The total income for Accreditation Council for CME — accredited providers is still on the rise, according to the ACCME's “Annual Report Data 2005,” though there are signs that the unparalleled growth the industry has enjoyed is beginning to slow. In 2005, total income topped $2.25 billion, a 9 percent increase over 2004's total income figures for the industry. While a healthy increase, it is a slower growth rate than in previous years. In 2004, total income rose 15 percent; in 2003 total income jumped 11 percent. Average income per organization also rose about 9 percent over 2004, to $3.1 million.

Publishing/education companies made up the largest percentage of that total income figure, accounting for more than $780 million of the $2.25 billion. This represents an almost 12 percent increase over 2004's total income for this group of providers. Nonprofit physician membership organizations — including specialty so-cieties, nonspecialty physician organizations, and state medical societies — were a close second at $738 million, and medical schools rounded out the top three at almost $400 million. This represents close to a 5 percent increase for nonprofit physician membership organizations in 2005 over 2004, while medical schools raised their total income just 2 percent.

The slowdown in overall total income growth is reflected in what these individual groups earned as compared to revenues enjoyed in previous years. In 2004, the publishing/education companies' total income grew 19 percent, nonprofit physician membership organizations increased their total income by 28 percent, and medical schools rocketed 22 percent. Hospitals and healthcare delivery systems also showed negative growth in total income; however, the nonprofit/other category saw total income rise 19 percent. Government and military CME providers' revenues soared 322 percent in 2005.

Commercial Support Still Slipping

Commercial support income also is showing a continuation of last year's slowdown trend. Total commercial support rose 4 percent, to $1.15 billion in 2005 over 2004, down from last year's 10 percent growth rate, and 30 percent and 31 percent in 2003 and 2002, respectively. Commercial support represents about half of the total income ACCME-accredited providers reported, with the remainder made up of advertising and exhibits, and other income.

Commercial support also shows a decline since 2004, where it accounted for 52 percent of the total income, down from 55 percent in 2003. The 2005 data report includes only commercial support from firms that manufacture products regulated by the Food and Drug Administration, not commercial support received from other sources as previous reports did.

Kopelow explains that some of the changes noted here could be due to a change in how ACCME defines commercial support. “We used to say that any money you received to do CME was commercial support; now [commercial support] is considered to be only the money you get from a firm that makes healthcare products or services.” Nontraditional commercial support, meaning that which comes from non-FDA-regulated organizations of all types, now falls under the “other” category. “It wasn't a huge amount, relatively speaking,” says Kopelow. “But it was in the tens of millions of dollars and could account for the redistribution.”

Other income, which also includes participant registration fees and allocations from a provider's parent organization or other internal departments, is up almost 15 percent in 2005 over 2004, and accounts for almost 40 percent of the total income received in 2005, up slightly from 38 percent in 2004. Total expenses also are on the rise, at $1.7 billion, a 6.5 percent increase over 2004.

Not surprisingly, those who had the most in total income also received the most commercial support in 2005: publishing/education companies, with more than $594 million. Medical schools received the second-highest amount of commercial support, $239 million, followed by nonprofit physician membership organizations, at $168 million. This means publishing/education companies made about three-quarters of their income through commercial support; the next largest recipient of commercial support went to medical schools, which got about 60 percent of their total income from this source in 2005. Hospitals/healthcare delivery systems relied on commercial support for half their income; other nonprofits 34 percent; nonprofit physician membership organizations about 22 percent; insurance companies/managed care companies almost 15 percent; and government or military providers in 2005 got just 4 percent of their total income from commercial support, even with a 94 percent increase in 2005.

State medical societies actually saw their total commercial support drop from almost $46 million in 2004 to $37 million in 2005. Kopelow says that the drop may be simply due to reporting issues, “because the quality of state data has been increasing over the past few years in terms of specificity. I think we need two or three more years to see what's really going on.”

Publishing/education companies increased their levels of commercial support 12 percent in 2005 over 2004, while almost all other provider types saw a decrease: Medical schools were down almost 6 percent; nonprofit physician membership organizations were down by less than 5 percent; hospitals/healthcare delivery systems were down 11 percent; and insurance/managed care companies were down 76 percent. However, along with the government/military category's huge jump (94 percent), the nonprofit (other) category also was up 20 percent in this area.

e-CME Coming Into Its Own

Internet-based CME is starting to really gain some traction, according to the 2005 data report. The total number of Internet CME activities — which for the first time includes Internet searching and learning, along with enduring materials and live activities — is up to 19,107 in 2005, from 15,532 in 2004, a 19 percent increase. In just six years, e-CME has increased its number of activities more than 1,000 percent, and it now accounts for almost a quarter of all CME activities. Credit hours for e-CME also are on the rise: In 2005 they numbered 36,714, up from 28,435 in 2004, a 29 percent increase. Physician participation also is going up: Participants in 2005 numbered more than 1.3 million, up 53 percent from 2004.

Compare this to regularly scheduled conferences, where the number of activities grew just 8 percent in 2005 over 2004, to 11,431 from 10,516. Kopelow says that this may be misleading, however, because of “a new policy we made on regularly scheduled conferences which is affecting our data. A regularly scheduled conference on neurology used to be counted as one activity, and another on anesthesia as a separate activity. Now we rolled them all into one activity. So the activity counts are going to fall, but the total number of hours and the participant numbers should be about the same.” Physician participation at regularly scheduled conferences did hold steady, though credit hours declined 3.6 percent. Courses, which have the highest number of activities of the formats tracked in the data report, increased by 7.5 percent in 2005, but hours are down almost 5 percent, and physician participation declined 6 percent. Journal CME is still on the rise, however, with a 34 percent increase in the number of journal CME activities in 2005 over 2004. Physician participation in journal CME also is up 10 percent, though credit hours are down about 9 percent.

Kopelow is most excited by what he calls an “interesting and compelling piece of data”: When you look at the hours of instruction, courses, which are considered to be the traditional lecture format type of CME, now make up only half the total hours of instruction; nontraditional CME now makes up the other half of the total CME enterprise. In the number of participants, there's now a five-to-one ratio of those participating in nontraditional versus traditional CME,” he says.

“Physicians are not going to the traditional lecture format in the U.S. anymore. That's dynamite.” And he expects the nontraditional formats to continue to gain in popularity as Internet searching and learning — which is only now beginning to be taken on by CME providers — continues to evolve. “While a person still has the ability to do all of their CME in a lecture format, our data shows that CME in diverse forms is available to the learner. I'm proud of that.”

For the full ACCME data report, visit accme.org.

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