I spend a lot of time with continuing medical education providers, but not so much with the meeting planners who make those meetings at which the CME is conducted happen, so it was fascinating to have the chance to sit in on a frank discussion of what their biggest challenges are, and what they are doing to resolve them, as my last session of PCMA 2012.

One thing that seemed to be of huge concern was the idea that exhibitors were going to start asking them to provide physician attendees’ National Provider Identification numbers. Since this is public information, I’m having a hard time understanding why that is the meeting planner’s problem—why can’t the exhibitors just look them up? If someone can explain why this is potentially a big issue for exhibitors, please let me know. I tried to find out from a few folks after the session ended, but everyone was in a rush to leave so I didn’t really get much other than if an exhibitor demands it, it’s their problem. Which I get, but I don’t get why exhibitors would demand this from them. Light-shedding on this would be welcome!

Other big issues were the costs of complying with government regulations and Accreditation Council for CME rules, pressures to find new sources of revenue, building traffic to the exhibition floor, international initiatives (including visa-related challenges), CME credit interchange with other countries, and all the various codes and rules and regulations they are supposed to follow nowadays.

One participant was particularly concerned about the Council of Medical Specialty Societies’ newish ethical code that is designed to limit drug and device company influence over patient care. While similar in many ways to the ACCME’s Standards for Commercial Support, it also prohibits society presidents, CEOs, and editors-in-chief of society journals from having direct financial relationships with relevant for-profit companies in the healthcare sector. One participant said her organization actually had to ask one of its journal editors to resign after her society agreed to abide by the CMSS code.

Sponsorships and exhibit dollars on the decline had most of the crowd at least someone frazzled. As one person said, “With the PhRMA Code, they don’t want to sponsor anything anymore.” Several said their organizations were going the same route as PCMA, offering year-round sponsorships that extend far beyond the meeting rather than providing one-offs on tote bags and banners. (Note: This article offers some good tips on how to get more sponsorship dollars. And here’s another one.) One thing sponsors particularly seem to like, said some participants, is being able to meet with board members and other influential people in the industry at board and other high-level meetings. Some said they give preferential treatment on the show floor to exhibitors that are also in more extensive sponsorship relationships, others said they kept it completely separate.

From what people were saying, I’m not sure they’d buy into this snip of research finding that physicians aren’t eschewing the trade show floor now that the tchotches are out due to PhRMA Code restrictions. It sounds like, for medical meetings as for other types of association conferences, it’s becoming more and more of a push to get people on the show floor and interacting with exhibitors. While product theaters can help, they don’t appear to be a major solution to the exhibition drain problem. As one person said, “The surveys say they value exhibitions, but they don’t go. We give them food, product theaters, we’re even putting the reception on the show floor. Nothing seems to help.”

One said she was going to take the “continue the conversation” idea from PCMA, where a follow-on informal session is held after a keynote so those who want to can dive deeper into the material, only hold it on the show floor. Which is fine, as long as it isn’t for credit, warned another person. Another pointed to a different angle on the problem: Maybe it’s the booths that aren’t so attractive. So that organization offers a consultant who can evaluate exhibitor booths and suggest ways to improve them.

Some said they had added a virtual trade show component as a complement to repurposing educational content from the conference for online distribution, but it didn’t appear that the value was all that high (one said that only 42 percent of virtual attendees visited the virtual exhibit, which I thought actually sounded pretty good. Another said it was more like 25 percent for his group). Streaming the educational session, with or without CME credit attached, live and archived, seemed to be pretty popular among attendees of most of the planners who said they had done it. However, interest dropped off a cliff when members were asked if they would pay for it, one person said (shocking, I know!). Another said she had a good response to charging one fee to get access to all the content, and an additional fee on top of it if they wanted to get CME credit for it.

They didn’t talk a lot about CME educational grants, but one person did point out that, now that pharma budgets for CME grants are shrinking, their ad budgets actually are growing. Accordingly, medical organizations are beginning to put more of their focus on attracting those ad dollars to support the overhead for their meetings.

There was more—a lot more—but I’ll leave this one with two of the wildest promotional ploys I’ve heard of:

One was a company that brought colored chalk and proceeded to draw its logo on the sidewalk in front of the medical conference’s headquarters hotel. Another person told of a company that put its logo on the mainsail of a big sailboat and had it sail up and down the harbor in view of the meeting (I’m not sure if this was in San Diego, but I could see it happening there.)

Note: This is cross-posted at the face2face blog.

A survey conducted by MDlinx earlier this month came up with some shouldn’t-be-unexpected results: That a quarter of the docs surveyed say they’re seeing the quality of their continuing medical education activities decrease as pharma pumps fewer dollars into commercially supporting CME. Two-thirds didn’t notice any change, and a scant 9 percent thought quality was improving, according to an article in Medical Marketing & Media. Most notably on the decline was faculty, they said, though they also said it was harder to find the education they needed, and that they had to pay for more of it themselves.

