What (Some) Physicians Think About The Potential Impact Of The Sunshine Act on CME

After last Tuesday’s Twitter chat on the Sunshine Act and CME, there was some interest expressed in surveying physicians and getting their opinion on the issue. I worked with Chris Lamond from the CME Coalition to develop a survey and then crowdsourced it with a number of my CME colleagues (special thanks to John Juchniewicz, Sue Pelletier, Glenn Laudenslager, Beth Brillinger, Regina Motarjeme, and Pam Beaton for their insights, suggestions, and comments!)

The survey was deployed to a panel of physicians by Medical Marketing Service, Inc. (MMS), the “industry leader in message delivery to healthcare professionals via email and direct mail.” You can find them at www.mmslists.com and on Twitter at @mmsemail.

We got 58 responses, the majority of which were from physicians who have been in practice for at least 10 years (68%). Only one responder was not currently practicing. I’m always a little leery of making broad conclusions based on a relatively small sample size, but I do think the results are interesting. It seems pretty clear to me that most physicians (well…most of these physicians, anyway) are not in favor of the increased regulations in CME that would be brought on by the Sunshine Act as currently proposed. Many of the fears and concerns that CME providers have about the Sunshine Act – and written about by groups such as the CME Coalition, ACCME, NAMEC, ACEHP, and others – are well represented by the results of this survey.

But…I’ll let you draw your own conclusions. To the data!

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Have you ever been paid an honorarium for participating as faculty for a CME-certified activity?

• Yes (44%)
• No (55%)

A good split between those who have and those who haven’t received an honorarium. 

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Public disclosure of all financial relationships between physicians and pharmaceutical or device manufacturers is:

• Necessary to ensure the public trust and monitor for potential bias (43%)
• Potentially confusing and misleading if not done carefully (25%)
• Unnecessary: Relationships can be managed without public scrutiny (15%)
• Potentially harmful to collaboration needed for new innovations (15%)

This shows that we don’t have an overwhelming percentage of our respondents already predisposed to being anti-disclosure. In fact, a nice percentage of them appear to be in favor of public disclosure of physician financial relationships with industry. 

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Would you be less likely to participate as a faculty member for a CME activity funded by a grant from a company in the pharmaceutical or device manufacturing industry if you knew your honorarium and travel expenses would be reported to Health & Human Services (HHS) as a direct payment from industry and published for public viewing?

• Yes (45%)
• No (54%)

This is when things start to really get interesting. Just under half of our respondents essentially said that if the Sunshine Act is passed in its current form, they will be less willing to serve as a faculty member for a commercially supported CME activity. That cuts the pool of potential faculty members almost in half. This is one of the major fears of CME providers about the Sunshine Act: losing top-notch presenters because of concerns over increased regulations. Again, this is a small sample size, but still a troubling trend.

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Are you less likely to participate in a CME activity if it is funded  in any part by a grant from industry?

• Yes, I am less likely to participate as a learner (8%)
• Yes, I am less likely to participate as a faculty member or planner (10%)
• Yes, I am less likely to participate in any capacity (15%)
• No (65%)

So, if a CME activity is commercially supported, a quarter of our respondents would be less likely to participate as a faculty member or planner. Add to that the possibility of their expenses being reported to HHS and the public as a direct  payment from industry and the number of those less likely to participate almost doubles. And 2/3rd’s of the respondents don’t give a hoot if it’s commercially supported or not.

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Would you be less likely to attend a CME activity as a learner if the cost of your meal were reported to HHS as a direct payment from industry and published for public viewing?

• Yes (62%)
• No (37%)

Looking at the previous question, at most, 23% of the respondents would be less likely to attend a commercially supported CME activity as a learner. Throw in the potential of their meal expenses being reported to HHS as a direct payment from industry and that number jumps to 62%. That’s quite a hike. So far the trend shows that the Sunshine Act would cause both faculty and learners to be less willing to participate in commercially supported CME. Awesome. (For those of you that may be new to the blog, that “Awesome.” was intended as sarcasm. Just covering my bases here.)

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Do you agree that all DIRECT payments in excess of $10 to physicians from industry should be publicly disclosed?

