CE/CME Financial Relationships Primer

(FKA “Conflict of Interest”)

Why are we interested in Financial Relationships for CE/CME purposes?

• In order to maintain ACCME (Accreditation Council for Continuing Medical Education) and ANCC (American Nurses Credentialing Center) accreditation, our CME and CNE (hereafter CE) activities must be free of commercial influence. The ACCME and ANCC now share the same Standards for Integrity and Independence in Accredited Continuing Education which are designed to ensure that accredited continuing education serves the needs of patients and the public, is based on valid content, and is free from commercial influence. There are two Standards in particular that apply to the work of the committees.

• Standard 2: Prevent Commercial Bias and Marketing in Accredited Continuing Education

• Standard 3: Identify, Mitigate, and Disclose Relevant Financial Relationships

Before we outline those Standards, the following definition is necessary: 

What is an Ineligible Company?

• An ineligible company is any entity whose primary business is producing, marketing, re-selling, or distributing healthcare products used by or on patients. (Examples)

Standard 2 outlines that accredited continuing education must protect learners from commercial bias and marketing, specifically requiring that:

• The accredited provider must ensure that all decisions related to the planning, faculty selection, delivery, and evaluation of accredited education are made without any influence or involvement from the owners and employees of an ineligible company.

• Accredited education must be free of marketing or sales of products or services. Faculty must not actively promote or sell products or services that serve their professional or financial interests during accredited education.

• The accredited provider must not share the names or contact information of learners with any ineligible company or its agents without the explicit consent of the individual learner.

Standard 3: Identify, Mitigate, and Disclose Relevant Financial Relationships outlines the requirements for the collection, review, and mitigation of financial relationships, as well as the disclosure of relevant financial relationships to learners. Many healthcare professionals have financial relationships with ineligible companies. These relationships must not be allowed to influence accredited continuing education. The accredited provider is responsible for identifying relevant financial relationships between individuals in control of educational content and ineligible companies and managing these to ensure they do not introduce commercial bias into the education. Financial relationships of any dollar amount are defined as relevant if the educational content is related to the business lines or products of the ineligible company.

What do we need from you?

• Complete the disclosure when requested by staff by the deadline.

• Ensure that you are disclosing ALL financial relationships with ineligible companies as defined above. Examples of financial relationships include:

  o   Salary

  o   Royalties

  o   Consulting fees

  o   Honoraria for speaking

  o   Payment for serving on advisory boards

  o   Stock/shareholder in public companies (excluding diversified mutual funds)

  o   Equity/ownership interest in private companies (stock options, patent or other intellectual property)

  o   Any other financial benefit

  o   Research funding such as contracted research funding is also considered a financial benefit for the principal or named investigator on the grant.

• Follow instructions from staff as if pertains to “mitigation” of relevant financial relationships – which must be completed before the committee begins planning in earnest.

A simple checklist for a financial relationship

Is there a financial relationship? If you can check all 3 boxes below, you’ve identified a financial relationship with an ineligible company that must be disclosed.

1. Financial relationship between person in control of content and an ineligible company.

2. Any amount ($)

3. In the past 24 months

Determining Relevance to Content

• Based on the disclosure of ALL financial relationships with ineligible companies in the past 24 months.

• Staff at ABA review the disclosed relationships against the person’s role in the accredited education and determine if the relationship with the ineligible company provides opportunity for commercial bias in the activity.

• If yes, then the relationship with the ineligible company is mitigated according to processes appropriate to the role of the person. Mitigation tactics will differ for planners, speakers/faculty, moderators, etc., and may differ for individuals within the same role. 

• If a presenter or planner divests themselves of a financial relationship – or the financial relationship is terminated – we do not need to mitigate for the relationship, BUT it still must be disclosed to the learners for 24 months from the time the relationship ended.

Mitigation of relevant financial relationships (RFR)

Many relevant financial relationships can be mitigated. One or more steps can be taken to mitigate for an RFR:

• The presenter or planner is recused from controlling aspects of planning, content or participating in all parts of the educational activity with which they have an RFR.

• The presenter or planner can revise their role with the ineligible company, so that they are no longer in a situation. (They still must disclose their prior relationship.)

• Not awarding continuing education contact hours for a portion or all the educational activity where there is an RFR. (example: a sponsored symposium)

• Ensuring that the presentation/content is balanced, fair, and that clinical recommendations are evidence-based and free of commercial bias (e.g., peer-reviewed literature, adhering to evidence-based practice guidelines). Do not use trade names or marketing/materials produced by an ineligible company.

• Monitoring the educational activity to evaluate for commercial bias in the presentation.

• Reviewing participant feedback to evaluate for commercial bias in the activity.

Are there any financial relationships that cannot be resolved?

• Owners (ownership interest or equity in a private company that falls under the definition of “ineligible”) and employees of an ineligible company cannot be planners for accredited education.

• Owners and employees of an ineligible company cannot be presenters or speakers for accredited education, unless they meet an exception outlined below. We need to use these exceptions sparingly.

1. When the content of the activity is not related to the business lines or products of their employer/company.

2. When the content of the accredited activity is limited to basic science research, such as pre-clinical research and drug discovery, or the methodologies of research, and they do not make care recommendations. 

3. When they are participating as technicians to teach the safe and proper use of medical devices, and do not recommend whether or when a device is used.

How is disclosure to learners done?

Presenters

• For a podium presentation, the speaker/presenter must open with a slide that states their RELEVANT disclosures or that states NO RELEVANT DISCLOSURES. We provide a template for this slide on the ABA Continuing Education webpage

• For a poster, the disclosures can be stated on the poster or on a paper affixed to poster.

Planners and/or Program Committees

• For meeting planners, all relevant disclosures or statement of no relevant disclosures needs to be provided and updated annually.

• We will ensure this is documented at our annual June meeting.

We will also provide a list of disclosures for all persons in control of content on the activity website and/or meeting app.