The amount of funding given to publishing/education companies by drug and device makers for continuing medical education (CME) increased markedly last year, a newly released report shows.
Viewed alongside an earlier study that demonstrated a sizable leap in funding for CME in the years after federal disclosure rules took effect, the two data sets show how a shift is occurring in use of education to reach clinicians.
Overall, industry support for CME saw a slight 1% uptick last year to $748 million, from $739 million in 2017, according to an annual report issued last week by the ACCME, the commission which accredits hospitals, medical schools and others to deliver certified CME to health pros.
Commercial support accounted for 26% of total CME funding in 2018, vs. 28% of total funding the year before. Revenue from advertising and exhibits rose, as did income from registration fees, private grants and the government, all of which pushed CME’s total income up 6% to $2.8 billion.
Although the vast number of activities were funded by other means, of those that were industry-backed, publishing/education companies were the biggest recipients of those independent grant dollars.
These providers, also known as medical-education & communication companies (MECCs), saw a 15% increase in industry support, to $433 million from $384 million, while other ACCME providers—medical societies (-8%), med. schools (-12%) and hospitals (-21%)—all saw decreases.
Asked for his opinion on the shift, John Ruggiero, the current industry chair for the Alliance for Continuing Education in the Health Professions, said, “I don’t think it’s a purposeful objective to support MECCs more than any other educational provider, because each educational provider demonstrates equal value depending on the knowledge or clinical gap needing to be addressed.”
More likely, he said, it’s that MECCs are designing and submitting the right educational grants which identify needs that are parallel to biopharma’s evolving grant approach. Given that academic centers are very important to biopharma companies, MECCs have been “very strategic to adapt to changing times, to partner with health systems to enhance their quality-improvement efforts.”
He stressed that this is his perspective, gathered from various conversations, but that others may disagree.
‘No rep’ policies
Many teaching hospitals these days are unable to accept independent funding directly from industry grantors due to institutional policies against accepting commercial support. They’re sometimes an extension of “no-rep” restrictions meant to prevent the perception that their clinicians could be influenced to use marketed products. At the same time, more doctors are now being employed by larger health systems and integrated delivery networks (IDNs).
MECCs, however, are not bound by the same restrictions. Their med ed can reach the all-important IDNs because they can jointly accredit commercially supported activities that involve academic hospitals.
“Ensuring that hospitals and systems including IDNs have medical education to equip clinicians and teams to put evidence into practice is more important than ever,” explained Caroline Pardo, director of CME for Haymarket Medical Education, an accredited med ed firm (HME and MM&M are both owned by Haymarket Media). “Commercial organizations find value in supporting certified content from medical education companies who work with IDNs and systems to ensure clinicians and their teams have access to best practices and evidence.”
Pardo also attributes the trend to increased recognition of the ability of MECCs to educate across all specialties, versus medical societies which may be aimed at one role, as well as to their ability to develop initiatives that collect and report real-world data.
“Healthcare systems may not be as eager to have promotional conversations but still want to engage with biopharma as partners in healthcare,” added Ruggiero. “They’re just interested in seeking additional ways to do so.”
The ACCME data come on the heels of a retrospective cohort study, presented at this year’s American Society of Clinical Oncology (ASCO) Annual Meeting, that tracked the amount and value of industry payments to a cohort of medical oncologists in the years immediately following implementation of the Open Payments disclosure program of 2010’s Sunshine Act.
Researchers found that, between 2014 and 2017, the oncologists received 1.4 million industry payments totaling $330.6 million. The value and number of payments for non-CME work fell annually by 18% and 25%, respectively, however the value and number of disbursements for accredited CME work jumped annually by 821% and 209%, respectively.
Payments attributed to doctors by drug and device makers were first made public in the government’s Open Payments database about five years ago.
The intent of the med-onc study was “to determine whether [the Open Payments program] has prompted fewer physicians to engage with industry or whether the types of interactions are transitioning to those associated with lesser conflicts of interest,” according to a report from lead researcher Deborah Marshall, M.D., of the Icahn School of Medicine at Mount Sinai.
Similar to the aforementioned increase of pharma CME support toward MECCs, CME funding among the oncologists may have remained high in order to engage academic faculty who would not otherwise be able to be engaged in non-CME activities—such as industry-backed speakers bureaus—due to restrictive policies at their institutions and/or a reticence among these physicians to accept any industry payments that could land their names in the public database.
Payments for non-CME invoke the reporting requirements, while payments for certified CME activities do not. That’s why some had speculated that the federal disclosure program might prompt fewer academic physicians to want to participate in promotional med ed.
Taken together, the oncology and ACCME datasets paint a picture of how such support has changed in a post-Sunshine Act world, specifically a trend toward the funding of certified CME and toward the funding of publishing/education companies.
Ruggiero added, “The med-ed companies, who live and breathe med ed 24/7, have the ability to not only compile and compartmentalize gap assessments but to also engage in partnerships with health systems, evaluate data, execute education and provide root analysis in order to provide further outcomes that identify future barriers that would inhibit care from taking place. That becomes an incredibly powerful approach for a biopharma company to consider when planning the best ways to accelerate best, personalized evidence for better patient care.”
Pharmacists and nurses surpass docs
When viewing the ACCME data, it’s important to keep in mind that the figures reflect interactions among a wider pool of HCPs. For the first time, the accreditation group corralled data from other types of learners into its database.
The launch of the Joint Accreditation Program and Activity Reporting System (JA-PARS) in 2018 enabled jointly accredited providers to report all of their program and activity data, including uni-professional and interprofessional continuing education (IPCE) activities, into a single, unified repository. Before 2018, jointly accredited providers reported data into multiple accreditors’ data systems.
“We can now see a more comprehensive picture of the scope of IPCE,” explained Tamar Hosansky, ACCME’s VP communications, by email.
And once factored into the overall report data, CME interactions among non-physician healthcare professionals, such as nurses and pharmacists, outpaced those of physician learners, by 15.5 million to nearly 21 million.
“Interactions with other learners have been increasing steadily over the years,” added Hosansky. “The significant increase this year (61%) is likely due to more comprehensive data collection from jointly accredited providers.”
That has implications for education.
“We need to educate all [HCPs]; physicians only hold one piece of the care plan,” said Ruggiero. “The educational gaps are wide and the needs vary depending on the players in the system that match the clinical gaps identified. Med ed supporters within biopharma are well aware of that, which is naturally allowing us to champion the need to support education that is interprofessional.”
This article has been updated to clarify the industry’s position.