Oliver Wendell Holmes once said, "Knowledge and timber shouldn't be much used until they are seasoned." And if you were to ask what the Healthcare Convention and Exhibitors Association (HCEA) believes shouldn't be much used until seasoned, the answer would be certain types of market research data.

Indeed, HCEA has collected health care meeting data for more than 50 years and has published a new report, The 2007 Industry Research Report on Healthcare Meetings and Exhibit Marketing, which features the last decade of reported health care meetings in the United States, encompassing data from 15,000-plus events. It's important to view the industry in context. Impacted by a number of market forces, the health care convention industry withstood a slowdown in the U.S. economy, the events of Sept. 11, and the rise of the Internet and Internet-based education, all in the last 10 years.

So, what do 15,000 meetings held during 10 tumultuous years tell us about the industry?

Counting Heads
Average reported professional attendance at health care conventions in the United States rose 13.8 percent over the last five years. The increase represents a five-year rebound in reported professional attendance from earlier in the decade when attendance was in steady decline. While the growth in professional attendance (defined as meeting attendees other than exhibitors) has risen over the last five years, when viewed as a 10-year trend, the data indicates that average reported attendance in 2006 is slightly lower than 10 years ago in 1997. Attendance levels are just now catching up to the level from a decade ago [see chart 1].

But how does the rebound in attendance compare to the number of exhibits vying for the attention of this market?

Interestingly, the trend lines for exhibits and professional attendance are similar over the last decade. In the last five years, there has been a 15.7 percent increase in the average number of reported exhibits. Average reported professional attendance increased 13.8 percent over the same time period, which suggests that while the opportunity to meet attendees has increased for exhibitors, so too has the competition in the exhibit hall. In fact, the rate of increase in exhibits is slightly higher than that of professional attendance over the last five years.

Combined, the average reported total attendance for all health care meetings (professional attendees and exhibitors combined) increased 19.2 percent over the last five years. However, when examining the 10-year trends, there are 4 percent fewer reported total attendees in 2006 than in 1997.

Where Did Health Care Meetings Go in 2006?
The top reported destinations for health care meetings in 2006 may be of no surprise to meeting industry professionals; however, this is the first time these figures have been officially tallied and reported by HCEA in a given year, and over 10 years.

In 2006, 46.9 percent of all reported health care meetings took place in the top 20 destinations [see chart 2]. How do these meetings compare to the overall meetings base in 2006?

Compared to the averages of all reported meetings, meetings held in the top 20 destinations, on average, reported 41 percent more professional attendance and 57.1 percent more total attendance. Additionally, meetings in the top 20 destinations reported 49.6 percent more exhibits and 35.9 percent more net exhibit square feet.

The average 10'x10' exhibit space cost is also 28.4 percent higher in the top 20 destinations.

As would be expected, the scope of meetings reported in the top 20 locations that classify themselves as national is, by far, the largest grouping, at 78 percent. U.S.-held meetings classified as international account for 10 percent, followed by state meetings at 8 percent. Meetings classified as either regional or local comprise the remaining 4 percent of all meetings in the top 20.

While quantifying this location information in 2006 is important, what might be more critical to meeting planners and exhibitors are the costs associated with these locations.

Money Matters by Location

Is it a surprise that there can be a 55 percent difference in average labor wages between two cities? This difference may not impact meeting attendees and show organizers as directly as it does exhibitors, but it is an important point to ponder for meeting organizers when considering the additional costs that exhibitors (and sponsors who exhibit) must incur from location to location.

"We know that certain convention labor costs have increased at several times the rate of inflation over the last decade," said HCEA Executive Vice President Eric Allen. "In some extreme instances for specific trade show labor in certain cities, we've actually seen labor costs skyrocket five times the rate of inflation. Labor costs can vary widely from city to city, and managing these costs from show to show is emerging as a major challenge for all health care exhibitors."

While the overall cost to exhibit at any show will vary widely based on a myriad of factors, data from the U.S. Bureau of Labor Statistics on average annual wages for cities across the country is a good resource for benchmarking potential high-cost locations. (The average labor wage for a city is not the same as the cost of trade show labor in that city, but the relative comparison between locations provides benchmarking value.) When isolating just the top 20 cities in which health care meetings are held, the average reported labor wage is 55 percent more expensive in Washington, D.C., the most expensive location, versus San Antonio, the least expensive location.

According to HCEA's 2006 survey data, with nearly half of all reported health care conventions taking place in these 20 locations, knowing this labor cost disparity can be an important budgetary consideration.

