A panel at the 23rd Annual Conference of the National Task Force on CME Provider/Industry Collaboration, held in Baltimore in October, tackled what has become a mantra for continuing medical educators lately: how to do more with less in today’s financially austere environment. Moderated by Karen Roy, MSc, CCMEP, principal, Ardgillan Group, the panelists from both the CME and commercial support side took a hard look at the cost constraints affecting the CME/continuing professional development/continuing education community, what can be done to come up with new funding models, and how to streamline the “administrivia” and paperwork that so often plagues the CME/CPD/CE process.
Stephen Lewis, MA, CCMEP, president, Global Education Group, kicked off the first segment with a hard look at the current state of accredited CME. He noted a growth in nonphysician participants, the 1 percent to 4 percent decline in accredited providers, and the more-than-doubled cost for physicians to participate in accredited CME that came to light with the most recent Accreditation Council for CME’s Annual Report Data.
More income is coming from exhibits and advertising than in the past, while direct and in-kind commercial support continues to flag. He pointed out that as the number of activities continues to rise, the cost per physician is falling. Once the numbers have been crunched, he said, it’s apparent that there is pressure on funding of all types, and the competition for dollars has caused CME providers to be more efficient—“We’re getting more physicians and nonphysicians to our activities, and we’re doing it for less,” he said. He added that the focus is also shifting from compliance with ACCME regulations to providing value. The question then becomes, “How can we maximize value while minimizing costs?”
Shrinking budgets aren’t just a provider problem, according to the panelists who represented the pharma side. One of the pharma panelists said she has seen her grants budget decrease from $140 million six years ago to around $30 million this year. Another reported a drop of available grant money of up to 90 percent over the past several years. Companies just can’t support as many activities as they once could, and, with some companies laying off staff to lower their overhead, they too have to streamline the process and reduce the number of proposals they have to go through to find the right fit for their clinical areas of interest.
These costs, of course, include time spent by staff developing CME activities. When Roy asked the audience via audience-response system if the time it takes to develop and implement activities has increased or decreased, the majority of the audience reported it was taking 25 percent to 50 percent longer than it used to. While 32 percent said that investing that extra time did result in their being able to provide higher-quality education, more than half said the extra time didn’t result in any change in the quality of education they provided.
Another big time-consumer is the need to get multiple commercial supporters for activities, which complicates the application and reconciliation processes. And, as Lois Colburn, executive director, University of Nebraska Medical Center–Center for Continuing Education, pointed out, “We get caught in the strange predicament of getting some of the funding, but then not knowing if we’ll be able to get the rest.” Deborah Samuel, MBA, director, Division of CME, American Academy of Pediatrics, said that, from the medical society perspective, grants are just one piece of what they have to worry about—the “administrivia,” including increasing institutional documentation demands, is what really bogs down the process. For example, she said, firewalls that separate education and development departments also result in a lot of duplication of funding outreach, and increasing reconciliation and evaluation requirements end up meaning more piles of paperwork.
Colburn also said that uncertainty about what they’ll end up needing for ACCME review also can add to the administrivia woes: “We’re trying to do quality education while ensuring that we have every bit of paper we might need if an activity gets pulled for ACCME review. It’s a never-ending battle.”
The challenges the provider panelists outlined were many, from complex submission processes to reduced funding, and communication snafus to time-consuming reconciliations. But what about solutions? The need to identify alternative funding sources outside of pharma was mentioned, as was increasing registration fees and growing the exhibition side of larger conferences. Lewis, who said his company had been working with non-pharma companies including fast-food chains and large alcohol distributors, said that alternative funding sources are great, but “it’s even harder working with outside companies than it is with pharmaceutical companies” because they want to control the content and the process. However, he said, even if it takes more time and energy up front, it’s worth the trouble.
One solution some commercial supporters are trying to reduce the backlog on the granting end is implementing a request-for-proposal, also called a “call for grants application,” something that three-quarters of the audience said they support, though not necessarily as the sole way to apply for grants. Companies like Pfizer that now are using an RFP process for more than 75 percent of their grants have seen the number of grant requests decrease, while the acceptance level has shot up due to a better alignment of proposals with a supporter’s areas of interest. Companies also are posting more information on their clinical areas of interest to their grant Web sites in hopes that providers will pre-screen to make sure there’s alignment before submitting a proposal. Another idea that was floated was to provide “simpler” grant applications for providers that receive ACCME Accreditation with Commendation.
One pharmaceutical company representative said her organization is trying a cost-sharing approach. The idea is to incentivize providers to develop CME so effective that it is worth paying more for—whether the payer is a healthcare provider, a hospital, or possibly an insurer. The pharma company would loan the funds to the provider, which would return it when they recouped their investment from participants or other entities. Whatever the provider might make above and beyond the commercial supporter’s investment could be used to develop new activities. Working closely with the company’s compliance department to avoid any whiff of kickback, the pharma rep says the idea is to provide a new source of revenue while adding educational value. Of the 12 high-quality proposals her company has received under this new approach, they have approved just two as being actually able to recover the funds and/or fulfill educational goals.
Another out-of-the-box solution one person proposed was to use something like the Kickstarter funding platform, where people post projects they’d like to do and set the amount they’d need to accomplish it, and the general public can peruse which projects they’d like to support financially. Each project has a defined amount of time to raise the stated amount; if it doesn’t reach its goal, no money changes hands. “That’s the kind of thinking we need to explore,” said Hilary Schmidt, PhD, the Task Force’s chairwoman and vice president, Independent Grants and Learning, with Sanofi US.
When it comes to the increasingly complex financial reconciliation process, the answers were a little harder to come by. One idea—to makeit acceptable to request only a sample of full financial reconciliations for internal review—was nixed by 59 percent of the audience. Companies need to be able to show the value of what they’re supporting, explained a pharma panelist.
While the Pharmaceutical Alliance for Continuing Medical Education, or PACME, has developed a standardized budget template, 26 percent of those who responded to the PACME Benchmarking Survey said they were not considering using it, while 53 percent said they were thinking about maybe using it, and 16 percent said they weren’t but they would accept it as an alternative to their company’s template. Only 5 percent said they were using it as published, and none said they had implemented a modified version of the template. The reason for the low adoption rate may be because the current template is hard-wired into some companies’ systems and can’t be changed without incurring a big expense, but others do allow attachments, so the lack of enthusiasm for the template largely remains a mystery.
Providers also would like to know why their grants are denied, in hopes of being able to increase their acceptance levels. But the PACME Benchmarking Survey data showed that more than 80 percent of companies surveyed weren’t planning to have those discussions, and a few were even considering decreasing the amount of information they provided about why a grant was denied. The good news, however, is that 89 percent also reported that they would have face-to-face meetings or conference calls with providers, particularly around innovative educational formats, to review outcomes and to discuss the status of approved grants.