According to the most recent Accrediting Council for Continuing Medical Education (ACCME) Data Report, “Thriving Through Growth and Innovation — 2023”, of the 247,019 total activities accredited in 2023, only 328 (0.13%) were performance/quality improvement activities. Despite this, quality improvement remains a central component of healthcare and physician performance in practice.
The American Medical Association (AMA) defines a performance improvement/quality improvement (PI/QI) activity as a process by which evidence-based performance measures and QI interventions are used to identify patient care areas for improvement and enhance physician performance.
Curi, an ACCME-accredited provider, developed its Risk Assessment activity, aligned with the AMA Performance Improvement (PI) Continuing Medical Education (CME) activity format, as an opportunity to both assess and address risk factors in clinical practice. Curi first implemented its Risk Assessment activities in 2019. Throughout the evolution of the activity structure and process, Curi distilled the following top five best practices for PI CME activities:
- Ensure compliance.
- Streamline the process for learners.
- Utilize technology.
- Provide clear instructions.
- Offer resources.
Risk Assessment Overview
As a malpractice insurance company, Curi often focuses on professional practice gaps tied to risk exposures in medical practice, coding and documentation, value-based care, and areas of compliance tied to malpractice. Consequently, Curi developed its Risk Assessment activity, which is now a core aspect of its accredited CME program.
Risk Assessment activities are individualized learning plans, tailored to each physician learner within the medical practice in which the risk assessment is conducted. The risk assessment format provides physician learners with a customized curriculum aligned to the AMA PI CME activity format to mitigate malpractice and improve performance.
Best Practice No. 1: Ensure Compliance
The AMA considers a PI CME activity to consist of three stages:
Stage A: Learning from current practice performance.
A physician or a group of physicians learn about specific performance measures and assess their current practice against such performance measures.
Curi’s Risk Assessment activity begins with Stage A, where a Curi Advisory Risk Consultant engages a medical practice to complete an assessment of risk for the practice and physician learners to track, collect, itemize and rank risk exposures, followed by the Risk Assessment Exit Conference. During the Risk Assessment Exit Conference, the Risk Consultant guides the learners through analyzing the data collected. Stage A of the Risk Assessment activity can also be conducted online utilizing an electronic form.
Upon completion of Stage A, the learner receives a report that includes resources, toolkits, dialogue and other resources directly tied to the identified risk exposures, and a discussion takes place on implementing best-practice changes. The learner is left with a “toolbox” to support competence and performance improvement.
Stage B: Learning from the application of PI to patient care.
At this stage, physicians implement an intervention(s) based on the analysis results in Stage A. It is key that appropriate tracking tools are utilized and that the physicians receive guidance on parameters for applying an intervention(s) (e.g., specified interval of time).
During Stage B, physicians are allowed time to implement practice changes to improve their identified risk exposures. Physicians utilize the tools, resources and forms to update and implement change(s) in their practice. Physicians are asked to submit a progress report to share the changes they plan to implement to address the risk exposures identified in Stage A and any barriers they have encountered.
Stage C: Learning from evaluation of the performance improvement CME effort.
In this final stage, a physician reassesses their current practice against the identified performance measures and reflects on their performance in practice as measured after implementation of the intervention(s).
During Stage C, a reassessment is completed to evaluate improvements made to practice approximately three to six months following the Risk Assessment Exit Conference. This final curriculum component is a chance for the Risk Consultant to guide physicians through reassessment and reflection. Risk exposures initially identified are re-evaluated, and the physician learner is asked to reflect on the areas of improved performance.
Additional requirements outlined by the AMA include:
Oversight mechanism/assurance of content integrity of performance measures
Accredited CME providers must have a mechanism to ensure the content validity of the performance measures identified and set for the PI CME activity. Performance measures should be evidence-based and well-designed.
- Curi’s accredited CME team works with its Risk Consultants and other subject matter experts to outline performance measures for each Risk Assessment activity.
Clear instructions to physicians
The educational process must be clearly defined and articulated to physician learners, including required documentation and timelines.
- Curi’s accredited CME team has refined its process to include clear instructions for physicians as they proceed through each stage and claim CME credit.
Provision of adequate background information
Physicians must be provided with sufficient information to identify and understand the performance measures that will guide the PI CME activity and the evidence behind those measures.
- Curi moved to topic-based risk assessments in 2022. Performance measures are evidence-based and clearly defined as physicians work through Stage A.
Validation of depth of physician participation
PI CME activity documentation must be reviewed to validate the depth of physician participation.
- Curi set up its Risk Assessment activity to capture documentation at each stage. Stage A captures data points on a participating physician’s current performance, while Stage B captures information on specific practice changes the physician has implemented. Stage C re-captures data points on physician performance so that changes in performance between Stage A and Stage C can be analyzed and reflected upon.
