Chris Lamond and Andy Rosenberg from the CME Coalition joined a discussion on a special #CMEReg chat on February 12 to talk about a proposed amendment to the Sunshine Act that has been causing anxiety in most CME providers who learn about it. Here are a few highlights of the chat.

The CME Coalition staffers, posting jointly as @CMECoalition, explained that, under the rules, manufacturers must report to the federal government a payment made by a third party such as a CME provider if they become “aware” of ultimate recipient of support. This means, they said, that CME providers will become responsible for having to track which bits of commercial support go where, especially when it comes to faculty-related expenses. Payments are exempt from the reporting requirements if the covered entity is “unaware” of the ultimate beneficiaries of the payment, and also if it’s for educational materials for patients or incidental refreshments.

The thought of having to divide up multiple supporters and block grants to pin which expenses went where is, @CMECoalition said in response to a question, “unclear and potentially unworkable.” One person commented that it would paralyze medical societies because of their “soft accounting practices.” Hospitals also would be hard-pressed to deal with the massive tracking and reporting burden, especially when it comes to grand rounds, said @CMECoalition. “I’m afraid this would be the end of many hospital CME programs,” commented another person. “The straw that breaks the overburdened CME coordinator’s back.” Others thought that the actual implementation was not so much the problem as was the idea behind it.

One of the concerns is how the docs are going to feel about having their honoraria and travel expenses for speaking at an accredited CME activity being reported as a payment from a pharmaceutical company. One person had done an informal survey of some physicians, whose answers included:

-It’s a “slap in the face to legitimate, ethical CME providers.”
-“Rule would potentially contribute to bias by ensuring faculty were aware of support source”
-“What better way to eliminate bias than cut the link, and what better way to introduce bias than to re-establish the link?” To which one commenter wrote, “That is a bizarre comment. … so [it’s better not to know] who the supporter is? Points to ignorance of many faculty.” He added, “Not sure who is more naive, the authors of the Sunshine Act or the faculty who have their heads in the sand to risk and bias.”
- “If physicians and CME providers must report then so too must ambulance-chasing attorneys who are the saviors of humanity against the evil empire of medicine!” (Apologies to any attorneys reading this.)
- “Is trying to help busy colleagues keep up with new advances really that bad?”
- “Time for some well-designed outcomes studies to address this disturbing issue.”

So if most seem to agree that this is bad for CME, bad for physicians, and bad for patient care, why the proposed reg? One person said that those proposing the rules are “blind to the facts,” that they don’t know what certified CME is and what providers do. @CMECoalition added, “We don’t think HHS knows enough about [the] benefits of CME. They believe more transparency always = better.”

@CMECoalition ended the chat by asking everyone to send public comments to HHS (resources here)--but to do it fast, because the deadline for public comments is Friday, February 17, 2012 (submit comments here). (Update: A copy of the Coalition's response, along with sample letters, can be found here.) Another suggestion: To create a polished set of case studies that outline just how this aspect of the Sunshine Act would play out in the real world of a CME provider, which several others thought sounded like a good idea.

A complete archive of the chat is available on the Confessions of a Medical Educator blog.

Related Materials
CME Coalition Urges CME Providers to Take Action Against the Sunshine Act Proposed Rule

The CME Coalition’s Sunshine Act Resources Center

The Alliance for Continuing Education in the Health Professions Responds to CMS's Proposed Rule Establising Implementation Guidelines for the Physician Payments Sunshine Act

Will the Sunshine Act Be a Hard Act to Follow?