As we round the bend into pumpkin spice here, there, and everywhere, it’s time to rip open the mailbag once again to see where the CME community needs our help. That’s right, it’s time for the latest edition of our Ask Us Anything advice column. We begged and pleaded for a few worthwhile submissions last week, and a few of you came through (but we still need more for the future if you’d like to offer up any current issues you are having).
Remember, if you have an issue (professional or personal) you want us to help with, you can click here to submit your question(s). While we may not have a professional degree that would be of use, we promise we’ll try our best to be helpful.
Dear Derek and Scott,
I’m employed in the CME department at a hospital where approximately 75% of our patients are covered under a state public health insurance program. Currently, we’re experiencing significant funding reductions that are impacting CME operations immediately. Given the policy shifts under the new administration, I anticipate many other academic medical centers will begin to feel similar pressures by the first or second quarter of next year.
From your perspective, what strategies have you seen academic CME and interprofessional continuing education (IPCE) teams use to sustain high-quality, innovative education in the face of financial constraints? How are institutions successfully engaging device and pharmaceutical partners to support educational content while maintaining independence and compliance? And where do you see the greatest opportunities for CME and CE programs to evolve over the next few years in terms of structure, partnerships, or delivery models to remain relevant and resilient in this changing environment?
With gratitude,
Lost in LA-LA Land
SCOTT: The political winds are always shifting, but certainly the latest maneuverings have had a substantial financial effect on academic institutions and hospitals throughout the country. I know many of my friends in hospitals and health systems are quite worried not only about their jobs but also about how to continue to provide important and impactful education to the providers under their roof.
I don’t pretend to have anything particularly innovative to suggest, but a few things come to mind that have been bandied around for years that may bubble closer to the surface once again in our environment:
- Find your internal partners — do you have patient safety or quality improvement teams that would be interest in breaking down their silos to work with you on one or more of their current projects or priorities? If not, is there something you can build from scratch that fits into organizational goals that might have some $$$ set aside to support it?
- Find your external partners — medical education companies (MECC) are always looking to work with academic institutions on grant-funded education. I was speaking to a friend last week about the challenges of placing grand rounds programs at hospitals because of their fear about letting an external party bring in “their activity.” This has been pervasive for years and years, and frankly, it’s not easy to understand. It’s too easy a win for both parties – you get a (usually) nationally-renowned clinician coming to your institution for free to educate your providers on a relevant topic. It’s an accredited program (many MECCs will even let you accredit it if you want) so the education shouldn’t be tainted with any sort of marketing messaging. What’s the problem?
- Be patient — Stress level are high within academic centers and hospitals. Everyone is scrambling to find creative ways to fill in those financial holes in the budget without needing to cut services. It’s difficult for many clinicians to make CME and IPCE a priority right now. I have a current project I am working on where we have a pot of money just sitting there waiting for a local institution who is willing to work with us. I have emphasized time and time again to people I know and trust within these institutions that the time commitment is negligible, but they are all balking because of the other demands on their time.
One more thing: There certainly are some academic institutions who go after unrestricted educational grants from pharma and device companies, but that is a difficult road to go down without prior experience/relationships. Again, do you have friends/colleagues at medical education companies (MECCs) who might have creative ways to bring you along on one of their current proposals? MECCs are always looking for reliable and realistic partners (don’t be a pushover when it comes to budgets, but also don’t be greedy — we are all chasing funds), so making new inroads can be mutually beneficial.
DEREK: Scott assured me that in this installment of Ask Us Anything, we would only have simple, easy to answer questions to respond to. So much for that…
I don’t think I have much to offer that is dramatically different than what Scott has already shared. It is definitely not easy times for individuals working in hospitals and health systems. I have three pieces of advice to suggest:
- I absolutely concur with Scott’s thoughts on finding your external partners. Different groups have different strengths and weaknesses. Many of the most impactful programs I have been part of were developed with partner organizations with vastly different backgrounds. Figure out what your department’s strengths are, what you need the most help with, and then start networking your butt off.
- Smaller organizations like hospitals can respond to RFPs. You do not have to be a MECC to respond to an RFP. You do not have to partner with a MECC to respond to an RFP (though that’s not a bad idea. See #1 above.) You do not have to have a large budget program to respond to an RFP. If your program aligns with the requirements and objectives of the RFP, you can submit an application for it. There will be a large time investment in putting together a proposal, especially for the first time, but it may be worth your effort if the end result is a proposal template you can use for additional responses in the future.
