While the slide in the amount of commercial support being provided to accredited continuing medical education continued into its third year with a $25 million drop, other income sources have more than made up the difference. The income for the accredited CME enterprise as a whole was up almost 3 percent from 2009 to 2010, according to the Accreditation Council for Continuing Medical Education’s “2010 Annual Report Data.”  This is good news for the accredited provider community, which had been watching its total incomes drift downward for the past several years. Most recently, an 8 percent decline in 2009 brought total income levels below what they were in 2005.
The report, which the ACCME has published since 1998,  provides an annual snapshot of the U.S. CME enterprise, including CME program revenue, funding, participants, activities, and activity formats. The 2010 report is the first generated using the regulator’s Program and Activity Reporting System, also know as PARS, a centralized Web-based system the ACCME used to collect and manage its accredited providers’ activity and program data.
Other Incomes and Commercial Support: A Reversal of Fortunes
Accredited CME income in 2010 totaled $2.2 billion. Thirty-seven percent ($830 million) of that came from pharmaceutical and medical device industry support. The remaining 63 percent came from sources such as registration fees, advertising, and exhibits. While advertising and exhibit revenues were down 2 percent in 2010 over 2009, “other income,” which includes registration fees—paid for by the docs themselves or their organizations—were up 8 percent, reaching $1.1 billion in 2010.
There is a complete reversal of the commercial support/registration income situation that existed just five years ago, as Thomas Sullivan, president and founder of medical education company Rockpointe, points out on the Policy and Medicine  blog. In 2006, commercial support accounted for 51 percent of CME revenues and other income made up 39 percent. Now commercial support makes up 37 percent of the total and other income such as registration fees constitute 51 percent. Expenses for accredited CME providers also were up slightly, to approximately $1.8 billion.
While the report does not track what is causing the continuing decreases in commercial support, it may be due to the increasing number of state and federal pharma marketing laws, unflattering media attention on pharma/physician collaborations, and pharma budgets that are shrinking overall due to economic issues, drugs coming off patent, and other changes in companies’ specific market niches.
Providers, Activities Down, Participants Up
The number of accredited providers tracked in the report also continues to shrink. The 2010 report tracked data from 694 ACCME-accredited providers, a decrease from 2009’s 707 accredited providers, which in turn was a tumble from 725 in 2008. It is unclear whether the drop in commercial support is behind the decrease, or whether it is due to the overall contraction of the U.S. economy, or if other factors may be causing some to close up their accredited CME shops.
Not surprisingly, given the shrinkage in the number of providers, the number of activities held in 2010 was also down. Accredited providers reported holding 82,000 activities in 2010, which is 14 percent fewer than in 2009. This continues a downward trend that began in 2007 when the number of activities offered by accredited providers peaked at 113,000. There was a concomitant 4 percent drop in the hours of instruction offered in 2010.
While the number of activities may be decreasing, physician participation was up 6 percent. And the push toward team-based learning seems to be paying off as well: Almost 8 million of the 19 million activity participants in 2010 were non-physicians, which was an almost 16 percent increase over 2009.
Publishing/education companies reported the highest non-physician participation, with almost 4 million pharmacists, nurses, and other healthcare professionals taking part in their activities in 2010. Next most popular provider type with the non-doc crowd were medical schools, followed by nonprofit physician membership organizations.
Online enduring materials held the biggest draw for physicians, who got 40 percent of their CME credits for archived courses; the other top activity types in 2010 were regularly scheduled series, courses, and non-Internet–based enduring materials. While performance improvement CME gained some traction with physicians (and in fact doubled since 2009), still fewer than 1 percent of CME learners—just shy of 30,000 docs—participated in PI CME in 2010.
Dividing the Commercial Support Pie
Medical education companies retained their spot at the top of commercial support recipients, but it’s not as cushy a position as it once was. The amount of commercial support they received dove 25 percent in 2010, meaning they got $93 million less from industry than just the year before. And 2009 was no picnic either; their commercial support levels dropped 21 percent that year. Unlike other provider types, MECs couldn’t recoup that level of loss through other revenue sources and saw their total income drop by 13 percent in 2010 over 2009, to $525 million.
Medical societies and associations were a bit more fortunate, with a 6 percent increase in total income to reach more than $887 million. While medical associations lost more than 3 percent of their commercial support between 2009 and 2010, and exhibit and advertising income also was down, these types of organizations got an almost 13 percent bump in that “other income” category that includes registration fees, putting an additional $58 million into their coffers. Other nonprofits didn’t fare quite so well, with a 12 percent drop in total income to almost $125 million that was brought on by decreases across the revenue board, most strikingly in a 55 percent decrease in income from exhibits and advertising.
Hospital and healthcare delivery systems were big winners in 2010, with a 13 percent bump in total income, derived from a 12 percent increase in commercial support, a 10 percent increase in advertising and exhibits, and a more-than 14 percent increase in other income. Medical schools did well, too. In addition to making an extra $17 million in registration fees and other income—a 10 percent jump from 2009—universities also scored $20 million more in commercial support in 2010 over 2009, a 9 percent increase. This brought their total revenues up more than 9 percent over 2009, to $434 million.
The report also included a snapshot of the size of the state-accredited provider community, which in 2010 numbered 1,450, down from 1,518 in 2009. Commercial support among these providers dropped 26 percent; combined commercial support, advertising/exhibits, and other income for this group dropped 5 percent. The report mentions that steady decline in the number of state-accredited providers may be due in some cases to providers choosing to let their accreditation lapse and instead partner with accredited providers.
Commercial Support Drops Again in 2009