CME PROVIDERS WILL face more confusion, frustration, and bureaucracy when soliciting commercial support, Bruce J. Bellande, PhD, told attendees at the Alliance for CME annual conference, which was held January 21 to 24 at the Hilton Atlanta. The conference drew nearly 1,200 attendees and 72 exhibitors.
Speaking during a session on system constraints to CME progress, Bellande, executive director for the Alliance, said pharma executives attending last fall's Medical Education Forum indicated that they plan to scrutinize CME grant proposals more carefully, require more intensive needs assessments, and question current educational models — the trickle-down effect of increased government scrutiny. Bellande and others also noted that Web-based CME grant applications are likely to become the norm and that medical affairs departments, not marketing departments, are increasingly calling the shots.
Bellande concluded, “We're going to see ever-accelerating changes as the industry educates itself and implements these changes.”
Adding to the confusion is the fact that pharma companies and CME providers are still struggling to understand how to comply with the OIG's pharma marketing guidance. Speaker Mark H. Schaffer, EdM, vice president, CME, Thomson Professional Postgraduate Services, Secaucus, N.J., emphasized that under the guidance, educational grants could be construed as kickbacks, and that the guidance also refers to influencing the practice of physicians. “This is the part that sent chills up my spine,” he said. “I don't know about you, but, as an educator, I live to influence the behavior of physicians so that they will be able to better treat patients.”
He advised CME providers to follow the letter and intent of all the CME guidelines, accept only educational grants, and not confuse CME initiatives with fee-for-service programs, where it could be perceived that the CME sponsor is really providing a service for the pharma company. Those arrangements imply a client or agency relationship, which is not appropriate for CME providers and industry supporters, he explained.
He also reminded attendees to be circumspect about their venue choices, and avoid selecting facilities that could be perceived as luxury destinations.
Schaffer and a number of other speakers at the Alliance conference said one way to avoid scrutiny would be to shift the cost of CME activities from third parties to the attendees. But most agreed that such a move would require a major mind-set change on the part of physicians. “Any time I suggest that doctors should pay for a program, there is a lot of resistance from the faculty,” said one medical school CME director.
Another hot topic was how to keep commercial bias from creeping into CME activities.CME organizers may think they've put together a balanced presentation, but too often attendees who are asked to rate whether a program is biased see it differently, observed Karen Overstreet, EdD, president of Nexus Communications, North Wales, Pa. She and Jacqueline Parochka, EdD, president, Excellence in Continuing Education Ltd., Chicago, offered some pointers to CME providers:
Content needs to include the pros and cons of a product, but presenters do not need to mention every product on the market.
An accredited provider must control the content. That doesn't preclude a company's sales reps from attending the meeting, Parochka said, “as long as they're not discussing off-label uses, or distributing samples…or planting questions — that's my favorite.”
Parochka also pointed out that faculty must take responsibility by refusing to lead programs that are clearly biased and declining gifts that violate guidelines. That's easier said than done, Parochka added, because the existing system has fostered a certain greed factor. “Have you met a physician yet who refuses a gift? I've only met one or two.”
At the North American Association of Medical Education and Communication Companies' meeting, held in conjunction with the Alliance conference, NAAMECC leaders announced that they asked the Accreditation Council for CME to allow them to review the next draft of the Standards for Commercial Support. If the ACCME re-fuses, they are prepared to lobby the ACCME's parent organizations during the six-month comment period for the new Standards for the opportunity to review them. They noted that MECCs represent 15 percent of accredited organizations but are not represented on any accrediting body.
For more about commercial support, see “The Frustration Factor,” page 34. For more coverage of the Alliance conference, see “Ask the Audience,” page 27.