Physicians Are Perplexed and Outraged
"We're confused and concerned," said Reid B. Blackwelder, MD, a family physician in Kingsport, Tennessee, and President of the American Academy of Family Physicians (AAFP). "We very much support transparency, but we have followed extremely strict guidelines, and there's no influence at all from industry in our CME." Nevertheless, if this change is accepted, he said, "the value of AAFP CME will have to be reported -- not just for speakers, but also for attendees."
As Gregory A. Hood, MD, an internist in Lexington, Kentucky, and member of the Medscape Editorial Board, sees it, "The bureaucrats are making everything as complicated as possible to justify their existence. It's impossible for physicians to know what's right or wrong in this situation. How can they figure out what the value of the CME is? They'll just have to go by what the people registering them at the CME activities tell them."
Doris Greenberg, MD, a developmental-behavioral pediatrician in Savannah, Georgia, has been a CME speaker in the past. "I don't think this exclusion should happen," she said. "I want to be transparent and ethical, and do the right thing. If I'm going to speak, it must be consistent with my belief system. When I've done unrestricted talks, the quality was as good as any that are not corporate sponsored. Never was I fed things to talk about." To Greenberg, the change would mean she won't accept any more CME speaking engagements at industry-supported events. "Anyone would be stupid to do anything to get on that list. I don't want to have my name besmirched in that way."
What impact will the proposed change have on physicians who rely on industry-supported activities for their CME credits? "This is going to take a lot of CME programs away," Greenberg said. "The fact is, many doctors don't have a lot of money, and these CME activities are very helpful. When people realize they're going to have to pay $5000 for a meeting, they won't go," she added. "They'll go online, but they won't learn what they could. Doctors learn a lot from sitting around with other doctors; that's going to disappear."
Greenberg was emphatic: "CME programs should be nonreportable, and the meals shouldn't be reportable either. If I attend a 7:30 AM meeting on depression, I don't think I should be denied my breakfast."
The Brouhaha About the Public Reporting
To Greenberg and others, being tagged with accepting payments (Open Payments) data in the CMS Website is tantamount to having a black mark in the National Practitioners Data Bank. Sunjay R. Devarajan, MD, a third-year resident in internal medicine and pediatrics at Georgetown University Hospital in Washington, DC, sees things differently. "I'm shielded from the process now because I don't yet take CME, but I think transparency is always a good thing -- especially in healthcare, which is too opaque. I personally don't have a problem with what would appear about me online. We should be fighting for more transparency."
Physician groups, such as the AAFP, are encouraging their members to register with the CMS's Open Payments system -- preferably by August 27, 2014, which is the end of the current Review and Dispute Period.[3,4]
Registration is voluntary, but if you don't register, you can't review data that industry may have submitted about you. "If you don't report, you run the risk of erroneous information being out there," said Blackwelder, calling the possibility that CME compensation may be included in the new system "a big mess with no benefit. They're adding additional hurdles with no relationship to CME."
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