Commercial CME funding and the rise of medical errors

While the percentage of commercial support for continuing medical education (CME) has continued to drastically drop over the past few years (29% decrease from 2007 to 2009), recent data, which show an epidemic of medication errors in hospitals, make this decrease even more troublesome.

Commercial CME funding and the rise of medical errors

At a time when 30 million more patients will flood our hospitals, do we really need to reduce the amount of funding that goes to educate our doctors and health care providers? With an increase of 277% in medication errors this past year, according to a recent two-year investigation of Nevada hospitals by the Las Vegas Sun, doesn’t it seem obvious that the more resources we take away from educating our physicians about the proper use of medications, the less they will have to learn about how to treat us? The evidence speaks for itself already, unfortunately.

What is more disturbing about this data is that “Nevada hospitals aren’t unusual.” In fact, “there’s evidence that facilities across the country continue to hide their safety lapses.” Critics of commercial support are content on banning such funding to save costs and money. But how can that be possible if physicians who are not kept up to date on treatments “inflict unnecessary pain and suffering on patients, while also driving up the cost of healthcare, which harms other patients by limiting their access to care?”

What made the Nevada hospitals a specific target was that hospital billing records for 2.9 million inpatient visits that have been submitted to the state over the past decade showed 1,363 occurrences, in which patients are harmed or threatened with harm, but Nevada hospitals reported only 402 events for those years.

“In other words, there was a big discrepancy between what the hospitals reported to the state and what their billing records revealed about medical errors they actually treated.” The article also lists specific occurrences and uses a table to show the types of events reported.

As a result of this data, “the state now plans to audit hospital medical records in order to find out what’s really going on.” This practice could also spread because “many other states collect hospital billing records, just as Nevada does.” If similar evidence is found of errors in hospitals, it will make a strong argument for physicians needing more education to reduce such problems and with less commercial support for CME, finding resources to provide such programs will be difficult.

A few years ago, the Joint Commission, which accredits hospitals, began requiring them to report “unexpected outcomes” — another term for sentinel events. A hospital survey done soon afterward revealed that a majority of hospitals disclosed medical errors at least some of the time. Through the Joint Commission’s database, evidence showed that the number of sentinel events that all accredited U.S. hospitals had reported in 2008 and 2009 for certain kinds were continuing to increase: e.g., 126 wrong-site surgeries were reported in the first nine months of 2009, up 34 percent from the same period a year earlier. Medication errors nearly tripled from 2008 to 2009.

Data such as this reveal a need for more education of health care providers and hospitals to prevent and detect such errors. If commercial funding of CME continues to drop at the current pace, who knows how many errors physicians and hospitals will be making.

Accordingly, In light of the fact that many hospitals accept commercial funding for CME, it would be extremely harmful to patients to prohibit such events or for staff to be prohibited from attending these events.

That’s why it would be in the best interest of patients, physicians and staffs at hospitals to have the ability to give continuing education programs supported by industry on medications that will help resolve medication errors and other issues that are obviously becoming an increasingly serious problem. And since hospital funds may be tied up paying out claims for such errors, commercial funding seems to be the best and most appropriate source for effectively reducing these gaps in care.

Thomas Sullivan is founder of Rockpointe who blogs at Policy and Medicine.

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  • http://cardiobrief.org Larry Husten

    As a self-described medical educator, Sullivan should know that association does not equal causation. Of course, if Sullivan is right, then it’s equally likely and plausible that the decline in commercially supported CME from 2007-2009 is responsible for the great recession. If this is the best argument the pro-CME forces can muster then they are in even more trouble than I thought.

  • http://www.conisus.com Richard Leff

    All good points and mostly unrelated. Loss of funding for CME can certainly be expected to have a negative effect on physician knowledge. Most likely, that will involve new drugs and tests and will slow adoption of new technology that might change paitents’ lives. It is very unclear, however, that CME significantly changes medical errors in hospitals. The large majority of these are created by communication problems and are systems related (e.g. misreading a hand-written order, administering a drug to the wrong patient, forgetting a dose of a drug, etc). Let’s strongly argue for continued easy availability of quality affordable CME because it improves care. Hospital errors need to be minimized but CME will not be the best or most direct route to a solution.

  • anonymous

    The studies I’ve seen on medical error indicate that faulty systems and ineffective communication are the most common factors. Lapses in clinical judgement do occur, e.g. premature closure of the diagnostic process, but this isn’t necessarily the same thing as outright lack of knowledge.

    IMHO, the bigger issue is that many, if not most, clinicians simply aren’t trained to think in terms of safe systems. It’s hard to see how more corporate-sponsored CME would fix this.

