Medical/Pharma Meetings: Keeping Up With Change

Planning meetings and conventions for health-care professionals has long been a highly complex task when it comes to complying with codes, policies and law. With the first reporting period of the U.S. Open Payments program -- formerly known as the Sunshine Act -- now on the books, M&C checked in with some thought leaders for a status report on how planners are coping with the new law, and which challenges keep them up at night.


A Massive Undertaking
First, some perspective: An Everest-sized pile of data was collected for the first Open Payments reporting period, which ran from Aug. 1 to Dec. 31, 2013 (results for the next period to be reported, for all of 2014, will be published June. 30, 2015). That translates to some 4.4 million health-care-professional (HCP) payments, valued at nearly $3.5 billion. "That's pretty impactful," points out Pat Schaumann, director of professional development for the health-care sector at Dallas-based Meeting Professionals International. "And it's a huge amount of information we're talking about. In that four-month period, Pfizer alone ran 276,000 meetings. That's just one company."

Open Payments was established as a transparency measure, to make it clear and easy for anyone to see how much is being spent on health-care professionals by biotech, pharmaceutical and device manufacturers at meetings, generally pertaining to research or education about their drugs and devices. Responsibility for the reporting, however, falls on these companies and not the doctors themselves. Misrepresenting the payment amounts can result in hefty fines for the manufacturers; for the health-care professionals, however, it isn't mandatory to even register in the Open Payments system. In fact, says Schaumann, out of the 893,851 licensed physicians in the United States (as reported by the Kaiser Family Foundation in September 2014), only 26,000 signed up. Teaching hospitals fared better, percentage-wise: About 400 out of the 1,100 such institutions nationwide registered.

Physicians who don't register can't review or contest the data entered about them; that doesn't lighten the load on medical and pharma planners, however, as all of the data must be collected and reported regardless.


Technology Vacuum
Given the vast amount of HCP expense data planners must gather, including attendee transportation, lodging, meals, gifts and more, there is a clear need for technology that will streamline the process, to take the information collected at registration and process it for payment and reporting purposes.

"There are so many tools out there," says Schaumann, who also serves on the faculty at St. Louis University and heads the Healthcare Meetings Compliance Certificate program. "But I'll tell you something, because I asked about this in class: Every one of my students, from the largest pharmaceutical and device companies in the world, still use Excel spreadsheets for their reporting."

Some of that is due to the comfort level planners have with old technology, acknowledges Schaumann, but many assert that myriad new health-care meeting tools simply don't meet industry requirements. "The biggest concern that our clients face is there is no single technology solution out there that really provides everything they need in order to record accurately, with the approval of the HCPs, the expenses that are associated with HCPs attending their meetings," says Steve O'Malley, president of St. Louis-based Maritz Travel's meetings and incentives division. "The process itself is just incredibly manual at this point. Clients will tell you they're doing it by brute force and spreadsheets. And that's just not sustainable for any organization.

"There's an opportunity around this, and a necessity," adds O'Malley. To that point, Maritz is working on its own proprietary technology, based on the needs of pharma clients, that it hopes to introduce in the next few months.

 It's proprietary technology that, in tandem with Excel, appears to be driving much of the reporting thus far. "The pharmaceutical companies that we work with have developed their own homegrown tools to report all of that data," says Agnes Canonica, CMP, CMM, the Norristown, Pa.-based general manager at MD Events. Canonica, who manages investigator meetings for pharmaceutical companies, notes that "there currently are no tools that would centralize the work based on all the different requirements that these pharmaceutical companies have, and for us it just doesn't make any sense to be spending a lot of money on any new tools now. We'd rather wait and see and find one tool that will be able to support all of the different requirements, instead of spending tens of thousands of dollars on something that will quickly become obsolete.

"Once the dust settles," Canonica adds, "maybe 18 months to three years from now, I'd be willing to look at that a lot more closely, because the ground rules of the new regulations should be better established." In the meantime, MD Events uses Cvent to collect registration data and then must manage everything through Excel.


