Out of the Quagmire

Apr 01, 2010
By Pharmaceutical Executive Editors

Dean Beals
When it is done well, continuing medical education (CME) is an invaluable means of conveying important information to clinicians. CME is the single best means of keeping clinicians current in their areas of practice. In numerous studies, it has been demonstrated to close practice gaps and lead to better patient care .

However, most constituents in the CME community—including outside observers, regulators, and clinician participants—recognize that the current funding model needs to evolve. The new model must: 1) continue to recognize that pharmaceutical companies want-and have a reason to-participate in funding CME; 2) mitigate potential for or appearance of bias; 3) insure a mechanism to measure outcomes; and 4) offer a funding mechanism that is easy to initiate and sustain. Above all, the CME community must avoid the temptation to create a system of funding that is overly complex, and eliminate the apparatus that has made CME more expensive, difficult, and less desirable for accreditors and funders alike.

Crossing Hurdles

The current controversy in CME revolves around the pharmaceutical industry's longstanding funding and the possible bias effect of those funds. Whether or not bias exists, the appearance of a conflict of interest is inevitable. Such an appearance suggests that pharmaceutical funding (no matter how it is managed) does a disservice to the mandate of CME and taints continuing healthcare education as a whole. Some have suggested ending pharma support for CME altogether, but that could be catastrophic—akin to destroying the village in order to save it. Nonetheless, change is in the air.

A recent Institute of Medicine report suggested that the US Department of Health and Human Services commission a blue ribbon panel to oversee design and implementation of an independent public–private Continuing Professional Development Institute (CPDI), with funding coming from a variety of stakeholders, as part of an overhaul of CME. However, reliance on industry for funding remains problematic. "In 2008, the CME enterprise developed 100,898 CME activities that together offered 769,439 hours of instruction according to data from the 2008 ACCME Annual Report. Total income for CME programs was $2.4 billion in 2008, down from $2.5 billion in 2007, a decrease of 4 percent. Approximately 44 percent ($1.04 billion) of that came from commercial support. Industry support, however, declined 17 percent from the previous year, the first such decline since the ACCME started keeping track in 1998. The cause for this decline can be traced to at least two factors: 1) the controversies surrounding industry support—which have lead to dramatically increased regulations; and 2) the recent challenges on the pharmaceutical industry's bottom line (the economy, blockbusters going off patent, etc.)."

Increased regulation to preempt bias has created a plethora of hurdles that make CME more costly to establish, more challenging administer, and increasingly unattractive to industry funders. The current model of funding has accreditors soliciting companies for support via a cumbersome and time-consuming process that requires detailed budgets, gap analyses, recruitment plans, and other components that can result in 20+ page grant applications. After submitting to multiple funders (often five or more), providers receive either a thumbs-up or -down with very little disclosure on why the program was accepted or rejected. This approach is counterproductive, to say the least.

The system requires accreditors to find the intersection between practice gaps and what funders are willing to support, creating a hit-or-miss proposition that is often a waste of time and resources. At the same time, there is a potential for CME content to be developed based on what funders want rather than on the issues that are the most important for medical professionals.

The use of Requests for Proposals, while helpful for both funders and accreditors, can have the same "content biasing effect" and may cause CME providers to take their eyes off what is most important: increasing knowledge, closing practice gaps, and improving patient care.

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