While commercial funding of continuing medical education (CME) has continued to decrease over the past several years, John Kamp, executive director of the Coalition for Healthcare Communication recently predicted to MM&M that within the next few years, “there will be increases in the amount of industry funding of certified CME.
Before industry funding of CME can begin to increase, MM&M noted that support must first stabilize, considering funding has only continued to drop. In 2009, the Accreditation Council for CME (ACCME) annual report showed that commercial grants for speakers and courses nationwide came to $856 million last year. This meant that industry support only amounted to 39% of the total expenditure for such courses, which is 17% less than in 2008. Grants dipped 14% the year prior from a high of about $1.2 billion in 2007.
One of the reasons pharmaceutical and device makers have curtailed grants, is “partly out of fear of liability and regulatory attention, and partly due to the recessionary state of the industry and the limited number of new products in the pipeline.” Another factor that has put industry supported CME under the spotlight, and has caused it to decline, was two Senate committee investigations, which debated whether medicine should develop a model of CME free of commercial support.
Further evidence of the decline of industry supported CME was noted by Maureen Doyle-Scharff, senior director, team lead, Pfizer Medical Education Group. She told MM&M that although Pfizer was not decreasing its funding for medical education, they were also not increasing it.
One way however, that CME companies are combating the negative image painted of industry funded CME is by “creating programs that are better than ever.” These programs, as Kamp pointed out, focus on gaps in treatment, develop innovative programs to fill those gaps, measure outcomes and continually improve educational programs that support patient care.” All of these points and issues were discussed this week at the American Medical Association’s Annual Conference of the National Task Force on CME Provider/Industry Collaboration, which Kamp chaired.
It is also important to recognize that despite criticism, “Certified CME continues to deliver innovative and practical educational solutions,” and because CME companies are providing better programs, it is possible that the right CME programs could spark a resurgence of industry dollars. As Doyle-Scharff noted, industry sponsors are starting to see some significant outcomes coming in from the grants companies are supporting. As a result, when senior leadership see the data and hear the stories, she predicted that there “may be in fact an increase in budget to do more of that good work.”
Another clear reason why industry funded CME is likely to increase is health care reform. Since millions of patients will be entering the system, with pre-existing conditions, genetic disorders, mental illnesses, obesity, and many other diseases, patients and healthcare providers will need CME more than ever. If the promise of healthcare reform is going to be delivered to the American patient, Kamp noted that there must be “Widespread financial support for CME from all sources—including biopharma and device companies—to meet this need.”
Kamp also pointed out that industry support will begin to increase because critics of industry supported CME are running out of gas, and “The vapors that have supported their position of bias are rapidly evaporating and being exposed as a bias of its own.” It should come as no surprise that critics are running out of gas because they made the same arguments repeatedly without any evidence of bias. Meanwhile, evidence showing that industry funded CME was free from bias keeps growing. A clear example of this, as we’ve covered many times, is the fact that the American Medical Association’s Council on Ethical and Judicial Affairs (CEJA) has failed four times in trying to end almost all commercial support for professional education.
Further evidence from a study commissioned by the ACCME in 2008 found that, “to date there is no empirical evidence to support or refute the hypothesis that CME activities are biased.” In addition, two years ago the ACCME had issued a call for comment to do the same before ultimately calling it off. Moreover, several studies looking for bias in commercially supported CME have found no evidence (Cleveland Clinic; Medscape, and UCSF).
Despite this evidence, attention around industry funded CME still remains because academic medical centers and other professional organizations continue to change rules about accepting industry funding, such as the University of Michigan Medical School. Such changes however, are unnecessary considering the ACCME, FDA and other regulators of certified CME have largely agreed on a set of standards for CME provider independence that manage potential bias and improper behavior by grantors.
In fact, various groups recognize the ability for the ACCME Standards for Commercial Support to prevent bias. For example, Dr. Dave Davis, VP for continuing healthcare education and improvement, Association of American Medical Colleges (AAMC), noted that “Using those standards as a tool is a very useful thing.”
In addition, MM&M recognized that “the CME profession is nearing consensus on the funding issue.” A national recommendation is due out in draft form early next year from the Conjoint Committee on CME (CCCME). Dr. Norman Kahn Jr., who is convening a meeting in August for the Conjoint Committee on CME (CCCME), predicted that future recommendations from the Institute of Medicine (IOM) are “unlikely to declare commercial support problematic.” A March 17 summit is planned for Chicago with the draft report due out this January.
Dr. Kahn further acknowledged that if CME follows the ACCME Standards for Commercial Support framework, “you can eliminate influence from commercial support.” This point is important to recognize because to date, there are no proposed models for industry-free CME. In other words, if commercial support of CME continues to drop, doctors and health care providers would face significant obstacles obtaining CME since continued decrease in funding will likely mean a decrease in number of activities and locations offered.
Fortunately, the evolution of CME does not necessitate an industry-free model. As Kamp pointed out, “A funding system is already in place: grantors have developed elaborate systems to comply, providers have compliance programs in place, ACCME has developed faster and more public enforcement programs, and doctors and other HCPs are attending these programs in increasing numbers.”
CME continues to make breakthroughs in medical education that improve patient outcomes and the skills and knowledge of health care providers, the public will recognize that because CME providers are following higher standards, commercial support enables these advances, not hinders them. In the end the financial support of CME is important for the future of our health.