Stricter rules linked to shift in CME funding

An annual tally of continuing medical education spending raises concerns that recent federal guidelines may be constricting commercial funding.

By Myrle Croasdale — Posted June 27, 2005

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The newly released 2004 Accreditation Council for Continuing Medical Education annual report showed revenues from two categories, commercial support and advertising and exhibit support, made up 62% of CME providers' total income, down from 65% in 2003.

This is the first percentage decline in at least seven years of annual increases in commercial spending on CME, now a $2 billion industry.

ACCME Chief Executive Officer Murray Kopelow, MD, said commercial support as a percentage may be down, but revenue from the categories driven by commercial funding was $1.26 billion, up $108 million from the previous year. The decline in its percentage of total revenue is simply a function of increases in other areas of funding, such as fees for registration and tuition, Dr. Kopelow said.

However, R. Van Harrison, PhD, CME director for the University of Michigan Medical School, said the decrease hints at a possible sea change in CME funding.

"Continuing medical education funding is essentially flat for the first time in a long time," Dr. Harrison said. "This is due primarily to the impact of the OIG guidance to the pharmaceutical industry and the changes the industry is implementing in response."

New barriers for CME

The Dept. of Health and Human Services Office of Inspector General ruled that CME funding that comes from drug and medical device manufacturers' marketing departments was a conflict of interest. In response, companies have either expanded other departments to handle the administration of CME funds or hired companies to distribute the dollars for them.

This restructuring temporarily interrupted commercial CME grants, Dr. Harrison said, and pharmaceutical companies incurred additional administration costs, which may be behind the three-point dip in CME revenue from commercial support and advertising and exhibit support.

Pharmaceutical companies also may have chosen to contribute less to CME in favor of other marketing avenues, Dr. Harrison said. Local sales representatives used to be the ones who doled out a good portion of pharmaceutical dollars for CME, because doing so gave them face time with physicians. Now that they don't have any direct involvement in the process, the marketing benefit from those personal connections is gone.

"When marketing looks at its budget, education is not going to have the same value when you're just sending the money for it by mail," Dr. Harrison said.

Whether these funding changes will be transitory or permanent will be clearer in the next ACCME annual report, Dr. Harrison said.

The structural changes implemented by commercial funders have produced unanticipated barriers, according to Harry A. Gallis, MD, president of the Alliance for CME. CME providers are struggling with the new and often faceless CME grant application process.

"Everyone who's doing CME has voiced concerns that it's more difficult to apply for and receive an educational grant now than three or four years ago," Dr. Gallis said. "Now almost all applications have gone online and require fairly stringent information to fill out all the boxes. If you don't know how to speak the language, you get rejected outright, and there's no one to discuss it with."

CME providers can no longer turn to their local drug representatives for help. "The desire and need is still there, but all of these road blocks have diminished people's vigor at going after pharmaceutical educational grants," Dr. Gallis said.

CME providers have also had to deal with the ACCME's updated standards for commercial support, which require CME organizers to not only identify conflicts of interest among faculty and planners but to make sure they get resolved. Because of confusion regarding these standards, the AMA has been actively involved in discussions with the ACCME, and the ACCME is clarifying issues through workshops and online materials.

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CME bucks

Accredited providers' continuing medical education revenues topped $2 billion in 2004 for the first time, with commercial support for these activities rising in dollars but declining as a percentage of total revenue compared to 2003.

Total income Commercial support,
advertising and
exhibits income
support as a
2003 $1.78 billion $1.15 billion 65%
2004 $2.04 billion $1.26 billion 62%

Source: 2004 Accreditation Council for Continuing Medical Education annual report

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