- Hang in there. Midterm elections are coming.
Dear Derek and Scott,
I am an accredited provider who sometimes works in joint providership. I am having a hard time agreeing with my education partners about when a change of scope (COS) should be provided to the funder as we seem to have a difference of opinion on what warrants a COS. Like, does a date change require a COS? What about an adjustment to a learning objective? How about if we swap out faculty? Do funders have guidelines for this and, if so, where do I find them? I’m worried we may under-communicate changes to the program and risk potential future support. Any advice you can provide would be super-duper helpful.
Fondly,
Lost in Translation… of Expectations
DEREK: Before I respond, I’ll offer the usual disclaimer that I am sharing my own opinion and not that of my employer or, for that matter, any other funder/supporter. With that out of the way, I am going to break down my response into two sections, starting with thoughts on communication and then moving on to COS.
My personal opinion on the scenario you have shared is that it is better to over-communicate with the supporter than under-communicate. I realize this may come as a surprise to those of you who were in attendance at the panel session I was part of at a past AIS meeting where a fellow panel member stated that providers with COS questions could always “just pick up the phone and give us a call,” to which I quickly grabbed the mic and pleaded, “Please never do that.” In fairness, that has more to do with my general disdain for talking on the phone and preference for emailed questions. Most supporters like to be kept apprised of what is going on with the programs they have supported. If you are sharing too much or too frequently, they will let you know. I have had some providers reach out to me after a grant was approved to ask for my communication preferences, which I appreciated.
Narrowing down to COS, if you are communicating with supporters about changes or updates to your program, they will tell you whether or not a COS is needed. That is not something you need to determine on your own. Since different organizations have different thresholds for when a COS is or isn’t needed, I’m leery of giving specific advice, but I can share a couple of tips from my experience.
- For the supporters I have worked for, a COS was not required for a date change if it was less than 30-60 days from the original start date. If it’s only changing by a couple days, then an email stating the new date is usually all that’s needed.
- A general rule of thumb is that if the changes you are making will alter the content, format, and/or outcomes of the program as stated in the original proposal/application, you will need to do a COS. Keeping that in mind, altering a learning objective would likely require a COS as it would likely change the focus of the content. Your program was reviewed and approved based on the original learning objectives, so changing them will require additional review. Swapping faculty (again, this is specific to my experience) usually would not require a COS. Most of the proposals I read do not have specific faculty listed and are not approved because of the faculty, so a COS is not needed if they change.
To summarize, major changes will probably require a COS. Minor changes will probably not. Don’t be afraid to ask supporters if they would like both types communicated to them.
SCOTT: Taking the perspective of the provider, I have always had the personal fear of, “OMG, if I send them a COS because something has changed and then they decide to deny our change and ask for the funding back, we are really, really screwed. Maybe we just say nothing, and they won’t even notice?”
That said, in my 20+ years on the provider side, I have not once had a supporter who rejected a COS or asked for funding to be returned. Hence, you’d think my concern would not still linger, but it does. I’d love to hear any supporter or providers share in our comments whether my doomsday scenario actually has happened to them so I could either continue biting my fingernails or finally breath easier. (note from Derek: As far as I can remember, I have only rejected a COS once, and it was because the provider completely altered the format from the original proposal.)
In general, I think Derek’s advice here is pretty good. If you know the person on the supporter’s side who is overseeing your approved grant, there is nothing wrong with proactively reaching out to them to see how they would like to remain apprised of progress on the project. If they gave you <$50,000, they probably won’t ask for much of an update, but if they gave you >$500,000, they most certainly will want to kept in the loop from time to time.
Now, to your question of what does/does not require a COS, there are no hard and fast rules that I have ever seen or heard of. From my perspective, if your project had an initial proposed launch date of September 15 and now you think it’s going to be September 20, that wouldn’t require a COS. But if it’s now going to be November 15, a COS is probably a good idea. An email to the supporter explaining why the launch date has been pushed back would also likely be a nice gesture. But it’s certainly a nuanced, grey area of our world.
CMEPALOOZA 