“No doubt about it, there's an art to raising money to support CME — especially these days,” says Steve Hasterok, CME coordinator with University of South Carolina School of Medicine — Palmetto Richland Memorial Hospital Continuing Medical Organization, Columbia, S.C. “There are a lot more CME providers out there looking for money from the pharmaceutical companies than there used to be, and some of the big supporters we've traditionally had success with are telling us they're either cutting budgets or just not supporting CME. I have to work hard for every dollar.”

That's why he's beginning to branch out from the comfort zone of drug company funding and into unfamiliar — but not necessarily unfriendly — waters. He's just one of the growing number of CME providers around the country who are looking into some alternative CME funding sources in the outer fringes of the medical world, such as medical software providers and disposables companies. Others are going out of the medical orbit altogether: Would you believe a brewery or a foundation like the National Endowment for the Arts could be a perfect match for CME?

“Pharmaceutical companies are your core group, but they're not the only group,” Hasterok emphasizes. But to be successful with alternative sources, you have to be prepared to beef up your marketing muscles: If you want a big return on your investment, you have to show your sources the return on theirs. You also have to follow the guidelines, and keep your internal committees, foundations, and development and advancement offices happy. Pulling it all together can get a little tricky, but more and more providers are finding it's worth the effort to expand their potential CME funding pool beyond the traditional pharma sources.

CIRCLING IN ON THE ALTERNATIVES

“I think the money is out there in nontraditional areas. You just have to begin the process to go out and get it,” says Hasterok, who began his own process about two years ago. “I picture it as concentric circles, with pharmaceutical and medical device companies in the center.” The next circle out, he explains, are companies that have a fairly close tie-in to the medical industry, such as medical software providers, textbook and magazine publishers, medical transcription firms, disposables companies, health insurance companies, HMOs, rehab and substance abuse treatment centers, nursing homes, pharmacies, and medical supply companies. Then there are companies that don't have a tie-in to health care, but are interested in getting their products and services in front of doctors, such as financial institutions and real estate companies.

Obviously, drug companies are the tried-and-true source, but even though many drug company's marketing budgets are continuing to increase, many providers are finding less and less of that money going to support their CME programs.

Equipment manufacturers and surgical supply companies also are traditional sources of support, but they're only interested in activities that give them the opportunity to reach the right specialized audience. Irwin Kuperberg, president of the Institute for Advanced Medical Education in Rye, N.Y., has long depended on these companies for commercial support of his diagnostic imaging programs. “The good part is that we're all in the same niche together. The bad part is that they usually don't have a lot of money to spend. Going after them for any kind of serious grant is like pulling teeth.”

The same budget crunch often holds true for others on the second-circle list, such as medical transcription services, textbook publishers, and the like, which may make better exhibitors than potential sources of major commercial support. One segment that does appear to have a fair amount of money available for CME is disposables companies, says Kuperberg. “The companies that make the needles and catheters, those are the most lucrative area we deal with.” Hasterok agrees. “Just look around at all the disposables in your primary care doc's office: tongue depressors, swabs, cotton balls…and these are made by Johnson & Johnson, Baxter Healthcare Corp., companies with larger discretionary budgets.”

Hasterok says he's also had some success with companies that are slightly further afield. For example, he says he's had good luck soliciting psychiatric and substance abuse treatment facilities for an addiction conference he puts on. He's also had limited success with getting support for a sports medicine conference from companies that make orthopedic products like braces and splints. But his success comes from finding the companies whose target market is his program's audience. “A logical supporter for a geriatric medicine conference might be an assisted-living facility,” he says. “They're not a core group — they're one or two circles out — but they're in a related health care field.”

But don't discount the possibility of going outside the medical community altogether. “There are so many companies that have a link to health care,” says Hasterok. “Just pick up a medical-related magazine and you'll see ads for everything from furniture to software.”

While you may not be ready to try to sell the local sofa store on the benefits of supporting your CME activity, nonmedical sources such as financial institutions, philanthropic organizations, real estate firms, stock brokers, law firms, and even out-in-left-field organizations like auto dealers may turn out to be great prospects. They also can be the hardest to sell because their connection to the physician population may be a bit hazy. But it can be done.

MAKING A MATCH

Be creative, and logical sources will come to you: If your course is about preventive health, it might make sense to talk with health and fitness centers. But don't get too creative, says Hasterok. “You have to think these things through and be sensitive to your audience's needs.”

Which means thinking about all the ways your activity might be attractive to potential supporters. Lynn Thomason, director of CME with the University of South Dakota School of Medicine in Sioux Falls, says, “If you're discussing a disease state or a therapeutic option, there are many groups who have a vested interest in getting the word out.” For example, since migraines affect one in six women, you might look for places that have a large percentage of female employees, such as long-term care facilities. “Look at the statistics of the disease state you're interested in, and you can find ways to match it up with employers, insurers, and nonprofit organizations that would have an interest,” she says.

