Last month, the Accreditation Council for Continuing Medical Education (ACCME) released its 2010 annual report data. The report provides an in-depth view of the size and scope of the CME enterprise nationwide. The report includes statistics on CME program revenue, funding, numbers of participants and format of educational activities.
In addition to this report, ACCME released an addendum to the ACCME 2010 Annual Report Data, which builds on the information included in the previously published annual reports, from 1998–2010, to provide long-term analysis of trends. In addition, this addendum includes new data.
The 2010 annual report is the first one compiled from data submitted through the Program and Activity Reporting System (PARS), a Web-based portal designed to centralize and streamline the collection, management, and analysis of program and activity data from ACCME-accredited CME providers. The structure of PARS enabled the ACCME to present an overview of the numbers and types of activities that do and do not receive commercial support across the national CME enterprise.
The new data includes analysis of commercial support distribution by activity types, numbers, hours, and participants.
As with the main body of the report, the aggregated information published in this addendum is based upon self-reporting by individual ACCME-accredited providers.
Addendum Information
The newly reported data showed that the number of participants in CME activities has increased steadily over the years. In 2010, there was a 6% increase in physician participants and a 16% increase in nonphysician participants from 2009.
In 2010, the implementation of PARS enabled the ACCME to better ensure that accredited providers submitted data that was consistent with ACCME’s descriptions. This review resulted in significant decreases from the prior year in some activity formats, including:
- Internet enduring materials
- Regularly scheduled series
- Performance improvement and
- Internet searching and learning
The 2010 data also shows a significant decrease in manuscript review activities because the ACCME modified its instructions for reporting those activities in 2010.
The number of ACCME-accredited providers grew steadily until 2007. The ACCME lost 42 national providers (6%) since 2007, including 13 providers (2%) between 2009 and 2010. The number of accredited providers now is at its lowest level since 2002.
Most of the loss has been from the following provider types:
- Nonprofit physician membership organizations,
- Publishing/education companies, and
- Hospital/health care delivery systems.
The numbers of schools of medicine, government/military providers, and insurance/managed-care companies has remained steady, and there has been a slight increase in the number of not classified organizations.
When providers voluntarily withdraw their ACCME accreditation, the ACCME ascertains the reason whenever possible. The most common reason providers give is corporate changes, such as mergers and acquisitions. In addition, smaller providers sometimes withdraw because they have decided to offer CME through partnerships (joint sponsorships) with larger accredited providers. For that reason, the decline does not necessarily represent a reduction in physicians’ access to CME.
According to Medical Marketing and Media state level providers have seen even greater significant losses with 18.7% losses of accredited providers from community hospitals.
CME Income
Total income increased 3% in 2010 from 2009. The balance of revenue has shifted, with commercial support income decreasing and other income increasing. In 2010, other income made up 51% of total income, commercial support 37%, and advertising and exhibits 12%. Other income has increased steadily over the years with an increase of 9 percent in 2010 from 2009.
The majority of providers (78%) received commercial support of $1 million or less each year, with almost half of providers (48%) receiving in $100,000 or less. Less than one quarter of providers (22%) receive more than $1 million per year in commercial support, with the smallest percentage of those ( 2%) with support of $10 million or more.
Regularly scheduled series and Internet enduring materials combined account for 67% of the physician participants and 71% nonphysician participants. Courses, Internet enduring materials, and regularly scheduled series account for the largest percentages of activity types, hours of instruction, and participants.
Courses make up the largest percentage (45%) of CME activity types, and account for 45% of the hours of instruction, but draw only 13% of the physician participants and 15% of the nonphysician participants. In fact, the majority of accredited CME, as measured by activity counts, hours of instruction, or participants takes place outside of courses.
Conversely, regularly scheduled series account for 12% of activities but provide 40% of the hours of instruction and attract 27% of the physician participants and 15% of the nonphysician participants.
Internet enduring materials make up 29% of the activities, but attract the largest share of participants, drawing 40% of the physician participants and 56% of the nonphysician participants.
In 2010, the majority of CME activities (80%) did not receive commercial support, accounting for approximately 80% of physician and nonphysician participants. Twenty percent of CME activities received commercial support, bringing in approximately 20% of participants.
One area of interest was in performance improvement CME. Despite countless hours of instruction on the value of PI CME at educational sessions around the delivery of CME, there is a huge disconnect in the number of actual activities. In 2010 there were 10 PI courses that were supported by industry and 118 that were not. This makes up just .02 percent of the total number of CME activities undertaken in 2010.
Discussion
According to a recent story in Medical Marketing and Media, What we still don’t know is the effect on quality, cautions the Association of Clinical Researchers and Educators (ACRE), a pro-industry group.
“When industry [funds] CME, it has the ability to bring in major, nationally known opinion leaders to a local event or a large regional or national event,” said Michael Weber, MD, professor of medicine at the State University of NY, Downstate College of Medicine.
Weber, who is also a member of ACRE, said attendees of commercially supported CME have the opportunity to hear from leaders in their fields, which plays a role in validating new research and medical breakthroughs.
“We may be losing that kind of activity, as industry reduces support,” he said.
According to the CME Coalition while the Report Addendum highlights a significant increase in the number of medical professionals seeking CME coursework in 2010, it also shows a dramatic decline in the number of CME hours provided over the course of the year.
These data support our members’ observation that while there is increasing demand from the medical professionals for CME, there are diminishing and inadequate resources to meet that need. Underscoring this contention is the fact, as reported in the Report Addendum, that industry support for CME continued on its alarmingly downward trajectory in 2010, which we believe, from reports from our members, will be reflected again in the report next year for 2011.
While non-industry support for CME increased sufficiently to keep CME funding essentially flat for the year, thanks primarily to an increase in advertising and exhibit revenues for live meetings, that may not be sustainable, the increasing budget constraints facing institutions and government agencies makes it unwise for our nation to depend on these sources so disproportionately. A balanced funding environment is the best way to ensure that we are able to meet our health care system’s future CME needs.
It is important to consider that industry support plays a key role in the quality of CME activities. Fortunately, with recently published outcomes studies industry has begun to understand the value this brings to physicians and improvements in patient care.