  • http://www.cmbe.net Carlos Cuello

    I totally agree with Larry. What kind of study is this? did the authors adjust all plausible confounders? Are they sponsored? COI declaration anyone? I think this study should be taken very cautiosly

  • stargirl65

    Maybe they are now better at detecting errors and there is no association? Maybe people are becoming more dependent on computers for dosing and therefore less careful when prescribing assuming the computers will catch things?

  • anonymous

    One more thing: Medical errors have always taken place; they just weren’t reported and the data weren’t collected. It might now look like we have an epidemic of errors, but how much of this is due to the fact that we’re now paying more attention to them and working harder to identify and report them when they occur? If you look at the data from 10 years ago, you’d be left with the impression there were zero wrong-site surgeries, which we all know is patently false.

  • Doc99

    No good deed goes unpunished.

  • http://medicalskeptic.com Duncan

    To understand Thomas Sullivan’s arguments it helps to know who he is. He and his company, Rockpointe, receive much financial support from the pharmaceutical industry. Please follow this link for more detailed information:

    http://carlatpsychiatry.blogspot.com/2009/11/tom-sullivan-of-acre-fame-is-swimming.html

  • SmartDoc

    Don’t detail the proper use of medications of OBVIOUSLY the result will be that medication errors will increase.

    In what other industry are the commercial representives of innovative technologies forbidden to provide education, meals, and even simple pens?

  • http://medicalskeptic.com Duncan

    Last time I checked, physicians were classified as professionals, not as agents of an industry. Lawyers are also professionals and they have very strict rules governing what they can accept in the way of gifts, etc.

  • anonymous

    First, everyone must realize that there is no “study” tying errors to reduced CME, this is just an observation. Like many things, there are obviously a number of factors (e.g. new systems, HIT, EHRs, etc.) causing medication errors and other problems in hospitals. The fact that tracking and reporting of such errors has become stronger over the years is exactly why we need to educate physicians. If hospitals can collect data that show 277% increase in medical errors, how do you suggest we fix that, better handwriting? Hospitals must address errors like these in a focused manner, and CME can do that by developing specific programs that address weakness in health care systems. If Obama wants to invest in EHRs and HIT, how do we educate our providers to use this system? Since the health care reform package didn’t include any funding for CME, where can we get the funding from?

  • http://www.cmbe.net Carlos Cuello

    If it is not a study, and just an “observation” this is worse than I thought. The autor state in the first paragraph “the evidence speaks for itself” WHAT evidence? this is an “observation”!

  • anonymous

    The point being made here is that doctors are making mistakes, and we are beginning to see gaps in care nationwide. How do we address these problems, such as medication errors and other mistakes made at hospitals? Other than education and training, how can health care providers and entities resolve these problems? Sullivan is pointing out that at a time when these errors and mistakes are growing, instead of finding and creating ways to fix them, physicians are beginning to lose access and opportunities to receive education on the very issues they are making mistakes in, such as prescribing medication. While other comments suggest there is no evidence that reduced commercial funding caused such errors, and that other factors are responsible, why add another factor (e.g. less CME)? The reason Sullivan addresses this issue is that as the amount of commercial support continues to decrease, if the numbers and errors at hospitals nationwide don’t continue to change, not only will it be too late for the patients who suffer, it will also be too late for physicians to try and learn from their mistakes because less CME will be offered, and it will be available infrequently and inconveniently. The observation is simple: critics of commercial support are calling for an end of industry funded CME at a time when its OBVIOUS that doctors need more education and training. If we wait until medical errors are up to 500%, and keep trying to blame it on technology, it will be too late to argue about whether commercial support is wrong or not because all the hospitals and doctors will be closed from malpractice suits.

  • http://www.pacificpsych.com/ pacificpsych

    What in God’s green earth are you talking about?

    That made no sense whatsoever.

    I have incontrovertible proof that medical errors have increased ten fold over the past 10 years, and this is due to the location of Venus relative to Mercury on dark nights, when you can’t see them. What happens is, they secretly conspire to change their positions ever so slightly, thus changing the gravitational field of the earth, which affects mostly high desert areas filled with sage and gamblers. This slight shift causes doctor’s pens to strike exactly 1 micron to the left of where they intended, and their scalpels to nick 0.007 more arteries than previously. The accumulative effect is that 10 fold increase in errors.

    And that’s a fact!

  • http://www.pacificpsych.com/ pacificpsych

    Thank you Duncan, that was very enlightening. I’m troubled by the fact that Mr. Sullivan was paid only $98,998 for that two hour breakfast lecture for Novartis. I feel this is wrong. Very wrong. What happened to the other $1,002? Did Novartis stiff him? I wouldn’t talk for two minutes for less than 100K even, let alone 2 hours. Or arrange the flowers and order the morning cocktails, which is, I presume, what he did.

  • doctor

    Agree these are random observations. Has not shown any causation at all.