While few would argue with the objective—keeping continuing medical education (CME) free of undue influence from drug companies—today’s increasingly regulatory atmosphere surrounding healthcare meetings is proving to be a hard pill for many planners to swallow.
The pressure to work under tight budget restraints, go over program content with a fine-tooth comb, plough through increased paperwork, and, above all, avoid any appearance of frivolity, lavish spending and general impropriety are just some of the challenges.
“The regulations and red tape are continuously becoming more stringent,” says Hannah Greenberg, director of conference services for Meeting Mavericks, a Voorhees, N.J., firm with a CME focus. “It means a lot more education on our part—of speakers, sponsors, attendees, and, most of all, our staff. And there’s a terrific amount of documentation to deal with these days.”
Also noting the lengthening paper trail is Catherine Chaulet, senior vice president of events for Best of Boston, a Boston-based DMC that has implemented reporting services to assist its medical meetings clients.
“Medical meetings are a huge challenge—not just organizing the meeting, but having all the reporting in place that is needed to comply with the regulations,” she says. “A lot of investment and training has gone into this on our part.”
Growing Scrutiny
Although state and federal scrutiny is nothing new to the CME industry, a report issued last year by the U.S. Senate Committee on Finance revealed that concern over the role played by pharmaceutical companies in CME programs has not abated in Washington. The committee launched a probe into the practices of major drug firms and looked into records kept by the American Council for Continuing Medical Education (ACCME).
The report stated that “ACCME records reveal numerous cases over the past three years in which [drug] companies had too much influence over the content of supposedly independent educational programs. In one case, a CME provider was cited for allowing a company to help select presenters; in another, the company allegedly influenced the setting and frequency of educational events.”
When unveiling the report at a press conference, committee chairman Max Baucus (D-Mont.) declared that “medical education funded by drug companies has to be real education, not a soft sell designed to skew treatment decisions.”
Quick to respond, ACCME announced it is adopting new, stricter accreditation criteria for medical education, set to go in effect this November, to ensure that CME is based on valid, independent content.
According to Greenberg, the complete elimination of drug company sponsorship at CME meetings has been discussed at recent industry conferences as perhaps the only way to keep CME completely independent. She believes it is highly unlikely to happen.
“Pharmaceutical companies underwrite a lot of the cost of events, so the cost without them would be prohibitive,” she says. “We’d have to charge the attendees so much that they couldn’t afford to come. So the best we can do is strive for balance.”
Making sure that everyone involved in the meeting is free of bias extends to such details as scrutinizing the content of speakers’ presentations and their affiliations.
“We send a list to speakers about what they can and cannot speak about and we also ask if they have any affiliation with any of the [drug] companies at the meeting,” Greenberg says. “Some have had to cancel because of this.”
Meeting Mavericks has also taken the step of putting guideline information into a syllabus that is distributed to doctors attending each meeting.
“For example, there is information on what’s not okay in terms of gifts and rewards from pharmaceutical companies,” Greenberg says. “For instance, it’s not okay for a pharma company to take you on a golf outing.”
No Funding?
As the ultimate remedy for biased content at CME meetings, the complete elimination of drug company sponsorship at CME meetings has been discussed at recent industry conferences. And a recent report issued by the Josiah Macy, Jr. Foundation, a philanthropic organization devoted to healthcare education, advises that “commercial entities that manufacture and sell healthcare products should not provide financial support” for CME meetings.
Both Greenberg and Concklin believe the loss of drug company financial support is an extreme measure that would do more harm than good.
“Pharmaceutical companies underwrite a lot of the cost of events, so the cost without them would make it prohibitive for healthcare professionals to attend,” Greenberg says. “We’d have to charge the attendees so much that they couldn’t afford to come. So the best we can do is strive for balance.”
While Concklin recognizes the need to avoid conflicts of interest, she is also concerned about the future of CME programs, given the growing possibility that drug company support could be curtailed. Because CME programs are often a necessity for healthcare professionals, Concklin fears some would be forced to attend inferior programs.
“I would hate to think that we would face a tiered approach in the quality of CME programs, with some costing less and offering a poorer product, but being attended because of the financial burden being placed on the attendee,” she says.
Perception Perimeters
For planners, the era of scrutiny is posing challenges related to both compliance and the perception of compliance. Such a climate means not only choosing a hotel for its value, but for its image.
“Perception is everything these days, even when it leads to decisions that might not be best for the budget,” says Carol Krugman, a meeting planner who has specialized in the healthcare field for over 25 years and currently director of client services for George P. Johnson Co. in Boston. “I know of a medical organization that wanted to hold satellite meetings in Orlando during a big convention. Although the Ritz-Carlton offered the best rates, they could not use the hotel because of the name.”
James Montague, chairman of Professional Meeting Planners Network, a Durham, N.C.-based organization that is launching a certification program for medical meeting planners, also notes the trend.
“I don’t think perception issues will ever go away,” he says. “There continues to be tremendous concern that CME doesn’t get a black eye by being too extravagant. The focus is on keeping education at the forefront. Pharma companies are very sensitive to this.”
Chaulet at Best of Boston notes that perception issues as well as some very real budgetary constraints are dictating every aspect of CME meetings these days.
“In other corporate events, you can blend business and pleasure, but in medical events, you can’t,” she says. “It comes down to using sedans, not limos. The venues have to be at a certain level. Entertainment cannot be over the top. With food, there’s only so much you can spend per head.”
Getting Creative
Despite these constraints, Chaulet says it is still possible to produce an enjoyable meeting.
“While the food cannot be lavish, a good chef can still make it memorable,” she says. “We’ve also seen venues get more creative. They know the restrictions planners are under and are working with us.”
Krugman also observes that a growing number of hotels are adding dedicated sales staff to serve the medical/pharma market and are offering RFP templates designed specifically for their needs.
“In order to keep this business, hotels have had to get creative and proactive,” she says.
Time Challenges
While time constraints are posing challenges for all kinds of meetings these days, they may be especially acute in the healthcare world.
“Managed care has made it more important for doctors to maximize their time—they want to get in and out of the meeting quickly and then back to the office,” says Eric Allen, executive vice president of the Healthcare Convention and Exhibitors Association.
Time constraints are having an enormous impact on where meetings are held and also seem to be leading to more regional events, according to Montague.
“Doctors are looking at more local programs and they want places they can drive to,” he says. “There’s not as much demand for the national programs where you have to be out of the office for several days. We’re also seeing doctors scrutinizing the programs more—time is precious, so they’re pickier about what they choose.”
As a result, site selection has become a matter of looking for convenience and accessibility above other concerns.
“The locations for CME have really changed—resorts and offshore sites are out, while convenient cities are in,” Greenberg says. “We’re looking at airports, cities that are air hubs and major arteries. Places like Atlanta and Charlotte.”
Although meetings are short and content-driven, some are positioned to end on a Saturday so attendees have the option of lengthening their stays, especially if the destination has family appeal.
“We’re seeing more attendees bring their families because, when people are pressed for time, they sometimes like to combine a meeting with a family vacation,” Chaulet says. “We’re planning more spouse tours and kids activities.”
In some cases, time factors are causing smaller medical associations to hold their meetings simultaneously with larger conferences.
“We’ve done this as a way for attendees to get to both conferences,” says MaryAnne Bobrow, head of Bobrow & Associates in Citrus Heights, Calif., who plans meetings for the American Association of Corporate and Public Practice Veterinarians. “The down side to this is that it’s a challenge for attendees to get around to everything. We used to get 150 people at a breakfast, now it’s more like 50,” she adds.
