During a session led by members of the Pharmaceutical Alliance for CME at the Alliance for CME 2007 Annual Conference, providers had the opportunity to grill their pharmaceutical industry partners on anything and everything on their minds. First up was the question of whether the pharmaceutical industry would ever create a standardized grant request form. “No. There's no hope of that,” said one pharma representative. “We all have different emphases, different lawyers, and different interpretations. Sorry.” Another added that there could be antitrust issues involved. Mike Saxton, Med, FACME, senior director, team leader, Medical Education Group, Pfizer, New York, did offer a ray of hope, saying that companies might allow providers to upload their own grant request proposals in the future, so that they wouldn't have to complete each company's form.
One CME provider wanted to know if, with all the emphasis on measuring outcomes, providers might be burning out their physician learners. But another provider called the burnout concern “a reactionary approach to outcomes — you educate them, then bother them afterwards.” Instead, he said, outcomes should be viewed as an integral part of the program, and another opportunity to learn.
Saxton agreed, saying, “Maybe we're relying too much on traditional pre- and post-tests. If outcomes measures are part of continuing practice improvement or embedded in the activity, it shouldn't cause that reaction.”
Another CME provider even said that his organization is thinking of using its outcomes measurement as a marketing tool for its programs. “We think it will help build user interest to share outcomes” with learners, he said.
Maureen Doyle-Scharff, director, health education, Ross Products Division, Abbott Laboratories, Columbus, Ohio, said that she's concerned about educational effectiveness, including needs assessment. “If someone is not doing a true needs assessment, whatever you measure at the end doesn't matter because you can't link it back.” Another pharma representative agreed, saying, “You can't have one without the other. We need to have outcomes to know if [education] was effective. We need to know the dollars we spend are spent effectively. Outcomes are going to continue to grow [in importance] for pharma.”
Saxton added that continuous assessment is more important than outcomes, and that sampling, rather than measuring for every participant, is appropriate. Another person from the pharma side said that outcomes measurement is becoming even more important, especially for larger CME initiatives, although it's not necessary to do population outcomes — some measures can be lower-level.
Saxton then got down to brass tacks and asked the question on every provider's mind: What's happening with commercial-support budgets? When Saxton asked about pharma companies' 2005/2006 budgets, none of the approximately 55 pharma attendees said their budgets went down, and about the same number said they either stayed the same or went up. When he asked about the 2006/2007 budgets, however, no one said funding increased, while about equal numbers said budgets stayed the same or decreased. The majority of the audience then predicted that the Accreditation Council for CME's 2006 data report, which will be released later this year, will show that commercial support stayed about the same or decreased since 2005. Why the change?
Some industry insiders said it was because CME responsibility has shifted from marketing to other departments, and the thought is, why give you money when we can't control it? Saxton said that a lot depends on where a company is in developing its medical education department. “Traditionally, you'll see a drop because there are both real and perceived issues, more about compliance than education. It's all about risk mitigation, and the less you do, the less risk you face.”
Doyle-Scharff brought it back around to measuring return on education: “It's hard to make the case without data that CME is where we should spend our dollars. As an industry, we believe that promotion works, and we can measure its return on investment.” Saxton added, “We're in a measure-or-die world. Arm us with the data to establish value. We can't prove it without your help.”
But an audience member said, “I hear a Catch-22. To have real impact, a single activity isn't going to cut it, so there's a need for something larger over time that we can measure. But that takes money, and you say the budgets are flat or decreasing.” Saxton asked the pharma folks in the audience if they would be more likely to fund a single activity or a multi-stage, multi-strategy activity. The latter won unanimously. The problem, one pharma person said, is, “I don't have confidence I can find too many providers to whom I can give a million dollars and know they'll be able to follow through and prove [the education] works.” Saxton added that commercial supporters will increasingly ask for timelines and project management milestones to boost that confidence level.
That brought the conversation around to the new ACCME accreditation criteria. Saxton asked if the criteria are moving CME in the right direction, which got a unanimous “yes” response from participants. But when he asked if the audience believed that all providers who are accredited now will continue to be three to five years from now, the providers were divided, with half saying “yes” and half “no.” However, all of the pharma representatives believed that some providers wouldn't make the cut under the new criteria.
“We're paying close attention to the competency of providers,” said Doyle-Scharff. “We're holding providers more accountable for truly meeting needs and making a difference.”