You've probably heard that the Accreditation Council for CME has proposed a revised definition of commercial interest. The new definition states: “A commercial interest is any proprietary entity producing, marketing, re-selling, distributing or otherwise participating in or profiting from the distribution, promotion, or sale of healthcare goods or services consumed by, or used on, patients.” This can be construed as a direct threat to private sector providers — medical education and communication companies — whose parent organizations or sister companies participate in marketing for industry and/or profit from the products sold by their “commercial interest” clients.

If this change is adopted, parent or sister organizations of accredited MECCs that derive income from promotional relationships with pharmaceutical companies would be redefined as commercial interests.

The ACCME redefinition of commercial interest may merely be a prelude to disallowing private, for-profit companies as accredited providers. This has been a goal for many academic providers, and the U.S. Senate Finance Committee report on CME seems to imply support for this change. But in our opinion, if such action were to be taken, it would be an invitation for litigation. The new ACCME definition of commercial interest exempts not-for-profit 501(c)(3) organizations. Perhaps it is time to revisit the issue of making your education company a not-for-profit 501(c)(3) organization.

Tough Questions, Tough Decisions

What should MECCs do next? First, consider asking these questions for every CME activity you are proposing to create:

  • Is content based on evidence that constitutes “best practices”?

  • Is there a gap between current practices and best practices?

  • Will closing the gap result in improvement in the health and/or outcomes of patients?

  • Will this activity increase the cost of care in the absence of quality improvement?

  • Will the proposed educational intervention result in changes in current practice?

  • Will this activity be planned independently and be fair balanced?

Second, MECCs should take immediate and clear steps to sever working relationships with parent or sister organizations that provide promotional services for industry. While in the past we have been hesitant to urge our clients to fully sever these relationships, the Senate report has caused us to change our view. (Nonaccredited MECCs that intend to remain as educational partners with accredited providers will also need to sever promotional relationships unless they are satisfied to have their role limited strictly to meeting logistics.) To ensure that they are “promotionally clean,” accredited CME providers should do the following:

  • Completely separate CME staff from any related organization involved in promotion.

  • Separate CME office space, preferably putting it in a separate location (meaning not in the same building and especially not on the same floor), from that of related organizations involved in promotional activities.

  • Establish a “firewall” for CME content decision-making so those involved with promotional activities have no connection to content decisions.

  • Invest in separate servers, business cards, stationery, e-mail addresses, and other indications of your independent status.

  • Develop a packet of documentation that can be presented to the ACCME and commercial supporters that verifies your independence, including organization charts, policies and procedures, lists of staff whose only responsibilities are to the accredited provider, and policies on content validation by an independent authority.

Third, academic, hospital, and association providers should establish clear criteria for selecting MECCS. Visit and click on the Medical Meetings magazine cover for a checklist.

Steven M. Passin is president of Steve Passin & Associates, LLC, a CME consulting company based in Newtown Square, Pa. He may be reached at