Questions and Answers About the EAT for Health Act (H.R. 4378)
The Education and Training (EAT) for Health Act is sponsored by Rep. Raul Grijalva (D-AZ).
Important things to keep in mind:
- CME requirements are determined by the state medical board for professionals practicing in the state. Healthcare professionals must fulfill their respective state requirements to be recertified.
- CME can easily be obtained by taking a brief online or in-person course, or attending a conference, workshop, or roundtable, or can be part of activities the healthcare professional is already undergoing such as research and publication.
- Many nutrition CME opportunities currently exist and there are several nutrition CME providers such as the American College of Nutrition. The Physicians Committee also offers nutrition CME.
- Nutrition CME is defined very broadly and includes any CME that describes the role of nutrition in the prevention, management, and, as possible, reversal of obesity, cardiovascular disease, diabetes, and cancer.
- This bill is not a mandate for CME. It encourages federal primary care providers to receive 6 CME credits in nutrition.
- This bill would encourage 6 credits, not 6 hours of CME. 1 credit may be less than or more than 1 hour.
- This bill does not add to existing CME requirements. For instance, the state of California requires 50 CME credits over a two-year period. This bill would not require federally-employed healthcare professionals in California to receive 56 CME credits. 6 credits of the 50 would go to nutrition.
- There is no cost to this bill.
- This bill does not endorse any particular diet.
Questions and Answers
1) What is the need for this bill?
While CME is decided at the state level by state legislatures or state medical boards for physicians, it does not necessarily reach federally-employed health care providers who serve special populations disproportionately impacted by diet-related disease and conditions such as veterans and Native Americans. As an employer, the federal government can encourage these health care providers receive the latest in nutritional science for adequate nutrition counseling.
2) Who would this bill impact?
This bill would impact full-time federally-employed primary care providers such as physicians, nurse practitioners and physician assistants. More than 18,000 of these healthcare professionals are employed by the federal government with the Department of Veterans Affairs as the largest federal employer of primary care providers. It does not apply to non-federally employed primary care providers. For instance, a physician who is not employed by the federal government would not be impacted by this bill.
3) How does the EAT for Health Act impact federally-employed nurse practitioners?
Nurse practitioners must meet annual continuing education requirements as set by the state board of nursing in which they are licensed, and by their professional certifying body. Nurse practitioners currently receive nutrition education as undergraduates. However, there is no educational requirement at the graduate level. Federally-employed nurse practitioners regardless of which state they are certified to practice in would be encouraged to obtain 6 continuing education credits in nutrition as part of their existing continuing education requirements.
4) What would healthcare providers learn?
Nutritional CMEs are available in a variety of topics from many different institutions and organizations. For example, the Mayo Clinic offers courses addressing the comprehensive management of obesity, nutrition supplements, and the role of nutrition and physical activity in disease prevention and management.
5) How does this bill fit it with other federal efforts?
The EAT for Health Act would support Healthy People 2020—the federal government’s framework for a healthier nation—meet its goal (NWS-6) to increase the proportion of primary care office visits that include counseling or education related to nutrition or weight.
6) Who else supports the bill?
Many organizations support this bill such as the American Heart Association, the American Nurses
Association, the Center for Science in the Public Interest (CSPI), and veterans groups such as the Returning Veterans Project.
7) Does this bill mandate CME?
No, this bill does not mandate CME. It instructs the HHS Secretary to issue regulations and report to Congress on agency progress. There is no punitive measure or enforcement mechanism, and is left to the discretion of the federal agency to encourage eligible employees to take CME in nutrition.
8) Why is it 6 credits of CME?
This bill is modeled after legislation in the state of California that would have required 6 credits of CME in nutrition.
9) What is the precedent for this kind of initiative?
While there is no federal precedent, at least 15 states have topic-specific CME such as HIV, domestic abuse, and end-of-life care. Currently, no state has nutrition CME requirements, despite the prevalence of diet-related disease and overwhelming demand for it.
10) Do 6 credits of CME take away from other CME credits?
The majority of CME is general and not topic-specific. Using California as the example, California requires 50 CME credits over two years and mandates a one-time 12 CME credit requirement for pain management and end-of-life care. For those to whom this would apply, 6 of the 50 CME credits would go to nutrition, and 12 would go to other topic-specific CME, leaving 32 credits for general CME over two years. While some states will have topic-specific CME in addition to the 6 CME nutrition credits, one can see from the California example that the total number of CME credits is always large enough to allow for general CME credits so that healthcare professionals can decide which CME is most relevant.
11) What is the average number of CME credits required by states?
The average number of CME credits required per year is 30. Four states do not require any CME credits (Colorado, Indiana, Montana, and South Dakota) and 11 states require up to 50 CME credits per year (Illinois, Kansas, Maine, Massachusetts, Michigan, New Hampshire, New Jersey, North Carolina, Ohio, Pennsylvania, and Washington). Federally-employed healthcare professionals living in a state that does not require CME would have to receive 6 CME credits in nutrition.