CME Reduces Costs in Bleeding-Related Disorders, Study Says

Mark Crane

June 05, 2013

Does continuing medical education (CME) result in better outcomes and more affordable care?

Although more than $2 billion is spent on CME annually in the United States, few studies detailing its economic benefits exist.

Using a computer model, a new study estimates that CME programs can save significant costs even when a modest number of physicians change their practice as a result of what they have learned.

The study by CMEology, a CME provider in West Hartford, Connecticut, evaluated the economic impact when 133 cardiac and thoracic surgeons applied learning from a CME course about prevention of bleeding-related complications and reducing the number of transfusions.

The model base used conservative estimates to predict what would happen if 30% of the attendees prevented bleeding complications in 2% of their annual surgeries. The savings estimates ranged from $1.5 million to $2.7 million, depending on the type of complication.

"Very few studies have done a robust economic analysis on an individual CME activity," Dana Ravyn, PhD, MPH, the study's chief author and scientific director at CMEology, told Medscape Medical News. "It's extremely time-consuming and expensive to do that kind of follow-up with extensive chart reviews.

Research Can Help Determine Resource Allocation

"We've created a relatively inexpensive tool to demonstrate that CME is cost-effective and relevant to society at large," he said. "We know CME enhances knowledge and competence but up until now we haven't shown the economic effects. Now stakeholders can better determine how to allocate limited resources at a time CME budgets are contracting."

The research was presented May 22 at the 18th annual meeting of the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) in New Orleans, Louisiana.

Cost estimates came from a retrospective database analysis of 103,826 cardiac and 142,533 noncardiac thoracic surgeries. Bleeding-related complications (BRCs) included hemorrhage or hematoma complicating a procedure, return to the operating room to control bleeding, or procedure or diagnostic codes for blood transfusions, Dr. Ravyn said.

The additional cost between those with a BRC vs those without a BRC was $12,128 for cardiac surgeries and $15,899 for noncardiac thoracic surgeries. The incidence of BRCs in cardiac and thoracic surgeries was 47.4% and 34.3%, respectively; the base case was prevention of a BRC in 2% of surgeries as a result of incorporating new competencies gained from the CME activity.

The CME symposium at the Society of Thoracic Surgeons (STS) 48th Annual Meeting in January 2012 promoted prevention of BRCs and implementation of blood conservation clinical practice guidelines of the STS/Society of Cardiovascular Anesthesiologists.

Model Can Be Applied Throughout Medicine

"The broader implication of this research is the creation of a model that can be applied to almost any therapy area and learning format," Dr. Ravyn said. "The greatest barriers to change of behavior are related to cost, and buy-in from hospital administration. Many initially felt that a blood conservation program is difficult to implement. With this study, we've shown that CME in this area is cost-effective."

Murray Kopelow, MD, president and CEO of the Accreditation Council for Continuing Medical Education (ACCME), told Medscape Medical News, "While it is not within our purview, as a CME accrediting body, to comment on the merits of this study, we do believe that it is critically important to demonstrate the effect of accredited CME on patient outcomes and healthcare costs.

"It is challenging to evaluate and measure the effect of CME on health outcomes and costs because there are a multitude of factors that contribute to change, including social, economic, and environmental factors," he said. "Despite the challenges, it is important to conduct research that assesses CME's vital role in supporting public health priorities, including its effectiveness in improving health outcomes while reducing costs."

"CME has been more focused on outcomes and performance in recent years," Morris J. Blachman, PhD, associate dean of continuous professional development and strategic affairs at the University of South Carolina School of Medicine, told Medscape Medical News.

"As that emphasis grows, we'll see more researchers use the data on outcomes to translate that into cost savings. The new payment and treatment models are pushing people to ask what contributes to improving care and being more cost-effective," he said. Dr. Blachman was not involved in the study.

The study was conducted by CMEology, a CME provider. Dr. Kopelow and Dr. Blachman have disclosed no relevant financial relationships. The WebMD Professional Network includes Medscape.com as well as Medscape Education, a portal for professional education. Medscape, LLC, is accredited by the ACCME to provide continuing medical education for physicians.

International Society for Pharmacoeconomics and Outcomes Research (ISPOR) 18th Annual Meeting. Presented May 22, 2013.

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