Focus on Education

Amenities have been eliminated, fees are higher, and there's less marketing, yet attendance has remained the same and participants have not complained, according to MSKCC evaluations.

Why? Fahey argues that the environment keeps the focus where it should be — on education — and that comes across to participants. “When you really focus on the quality of the program — and stop worrying about the amenities and the place where you can hold it — then you're looking at what the objective of CME is,” he says. “In the long run, this will keep us much more focused on what's important.”

The quality of education is as good if not better than it was with commercial support, he says. “I don't think there's any evidence to show that the extra money made it better.”

A potential negative, or “hidden negative” as Brodhead calls it, are the courses that may not be brought to the CME office because of this policy. “It's very possible that there are course directors who have said, ‘I can’t do this here because there's no commercial support, so I'll go elsewhere,'” explains Brodhead. “That's something we can't quantify. But as far as concrete negatives go, I was anticipating a lot of them, and so far I have experienced none of them — other than some of the strain on us, but that's OK.”

Good Old Days

Sloan-Kettering is among a small percentage of CME providers that don't accept commercial support; however, given the current environment, it's a question that more providers are going to face, says Fahey. In fact, the American Society of Clinical Oncology, where Fahey sits on the CME committee, is currently discussing whether or not to make changes to its commercial-support strategies.

However, Fahey recognizes that shutting off commercial support could be much more difficult for other providers. “It depends on how much money you have coming in from the outside,” he says. Also, while Sloan-Kettering has its own conference center and doesn't need to rent hotel space for meetings, not all providers are so fortunate.

But MSKCC doesn't want to evangelize about the merits of their new model. “This is not an effort by Memorial Sloan-Kettering to differentiate itself or take a lead in any way,” says Brodhead. “This is what's right for us and our population.” And after a year, he's even more convinced of that, despite having his initial doubts. He's not condemning commercial support, but over the last 10 years or so, as it has increased, it has led to a fair amount of fluff, he says.

Operating without commercial support is “like going back to the model of people sitting at a flip-top desk, having a peanut butter and jelly sandwich for lunch, as opposed to what CME in many ways has become over the course of the commercially supported years,” says Brodhead.

Whether the old ways can survive in a new era remains to be seen. “Basically, we want to see if we can do this,” says Brodhead. “The jury's still out. So far we've been OK, but I certainly have a few more grey hairs than I remember.”

Co-sponsor Challenges

One big challenge the commercial support ban creates for Memorial Sloan-Kettering Cancer Center in New York City involves co-sponsored CME. “Our prohibition of commercial support extends into those relationships,” says Peter Brodhead, administrator, continuing medical education at MSKCC. “If we are co-sponsoring, there has to be an understanding that there's no commercial support [for the activity] from either institution. It's just impossible to mix those two recipes.” In one case, they had to withdraw from the partnership and offer the course themselves. In another case, the course will go on as scheduled because the other partner agreed not to accept commercial support for this particular program.

MSKCC will continue to look for partnership opportunities; in fact, they are collaborating with Harvard University on a new pathology course later this year. Harvard won't accept commercial support for this program, but does for others.

The center has even added a few courses since the ban took place, the course with Harvard being one. “There are actually several brand-new courses that have worked well within the new model,” says Brodhead. Among them are some new pathology courses, for example. “The way it used to be, I had to figure out the universe of potential supporters, why they'd want to support this, then build my case and fill out the application,” says Brodhead. With the new model, there are opportunities at just about every area of the hospital for CME courses, many that didn't exist before.

However, there was one course that an MSKCC staff member assembled that ultimately had to be farmed out to another CME provider as a result of the ban. MSKCC staff had contracted with a hotel, but the hotel costs put the program over budget, too high to accommodate without commercial support.

Funding Plan B

While year one without commercial support proved to be a success, CME personnel at Memorial Sloan-Kettering Cancer Center in New York City know that the day will soon come when additional funds will be necessary to run certain CME activities.

In December 2007, Peter Brodhead, administrator, CME, MSKCC, proposed the creation of an internal “start-up” fund. If a course ends up making money, then half of the profits would go into the fund while the course director's department would keep the other half. For instance, MSKCC had a course last year that made $45,000 without commercial support. If that were to happen under the proposed framework, half of that money would go into the start-up fund. If a course were to lose money, the fund would cover half of the shortfall, but the course director's department would be responsible for the rest.

Does this penalize departments that produce a profitable program and reward those that don't? Brodhead doesn't think so, but he will stress to departments that a collaborative effort is necessary to make this work. At press time it had not yet been determined whether this strategy would be approved.

The CME committee has also talked about working with MSKCC's development department to set up a fund for noncommercial donors. There are many people who have been treated at the Center who want to make a donation, says Brodhead. With a donor fund, those patients would have the option to contribute to CME. Foundations and nonprofits could also contribute.

Finally, there has been talk in the CME department about creating a commercial-support pool. Pharmaceutical and medical device companies would not be solicited for a specific course, but they could contribute to a central fund that the CME professionals could access for a variety of CME activities. Obtaining funds in this manner would provide separation, but Brodhead doubts that it would be approved. “I don't think our leadership is going to want any commercial support.”