And again, look at every aspect of your activity to find new avenues, says Pam McFadden, director of CME with the University of North Texas Health Science Center in Fort Worth. “A bioterrorism course can bring in a whole new group of people: fire departments, risk management attorneys, hospital chaplains, government agencies. With those new attendees come new possibilities for commercial support.”

If this sounds like more than you want to take on, consider finding another CME provider who has the skills, contacts, and abilities you need and work together to build a stronger case for a nontraditional supporter. “It may mean sharing the revenue, but it may be worthwhile, depending on what your overall objectives are,” says Lewis Miller, chairman of Darien, Conn. — based Intermedica Inc.

PROVING ROI

Since physicians control a significant proportion of health care spending, either directly through what they order, or through prescriptions, the link between pharmaceutical companies and physician education is a no-brainer. You may have to work to convince the pharma rep that your activity dovetails with their product lines, but the reason you're going to a pharma company to begin with doesn't need much explanation.

This changes as you move outside the traditional realm of funding sources: The farther out you go, the more explaining you need to do. Hasterok would be the first to admit that it's not always easy to get non-medical-related companies to support CME: “You have to really sell it to the third circle. But if you get to the right people and sell them on the value of supporting your activities, they'll climb onboard.”

Hasterok says he usually starts with the marketing department of the potential supporter and explains to them how supporting his CME activity would be a good marketing strategy for them. “They have to have it in their minds that this is a positive thing before they'll agree to do it.” He uses two approaches. One is to appeal to their corporate goodwill and explain how supporting CME can be an image-enhancement opportunity. “Tell them how providing this education aims to improve patient care and the level of health care available to the population,” he says. “Similar to pharmaceutical companies, a bank or real estate firm also wants to enhance its image in the community by showing it supports efforts toward making the population — its customers — healthier.”

But what really works for him is the target marketing approach. “It sounds crass, but I tell them that we realize they have products and services that might be interesting to a group of doctors who have a fairly high level of income. It's hard to get physicians' attention; at a CME activity, you have a captive audience.” For example, treatment facilities are hoping to get their message out to physicians who can refer patients to them, or at least put their facility on the resource lists given to patients. Whether it's a bank or an HMO, “before they commit, they want to make sure that it's going to at least give them exposure” to people who can use their products or services, he says.

Thomason adds that it helps if you can find people within the potential support organization who have both a passion for your topic and know the value of education. She also makes her programs more attractive by sometimes including an arm of consumer education with the activity. “That way, we're not just getting word out to the provider, we're also reaching consumers, and better-educated consumers have better outcomes. We're always looking at return on investment and getting a bigger bang for the buck. Everyone wins.”

“You're constantly having to be on the lookout for new ways of doing things,” says McFadden. Having worked at the local chamber of commerce before moving into the CME arena, she knows the value of assigning benefits to each and every person and organization she deals with. “As much as I hate to admit it, three-quarters of my job is sales — selling a concept, selling why our program works when others don't. It's all about getting out there and keeping it fresh, thinking of who might benefit from supporting our programs and what their derived outcome will be.”

It seems to work: Miller Brewing Co. regularly provides a sizeable grant for one of McFadden's nationally marketed programs as a way to give back to the community and improve its image. “It's an outreach for them,” she says. McFadden's also gotten banks, title companies, and insurance firms to provide block grants for her grand rounds programs. “Their reasoning for giving us a block grant with no strings attached is that they're looking to get exposure to residents and house staff, and that's who comes to the grand rounds. We all benefit, which is important, because otherwise you may get them in once, but you won't get them back. You have to show them that there's value in participating.”

She does that by acknowledging the company verbally during the program and in CME department publications. “But first and foremost, we stay in touch with them throughout the year and include them in opportunities where we may have very little reason other than creating goodwill for future activities,” McFadden says. “Once you build a relationship and a level of trust between your organization and the company, the chances that they'll come back and support future programs grows exponentially. ‘Do unto others’ equals good business!”

AVOIDING THOSE STICKY WICKETS

Alternative sources can be lucrative, but be careful: While it'd be nice to think companies support CME for altruistic reasons, the reality is that everyone has an agenda, says Intermedica's Miller. This means that pharma companies may not be the only potential sources looking to sway course content, speakers, and attendees. For example, you could find that a national managed-care organization is interested in giving a grant to support a program on new therapeutic protocols for a particular disease, but it insists on physician attendees who have a certain type of profile.

Which leads to a very important point: It doesn't matter what type of product or service the potential commercial supporter provides or how large a percentage of the activity they underwrite; everyone is subject to the rules outlined under the ACCME Standards for Commercial Support of Continuing Medical Education. “Just because you do an unconventional type of funding doesn't mean that you don't have to follow the guidelines,” says McFadden.

