Wednesday, August 15, 2018

MOC's Greatest Lesson

Yesterday, I read with interest the American College of Obstetricians and Gynecologists widely circulated piece authored by Lucia DiVenere, MA entitled, "MOC: ACOG's role in developing a solution to the heated controversy" published in the August issue of OBG Management. By carefully listing the numerous physician concerns with MOC (costs, relevance to practice, lack of data to improve care, relationship to licensing, employment, privileging, and reimbursement), the article reinforced many of the issues on this blog while being simultaneously crafted to sound as if ACOG was really "listening" to physicians concerns about ABMS Maintenance of Certification (MOC).

It didn't take long for me to realize the article was really about the tired trope that the "ACOG asserts the importance of maintaining self-regulation." The leadership within the ACOG and Ms. DiVenere herself can hardly be described as "self" as far as working physicians are concerned. Ms. DiVenere is Officer, Government and Political Affairs, at the ACOG and OBG Management contributing editor. And while she "reports no financial relationships relevant to this article," her very job may have depended on writing it.

Which leads me to MOC's Greatest Lesson that it consistently teaches working physicians, both young and old: In medicine, it is okay to lie, cheat, and steal.

I do not say those words lightly. Everything MOC touches is corrupt. For a once simple medical accolade to be allowed to secretly morph into a one-billion-dollar-a-year enterprise and physician cudgel to fund the bloated bureaucratic and political aspirations of the Accreditation Council for Graduate Medical Education is beyond me. Yet this is precisely where working physicians find themselves. Are these the ethics to which we want our young doctors of tomorrow to aspire? Should they model turning a cheek the other way to ignore the implications of these actions on our patients just so specialty societies can maintain handsome salaries, political power, and "self-regulation?"

Despite all that has been uncovered by following the money, I still can't believe it's taken one simple GoFundMe page three months to raise $150,000 from working physicians to fight this corruption.

It seems MOC's Greatest Lesson has been taken to heart.

-Wes



Saturday, August 11, 2018

On Trust

Elizabeth A. McGlynn, PhD, immediate past chair of the ABIM Foundation and Vice President for Kaiser Permanente Research and Executive Director of the Kaiser Permanente Center for Effectiveness and Safety Research (CESR) with Richard Baron, MD, President and CEO of the American Board of Internal Medicine,  at the 2018 ABIM Foundation Forum on "(Re-)Building Trust"
Recently, the ABIM Foundation hosted a webinar entitled "(Re-)Building Trust." Oh, the irony. The fact they need to have such a conference is telling of the dire straights the staid and outdated medical credentialing complex has become.

As physicians who funded the ABIM Foundation, why do we fund such nonsense?  The American Board of Internal Medicine has never sufficiently explained why this organization felt compelled to use over $78 million of physician testing fees to create the ABIM Foundation or how and why it uses that money. Is it really to fund such conferences?  Or might conferences like this really be a distraction for the real reason the ABIM Foundation was created: their retirement fund. By the way, whatever happened to those funds shipped off to the Cayman Islands? Why will we lose our privileges at hospitals or insurance payments if we don't pay into this scheme? And why is the ABIM Foundation colluding with Kaiser Permanente directors? What does Kaiser get for this relationship?

If physicians trusted the ABIM, we would not have to ask such questions and the ABIM Foundation would not have to hold conferences on "re-building" trust.

Three years ago, Richard Baron, MD issued the now infamous: "We got it wrong" mea culpa press release when the 2014 iterations of Maintenance of Certification (MOC) foisted on US physicians resulted in a powerful working physician backlash. Lots of soft-shoe, "listening," and MOC program changes have occurred since then. But in reality four years later, little has changed other than parsing our payments into annual aliquots rather than a single lump sum every-10-year payment. The growth of fees is back on schedule, climbing an incredible 276% in the past 18 years.  Even the ridiculous Part IV of MOC is back as before.

It is hard to trust any business, especially a nonprofit organization when they ignore the customer.

We should not lose sight that physicians are the customer of ABIM, not patients. We pay for their medical accolade and the paper certificate that ABIM issues when we successfully complete our initial Board certification and (now) subsequent MOC requirements.

There are many within the US medical board credentialing system who feel otherwise; for them, they are there to serve "the public." Yet this deflection is little more than a propaganda message created to justify their use of our money for their political and financial purposes.

When we see our funds continuing to be wasted at Las Vegas convention venues for American Board of Medical Specialties meetings with their "stakeholders" we realize that this old-school attitude of colleague disrespect and self-importance is endemic to the entire US medical board certification and medical credentialing industry. Hard to re-establish trust with overt demonstrations such as these.

-Wes

PS: Wonder what you can do to change things?  Donate here and get a free book at the same time! We're 78% of the way there!

Monday, August 06, 2018

Moving Mountains By Example: Doctor Inspires Others to Fund Anti-MOC Legal Effort

In a reaffirming gesture of solidarity, San Francisco cardiologist Michel Accad, MD has offered to supply an electronic copy of his book "Moving Mountains: A Socratic Challenge to the Theory and Practice of Population Medicine" (seen on Amazon) free of charge to anyone donating $50 or more in the next two weeks to our legal effort to end the onerous and unproven ABMS Maintenance of Certification (MOC™) program nationwide.