When comparing average exhibit 10'x10' space cost between locations over the last 10 years, conventions held in Boston, for example, on average report space costs 64 percent higher than they were 10 years ago. The data indicates that the average space cost for meetings held in Boston in 2006 were 58 percent more expensive than average space cost reported for meetings in Las Vegas in 2006. By comparison, average labor wage data collected by the U.S. Bureau of Labor Statistics indicates that wages in Boston, on average, are 47 percent higher than wages in Las Vegas.

What does this mean for the bottom line of meeting organizers and exhibitors? In the example of Boston and Las Vegas, you could pay nearly 50 percent - 60 percent more for both exhibit space and labor in one city over the other. However, cost is a relative figure that must be analyzed in context to return. Moreover, HCEA's 10-year trend data on exhibit space cost offers interesting insight into where costs are today relative to a decade ago.

The Investment Benchmark
The ratio of 10'x10' exhibit space cost divided by professional attendance provides what HCEA calls the "investment ratio," or the baseline relationship between the standard minimum unit of cost to exhibit and the total professional attendees at an event that an exhibitor can reach.

The investment ratio raises a critical question for all convention marketers and meeting organizers: Is the baseline space cost per attendee more or less expensive now than it was 10 years ago?

This value was most ideal in 1997 at 56 cents per attendee, or 16.4 percent less expensive in 1997 than 2006 - at face value. However, when adjusted for inflation (2.66 percent average annual inflation from 1997 to 2006) the cost per attendee in 2006 would be 70 cents, using 1997 as a starting point. That compares to an actual number of 67 cents, or roughly a 4.4 percent better investment ratio in 2006 than 1997 when adjusted for inflation.

Examining all meetings in aggregate is great for observing overall industry trends, but not all meetings are the same.

Does Size Matter?
Absolutely. Or at least when comparing the differences in certain meetings. The range of health care meeting sizes is very diverse and the demographics and costs associated with very large meetings with tens of thousands of attendees are very different from that of small meetings that may only have a few hundred attendees. All meetings that report attendance in HCEA's study have been placed into category sizes to compare trends and metrics of like-sized meetings (see the "Meeting Size Categories" listing, p. 52).

Of all meetings that report attendance figures over the last decade, 74 percent are classified as small meetings, 11 percent are medium-sized meetings, and 15 percent are large meetings. The large meeting category also includes a subcategory for very large meetings to acknowledge the presence of exceptionally large meetings that report 10,000 or more attendees. Within the large meeting category, 38 percent of meetings can be subcategorized as very large.

While trends for all meetings in aggregate illustrate industry ebbs and flows that correlate with outside forces, different meeting size categories were not all affected the same way.

In order to provide 10-year trend figures representative of larger periods of time, HCEA examined all meeting category sizes by comparing the averages reported over the first three years (1997-1999) with the averages reported over the last three years (2004-2006).

The trends for reported average professional attendance suggest that meetings in these size categories changed in different ways over the last decade. Using the first three-year average and the last three-year average, reported professional attendance at very large meetings grew 6.6 percent. Large meeting professional attendance grew 7.7 percent, and medium-sized meeting professional attendance grew 5.5 percent. Small meetings declined, reporting 2.1 percent fewer professional attendees.

And how have exhibits and net exhibit square feet trended over the last decade by meeting size?

Using the first three-year average and the last three-year average, the data indicates that average exhibit hall net square feet has increased greater than the average number of exhibits. For large meetings, average reported net square feet increased 25.5 percent from 1997-1999 compared to 2004-2006, yet there are 2 percent fewer average reported exhibits. Similarly, in medium-sized meetings, there is a 27.8 percent increase in average reported net square feet, yet only a 2.3 percent increase in average reported exhibits. Small meetings reported a 12.7 percent increase in net square feet while the average number of reported exhibits stayed the same. Based on this, the data suggests that relatively the same number of exhibitors are taking more space in health care meeting exhibit halls.

Therapeutic Specialties
The HCEA report also analyzes health care meetings over the last decade by therapeutic class, comparing the same metrics of attendance, exhibits, net square feet, and space costs. The meetings reported in the top 20 therapeutic classes comprise 57.5 percent of all reported health care meetings held in the United States during 2006.

Dental meetings took the top spot as the most reported meeting in the United States during 2006. Surgical meetings ranked second followed by nursing meetings and family medicine/primary care meetings. Radiology meetings rounded out the top five most reported U.S.-held healthcare meetings in 2006.

HCEA measured the first three-year average to the last three-year average of the decade in order to achieve a more representative measurement on 10-year trends, due to smaller sample sizes when isolating therapeutic classes. So, what interesting therapeutic class trends come to light?

The reported data indicates that oncology/cancer meetings have experienced the fastest growth in reported average professional attendance over the last decade at 79.6 percent. Family medicine/primary care reports 73.6 percent growth in attendance, followed by geriatric at 56.8 percent and emergency medicine at 40.7 percent. Radiology rounds out the top five at 40.1 percent.

