The CME funding system has become ever more stringent, forcing medical meeting planners to file more grant proposals in pursuit of fewer dollars — and to explore other revenue pipelines for their CME programs.
Each year, Sandra Harwood, CMP, vice president of meetings and education for the Infectious Diseases Society of America (IDSA), organizes a Clinical Fellows Meeting, a continuing medical education (CME) event for medical fellows heading into private practice that has helped train more than 1,300 physicians.
In years past, Harwood had no difficulty securing financial support for the meeting. A single proposal might have netted a $350,000 medical education grant from a pharmaceutical company. But those days are gone.
“Today, I hear, ‘We don’t have that kind of money. Maybe you could submit a proposal for $20,000 or $30,000,’” Harwood said. “We’re committed to having the meeting, but this is going to be tough.”
Working Harder for Fewer Dollars
Pharmaceutical and medical-device companies provide support for CME activities through medical education grants, with CME providers — such as hospitals, medical schools, medical associations and societies, and medical education/ communication companies (MECCs) — submitting grant proposals to a company’s medical education group.
Over the past few years, federal regulators and industry watchdogs have turned an increasingly watchful — and skeptical —eye on this grant-making activity. Their concern has been that companies were using CME grants to influence physicians and increase their market share. Calls for increased transparency and accountability in CME funding changed how companies review and award grants, putting increased pressure on CME providers to demonstrate the need for the activity and the expected result.
Not only is it more work to prepare a grant proposal today, there are also fewer grants to go around. Fines for violating rules governing industry-physician relations have tallied in the billions of dollars. That, combined with the threat of jail time and negative public perception hanging in the air, has caused a number of pharmaceutical and medical device companies to reduce their CME programming. Most have shrunk their medical education budgets, and many are accepting fewer grant proposals or putting strict parameters on the types of proposals they’ll accept.
What that means is today’s medical-meeting professionals are working harder for fewer industry dollars. “There’s more competition for a finite number of dollars,” said Harwood, who this year is tasked with putting on essentially the same Clinical Fellows Meeting as in years past, but with a budget that’s $100,000 less. To obtain the necessary revenue, Harwood and her staff are submitting multiple grant proposals. It’s time-consuming and laborious, and Harwood and other planners say their small staffs are struggling under the workload.
At the same time, Harwood said she can’t risk becoming consumed by the grants process, because she has to keep one eye on the horizon. Revenue streams are shifting and a new generation of learners is entering the ranks of CME attendees. The CME of tomorrow will not be the CME of yesterday, or even today. To remain relevant, planners must make strategic choices today that will help them navigate the current system and also prepare them for a new paradigm for CME funding. “We should all care about this,” Harwood said, “because those of us who do not adjust and figure out how to deal with this will be out of a job.”
The Shrinking Pool
Drug and medical-device makers have long been key sources of revenue for CME providers. In 1998, the first year the Accreditation Council for Continuing Medical Education (ACCME) began publishing data on accredited CME program revenue, industry support was nearly $302 million, or 33 percent of total revenue. By 2007, industry support had increased by 300 percent, to $1.2 billion — 47 percent of total revenue
For backers of industry support, this is all as it should be. Industry involvement in CME, they say, is a natural outgrowth of scientific collaboration, and vital to the advancement of medicine and best-practice health care. Even the American Medical Association’s Council on Judicial and Ethical Affairs, which suggests industry grants be avoided whenever possible, admitted in a 2011 report: “Relationships between medicine and industry have … provided significant resources for professional education, to the ultimate benefits of patients and the public.”
But $1.2 billion is a lot of money — and all those industry dollars raised suspicions about the integrity of the medical education they were paying for. (See the timeline below.) Whether or not bias truly existed, the pressure of a multi-year congressional investigation into industry support of CME (spearheaded by U.S. Sen. Charles Grassley, R-IA, a ranking member of the Senate Finance Committee, and occurring from 2005 to 2007) and negative media attention took a toll, and drug and device makers began to pull back from CME. In 2010, accredited CME providers received $830 million — 37 percent of total income — in commercial support. That’s a drop of 3 percent from the previous year and 31 percent from 2007. While the economic downturn that played out over the same time surely also played a part, most within the industry agree that the increased scrutiny led to at least some of the withdrawal.
Given that 80 percent of accredited CME providers accept at least some commercial support, the decrease in CME grants has had a significant impact on revenue mix. “Five years ago, our funding was one-third from registration, one-third from exhibits, and one-third from industry funding,” Harwood said. “Now it’s two-fifths registration, one-fifth exhibits, one-fifth industry, and one-fifth other.” For IDSA, “other” includes governmental grants and royalties from tape/DVD sales.
At The Endocrine Society, industry support is currently about 26 percent of total CME income. “It used to be higher,” said Wanda Johnson, CMP, CAE, senior director of meetings and education. “It’s definitely a different landscape today.”
MECCs have traditionally been the most dependent on industry support, so it’s no surprise they are feeling the brunt of the decrease. In 2010, accredited MECCs received $93 million less in commercial support than the year before, according to ACCME, while total income for accredited MECCs fell for the third straight year. “We’ve seen a lot of companies go out of business,” said Tom Sullivan, president and founder of Rockpointe Corporation, a Columbia, Md.–based MECC.
Devil’s in the Details
Whether a CME provider accepts a lot or only a little industry support, the competition for the shrinking number of grants has gotten tougher, and pressure to write a successful grant proposal is greater than ever. “We may not have viewed it as a competition in the past, but it most definitely is today,” Johnson said. “And you need to position yourself as best you can.”
In the old days, a grant proposal might have been a one-page explanation of the planned activity. Today it must provide a data-driven needs assessment that explains the practice gap and justifies the need for the programming. It must incorporate adult-learning principles and provide evidence that the activity will result in changed physician behavior and improved patient care. And every CME grant proposal must adhere to stringent industry and federal guidelines designed to ensure that industry-sponsored CME is scientifically rigorous and free from bias.
“It is very time-consuming,” said Lisa Hathaway Stella,