 Dr. Accad's affable and insightful personal blog (Alert and Oriented) and podcast (Accad and Koka Report) co-produced with Philadelphia cardiologist Anish Koka, MD, have garnered wide physician followings by respectfully and thoughtfully discussing timely issues that matter to doctors. (My recent 46-min podcast discussing this funding drive with them can be heard here).

While the sponsor of the legal effort, Practicing Physicians of America (on whose board I serve), has already reached over 75% of the $150,000 funding goal, I hope Michel's generosity will inspire many other physicians to join this funding drive in hopes working physicians of all ages can help end - once and for all - the expensive, onerous, and corrupt ABMS MOC™ program that has the potential to unjustly limit a physician's right to work.

-Wes

Sunday, August 05, 2018

Federation of State Medical Boards Attempts to Legislate Away Liability

In a press release, the Federation of State Medical Boards (FSMB) announced their support of the “Occupational Licensing Board Antitrust Damages Relief and Reform Act of 2018 (H.R. 6515),” introduced by Rep. Mike Conaway (R-TX) and co-sponsored by Rep. Lamar Smith (R-TX). According to the press release:
H.R. 6515 eliminates fiscal antitrust damage liability for state licensing boards-including state medical boards- their members, and staff who are acting within their statutory mandate to protect the public. Currently, board members and staff are exposed to personal liability and treble damages for actions taken as part of their service on a board. The lack of protection has had a chilling effect on the willingness of some individuals to serve on boards, causing some board members to resign for fear of personal financial liability.
It is interesting that this new bill attempts to circumvent the 2015 Supreme Court decision that held professional boards could not make decisions that potentially violated antitrust laws and quashed competition. The justices, in an opinion by Justice Anthony Kennedy, agreed with the government’s claim that although state entities are usually exempt from federal antitrust laws, the exemption did not apply because the board was not actively supervised by the state and because it was made up of self-interested private businesses.

The FSMB President and CEO, Humayun Chaudhry, DO, MACP has quite a history of working with similar self-interested private businesses.

In fact, Dr. Chaudry has long supported the notion of Maintenance of Licensure (MOL) that required Maintenance of (board) Certification (MOC®) and "lifelong learning." Chaudhry chaired a CEO Advisory Council (comprised of a slew of non-governmental U.S. medicine regulatory organizations) that advised the FSMB's Board of Directors and worked with an FSMB MOL Implementation Group (with Richard Hawkins, MD, the current President and CEO of the American Board of Medical Specialties (ABMS), in 2009). That group recommended that physicians actively engaged in the Maintenance of Certification (MOC) program of the American Board of Medical Specialties, or the Osteopathic Continuous Certification (OCC) program of the American Osteopathic Association, should be recognized as "substantially in compliance" with any MOL program that is adopted by a state. Because of this tie between MOL and MOC, the activities of the FSMB in the state of Ohio were met with formal opposition from the Ohio State Medical Association in 2012.

No wonder the board members from various state medical boards have resigned from their positions out of liability concerns. They understood there is credibility to the Federal Trade Commission's concerns that were upheld by the U.S. Supreme Court.

Legislators (especially Rep. Mike Conaway and Rep. Lamar Smith) would be wise to realize that the multi-million dollar FSMB has financial conflicts of interest that may cause more harm than good to our patients.

-Wes

P.S.: Like the FSMB, ABMS collusion with state medical societies regarding MOC® is also evident in this recent ABMS press release.

Saturday, July 28, 2018

The ABIM Has Lost Their Marbles

From the institution that secretly funded itself with ABIM diplomate fees to the tune of over $78 million that culminated in the purchase of a $2.3 luxury condominium for itself complete with a Mercedes S class town car, and offshored funds to the Cayman Islands,  comes this news release:
The 2018 ABIM Foundation Forum will consider the importance of trust in health care – and how to build and maintain it – against a backdrop of political and social turmoil and all-time lows in Americans’ trust in institutions across society.
Make no mistake: this is our physician Board re-certification money they are playing with.

At the very least, the optics of such a conference are horrible given the ABIM Foundation's past.

I hope everyone will make good use of the hashtag #abimf2018 on Twitter and then contribute to our legal fund to permanently end this shameless gaslighting of US physicians and our patients.

-Wes

Wednesday, July 25, 2018

Board Certification: From Marketing Accolade to False Idol

I'm Board certified.

So is Carmen A. Puliafito, MD.

So is Farid Fata, MD.

So are plenty of other Medscape "Best and Worst" physicians from 2012-2016.

So what is "Board certification?"

Truth be known, it is little more than a marketing accolade.

And for a while, it worked.  Doctors took board certification examinations to market themselves as competent in their field. They would take a written or oral examination created by their peers to demonstrate to others they knew their stuff. And while it remained a lifetime designation, it had some legitimacy. In reality, however, it was up to the residency training programs to train the physicians and verify they knew their stuff.  Hospitals used to verify credentials by calling residency programs and verifying doctors participated. They had large credentialing departments that kept everything on file.

