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 did not receive commercial support, including 89% of activities and 59% of providers.

*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.

July 21, 2015

JAMA: Advancing Continuing Medical Education

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In an article issued Online First in The Journal of the American Medical Association (JAMA), the Accreditation Council for Continuing Medical Education (ACCME) authored "Advancing Continuing Medical Education," by Graham McMahon, MD, MMSc, President and CEO of the ACCME. Dr. McMahon articulates the importance of accredited CME in supporting physicians' continuing professional development and the evolving healthcare environment. He explains the evolution of CME over the past 15 years, as increasingly CME has been designed to create meaningful change in healthcare professionals' skills and performance and to affect patient outcomes.

Today, educational partners base activity construction and pedagogy on assessment of needs underlining problems in practice and are required to measure outcomes. However, not all changes are visible to learners. For example, CME is often considered to encompass only lectures and knowledge but now increasingly is designed to improve skills and performance, and many activities aim to specifically affect patient outcomes. Dr. McMahon writes that of the more than 140 000 learning activities offered by accredited organizations each year, approximately 60% are designed to achieve improvements in physician performance, with 40% measured for those changes. Thirty percent are designed to improve patient outcomes; 13% measure those changes.

Stressing the need for independence of content, Dr. McMahon states that resources used to support CME, including commercial support, deserve scrutiny and stewardship so the independence of content from any external support is protected. He cites data from a 2010 report suggesting that physicians perceive low rates of commercial bias in CME and that there is no association between the extent of commercial support and the degree of perceived bias in CME activities. The importance of ensuring that CME activities are free of commercial bias is a critical priority for ACCME and is under continual review. To review accreditation, 3 sources of data—randomly selected activity files, interviews conducted by trained surveyors, and self-study reports—and a complaint process, is employed by the ACCME. However, while the entire medical community needs to take responsibility for preventing and detecting commercial bias, it is imperative that regulation does not impede the rapid dissemination of discovery and research into clinical practice.

Dr. McMahon continues his theme of shared responsibility, outlining that private/public partnerships provide a vehicle for responding to emerging health issues and accelerating research into practice. He cites the FDA's use of accredited continuing education to deliver prescriber education for opioid abuse and the agency is considering other opportunities for collaboration. Providing value is important, and Dr. McMahon calls upon the CME system to highlight "educational deserts" in which important public health issues are receiving inadequate attention.

Describing continuing education accreditors, Dr. McMahon calls them "service organizations," highlighting their mission to reflect and meet the public's needs and maintain the integrity of the system for educational providers and their learners. Accreditors have a role in promoting engagement among stakeholders, such as ACCME's proposed menu of Accreditation with Commendation Criteria. It is designed to respond to emerging issues and award commendation status to CME programs that address the integration of health data, interprofessional collaborative practice, individualized learning activities, CME research, and higher levels of outcomes measurement.

Concluding his article, Dr. McMahon states: "Effective CME programs have the capacity to help physicians and healthcare teams learn how to improve practice and patient care; how to intervene in health behaviors, social and economic factors, and the public's physical environment; and how to improve the health of the nation." Ultimately, this will meaningfully improve health, but it demands the cooperation of educators, health system leaders, and engaged learners.

We are perhaps in the "Golden Age" of CME with the emphasis on education focused on improved patient outcomes and tremendous innovation in the delivery of educational content. It is encouraging that the ACCME along with other stakeholders are speaking up about the tremendous activities that CME providers are producing. It is essential that the contribution that CME makes towards improving healthcare here and around the world is publicized, and it is promising that JAMA and other journals are beginning to take notice.

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