Life Science Compliance Update

July 29, 2015

ACCME Annual Report Data 2014

The Accreditation Council for Continuing Medical Education (ACCME) recently published its 2014 Annual Report Data which includes data on the size and scope of the continuing medical education (CME) enterprise nationwide.

In looking at the trends from 2007-2014, the report shows:

*In the last year, the CME Economy grew by 4.9%, by $124,945,126, to $2,668,123,727. However, in seven years since the market crash, CME is still 1.7% below the peak revenue from 2007.

*Commercial support for CME increased by 2.4%, by $15,959,275, to $675,912,838 ending seven years of decline. This is a 45.9% total drop in commercial support since 2007. Commercial support now represents 25.3% of the total CME funding, down from 46.5% of total funding in 2007, and slightly down from 25.8% last year. Thus, while funding slightly increased, the percentage went down in the last year.      

*Physician attendance decreased -1.2%, by -165,209 attendees, to 13,599,687. Non-Physician attendance, on the other hand, increased 6%, by 658,301 attendees, to 11,587,518.

*The majority of CME activities (59%) did not receive commercial support.

*33.7% of physicians attended regularly scheduled events such as grand rounds, followed by 31.9% who received credit for internet enduring materials, 14.8% for courses, and 8.5% for Journal CME.

*The cost per learner in CME programs varied widely, from $37 for hospital physicians to $236 for physician membership organizations.

*Physicians' attendance in CME provided by publishing and education companies represented 27% of all participants, followed by Hospitals at 22.9%, Universities at 22.6%, and Associations with 22% of the attendees.

*The data shows that there are more than 1,900 accredited CME providers across the country that offered more than 147,000 activities in 2014, a 6.4% increase from 2013. Accredited CME providers report that their 2014 activities educated more than 25 million participants including nearly 14 million physicians and nearly 12 million non-physician health care professionals.

In addition, the 2014 Annual Report Data features separate data sets about the CME delivered by ACCME-accredited providers and by state-accredited providers, offering an overview of the CME system at both the national and state levels.

The ACCME directly accredits providers that offer CME primarily to national or international audiences of physicians and other healthcare professionals. The ACCME also recognizes state and territory medical societies as accreditors for providers that offer CME primarily to learners from their state or contiguous states. All accredited providers within the ACCME accreditation system are held to the same high standards and are required to report information about their programs that the ACCME collects and analyzes in order to produce annual report data.

Physician v. Non-Physician attendees:

This chart shows the trend that while less physicians are attending CME activities, the last few years have seen a noticeable increase in non-physician attendees. Physician attendance decreased by 165,209 attendees to 13,599,687 in 2014. Physician participants still occupy a greater percentage of attendees, but the gap is narrowing.

Total CME Income by Source and Year 2007-2014:

The 2014 Annual Report Data includes an overview of commercial support received by ACCME-accredited providers. The data shows commercial support distribution by numbers and types of activities, hours of instruction, and participants. The ACCME is able to publish this commercial support overview because of the Program and Activity Reporting System (PARS). Launched in 2010, PARS is a Web-based portal designed to centralize and streamline the collection, management, and analysis of program and activity data from accredited CME providers. The structure of PARS and the CME community's adoption of PARS enable the ACCME to produce new information.

The 2014 Annual Report Data marks the 16th year the ACCME has been collecting, analyzing, and publishing information about accredited providers, and offers more than a decade-long perspective on the evolution of the ACCME accreditation system. 

The total income of the CME industry increased by $124,945,126, or 4.9%, to $2,668,123,727 between 2013 and 2014. The total income has decreased by -$16,998,570, or -0.6% since 2007.

Commercial support of CME increased in terms of dollar value, but decreased in terms of percentage of the total industry. Commercial support increased from $659,953,563 in 2013 to $675,912,838 in 2014, falling for 25.9% of the total to 25.3% of the total. The amount of commercial support in 2014 is a 45.9% reduction since 2007, from $1,248,924,872 down to $675,912,838.

