Drug firms increased their continuing medical education (CME) grant activity last year, a sign of faith in what has been a heavily scrutinized area. But an analysis of spending shows industry is directing more money into organizations that may appear safer from a public relations standpoint.

“The trend is still moving toward a direction where people feel secure in making their investments,” said Marty Cearnal, chief strategy officer, Jobson Medical Information.

Despite last year's climate of heightened scrutiny, including a Senate Finance Committee investigation which culminated this year, total commercial support for CME rose 8% vs. 2005 to nearly $1.2 billion, according to recently released data from the Accreditation Council for CME (ACCME).

That surprised some observers, who had expected a continued slowdown in the growth rate, which seemed to hit a rock-bottom 4% in 2005. With funding from drug firms still hovering at half of total CME revenue of $2.4 billion, the numbers evince an industry that continues to believe in sponsoring CME after maneuvering to separate grant decision-making from sales and marketing and taking other compliance steps.

“Some had predicted the demise of CME, because of those regulatory changes,” said Frank Britt, EVP, Pri-Med. “We're generally very positive about how the industry is evolving.”

Perhaps more predictable was the direction of funding. Medical schools and societies saw the highest commercial funding increase of any of the provider groups, drawing 8% and 7% increases, respectively. Medical education and communications companies (MECCs) gained 4% more.

According to Cearnal, that reflected grantors' delayed reaction to the 2003 OIG guidance and other compliance concerns, which was to temporarily scale back funding as they moved CME authority into the medical department.

Supporters may have emerged from those changes with a more conservative posture. “[Grantors are] trying to demonstrate their compliance by getting into a situation where they feel like they're less exposed,” he said.

To be sure, MECCs attracted the most drug company funding of any provider group by far, about $621 million last year. But the pursuit of what some see as a safe haven could accelerate even more if another trend started by Eli Lilly this year—disclosure of educational grants—takes hold throughout the industry.

“If [grantors are] going to publish that information, they would rather have the names on that list be medical societies, medical schools, not-for-profit foundations and health organizations, as opposed to for-profit providers, whether they are accredited providers or non-accredited providers,” Cearnal said.

The trend toward safety parallels a focus on efficiency—reaching more audience members for less money. The most common activity among medical schools and societies are grand rounds and didactic presentations. These happen to be the two activities which can expose the most people for the least amount of money.

Research shows didactic lectures have minimal impact on behavior change, though, and many grantors want to fund quality improvement-oriented activities, in addition to traditional update-oriented activities. Shifting funding toward quality programs requires data on which programs are most effective, and outcomes research is only beginning to tackle this need.

Last year's spending variability also may reflect a quirk in the CME money trail. Those who receive a grant report 100% of it to the ACCME, even if they partner with another organization on the activity. Transfers from schools or societies to a MECC are not visible, even if the MECC ultimately receives a large percentage of the grant. Such transfers, known as joint sponsorship, are common.

“In the past...a university or a medical school or medical society that was accrediting the program ...would appoint their MECC partner as having financial responsibility, and the check would be written to the MECC because the medical school didn't have the infrastructure to handle the finances,” Cearnal recalled. “In today's environment, the grantors resist that kind of behavior, because they want the medical society's or university's names on a check.”