In the last 12 months, 142 medical-education providers either lost their accreditation to offer CME or decided not to apply for renewal, said the ACCME in a report issued last Friday. The tally includes med-ed companies, societies, hospitals and other entities which, for a variety of reasons, have found it too difficult to offer certified activities or, in some cases, to remain in operation at all.
The figures, posted on the Accreditation Council for CME (ACCME) website along with a summary of its December 2009 board meeting, show the extent of attrition taking place in the industry. There are now 713 accredited providers (vs. 725 in 2008) and 1,523 providers accredited by ACCME-recognized state and territory medical societies (vs. 1,600 in 2008).
And this could just be the beginning. With fees and administrative work set to rise and funding scarce, the lopsided equation could lead to further attrition in the med-ed sector.
ACCME CEO Dr. Murray Kopelow foreshadowed a period of winnowing when he told MM&M last year
, “The system (enterprise) needs to evolve. System changes will occur, and are occurring, at the people and organizational levels. Some people will move on to other professional pursuits. Some organizations will stop being accredited providers.”
As for the reasons behind the shrinkage, providers today are struggling with less funding, after overall pharma support dipped 14% in 2008 to $1 billion. Three big pharmaceutical companies—GlaxoSmithKline, Pfizer and Johnson & Johnson—have also decided to no longer award grants to accredited medical-education companies.
Meanwhile, “the increasing administrative requirements and fees are placing additional stresses on providers,” said Michael Lemon, president of Postgraduate Institute for Medicine (PIM), an accredited medical-education firm. ACCME is set to increase user fees by several hundred dollars for all accredited providers.
In addition, the ACCME is considering switching to a real-time, web-based system of collecting data about activities which would require providers to report more extensive information, including data on budgets and funding. ACCME has called the shift to this system a “potential, future goal,” although some providers are already gearing up for it.
Still others are having a hard time complying with new accreditation criteria. According to ACCME, two providers have lost accreditation since November 2008, when the council began evaluating them based on the stricter standards.
Acknowledging “the current economic environment,” the ACCME has taken steps to trim providers' expenses. In the same executive summary, the council said it was delaying onset of user-fee increases for state-accredited providers as well as taking other cost-cutting measures this year to reduce cost expenses related to teleconference surveys.
Nevertheless, there has been a thinning of the ranks. The list of providers no longer accredited reflects those which voluntarily withdrew accreditation or those whose accreditation was withdrawn by ACCME, the council said. Of these, 109 were state-accredited and 33 were ACCME-accredited.
While ACCME has been posting such lists since early 2003, the new list offers the first update on the size of the provider universe since the council initiated a policy change preventing non-accredited providers owned by a for-profit interest—the education unit of an advertising agency holding company, for instance—from partnering with an accredited provider.
In order to maintain these partnerships and to meet the new standard, non-accredited outfits would have had to divest themselves completely from their commercial owners and, in some cases, undergo an expensive corporate reorganization, in addition to the firewalls many already had in place.
This new definition of what constitutes a commercial interest went into effect last August. It was aimed squarely at medical-education and communication companies (MECCs)—medical schools, hospitals and societies were exempted—and, as it turns out, the change has exacted a toll.
PIM's Lemon said ACCME's new definition has forced a large number of organizations, both non-accredited firms and accredited organizations which used to work with them, out of the CME space.
Health Learning Systems (HLS), a subsidiary of WPP's CommonHealth medical ad agency, for instance, had always sought co-accreditation with an institution or a for-profit CME group. But the new definition prompted HLS to no longer support CME programming, the firm's president Mary Anderson said in an email.
Some MECCs, like Professional Postgraduate Services (PPS), pulled out of CME prior to the rule change, as previously reported
, while Physicians Academy for Clinical and Management Excellence is among those that have departed since, according to the new list.
Other providers have found a way to continue educating doctors without shouldering the costs and administrative work associated with accreditation. Cambridge Health Alliance (CHA), a Harvard Medical School teaching affiliate, had been accredited to offer certified CME courses by the Massachusetts Medical Society. The health system simply switched its affiliation with regard to CME over to Harvard, a spokesperson said.