CME self-reporting: Cheating hardly worth it
Top CMS official’s case is an exception, expert says
With the plethora of continuing medical education (CME) resources available to most physicians in the United States — many of them free or paid for by employers — it would appear that falsely reporting CME credits would be a pointless risk.
But that’s just what a top Medicare policy-maker did, according to his state medical board, which suspended his license to practice for one year in May.
"It’s a silly reason to risk losing your license or to put it in jeopardy," says Dale Austin, MA, senior vice president and chief operating officer for the Federation of State Medical Boards (FSMB), a nonprofit organization of state medical boards that promotes standards for physician licensure and practice, and monitors state disciplinary actions against physicians.
Self-reporting done honestly, usually
Sean Tunis, MD, chief clinical officer for the Centers for Medicare & Medicaid Services (CMS), was charged earlier this year by the Maryland Board of Physicians with falsifying documents submitted to the state about his CME. The Maryland board charged Tunis with falsifying records, making a false report in the practice of medicine, and unprofessional conduct in the practice of medicine. According to the board, Tunis falsified CME certificates sent to the board indicating he earned more than 50 CME credits and, additionally, claimed 60 CME credits for grand rounds that the hospital has no record of him attending.
Following a hearing on May 25, Tunis’ license was suspended for a minimum of one year, with two years’ probation to follow.
While Tunis’ case was seen as a sign of weakness in the current method of reporting CME — not all states require CME to maintain licensure, but many medical societies do, and nearly all rely on self-reporting by physicians — Austin says the self-reporting system works nearly all the time. A big reason for that, he says, is the prevalence of CME opportunities.
"CME is very, very easy to come by, and it’s not terribly expensive, so most physicians have no problem capturing and documenting the amount of credit they need for reporting purposes," he says. "So, to go to the effort of falsifying records is really silly."
Many states and medical associations have on-line CME accounting systems that permit users to log in, enter their CME hours, and keep track of how much they have earned throughout a reporting period. Typically, physicians are not required to submit certification of their earned CME, but are subject to random audits and are advised to keep their certificates on file in case of an audit.
"About two-thirds of our member boards require CME for re-licensure, and they have various reporting systems in place for auditing that CME," says Austin. "But in large part, they rely on physicians self-reporting, and then have various audit procedures in place. Usually a certain percentage, or every fifth [physician] is audited and followed up for details."
He acknowledges the system relies on the honesty of the reporting physicians and the deterrence of the random audits.
"Is it a perfect system? No," he says. "But falsification is a deliberate act, and I think that’s relatively rare. It’s far more common for a doctor to not meet the timeline, or not meet the required credit levels."
States keeping an eye out
While there are some critics who are calling for a more secure CME credit monitoring system, states that now require CME for re-licensure rely on self-reporting. Currently, 39 states require CME for re-licensure; states that do not require continuing education for MDs are Colorado, Connecticut, Hawaii, Indiana, Montana, New York, Oregon, South Dakota, Vermont, and Wyoming, as well as Washington, DC. Some states maintain separate boards for osteopaths and MDs.
The FSMB gets reports of between 50 and 80 CME disciplinary actions a year, but few arise from falsifying CME certificates, Austin says. During the past five years, the number of reports each year of falsifying CME reports has ranged from zero to five for the entire country.
The bulk of CME disciplinary actions arise from late submissions of CME credits.
The Pennsylvania Medical Society in 2004 put into effect a CME monitoring system — CME Tracker — that serves as a repository for physicians’ CME logs. The system lets them keep an ongoing account of how many CME credits they have in Categories 1 and 2, and keeps up with how they are doing in meeting specialty requirements for CME in patient safety and risk management.
Judd Mellinger-Blouch, director of marketing for the PMS, says the program doesn’t monitor the veracity of the information physicians enter, but by providing physicians a means of keeping track of what they have earned vs. what they need, they are less likely to reach the end of the reporting period and find themselves short.
"It’s simply an online database, but it helps [physicians] keep their records organized," Mellinger-Blouch says. "And it helps with self-reporting because, if you’re claiming Category 2 credits, you have to keep a journal of all the reading you did, so the tracker can serve as the journal or log for that."
Austin says, while cases like Tunis’ draw attention to the potential for abuse in an honor system of reporting, in reality, few physicians are willing to take that risk.
"Look at all they stand to lose, when CME credits are very easy to obtain," he points out. "It’s just not going to be worth it to the vast majority."
Sources
- Dale Austin, MA, Senior Vice President, COO, Federation of State Medical Boards of the United States Inc., P.O. Box 619850, Dallas, TX 75261. Phone: (817) 868-4000.
- Judd Mellinger-Blouch, Director of Marketing Communications, Pennsylvania Medical Society, 777 E. Park Drive, P.O. Box 8820, Harrisburg, PA 17105. Phone: (717) 558-7750.
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