This quote at the end of the article is really interesting, I thought: [Stephen Smith, chief strategist, MDLinx] called the perceptions of lesser quality an unintended consequence of the increase in regulation on pharmaceutical companies’ communications and their resulting pull-out from CME. “We’ve squeezed everything toward mediocrity to prevent abuses.”

Some pretty big news came out last week while I was in San Diego for our West Coast Life Sciences Meeting Management Forum: The Centers for Medicare & Medicaid Services announced a proposed rule designed to increase public awareness of financial relationships between drug and device manufacturers and certain healthcare providers, as required by the Sunshine Act provision of healthcare reform.

From a pharmaceutical/device meeting manager’s perspective (which I got last week in spades, being surrounded by these good folks), no one seemed to be anticipating it making much of a difference in their lives. The biggest issue for them was CMS’s delaying the collection of data on physician spend from Jan. 1, 2012, until after final regulations are issued.

I heard over and over again that if they weren’t already tracking physician and other healthcare worker spend as a requirement of a corporate integrity agreement, they have been working since healthcare reform passed to get a system up and running. In fact, a survey of the forum’s participants found that 88 percent had a system already to track their spend on physicians and other healthcare professionals, and 76 percent were either already testing their system or were confident that their system was ready to roll with the new year.

But that’s about as far as I’ve had time to get with CMS’ announcement. I’m not sure whether it’s a blessing (so thankful someone’s keeping on top of all this!) or a curse (ain’t no way I can keep up with the flow of information the dude puts out, much less beat him to the punch, so I have to live with being continually scooped!), but Tom Sullivan has been churning and burning all this up on his Policy and Medicine blog. Keep in mind that he comes at it from a pro-collaboration perspective, but he provides a great overview of possible affects this announcement could have on the CME community. Some posts to check out:

Physician Payment Sunshine Act: CMS Proposed Rule - Impact on Continuing Medical Education, Medical Societies and Patient Organizations

Physician Payment Sunshine Act: CMS Proposed Regulations — Public Posting, Data Submission and Correction

Physician Payment Sunshine Act: CMS Proposed Regulations Delayed Reporting for Clinical Trials, Penalties and Preemption

Physician Payment Sunshine Act: CMS Proposed Regulations – The Cost for Sunshine

Physician Payment Sunshine Act: CMS Proposed Rule Overview

Physician Payment Sunshine Act: CMS Releases Proposed Regulations

Update:Daniel Carlat, MD, has a different take on how the new rules could affect CME (namely, he’s ecstatic that the language could include faculty honoraria in reportable income) on his Carlat Psychiatry blog.

Pfizer recently reorganized its Medical Education Group in a pretty dramatic way, including moving 90 percent of its budget into a request-for-proposal model, rather than one based on unsolicited grant requests (here’s a fairly thorough run-down of the changes). Another big change is that the model is no longer going to be CME-centric; CME, accredited or not, may not get a very big piece of the Pfizer pie moving forward. While MEG leader Maureen Doyle-Scharff tells me that this is actually an opportunity for CME providers to prove their relevance to the big performance-improvement picture, I’m not so sure everyone would agree.

First GlaxoSmithKline limited the possible field of contenders to just 20, then Pfizer decided to eliminate medical education companies from their grantee mix, and now this. Like it or not, the grant-making models are changing.

What do you think of the evolution of commercial support models? How have these changes affected the CME community? What else do you think will be coming down the pike? (If you don’t want to leave a comment below, please e-mail me at spelletier@meetingsnet.com. I really want to know what people think about all this.)

From this article in the British Medical Journal, it sounds like AstraZeneca’s announcement that it will no longer pay for doctors to attend international conferences was part of a larger movement toward rethinking physician/industry relationships in Europe.

Key quote: “’I think sunshine in Europe is both desirable and inevitable,’ says Richard Bergstrom, head of the European Federation of Pharmaceutical Industries and Associations, the Brussels based industry trade body that represents companies across the EU. But he stresses the need to take into account the varied approaches and interactions between doctors and companies in different countries.”

Pharmaceutical Meeting Management Forum 2012

March 2012

Call for Presentations

Submission deadline: August 1, 2011

The Center for Business Intelligence and Medical Meetings are now accepting submissions for new workshops and sessions for the 8th Annual Pharmaceutical Meeting Management Forum, March 2012 on the East Coast. Do you have an idea for a session that would help pharmaceutical, biotech, and medical device meeting professionals, independent meeting management company personnel, and suppliers to the medical meetings industry better comply with relevant regulations or help them meet the other challenges they face? To be considered, the session must be free of commercial content and specific product endorsements.

