that says comments will be asked for any new rule that could “directly and materially impact the ability of accredited providers to conduct business,” and there you go.

3. The ACCME board is taking this very, very seriously, and is looking at it from all sides and angles, backward and forward. This Dr. Kopelow did say, “There are 1,600 state- and nationally accredited providers in our community who are trying every day to have an impact on physician learning and help those physicians have an impact on patient care. That’s what we support every day in the accreditation system.” They’re not going to make any disclosure decisions lightly — that much I’d put money on.

Am I out in left field, on the ball, or somewhere in between? I’d be curious to know what you think. As always, feel free to leave a comment below or shoot me an e-mail.

Update: Dr. Kopelow is going to talk with me this afternoon. I know he likely won’t be able to give me many details, but I look forward to hearing whatever he can say, and will share it with you as soon as I can.

OK, I admit I was a little miffed to learn we had been scooped on our own turf by The New York Times when that venerable paper reported that the Accreditation Council for CME was going to be publicly outing accredited providers who were found to be in violation of its accreditation criteria. But really, shame on me for not jumping on the story first, I thought.

But now I am doubly miffed. After waiting for weeks for an interview, then at least some e-mailed comments, yesterday ACCME Chief Executive Murray Kopelow, MD, declined to discuss with me at all what he had already told the Times, much less answer any follow-up questions I sent. They did issue a statement last week that, to me anyway, didn’t say a whole lot (here’s the best I could do to provide an update, based on the information in the statement).

I understand that his hands are tied due to the nature of the organization, which answers to many masters, but it makes me think that the ACCME’s new approach to transparency is going to be one of those one-step-forward, two-steps-back type of things.

On one hand, ACCME wants to open up its processes and let people comment, as it did last spring when it issued a request-for-comment on four proposals it was considering. On the other hand, in this case anyway, it sounds as if ACCME doesn’t want to publicly specify—except in very general terms—what the board is even deliberating until the deliberation is done. Except to The New York Times, of course. But now ACCME’s lack of willingness to talk about what it already said makes me think it is backing off from those statements as well.

Any time the ACCME sneezes, the entire CME community gets pneumonia, and questions were flying around the Alliance for CME listservs after the Times article came out. If an accredited provider is found to be noncompliant, would it be required to notify learners and provide corrective materials? Who would have to pay for it? How would it work? A lot of people seemed to jump the gun and, as this community is wont to do, start sweating the details before any decision is finalized. It would be nice to know if in fact this is something people need to start thinking about or not. It also could be a good argument against increased transparency, if all that transparency is going to do is cause unnecessary stress if the board decides not to go this route.

But it would be nice to at least be given the sense that the community’s input is important to the board’s decision-making process. While I’m still miffed, I’m putting my faith in the ACCME and hoping that one of the next steps it will make as soon as the board issues its decisions on whatever specific policies it is deliberating will be another call for comments—before it hands down any final decisions.

What do you do if you have a CME activity planned, say, for tomorrow on breast cancer prevention and treatment, and a controversial new mammography guideline comes out that contradicts long-standing previous standards of care?

I’m sure most faculty worth their salt could and would be up on something like this soon after it hits the news, but it’s got to be a scramble. Do you add more time to the Q&A? Provide more followup? Get down on your knees and wail, “why me?” Just curious. It’s probably nothing to you all, but I’m just thinking about stories that change five minutes before the magazine goes to press and the angst that can cause, and thinking this is pretty analogous.

While of course no one’s talking on record, my colleague Rachel Eccles managed to dig up some information about the potential impact of the Pfizer-Wyeth merger on its meetings and medical meetings department.

What I want to know is the potential impact it will have on its CME granting, and those in that department. One has to assume that is going to be streamlined as well, with cutbacks. Has anyone heard anything? If so, drop me a line (it’d be confidential, of course, and just to appease my curiousity, not for publication).

I haven’t yet tried to get an official statement, but I’m guessing that, until it all shakes out anyway, I’d get the same kind of answer Rachel did: “I can tell you that Pfizer is continuing to evaluate its global workforce, which includes our medical meetings group, to determine how best to support patients and customers, support our businesses, and operate at a cost-competitive level.”

Here are a couple of editorials I ran across recently that painted commercially supported CME in a bad light:

Aren’t You Glad Your Doctor Completed Pharma’s CMEs?

Dr. Kate Scannell: Educating doctors — When Pharma writes the script

My question is: Where are the stories about CME that truly does educate docs and other healthcare providers? We run them all the time in Medical Meetings; then again, we’re preaching to the choir. What will it take to get the mainstream media interested in what’s happening in the majority of CME, which is not biased? Ah well, I guess good news doesn’t sell papers, does it?