Best Practice No. 2: Streamline the Process for Learners
The PI CME activity must be learner-oriented, meaning the accredited provider must ensure the process is streamlined for its learners. Each stage should be clearly defined and straightforward. Here are some tips for streamlining each stage:
- Share a detailed outline of the process and the timeline to complete the PI CME activity.
- Ensure a clean, clear layout.
- Simplify the process so it’s not cumbersome (e.g., if using an online platform, reduce the number of clicks required to complete an assessment).
- Provide clear results and actionable data. The results from Stage A should be easy to interpret to identify areas for improvement.
- Provide actionable next steps at the end of Stage A so learners have a clear path forward. More information is below under the “Offer Resources” section.
Best Practice No. 3: Utilize Technology
Technology can help streamline the process for learners and the accredited CME team. Using an online platform, whether a learning management system and/or proprietary software, requires involvement by multiple stakeholders, including the accredited CME team, content or subject matter experts, IT and others. Ensure all stakeholders are involved and invested from the get-go.
It’s also crucial to ensure the process is seamless before rolling it out to learners. A pilot test is an excellent way to ensure the system and processes function as intended and can help surface any existing or potential concerns. Engaging multiple reviewers can provide different perspectives and feedback.
For Curi, identifying a user-friendly platform and ensuring buy-in from our IT team was critical for implementing the Risk Assessment activity. Additionally, automating steps, where feasible, transformed the process. For example, upon completion of Stage A, a learner is automatically sent a summary report of their individualized risk assessment results and resources directly tied to their identified risk exposures for moving into Stage B.
Best Practice No. 4: Provide Clear Instructions
Providing clear instructions is an AMA requirement but is also central to streamlining the process for learners. Accredited CME providers should focus on crafting simple, straightforward instructions. For Curi, creating an infographic to summarize the process helped the accredited CME team define and refine it so that they could articulate it to learners and leadership. The team also created written instructions for each stage. Multiple stakeholders reviewed the instructions to ensure clarity and conciseness.
Best Practice No. 5: Offer Resources
To maximize performance change and mitigate risk during Stage B, Curi recognized that offering ample resources to learners is critical. Upon completion of Stage A, Curi offers numerous resources to help facilitate implementation of interventions during Stage B and improve their performance in practice.
For example, with the Technology Risk Assessment, Curi offers the following resources: AMA STEPS Forward Open Access Module, Office for Civil Rights Business Associate Contracts Sample Business Associate Agreement and the Individuals’ Right under HIPAA to Access their Health Information.
In addition to these resources, Curi shares sample forms, policies, documents and toolkits developed by the Curi Advisory Risk Solutions Team. Access to resources helps promote learner engagement and streamlines the change implementation process.
Closing Thoughts
Implementation of a PI CME activity requires significant planning and preparation, along with coordination of stakeholders. However, it can yield substantial gains regarding physician practice performance and quality improvement. Curi’s most recent analysis of Risk Assessment activity data demonstrated that 80% of identified risk exposures were corrected six months following the initial audit of medical practices.
For accredited CME providers who might not know where to begin, some questions for reflection are included below.
Questions for Reflection
Consider the following reflective questions revisions to help you assess opportunities for implementing PI CME activities:
- What areas of risk or performance improvement could be addressed within your organization?
- How could a PI CME activity help mitigate critical risk issues at your organization?
- What steps are needed to engage key stakeholders in implementing a PI CME activity?
References
ACCME 2023 Data Report https://accme.org/resource/accme-2023-data-report-pdf/
AMA Performance Improvement Continuing Medical Education (PI CME) https://www.ama-assn.org/education/ama-pra-credit-system/performance-improvement-continuing-medical-education-pi-cme
AMA PRA Credit System Frequently Asked Questions Related to PI CME https://www.ama-assn.org/system/files/2019-09/picme-faq.pdf
Curi’s risk mitigation resources and guidance are offered for educational and informational purposes only. This information is not medical or legal advice, does not replace independent professional judgment, does not constitute an endorsement of any kind, should not be deemed authoritative, and does not establish a standard of care in clinical settings or in courts of law. If you need legal advice, you should consult your independent/corporate counsel. We have found that using risk mitigation efforts can reduce malpractice risk; however, we do not make any guarantees that following these risk recommendations will prevent a complaint, claim, or suit from occurring, or mitigate the outcome(s) associated with any of them.
Sharon Nichols, BSN, RN, CPHRM is the senior Risk Consultant for Curi Advisory.
Kasha Askew, MSM, is the manager, CME operations, for Curi Advisory.
Sarah Porter, CHCP, is the accredited CE compliance officer.