While HMOs most likely will be familiar with the ACCME guidelines, a bank probably will not. That's why, Thomason says, you may need to do a little educating about the rules when you step outside the traditional sources. “The company may not know what the rules are, so you really have to know them yourself, be able to communicate them to the other entity, and have the trust level that the other entity will follow them as well.”

“You can be solvent and successful, and still follow the guidelines,” says McFadden, who adds that she would never accept a project that wouldn't have an impact on the patient. “What's the point? There's a lot of room to work with; you just have to find out how to work it for your own institution.”

So, is it worth all the effort to pursue nontraditional sources of support? McFadden says an emphatic yes. “As the economies evolve, with more CME programs coming online all the time, and less pharma funding to support it, CME providers are going to have to think more aggressively about alternative support sources,” she says. “The more players that come into the market for CME, the better your pool of resources. It's all about staying on the cusp and knowing your market — and your marketability.”

10 TIPS TO TAKE AWAY

  1. Look for logical tie-ins to your program topic: Perhaps a law firm would be interested in supporting a program on legal and ethical issues for docs dealing with dying patients; or health and fitness centers might support a preventive health program. What types of businesses would be interested in being identified with your program's message?

  2. Look for logical tie-ins to your attendees: Other than pharmaceuticals, what products and services do your docs use in common? What are their demographics? What types of organizations want to reach that group of people?

  3. Check out the types of companies that advertise in medical trade magazines and that exhibit at industry trade shows. They have marketing budgets: Would they be interested in spending some of those dollars on your CME activity?

  4. Coordinate with your development and advancement offices, and your organization's foundation, to find alternative sources. If at all possible, try to put together a consolidated, one-stop-shop approach to a particular company or organization so different arms of your organization aren't nickel-and-diming for a research study here, a speaker there, and a general session elsewhere.

  5. Learn a potential source's financial cycle. They'll be more likely to commit at the beginning of their fiscal year for a yearlong round of funding than they will be if you hit them up willy-nilly or at year's end when the money's already been spent.

  6. Be clear and comprehensive in all your communications, both internally and with external companies. Let everyone know what the goals and objectives are — and who will be the key players.

  7. Find the right people to deal with at the potential supporting organization. Marketing folks are a good place to start.

  8. Keep in touch with supporters even when you don't have an immediate need. Developing and maintaining the relationship is vital to having them come back for more.

  9. Know the rules. Alternative support sources probably aren't familiar with the ACCME Standards for Commercial Support of CME. The better you know the rules, the easier it will be for you to educate them.

  10. Follow the rules. The ACCME Standards apply to all commercial supporters, regardless of what industry they're in. The only exception to this rule is government agencies. But don't stop there: You also have to keep in mind your own organization's mission and procedures when dealing with alternative sources of support.

SIDESTEPPING TOES

Some CME providers find that the alternative sources are willing and able, but that their internal foundations and advancement and development offices aren't too keen on the CME office pursuing what have traditionally been their own funding sources. Say a hospital's development office is pursuing a bank for a $200,000 donation. They would undoubtedly be a little peeved to hear that the bank bowed out because it already gave $5,000 to support a CME activity. The upshot? You have to coordinate your efforts to keep everyone's toes intact.

Steve Hasterok, CME coordinator with University of South Carolina School of Medicine — Palmetto Richland Memorial Hospital Continuing Medical Organization, Columbia, S.C., works for both a hospital and a med school, each of which has its own foundation and development offices. “We have to be very careful about talking with them and making sure we're following whatever rules they have,” he says.

Pam McFadden, director of CME with the University of North Texas Health Science Center in Fort Worth, also works very closely with her university's advancement office. “Just like we partner with various folks to secure commercial support, we partner with our advancement office to identify potential supporters. They know all the players — the bank trust officers, foundations, individual trusts and other community resources.” You also may be able to find ways to “bundle” opportunities for commercial support to get CME funding in unlikely places. For example, McFadden's office has partnered with the University of North Texas Center of Music, the department of rheumatology, and various other organizations to get a matching grant from the National Endowment of the Arts for an activity to raise awareness in physicians about the special medical needs of artists and musicians.

“As a CME office, we don't have the credibility, experience, or expertise to receive this grant on our own. We need that partnership, because we don't have the contacts the advancement office has.”

The only time she's ever had a problem is when “we haven't kept each other in the loop,” says McFadden. “You're building a relationship with them, just as you are with everyone else you deal with. Communication is everything.”

This also goes for planning committees, says Hasterok. “I always run it past the planning committee to get their buy-in and sign-off. I don't do anything without their approval.” Some planning committees just won't go for nontraditional commercial supporters. “Their main objection would be that this is a medical conference and they only want medical-related sources,” Hasterok explains. But for the most part, he's found his committees to be receptive to the idea.