Update on CME Requirements for Act 13: Allopathic and Osteopathic Physicians

Important Note: There are differences between allopathic and osteopathic physician licensure CME requirements.

Allopathic Physicians (MD’s)

The State Board of Medicine finalized the CME requirements for physician licensure in the state of Pennsylvania . Beginning with licensure renewal period commencing January 1, 2007 , proof of completion of 100 credit hours of continuing medical education in the preceding biennial period ( January 1, 2005-December 31, 2006) will be required. For the licensure renewal period commencing January 1, 2005, a physician will need 25 total hours (Category 1 or Category 2 CME) in the preceding biennial period (January 1, 2003-December 31, 2004) and of the 25 required hours, 3 hours (Category 1 or Category 2) needs to be in risk management or patient safety. Since we are 75% of the way through the current cycle, they are requiring only 25% of the totals. No minimum will be required in Category 1 for this period ( January 1, 2003-December 31, 2004) and the credits could have been obtained at any time in the licensure cycle.

As the proposed CME requirements currently stand, the following is required for allopathic physicians.

• Complete 100 CME credits per renewal period (2 year licensure cycle)
• 20 hours of the 100 per 2 year cycle must be Category 1 CME (documented by; (1) AMA PRA certificates, (2) Category 1 CME certificates, (3) certificates form a medical professional society, (4) healthcare system credential certification, (4) third party payor credentialing certification, or (5) certification from a CME organization.)
• 12 hours of the 100 per 2 year cycle must be patient safety or risk management hours in either as Category 1 or Category 2 CME
• The remaining 68 hours can be of Category 1 or Category 2 CME (Category 2 CME acceptable documentation includes; (1) personal log books, (2) journal notes, or (3) notes identifying the type of activity and time.)
• Credit will not be granted for courses in office management or practice building.

Allopathic Physicians (MD’s) Only

Note: Category 1 AMA Risk Management/Patient Safety credits also count toward the 20 general Category 1 AMA hours required. Thus if you received 5 Category 1 AMA credits and 7 Category 2 AMA credits to meet your patient safety/risk management requirements, you would only need 15 additional general Category 1 AMA credits and 73 general Category 1 or Category 2 AMA credits. See the following example:

Sample CME Credit Summary for M. Jones, MD: 2003 & 2004

Risk Management or Patient Safety CME Topics

The State Board of Medicine approved the list of CME programs that will satisfy the patient safety/ risk reduction program requirements of Act 13.

The approved Risk Management or Patient Safety CME topics are:

• Mortality/morbidity conferences
• Improving communication among physicians and with other health care personnel
• Communication between physicians and patients
• Medical team building
• Human error factors
• Theory of error reduction
• Medical error identification/avoidance strategies
• Technology and information systems to improve practice
• Preventive medicine education
• Improving medical records systems
• Evidence-based care (Includes programs such as teaching techniques of documented medical efficacy or avoiding commonly used interventions that are not beneficial as documented by outcome studies)
• Patient health monitoring methodologies
• Health care quality improvement
• Medication safety

The CME Office and Committee are developing a process to “flag” Category 1 CME conferences here at Lancaster General as having risk management or patient safety content. Conferences that are approved for risk management or patient safety will appear on transcripts mailed to physicians.

AMA CME Description (www.ama-assn.org)

Category 1 Activities

Accredited providers may designate the following types of activities for AMA PRA category 1 credit:

1. Live or attendance-based activities
2. Enduring Materials: Enduring materials are printed, recorded, audio, video, and electronic activities that may be used over time at various locations, and that in themselves constitute a planned CME activity. To be designated for AMA PRA category 1 credit, enduring materials must:
3. Journal-based CME
4. New procedures: Through new procedures and skills courses, providers train physicians on topics that allow them to request new or expanded clinical privileges. For these activities, a provider must assess whether a physician has acquired the knowledge and skills to carry out the new procedure. The AMA has established a system of four levels so that providers and participants can clearly identify the depth and complexity of the course. After completing a new procedure educational activity, physicians can present their credit certificate to the appropriate credentialing authority as documentation of his or her education and training.
5. Category 1 activities providers do not designate: US licensed physicians may also earn AMA PRA category 1 credit for certain specific activities that providers cannot so designate. To obtain credit for these activities, physicians must apply to the AMA Physician’s Recognition Award department. These activities include:

• Articles physicians publish, as first or second lead author, in journals indexed by the Index Medicus.
• Teaching at a live activity approved for AMA PRA category 1 credit;
• Preparing a poster presentation, which is also included in the published abstracts, for a live activity approved for AMA PRA category 1 credit;
• American Board of Medical Specialties (ABMS) member board certification and recertification;
• Medically related advanced degrees, such as a masters in public health; and
• Participation in an Accreditation Council for Graduate Medical Education (ACGME) accredited residency or fellowship program.