Is the state of the industry for medical meetings and conventions healthy? Certainly the overall attendance trends suggests that it is rebounding, but the answer may not be that simple. It varies from meeting to meeting and from exhibitor to exhibitor. However, these new industry data benchmarks and trend research can be used as a tool by both meeting organizers and exhibitors to better plan for identifying and capitalizing on opportunities.

Frank R. Skinner is a market research analyst for the Healthcare Convention & Exhibitors Association and is co-author of HCEA's 2007 Industry Research Report on Healthcare Meetings and Exhibit Marketing. For more information on the report, or to access the full report, please contact HCEA at (404) 252-3663.

New Positions Proposed for Two CME Issues
In response to questions posed by accredited providers, the Accreditation Council for Continuing Medical Education (ACCME) Board of Directors discussed issues at its December 2006 meeting relative to the ACCME Standards for Commercial Support: Standards to Ensure Independence (SCS). These discussions resulted in the board proposing new positions related to two issues: (1) written agreements for commercial support; and (2) an expanded definition of commercial interest.

ISSUE No. 1:
WRITTEN AGREEMENTS FOR COMMERCIAL SUPPORT
The ACCME's SCS require that the development and delivery of CME be independent from the influence of commercial interests. SCS 1.1 states, "A CME provider must ensure that the following decisions were made free of the control of a commercial interest. The ACCME defines a "commercial interest" as any proprietary entity producing health care goods or services, consumed by, or used on patients, with the exemption of non-profit or government organizations and non-health care related companies.

• identification of CME needs ‰ determination of educational objectives 
• selection and presentation of content
• selection of all persons and organizations that will be in a position to control the content of the CME
• selection of educational methods 
• evaluation of the activity.

In addition, SCS 3.2 states, "A provider cannot be required by a commercial interest to accept advice or services concerning teachers, authors, or participants or other education matters, including content, from a commercial interest as conditions of contributing funds or services."

Proposed Position
The ACCME expects that providers will not enter into written agreements for commercial support that stipulate the manner through which the accredited provider will fulfill any of the ACCME's requirements. To make this explicit, the ACCME has proposed the following position that will be used to determine compliance with respect to written agreements:

"A provider will be found in Noncompliance with SCS 1.1 and SCS 3.2 if the provider enters into a commercial support agreement where the commercial supporter specifies the manner in which the provider will fulfill the requirements of the ACCME's Elements, Policies, and Standards."

ISSUE No. 2:
EXPANDED DEFINITION OF A COMMERCIAL INTEREST
The ACCME's SCS require that the development and delivery of continuing medical education is independent from the influence of commercial interests. The ACCME defines commercial interests as, "any proprietary entity producing health care goods or services consumed by, or used on, patients."

Proposed Expanded Definition
In keeping with developments in the health care industry and the continued interest in maintaining the effectiveness of the ACCME's SCS, the ACCME has taken action to propose a modification to its definition of a commercial interest, as follows:
"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 health care goods or services consumed by, or used on, patients."

Prior to implementing these changes, the ACCME solicited feedback from "interested parties regarding their impact, consequences and value for the CME enterprise." Comments were due March 31.

Some providers made inquiries of ACCME regarding this Call-for-Comment, regarding No. 2 - Expanded Definition of a Commercial Interest, asking:
Q: Will the current organizational exemptions to the definition of commercial interest be retained, if the expanded ACCME definition of a commercial interest is adopted?
A: Yes, ACCME is retaining the list of exempt organizations, as shown below.

Proposed Expanded Definition of a Commercial Interest
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 health care goods or services consumed by, or used on patients. Exemptions and conditions already in place are to be retained as exemptions or conditions accompanying the "Proposed Expanded Definition of a Commercial Interest." The ACCME does not consider providers of clinical service directly to patients to be commercial interests. A commercial interest is not eligible for ACCME accreditation. Within the context of this definition and limitation, the ACCME considers the following types of organizations to be eligible for accreditation and free to control the content of CME:

• 501-C non-profit organizations
• government organizations 
• non-health care related companies
• liability insurance providers 
• health insurance providers
• group medical practices
• for-profit hospitals
• for-profit rehabilitation centers
• for-profit nursing homes.

ACCME reserves the right to modify this definition and this list of eligible organizations from time to time without notice.Visit www.accme.org for more information. 

Convene asked several planners to name their No. 1 challenge in planning medical meetings and to share any innovative ways they have approached their top issue of concern. Their comments follow in red throughout this article.

