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Alliance meeting day 2: PACME dialogue

This free-for-all, no-holds-barred CME provider/industry dialogue, led by Maureen Doyle-Scharff of Abbott Laboratories and Mike Saxton with Wyeth Pharmaceuticals was pretty lively, to say the least. It was pretty much all a back-and-forth between the pharma and CME people in the audience, so I'll just do my notes up as a Q&A (there sometimes were several A's to each Q). Here goes:

Q: As companies move to online systems, some have also gone to an online contract. According to the Standards, we need an actual signed contract, not a virtual one. Is pharma working with ACCME on this?

A: The short answer is "no." You'll get a different answer from every company in this room. The dialogue is only happening on an individual basis, and at this meeting.

A: The closest thing to it is the Task Force (on CME collaboration), which has asked if we can be on the same page with some of the basic documents. Keep in mind that these online systems were built based on compliance [with OIG and PhRMA] compliance only, not ACCME regs.

Q: What can a CME provider do to make their application stand apart from all the other proposals in the Web-based system?

A: Quality, basically. Outcomes, needs assessment, objectives, methods. Another fundamental is that it's aligned with our research interests.

A: We expect to get between 10,000 and 24,000 proposals this year. Short is good. Needs assessments are very important, too. The main reason we turn grants down are that they just present a need for a lump sum and don't break it down into what will be spent for each faculty, for example. Also, we don't give grants if meals are over $100 per person.

A: Don't ask for meals, just educational expenses.

Q: The online forms are mainly geared toward live meetings, which makes it next to impossible to find the right fields for enduring materials or Internet activities.

A: Every week we have meetings on what we need to change. Give us some time; we're still working it out.

Q: Are there limits on grant size that can go through an online system?

A: Our Web site is for smaller proposals; anything over $50,000 is given to managers to handle.

A: For us, it's anything over $10,000.

Q: Is there any value in putting in a $9,999 request, then, to keep it under the threshold?

A: We see more of the opposite: If you have a proposal for $12,000, we may ask you to push it down to $10,000 to get it through faster. If it has to go to a manager, then to a committee, it will take longer.

Q: A lot of times we ask for $10,000, and they come back with, "we'll give you $5,000." Also, it's hard to find the right Web site. Is there some way to find the right place to go?

A: Both the Alliance and the Task Fore are talking about developing common letters of agreement, which I don't see happening. More likely, they'll publish a guide to the right place to go. It's one way to help you sort through the clutter. Cojmjpanies will have to wade through a lot of red tape, but I'm dedicated to making it happen this year. But it won't be comprehensive, because some companies won't agree to do it.

A: Call PACME members directly. They'll help you if they can.

Q: Is there any hope for a topic that's not product-related to get funded? Like medical ethics? If so, who would fund that?

A: Merck. There's a list of "other" topics they're willing to support on their Web site.

A: Does industry view this as a charitable contribution or as a return on education? We fund a lot of charitable contributions, and that might be one of them. But keep in mind that charitable contributions are only maybe 3 percent of our budget. The bulk of the money will always be evidence-based medicine areas related to our product areas.

A: We stick to areas of educational interest. There are broad interests, sometimes, like multicultural disparities, that we can support. What trips us up are topics related to practice management—we're uncomfortable going in that arena.

A: Nontraditional topics may still have value to us. But you need to do more primary research during the needs assessment.

Q from pharma: We don't have an online grant process yet, but we will by the end of the year. Could you give us the five things we need to keep in mind as we build that system?

A: Logical budget item entry.

A: Entries that allow enough characters in the field, or the ability to upload.

A: Flexibility in allowing providers to propose programs other than live events.

A: Make it stable (BIG applause on this one).

A: Make it saveable, and don't let it time out on you.

A: List the company's main research areas that are open to funding at the present time.

A: Ability to upload budget, agenda, needs assessment, etc., so we don't have to re-input it all.

A: Save some of the basic information in the template so I don't have to re-input it every time. Also, give us some idea of whether it actually went through and where it is in the process. Also, why a grant was rejected (pharma replied that that's not going to happen, due to the sheer volume of requests they get).

A: A phone number to call for troubleshooting (one pharma person said, "I didn't understand when I was a provider how much money it costs us to give away money. I would have to hire five more people to answer all those calls if we installed an 800 number).

Q: We have heard that some field-based personnel are coaching some providers on how to get a few steps up on the online process. Is this going to continue?

A: This shows there's still a need for compliance training. Alert the company when something like this happens.

A: We would want to know if there was any coaching going on.

Q: I want to know about location. One of our hospitals is in the Florida keys, and they want to have the CME in their own backyards, not to have to travel to the mainland for it. It's totally unfair that I get penalized for living in a beautiful place.

A: I would document your reality, in detail, in your grant request.

A: The tendency is to see "resort" and "Keys" and turn it down. Show how it's an appropriate exception.

A: If you were in Iowa (not to pick on Iowa) and wanted it to be in the Keys, we would get nervous. For people in that circumstance, I would suggest restructuring your meeting so instead of having a five-day, four-hour/day meeting, have a two-day intensive on Thursday and Friday, and let them do the weekend on their own.

Q: We go to a nice place, but we go off-season, and we go all day long, every day.

A: Remember that it's about perception, not actual costs. That's why any application with "resort" in it will be kicked out. I don't care if you got a $59 room rate and you went 24/7. All that would get printed in the paper is that you went to a resort. Some brand hotels are off-limits, period. It's all about perception.

Q from pharma: We've been talking for almost an hour now, and it's all been about money. We get tired of being your money pit. Isn't there anything else you want to ask us about?

Q from CME: What market research can pharma give us that we can use for our needs assessment?

A: We couldn't provide any.

A: As a provider, I remember drooling over that data. But our lawyers won't let you have 95 percent of it. But ask anyway, because we want to show our lawyers that it's important to share it, as long as it's done right.

A: The amount of time it would take to go through all the data would prohibit this, since we can't share anything that's product-related, which most of it is, and rightfully so.

A: Find the info that's published in clinical trials. You're supposed to come up with an independent needs assessment.

We ran out of time at this point, but tomorrow (Saturday) there's another three-plus-hour session on this kind of stuff that I plan to attend, so more is on the way (I feel like the pharma queen at this conference—for some reason, I'm going to all the pharma-focused sessions. But that's OK, because they get pretty rowdy.)

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