Making up for some of this lost income over time, however, were increases in Advertising/Exhibits (4.2% in 2014 and 24.7% since 2007) and "Other Income," (6.1% in 2014 and 42.2% since 2007). Other income accounts for 62% or $1,637,853,145 of the total. According to the ACCME, "Other income" represents income other than commercial support and advertising and exhibits income; for instance, participant registration fees, government funding, and allocations from a provider's parent organization or other internal departments.   

CME Income Sources Since 2007

Commercial support now represents only 25% of the total CME enterprise, a 2.4% increase since 2013, a -47% decline since 2007.  The rate of decline has fallen, but that may be due to the economy finally getting better. "Other Income" now represents 62% of the total revenue for accredited CME providers. Advertising and exhibits share has increased over time but not by very much.  

CME Income By Type of Organization:

There are wide variations in the changes to CME income by provider type.  Publishing and education companies saw their revenue increase by 13.6%, Government had a 15.2% increase.

 Publishing and Medical Education Companies

Total income increased 13.6% for publishing and medical education companies. However, total income since 2007 has decreased -9.9%. For publishers, commercial support increased 8.8% in 2014, which is up from 2013's increase of 5.3%. However, as a percentage of the total, commercial support is down to its lowest percentage, 41.6%--down 1.8% from last year and down from 71.5% in 2007.  The overall decline of commercial support going to publishers is -47.6% since 2007. The income has increased dramatically in advertising and exhibits (22.8% in 2014) and seen a significant increase in "other income" (16.9% in 2014). 

27.3% of CME activities taken by physicians were provided by Publisher/MEC's. 

Medical Schools:

For schools of medicine (universities), total income decreased -1.2%.

Commercial support decreased by -4.6%, a difference from the year before which saw growth of 2.4% in 2013 and a -36.1% decline since 2007.

In the category of "other income" medical schools saw a decrease of -1.6% in 2014.  Exhibits increased 23.4%.

Schools of Medicine delivered most of their programming via courses, regularly scheduled series, and internet enduring materials. The vast majority of the physicians participating in CME associated with schools of medicine did so in regularly scheduled series.

Associations and Nonprofits:

For Nonprofits (physician membership organizations and other nonprofits), total increased 4% vs 2013, which saw a -0.3% decrease, and has increased 12.3% since 2007. Commercial support increased 6.9% in 2014, and has declined -46.2% since 2007.

The main physician participants in CME activities offered by associations includes internet enduring, journal CME and live courses.

Physician Participation by Activity Type:

The grand total types of activities supported directly by accredited CME providers are broken down below:

  • Courses: 71,047 activities, with 406,740 hours of instruction and 2,017,323 physician participants
  • Regularly scheduled series: 23,427 activities, with 488,230 hours of instruction and 4,592,819 physician participants
  • Internet (enduring materials): 34,006 activities, with 65,178 hours of instruction, and 4,338,342 physician participants
  • Enduring materials (other): 8,452 activities, with 46,027 hours of instruction and 1,129,995 total physician participants
  • Journal CME: 6,996 activities and 1,162,319 physician participants

Activities by Organization

The total numbers of directly sponsored activities based on type of CME provider and the top three formats of CME offered are as follows:

  • Hospital/health care delivery system: 48,514 activities. Courses (27,851); Regularly scheduled series (14,361); internet (enduring materials) (3,227)
  • School of medicine: 28,672 activities. Courses (10,996); Regularly scheduled series (7,809); internet (enduring materials) (8,582)
  • Publishing/education company: 24,070 activities. Courses (4,780); internet (enduring materials) (13,757); enduring materials other (4,204). journal CME (664)
  • Nonprofit (physician membership organization): 26,673 activities. Courses (15,376); internet (enduring materials) (5,529); journal CME 3,313; enduring materials (other) (1,287)
  • Government or Military: 8,481 activities. Courses (5,549).
  •  

 Total Hours of Instruction 2007-2014:

Overall there were over 1,033,615 hours of CME content delivered. Regularly scheduled series offered the most total hours of instruction for directly supported CME (488,230); followed by courses (406,740); and internet, enduring materials (65,178); and enduring other (46,027).