But competition between hospitals vying for patients soon grew fierce and hospital marketing departments jumped on the credentialing bandwagon. Soon billboards would appear: "Come to see our board-certified specialists!" and the race was on.

Lawyers joined the fray, too. "My expert witness is better than your expert witness - see how many board certificates he has?"

Truth is, we love this crap. Just look at how many nurse practitioners are "board certified" now!

In the 1960's to 1970's, the American Board of Internal Medicine recognized how lucrative this craze could be, but they had one big problem if they were going to make certifying doctors a full-time business: the number of doctors out there was finite. (It was about that time the board members started paying themselves). They also saw how much money the American Board of Family Medicine, founded in 1969, was generating using 7-year time-limited certifications.

But the ABIM knew internists would be on to them changing the rules for board certification from a lifetime to time-limited credential. So they first tried making a voluntary "super accolade" for internists, called the "Advanced Achievement in Internal Medicine." Needless to say, after four attempts that garnered progressively declining enrollment, the AAIM concept flopped. It was Lynn O. Langdon, MA (a non-physician and Chief Operating Officer of the ABIM) who declared the "End to Voluntary Recertification" and time-limited certification was born with the threat of "uncertain circumstances" if doctors did not participate.

Needless to say, with the help of conflicted members of the ACP who stood to make handsome returns from the Medical Knowledge Self-Assessment Program (MKSAP), they were off to the financial races. And what a race it has proven to be: a nearly $1 billion dollar-a-year enterprise for the entire ACGME.

Unfortunately, no one has ever stopped to study what happens to skilled, competent, board-certified doctors that fail their computerized "re-certification" examination or fail to garner enough "MOC points" to sit for their examination. No one asks about the damage this time-limited credential is having on our physician numbers and access to care. The money is too important to the system.

Not long ago, the chairman of our cardiology division had to relinquish his role as a teacher to medical students because he refused to re-certify in cardiology while also being "certified" in interventional cardiology. (He could keep performing catheterizations and stent placements and remain credentialed thanks to the change in double jeopardy rules that changed just in the nick of time). How many medical students lost out on his experience as a result? Are we happier that medical students are now being taught by younger (time-limited) Board-certified physician instructors rather than life-time certified physicians with decades of experience in the field?

Doctors and nurses know the truth. That's why when seeking out a "quality" physician for their own care, they NEVER ask if a colleague is board-certified since board certification is now a false idol - a hoop to complete whether they're competent, ethical, or not.

We know that it's now far better to ask a trusted colleague or health professional when seeking care because there's much more to being a "quality" physician than holding a computer-generated "certificate."

-Wes

Reference: Fisher WG, Schloss EJ. Medical specialty certification in the United States - a false idol? J Card Electrophys October 2016; 47(1): 37-43.

Wednesday, July 18, 2018

US Physician ABMS Board Certification: From Voluntary to Mandatory

The American Board of Medical Specialties (ABMS) is very careful to claim their version of "Board certification" is a "voluntary process," otherwise, this Chicago-based non-profit 501(c)(6) organization might be accused of anti-trust behavior.

"ABMS Maintenance of Certification" and "ABMS MOC" were registered by the ABMS in the US Patent and Trademark Office August 21, 2007 after filing the terms February 23, 2007.

MOC for ABMS has value.

We also know Ms. Margaret O'Kane, founder and President of the non-profit "National Committee on Quality Assurance" and that created and owns the Healthcare Effectiveness Data and Information Set (HEDIS). HEDIS is a tool used by more than 90 percent of America's health plans to measure performance on "important dimensions of care and service." We also find that Ms. O'Kane was a "public member" of the Board of Directors of the ABMS and advertised the importance of the ABMS MOC program "to patients and the pubic" by video and implies the ABMS board's actions assures improved "outcomes" for patients.

So it should come as no surprise that some of those payers who stand to benefit by limiting patients' access to care (in this case, Blue Cross Blue Shield of Michigan) have made initial ABMS Board certification mandatory for physicians on their panels:


(Click to enlarge)

While claiming MOC as a requirement for physicians to receive payments because it assures their  "quality," BCBS of Michigan does not demand the same of mid-level providers like physician assistants and nurse practitioners without similar subspecialty training. Additionally, physicians who received their "Board certification" before 1990 and are farthest away from their training are not required to perform ABMS Maintenance of Certification to remain on those same insurance panels, introducing a hypocritical and discriminatory double-standard that financially benefits insurers and hospital systems (more insurance claim denials and cheaper staffing requirements).

ABMS is the puppet of the insurance companies, just as they were the puppets of Big Tobacco in the 60's.

The IRS, FTC, and SEC need to get serious about investigating this ruse.

Why?

It's compromising patient care and our patients' access to care.

-Wes

P.S.: If you haven't contributed already, please consider donating to the legal fund sponsored by Practicing Physicians of America that hopes to bring an end the ABMS Board certification/MOC monopoly nationwide.