• Strongly Agree (20%)
• Agree (8%)
• Neutral (12%)
• Disagree (20%)
• Strongly Disagree (37%)

Do you agree that all INDIRECT payments to physicians from industry in excess of $10 should be publicly disclosed? For example, should an honorarium or travel expense reimbursement received by a physician from an accredited CME provider for their role in a grant supported CME activity be publicly disclosed?

• Strongly Agree (15%)
• Agree (8%)
• Neutral (13%)
• Disagree (25%)
• Strongly Disagree (36%)

Quick summary: Respondents were not too thrilled about direct payments from industry to physicians being reported (28% Strongly Agree/Agree; 57% Strongly Disagree/Disagree) and were even less excited about indirect payments (such as those from CME) being reported (23% Strongly Agree/Agree; 61% Strongly Disagree/Disagree)

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Do you believe that classifying CME expenses (honoraria, travel, etc) as direct payments to physicians from industry that will lead to misrepresentations/misinformation regarding the relationship between commercial supporters and CME providers? 

• Strongly Agree (39%)
• Agree (27%)
• Neutral (13%)
• Disagree (12%)
• Strongly Disagree (6%)

63% of respondents believe the Sunshine Act will lead to misrepresentation/misinformation regarding the relationship between commercial supporters and CME providers. That’s bad news considering how misinformed many people already are about the relationship between the two. The last thing we need to do is muddy the waters even more.  

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Do you believe that classification of CME expenses (honoraria, travel, etc) as direct payments to physicians from industry will positively benefit health care? 

• Strongly Agree (10%)
• Agree (6%)
• Neutral (6%)
• Disagree (27%)
• Strongly Disagree (48%)

When it comes right down to it, isn’t this what it’s all about? 75% of respondents believe health care will not benefit. Only 16% believe it will. This sums it up for me pretty well. 

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Below are some of the comments respondents shared. There were too many to include all of them, but some were too good not to share. I’ve tried to give a fair representation of both sides of the issue, but truth be told, the overwhelming majority of comments were very negative towards the regulations included in the Sunshine Act. Some of the comments have a very definite tone of anger to them.

The last thing medical education needs is more rules.

Overall tricky issue. I do believe that industry-sponsored CME activities and the activities that surround them may have inappropriate influence on physicians.  Some are more objective than others. Disclosure is one way of addressing this problem.

I think that it is ridiculous for physicians to have such intense scrutiny and ridiculous regulations when Congress, politicians, and other professionals do not. All of the healthcare providers wish to learn and enhance their knowledge while attending dinner meetings. It is a positive way to network with other such professionals, keep abreast of new developments, and to discuss important topics which positively benefit healthcare. To limit this with increased regulations, etc. would be a tremendous mistake to the welfare of patients who in the end will suffer with physicians who have not cared to keep up with the current trends etc. Dinner, lunch meeting or other such meetings along with pens etc. do not influence physicians who care about patients and have integrity. Additionally, if these regulations occur, you will not get the same quality of speakers and physicians will be afraid to attend thereby limiting their knowledge and interaction with key opinion leaders. The Congress and politicians should first regulate themselves!

Industry’s interest in educating physicians is grounded in a profit motive, which creates an unavoidable and inherent conflict of interest with that of the physician-learner, which is (or should be) grounded in patient outcomes.

It is an insult to my integrity as a physician. It is applicable to a small number of physicians.  For thirty years I have obtained a great deal of my education from Pharmacy supported events and I practice on the basis of evidence, not pens, coffee or a dinner! I teach and present worthwhile information to other physicians made available through Pharmacy grants. It is not abused by me.

As written, and with current oversight agencies as they are, the new regs are/will be counter-productive, burdensome and ultimately cost the general public via cost of drugs and will do nothing to improve the quality of healthcare for the public.

Shrinking reimbursement and escalating malpractice premiums are driving physicians out of this profession.  Publicly disclosing CME activity honorariums and travel stipends will be detrimental.  Leave us alone!

THERE IS NO FREE LUNCH!!

No data has ever shown that disclosure benefits patients of health care.  It will benefit bureaucrats and trial lawyers, however, at an enormous expense to the health care machine which now must direct resources to the gargantuan task of tracking these payments.