Category 2 Activities

Physicians may claim Category 2 credit toward the PRA for such physician directed learning activities as: the teaching of residents, medical students, or other health professionals; online study; reading authoritative medical literature; or attending live activities not designated for AMA PRA category 1 credit. In each case, the physician individually determines the educational value of those AMA PRA category 2 activities he or she participates in. Accredited providers do not designate activities for AMA PRA category 2 credit. Physicians should claim credit for appropriate AMA PRA category 2 activities on the PRA application form.

Osteopathic Physicians (DO’s)

The current requirements for osteopathic physicians are as follows: A licensee shall biennially renew their license by completing a form obtained from the State Board of Osteopathic Medicine in advance of October 31 of every even-numbered year, and by paying the required fee. Proof of completion of 100 credit hours of continuing medical education will be required for licensure renewal. At least 20 credit hours shall be completed in category 1 AOA approved courses. The remainder shall be any courses approved by either the AOA or ACCME. Credit will not be granted for courses in office management or practice building.

The requirements for licensure in the State of PA for Osteopathic physicians are also changing starting with the 2006 renewal year (covering the period of November 1, 2004 through October 31, 2006 ). In addition to the existing requirements, licensees will need to show proof of 10 hours of risk management or patient safety CME. These risk management or patient safety hours can be in Category 1 or Category 2 AOA, Category 1 or Category 2 AMA. Category 1 AOA Risk Management/Patient Safety credits also count toward the 20 general Category 1 AOA hours required.

Osteopathic Physicians (DO’s) Only

Note: Category 1 AOA Risk Management/Patient Safety credits also count toward the 20 general Category 1 AOA hours required. Thus if you received 5 Category 1 AOA credits and 5 Category 2 AOA credits to meet your patient safety/risk management requirements, you would only need 15 additional general Category 1 AOA credits and 75 general Category 1 or Category 2 AOA, Category 1 or Category 2 AMA credits. See the following example:

Sample CME Credit Summary for E. Jones, DO: 2003 & 2004

AOA CME Description (http://do-online.osteotech.org/)

Category 1-A Credit

AOA Category 1-A credits are granted to attendees for formal educational programs designed to enhance clinical competence and improve patient care. These programs must be sponsored by an AOA-accredited Category 1 CME sponsor.

1. Formal Osteopathic CME
   Consists of formal face-to-face programs that meet the Category 1 quality guidelines and faculty requirements and are sponsored by AOA-accredited Category 1 CME sponsors.
2. Osteopathic Medical Teaching
   Physicians who deliver formal osteopathic medical education in a didactic format are eligible to receive Category 1-A credit on an hour-for-hour basis. Methods of such education include:
   1. Formal delivery of osteopathic medical education lectures in colleges of osteopathic Medicine,
   2. Formal delivery of osteopathic medical education to students, interns, residents, and staff of AOA-approved healthcare facilities. Teaching credit must be submitted by the CME Department of an AOA-accredited Category 1 CME college of osteopathic medicine or Category 1 CME hospital.
3. CME Credit for Standardized Life Support Courses
   All osteopathic physicians who take an eligible standardized life support course will be awarded the same amount of Category 1-A CME credit for that course regardless of the actual number of class hours it may require.
4. Standardized Federal Aviation Courses
5. Bioterrorism Courses
6. Federal Programs
7. Grand Rounds

Category 1-B Credit

Category 1-B credit may be awarded for the following:

1. Publications, Inspections, Examinations, and Committee Meetings
2. Osteopathic Preceptoring
3. Certification Credit
4. Activities in Non-AOA Accredited Institutions
5. Non-Osteopathic CME Programs
6. Journal Reading
7. Faculty Development Programs
8. Test Construction Committee Work

Category 2-A Credit

Category 2-A includes formal educational programs that are ACCME-accredited, AAFP-approved, or programs sponsored by AOA-accredited Category 1 CME sponsors that do not meet the 1-A faculty/hours requirement for Category 1-A credit.

Category 2-B Credit

Category 2-B credit includes the preparation and presentation of scientific exhibits at a county, regional, state, or national professional meeting (10 hours per scientific exhibit); home study; reading medical journals; viewing non-osteopathic medical video and audio tapes and cassettes; journal type CME on the Internet; faculty development; physician administrative training; quality assessment programs; observations at medical centers; medical economics; CME programs on the Internet; risk management programs that are administrative in nature; and programs dealing with experimental and investigative areas of medical practice. Five credit hours may be granted for reading medical textbooks. A copy of the home CME certification form is published monthly in the JAOA.