Besieged, commercial CME providers again on defensive

A recent set of proposals from CME authorities could usher in a new round of corporate and other structural changes to medical education and communication companies. To no one’s surprise, then, the two proposals—released last month by the Accreditation Council for CME (ACCME)—elicited a cascade of questions from groups including the Coalition for Healthcare Communication (CHC), which questioned ACCME on its rationale. Last week the ACCME responded to CHC via a private communiqué. “It’s clear to me…that there’s not an intent to disenfranchise the existing commercial CME providers but to better track conflicts of interest that all providers have,” said John Kamp, CHC executive director. “But we’re concerned.” ACCME could be preparing a set of guidelines for how large communication companies can effectively separate their commercial units that do promotion, publishing and other activities from their independent CME provider units, Kamp said. (Many MECCs that do both kinds of education already have such firewalls, but typically it’s at the behest of grantors.) Meantime, ACCME is asking for feedback from the CME community on the two proposals, the first of which suggests changing the limits on what can and cannot appear in a letter of agreement (LOA) between a grantor and a CME provider. It may get more feedback on the second one calling for a new definition of a “commercial interest.” Currently that includes “any proprietary entity producing healthcare goods or services consumed by, or used on, patients.” This definition would be broadened to include any entity “marketing,” “re-selling” or “distributing” same. Some say it's a little too broad. If the suggestion passes muster as is, “It could be interpreted that some types of providers, for example MECCs, would be considered a commercial interest,” said Karen Overstreet, EdD, RPh, president of the North American Association of Medical Education and Communication Companies (NAAMECC). Under the vague language, journals, too, could be roped into the definition. Commercial interests, per ACCME rules, may not plan or present CME activities. The definition was last broadened two years ago to include pharmaceutical companies, to the consternation of some in industry who decried what they saw as a double standard. (Insurers, medical practices and for-profit hospitals may still act as providers.) This is not the first time MECCs have felt a lack of love from the establishment. Last year a group of academics writing in the Journal of the American Medical Association opted for excluding them from receiving support “directly or indirectly” from pharmaceutical companies due to conflicts of interest, saying academic medical centers should take the lead in stewarding such funds. Yet teaching hospitals, such as the Cleveland Clinic, also have wrestled publicly with financial conflicts and industry influence. A perceived double standard goes to the heart of the matter, according to Kamp, who said that the CHC is likely to point out that “all kinds of providers…also have conflicts of interest.” A four-person panel from CHC will “provide our response and provide a way for other CHC members to respond,” Kamp said. The members are Lew Miller, WentzMiller & Associates principal, Marty Cearnal, Jobson Medical Information EVP and chief strategy officer, Tony Iaccono, Access Medical Network president, and Eric Peterson, Academy for Healthcare Education VP. NAAMECC is drafting its own response. The deadline for comments is March 30, but some say ACCME may extend it or at least consider comments received after the deadline. Still, the coalition and other interested parties may have to play ball. “Given that ACCME is at least considering developing standards for these firewalls, we’re going have to participate,” Kamp said.