Back to School
Essentially, it seems providers are rushing to capitalize on a market need before doing all of their homework. "Just like with any new regulation," points out O'Malley, "there's going to be a rough period to go through before the market figures it out. Part of it is that these are technology companies trying to solve very specific medical meetings issues. And I'm not sure that they have the depth of understanding of what the issues are that need to be solved."

Pat Schaumann has a simple explanation for that lack of understanding. Since last July, nearly 300 people have taken her health-care compliance certification course, among them a mix of device, pharmaceutical and biopharma planners, as well as representatives of hotels, restaurants and city convention bureaus. "And I've only had one technology company take the class," she points out. "It's just odd to me that technology companies aren't investing in the education before they develop a tool." (One technology company, SpendMD, did send its entire staff to take the course. As of press time, however, SpendMD was adjusting the direction of the company and could not comment for the story.)

Creative Interpretation
Just as manufacturers are using a slew of different homegrown technologies to process and report their HCP data, they have widely varying methods of data collection. They're not even all collecting the same information.

This is absolutely a challenge to planners who work with more than one client, says Agnes Canonica, whose company currently works with 15 pharmaceutical companies. "Because of the newness of all of this, and all the confusion and so many different elements, companies are interpreting things on their own right now," she explains. "They're setting their own standards until things are more ironed out."

For example, Canonica says, MD Events has some clients that take aggregate HCP spend and then divide it by the number of physicians, and others that literally calculate the spend for each individual HCP. As for which way is correct, "It's a gray area," she says. "It's not well defined."

Calculating the spend for each HCP presents some complex challenges, she notes. "And it's not so much the flights or the hotel rooms, because those are pretty clearly defined. It's meals and ground transportation."

In terms of the latter, consider that one flight may be carrying 10 HCPs, who are then shuttled to the host hotel. What about the physician who arrives on a later flight and requires his own airport transfer? Does the cost of the shuttle all go under his name? "If I were an HCP," Canonica says, "I'd be concerned about that $200 spend showing up on my record for a transfer. As an agency, we have to have this dialogue at the start of our relationship with these companies. We ask them how they interpret certain things and then we help them shape some policies around that, because this is not their core business.

"There are a lot of gray areas," Canonica adds. "But one thing that will really help, if you ever get audited by the FDA or CMS [Centers for Medicare and Medicaid Services], is if you can demonstrate consistency. And one of the ways you can do that is by having a clear meetings policy."


Data Inaccuracy
One of the major hiccups revealed in the premiere Open Payments reporting period was what the Centers for Medicare & Medicaid Services have called "de-identification." Essentially that means that identifying information collected from some health-care professionals -- specifically their National Provider Identifier and/or state license numbers -- were wrong. And while the errors occurred because physicians entered the incorrect numbers at the time of registration, it becomes the responsibility of the planners to get updated information and make corrections.

While this may sound at first like a minor administrative task, the scope of the inaccuracy is staggering: Forty percent of all the records published are de-identified, says Schaumann. A national database that houses such information, she adds, is estimated to be only 50 percent accurate.

So what that means is the correction process will have to be a manual one, likely with planners tasked with contacting HCP attendees to get to the bottom of what were probably careless entry errors.

 

It won't be a major issue for all planners across the board -- Canonica says that none of MD Events' first-reporting-period data has yet been questioned, and Steve O'Malley notes that Maritz's de-identification rate is far lower than 40 percent. "But that comes at a price of full-time head count devoted to just these administrative tasks, to ensure accuracy," he says. "We'd like to get to a place where we can invest in things that drive greater value for the investment that all of our health-care clients are putting into their meetings, events and incentives."

A technology-based solution would be wonderful, O'Malley adds, but that will be dependent on the federal database being updated and accurate.


Losing Focus
These hiccups and challenges presented by new regulations aren't the biggest problems facing medical and pharmaceutical planners, asserts O'Malley; rather, it's the effect these issues are having on the big picture.

"It's pointed everyone's attention away from what these meetings are all about," he says, "which is education. It's about engagement, the ability to serve patients better. As an industry, we need to get those investments that we're putting into HCP meetings to be even more effective. We need to focus on the outcomes; and as a result of all the activity that's surrounding the new regulations and reporting, that has kind of fallen by the wayside. We need to get back there as quickly as we can."