Since our meeting is an international meeting (approximately 40 percent) of 15,000 attendees, we [are at the mercy of how smoothly] the VISA process will go for those especially in high-risk areas. Also, given the shift in demographics, we have had to market to those groups that are U.S.-based to make up the shortfall of international attendees.
Deborah Richardt, Director, Meeting Services Services, American Thoracic Society

We are such a small group, and dropping. Our attendance has been dropping because more and more of the folks are having to pay their own way to conferences instead of having their employers pay. We are going more and more to teleconference workshops to supplement our education budget since an agency can pay one nominal fee and have as many people as they want hear the workshop at their own facility.
Bonnie Abramson, CMP, Director, Membership Services, California Hospice Foundation

One of our biggest challenges is managing the voluminous paperwork and policies for CE credits. I am currently researching Web-based solutions to lessen some of the labor resources necessary to administer the paperwork and required forms.
Cynthia Adams, Director, Medical Meetings, Cystic Fibrosis Foundation

A big challenge is getting space in the venues where we wish to hold our meetings. We would love to hold our meeting at a hotel that has the meeting space we need. Our meeting requires a lot of exhibit and meeting space, but our room nights do not necessarily warrant the space needed. We moved to convention centers in 2002 and are still trying to get used to the differences. I'm not sure that
Sheila Smith Cornett, Meeting Manager, American Society for Aesthetic Plastic Surgery

One of the American Dental Association's [ADA] biggest challenges is understanding how our attendees behave during our meeting. Because our meeting moves to a different city each year, it is even more difficult to measure what works and what areas need improvement. This past year, we worked with a company called Ethnometrics to study our attendees' perceptions and activities during the show. The results were eye-opening and have allowed our staff to establish benchmarks for almost every area of our meeting.
Jim Donovan, Director of the Council on ADA Sessions, American Dental Association

Medical Meetings Face Declining Time,
Declining Financial Support, Rising Liability
In speaking with other medical meeting planners over the past year, I have come to believe that some of the same issues plague most medical meetings. Among the most damaging issues: the decline in the amount of time that physicians have to attend meetings, medical liability, and the reduction in financial support from pharmaceutical/medical companies. Any one of these issues afflicting our industry could easily change how we have managed our meetings in the past, will certainly dictate the future of medical meetings, and could obviously affect the destinations that have come to rely on the revenue from these meetings.

Doctors are likely even more time-deprived than other professionals, as they deal with changes to managed health care, the need to see more patients and keep longer office hours, while struggling to have the semblance of a personal life. No wonder the attendance at continuing medical education meetings, at least for some groups, has already started to decline.

Another issue of paramount importance regardless of the medical specialty is medical liability. Medical liability seems to be systemic with very little - or I would go as far as to say zero - hope for improvement in the near future. I believe medical liability already has or will affect more and more medical organizations each year, causing organizational memberships and meetings to shrink in size, until some form of sweeping legislation is passed to control this issue.

Perhaps the most immediate and daunting of all of the issues facing medical meetings is the financial cutback of support from the medical/pharmaceutical industry. With the changes caused by Sarbanes-Oxley regulations and Pharma guidelines, coupled with the fact that medical supply and pharmaceutical companies are investing in more direct marketing efforts, the support that medical meetings have relied on for years has decreased immensely.

To help combat the effects of all of these issues, the American College of Obstetricians and Gynecologists has changed many standard practices. To address the limited amount of available time in a physician's schedule, we have created courses online, changed the format of some of our meetings so that the doctors don't have to close their offices to attend, and created materials that allow them to obtain CME in their offices or at home.

When thinking of ways to assist physicians with medical liability, we confront a systemic problem that is much bigger than any one organization. We have therefore developed initiatives to assist doctors who have encountered adverse medical liability situations. These workshops help physicians deal with the economic and social aspects of surviving litigation. Other initiatives have been created to focus on improving patient safety, risk management, and ethical practices. These obviously cannot dictate whether insurance companies are going to decrease their rates, but they do contribute to physicians' ability to provide a better standard of care - which will hopefully have a positive effect across the board.

The issue of declining financial support has caused us to be especially creative. As an organization, I can't say that we've trimmed the fat; we have always been pretty lean. Now I think necessity dictates that we trim the muscle. Nonetheless, we have created new marketing vehicles that are available to exhibitors, as well as created new and unique sponsorship opportunities that create win - win situations for exhibitors and the organization. We have also increased efforts to provide more visibility for exhibitors, which have been successful in stimulating exhibitor participation across all fronts.

These issues can keep medical meeting planners twisting in their sleep for quite some time - especially as we attempt to maintain the high standards that our organizations and members have come to expect from our meetings. The decline in the number of attendees who participate in medical meetings will have an obvious trickle-down effect on the hospitality industry, especially in those cities across the country that have grown accustomed to the significant revenue medical meetings have generated for the local economies.
Victor Robinson
Director of Meetings and Exhibits
American College of Obstetricians and Gynecologists