CME Provider Breakdown by Hours:

  • Hospital/health care delivery system: 360,445 hours; most hours are Regularly scheduled series (236,906)
  • School of medicine: 339,196 hours; most hours Regularly scheduled series (225,317)
  • Nonprofit (physician membership organization): 142,983 hours; and the most hours were for courses (95,044)
  • Publishing/education company: 84,383 hours; most hours courses (34,473); internet (enduring materials) (22,312); enduring materials (other) (21,737)
  • Government or Military: 57,530 hours; most hours courses (43,151)
  • Non-profit (other) 29,238 – most hours courses (19,053)

Total CME Physician Participants by Provider Types:

Below is the number of total physician participants attending CME programs based on the provider of the CME.  

Overall, publishing/education companies have the most physician participants (3,717,507) followed by:

  • School of medicine: 3,084,294
  • Hospital/health care delivery system: 3,125,707
  • Nonprofit (physician membership organization): 3,002,062
  • Non-profit (other): 261,724
  • Insurance company/managed care company: 111,929
  • Government or Military: 172,600
  • Other: 261,724
  • Publishing/education company3,717,507 participants; most participants: internet (enduring materials) (2,399,891); enduring materials (other) 754,613; courses (182,031).
  • Hospital/health care delivery system: 3,125,707 participants; most participants: Regularly scheduled series (2,247,159); courses (519,230); internet (enduring materials) (193,234).
  • School of medicine: 3,084,294 participants; most participants Regularly scheduled series (2,132,865); internet (enduring materials) (524,326); courses (360,556)
  • Nonprofit (physician membership organization): 3,002,062 participants; most participants internet (enduring materials) 958,910 followed by journal CME (891,084); live courses (791,265).

Cost Per Learner:

In 2014, the cost per learner in CME programs varied widely, from $37 for hospital physicians to $236 for Nonprofit physician membership participants. 

Conclusion

The CME Economy is slowly coming back from the big drop with the stock market crash. New innovations and a stronger focus on outcomes are driving important CME programs.  Unfortunately, accounting for inflation, the data should actually be considered a larger drop than the numbers reflect.

There are bright spots with some sectors growing, but at this point the CME enterprise is growing at the same rate, roughly 4%, as the overall economy.

June 08, 2015

Communicating the Value of Accredited Continuing Medical Education

ACCME

Graham McMahon, who began his tenure as President and Chief Executive Officer of the Accreditation Council for Continuing Medical Education (ACCME) last month, announced a new resource that CME providers and other stakeholders can use and distribute to communicate the value of accredited CME. “The resource describes how accredited CME promotes engagement with healthcare professionals by providing them with opportunities for relevant, practice-based, independent education and improvement in a system that meets their needs, and promotes quality in patient care,” he states. The document includes facts about CME’s effectiveness, independence, and responsiveness to the evolving healthcare environment.

View the resource here: The Value of Accredited Continuing Medical Education

The document consolidates much of the reports, research, and policies that the ACCME has articulated in the past few years.  

First, research shows that CME has a positive impact on physician learning, performance, and patient outcomes, notes the ACCME, which provides a link to a comprehensive study released last year that convincingly demonstrates the impact of CME on physician performance. The research also demonstrated that “CME is most effective if it is founded on practice-based needs assessment and is ongoing, interactive, and focused on outcomes that are considered important by physicians.”

The ACCME then outlines how CME promotes physician learning and improved outcomes:

  • Each CME activity is designed to meet the practice-based educational needs of the learners.
  • Each CME activity addresses one or more of the professional competencies established by the Accreditation Council for Graduate Medical Education (ACGME)/American Board of Medical Specialties (ABMS), Institute of Medicine (IOM), or Interprofessional Education Collaborative (IPEC).
  • Each CME activity must be designed to change competence, performance, or patient outcomes. CME providers are then required to analyze the changes achieved as a result of the activities.
  • Almost 100% of activities are designed to change competence. More than 50% are designed to change performance. More than 20% are designed to change patient outcomes.
  • More than two-thirds of accredited CME programs demonstrate that they integrate CME into the process for improving professional practice.  
  • About two-thirds of accredited CME programs demonstrate that they participate within an institutional or system framework for quality improvement.
  • With 140,000 activities comprising one million hours of instruction delivered annually, accredited CME offers an array of resources to promote quality, safety, and the evolution of medical care