Please include in your proposal the session’s goal or objective, primary audience, title, presenter names and bios, preferred format and length, and a 50-word description with three learner outcomes.

Submit your proposals to Brendan Emerson by August 1, 2012.

I can hear the moans now: The American Medical Association’s House of Delegates has finally approved the latest of its Council on Ethical and Judicial Affairs many versions of proposed recommendations around commercial support and CME. Sigh. I’m with our MM columnist Stephen Lewis on this one: CEJA just officially turned itself into an oxymoron. Never mind what the Alliance for CME thinks, or what I would guess would be the opinion of vast majority of CME providers who actually do this stuff day in and day out.

No, this must mean that at least some of the greater minds at the AMA HOD think it’s a good idea to ignore current safeguards and react to the potential for the perception of some possible problem, rather than base actions on evidence and data.

“We have decided that we will no longer pay for doctors to attend international scientific and medical congresses but will instead focus our educational efforts on local educational opportunities for healthcare professionals,” said AstraZeneca chief executive David Brennan at a conference in Istanbul in May, according to a Reuters report. This makes the drug firm the first to drop the practice of financially assisting foreign physicians who want to attend medical congresses outside of their home countries.

The reason Brennan gave for the policy change is that the company wanted to ensure that it didn’t do anything that could be perceived to be a bribe to get an HCP to prescribe its products, according to the article. The pharma industry has been under a lot of scrutiny in recent years, something that has further intensified when it comes to cross-border meetings due to investigations triggered by the U.S. Foreign Corrupt Practices Act and the U.K.’s new Bribery Act, which is expected to go into effect in July.

Given this environment, Richard Bergstrom, director general of the European Federation of Pharmaceutical Industries and Associations, told Reuters that he anticipates other companies may well follow suit.

What do you think about AstraZenica’s decision to stop funding foreign physician travel to meetings? Will it significantly affect attendance at large U.S.-based meetings? Do you expect other companies will in fact follow suit?

Please leave a comment below, or e-mail some thoughts. I’m thinking that, if a lot of companies do follow AstraZenica’s lead, it could put a world of hurt on some of our large national medical association conferences. Not to mention that it would cut off a fairly major source of education for physicians, especially those who come from countries where CME is not as prevalent or well-policed for bias as it is in the U.S.

It’s mid-May, so it must be time for the latest American Medical Association Council on Ethical and Judicial Affairs report on financial relationships between industry and CME. I’ll leave it to others to weigh in on it at this point (here’s Tom Sullivan’s take) because, quite frankly, I’m getting a little tired of writing about it.

Want some background?

CEJA Report Sent Back Again

CEJA Releases Fourth Funding Report

AMA Again Rejects CEJA Report

CEJA Report Recommedations: Rejected Again

CEJA Report Misses the Mark

CEJA Report: Close, but No Cigar

Etc., etc., etc. Hopefully this time around it won’t be another remake of Groundhog Day.

On a semi-related note, I read an article in The Boston Globe over the weekend that I found both interesting and kind of troubling, seeing as the CME world relies so heavily on disclosure and transparency to manage conflicts of interests. Called Deeply Conflicted, it talks about some recent research that finds that “Coming clean about conflicts of interest … can promote less ethical behavior by advisers. And though most of us assume we’d cast a skeptical eye on advice from a doctor, stockbroker, or politician with a personal stake in our decision, disclosure about conflicts may actually lead us to make worse choices.” As is almost always the case with we humans, it’s more complicated than we’d like to think, though how disclosure works for CME does seem to be the best-case scenario for it being effective (handled by a third party, with discloser and disclosed-to being peers).

Here are two articles you might find interesting:

Doctors Loath to Pay for Unbiased Education: Survey, which tells about the not-so-shocking results of a survey asking docs whether they think commercial support can bias CME (88 percent said yes), and whether they would be willing to pay more to eliminate the need for commercial support (less than half said yes; only 15 percent were willing to get rid of commercial support completely). The study is published in Archives of Internal Medicine, May 9, 2011 (thanks once again to @cmeadvocate for the pointer.)

And ProPublica is at it again: Doctors’ groups welcome medical company dollars, which excoriates the Heart Rhythm society for having sponsors and exhibitors at its conference (as do probably 99 percent of conventions of all types, medical and otherwise). If the Society is doing something wrong, as the article implies, then the tradeshow model as we know it is unethical and needs to change, which I do not believe (though I do believe it likely will be changing in our lifetime for other reasons). Or is it only unethical for medical shows, and okay for everyone else? Seriously, someone explain why this is so heinous, because I don’t get it.