Accreditation Council for Continuing Medical Education-accredited CME providers appeared to have had a tough year in 2011, according to the recently released ACCME Annual Report Data 2011. While a change in the reporting requirements makes it difficult to compare numbers year over year, it appears that the trend for commercial support, which hit its peak of more than $1 billion in 2008 and has been falling since, has now declined to $736 million.

Total income, which had been holding its own due to increases in exhibit fees, advertising, registration, and allocations from parent organizations, also appeared to take a hit in 2011. While advertising and exhibit income crept up 4 percent over 2010 and the “other income” category was up 7 percent, it wasn’t enough to keep total income from hitting $2.2 billion, which is a slide of just 1 percent. Interestingly, the incomes that don’t fall under exhibits, advertising, or commercial support now make up 53 percent of the total income, compared to not quite 42 percent just four years ago. All categories except for nonprofit physician organizations saw increases in this income in 2011.

However, take the total income and commercial support news with a big grain of salt: The 2011 commercial support and total income numbers likely are artificially low because, beginning in 2011, the ACCME now asks providers to report in-kind support such as equipment, supplies, and facilities qualitatively, not quantify and include it in their commercial support reporting as had been the case in the past. It is unknown how big a piece of either pie that in-kind support represents, Because there was no standard way in which organizations tracked and reported the dollar value of in-kind support, the ACCME excluded it to improve the data quality.

Also note that the 2011 data show that 79 percent of CME activities, attended by 80 percent of physician participants and 75 percent of nonphysician participants, were not commercially supported. Murray Kopelow, MD, ACCME chief executive, adds that 20 percent of activities produced by ACCME-accredited-providers are commercially supported and about 60 percent of all accredited providers accept commercial support; the other 40% do not accept support from commercial interests. “Those who say that commercial support drives the curriculum of accredited CME need to get this data so they can recraft their thoughts,” he says. In addition, he says, “It’s not about who funds it—whether it’s doctors or government or companies—it’s about starting with the learner’s professional practice gaps and discovering what causes the gaps. How can anyone say there’s something wrong with CME funded by the companies that make long-acting and extended-release opioids to address data that the government has given us and educational directives the government has given us?

The report, which the ACCME has published since 1998, provides an annual snapshot of the US. CME enterprise, including CME program revenue, funding, participants, activities, and activity formats. The 2011 report is the second generated using the regulator’s Program and Activity Reporting System, also know as PARS, a centralized Web-based system the ACCME used to collect and manage its accredited providers’ activity and program data. The latest report also is the first to include combined data from ACCME- and state-accredited providers. This is because the state medical society system and the ACCME system have strengthened their alignment during the past decade, in particular during the past 3-5 years, says Kopelow. “All providers follow the same Standards for Commercial Support and accreditation criteria, the state medical society accreditors use the same definitions and quality controls as the ACCME. The accredited CME enterprise is in fact these 2,000-plus organizations. This is now very much a unified system.”

According to Kopelow, the most important takeaways are not about year-over-year comparisons of total revenue or commercial support, which he notes are relatively stable. Though, he does add, “Stability, given what’s going on in the world right now, is remarkable.” More important is the sheer size of the combined ACCME-accredited and state-accredited CME enterprise, including a million hours of instruction and more than 130,000 individual activities, which in addition to CME professionals is run by an estimated 20,000 to 30,000 volunteers. And, he adds, the CME system has to come up with a new curriculum every year, and find the funding to keep going, unlike medical schools and residency training programs funded by tuition.