ACCME also describes how CME can be delivered in flexible and diverse formats in order to meet the needs of individual learners. “Accredited CME offers multimodal educational opportunities” including “simulation, online courses, self-directed performance improvement projects, participatory group learning, hands-on training, and just-in-time learning at the patient's bedside,” they state. The ACCME allows for providers to choose the format the best meets their objectives and notes “[a]ll activity formats (eg, didactic, small group, interactive, hands-on skills labs) are perfectly acceptable and must be chosen based on what the provider hopes to achieve with respect to change in competence, performance, and/or patient outcomes.”

The ACCME next identifies the “perception versus reality” of industry-funded CME. “The hallmark of accredited CME is its independence from commercial influence and bias,” they state. The resource outlines a number of important facts about industry funding of continuing medical education:

  • Most CME revenue is not derived from commercial support. Commercial support accounted for 26% of revenue in the accredited CME system in 2013.
  • The majority of CME activities (83%), accounting for 80% of participants, do not receive commercial support.
  • Since 2010, the first year the ACCME presented data about commercial support at the activity level, the percentage of activities receiving commercial support has decreased 3%.
  • The ACCME Standards for Commercial Support have evolved into a common interprofessional standard shared by continuing education accreditors across the health professions. The value of the Standards has been recognized by government, regulators, and industry.
  • Research has demonstrated that commercial support does not increase the risk for commercial bias when CME providers abide by the ACCME Standards for Commercial Support. (see the report entitled “Is There A Relationship between Commercial Support and Bias in Continuing Medical Education Activities? An Updated Literature Review”)

The ACCME also outlines how accredited CME has contributed to public health initiatives. They indicate that the recognition that accredited CME is independent of commercial bias “has enabled public health collaborations that include commercially supported CME.”

For example, the Food and Drug Administration (FDA) mandated that industry fund accredited CE about safety and risk issues involved in prescribing opioid medications. The FDA is now considering other ways to work together with the CE community to advance public health, the ACCME states.  The ACCME also provides ongoing support for the initiative led by the National Human Genome Research Institute, National Institutes of Health, to improve the integration of genomics into health professionals’ continuing education and practice. Further, the ACCME convenes Public Health Imperatives Forums at its CME as a Bridge to Quality™ Accreditation Workshops, which bring together government representatives and accredited providers to identify opportunities for CME to be a strategic partner in addressing public health priorities.

The ACCME also “partnered with its colleague accreditors in nursing and pharmacy to create the only interprofessional continuing education (IPCE) unified accreditation program in the world—Joint Accreditation for Interprofessional Continuing Education™,” states the ACCME. “Joint Accreditation offers organizations the opportunity to be simultaneously accredited to provide medicine, pharmacy, and nursing continuing education activities through a single, unified application process, fee structure, and set of accreditation standards.”

Finally, the ACCME resource outlines how they have responded to evolutions in the healthcare community. They include, for example:

  • The Standards for Commercial Support were updated in 2004 to further strengthen the separation of education from promotion.
  • The ACCME has increased accountability and transparency in recent years. The accreditation process was accelerated to ensure more timely and rigorous oversight of issues related to independence. The ACCME published more data about accredited providers, including information about which providers accept commercial support.
  • The ACCME released new accreditation requirements in 2006 to reposition CME as a strategic asset to the quality and safety imperatives of the US healthcare system.
  • The ACCME implemented changes in 2014 to simplify the accreditation requirements and process and offer greater flexibility, while retaining the Plan-Do-Study-Act cycle which is integral to the ACCME’s expectations. These changes reflect the ACCME’s ongoing process of engagement with the CME and stakeholder communities.
  • As part of the ongoing engagement process, the ACCME issued a proposal for new commendation criteria. Developed collaboratively with the CE community, the proposed criteria aim to respond to current and emerging health priorities. The proposed criteria reward CME programs that address the integration of health data, interprofessional collaborative practice, individualized learning activities, and higher levels of outcomes measurement.

 

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