Sunday, December 09, 2018

Boarded to Death: Physicians Sue the ABIM

On Thursday 6 December 2018 in the Federal District Court of Eastern Pennsylvania, a class action lawsuit on behalf of over 100,000 internal medicine physicians was filed against the American Board of Internal Medicine (ABIM) by four internists.

The plaintiffs brought the action pursuant to the Clayton Antitrust Act, 15 U.S.C. §§ 15 and 26 to recover treble damages, injunctive relief, costs of the suit, and reasonable attorney’s fees arising from violations of Sections 1 and 2 of the Sherman Act (28 U.S.C. §§ 1 and 2). The suit alleges that there is illegal tying of the ABIM’s initial board certification product to its maintenance of certification® (MOC®) product in violation of Section 1 of the Sherman Act and illegal monopolization and monopoly maintenance in violation of Section 2 of the Sherman Act. The suit claims that after the ABIM's attempts to sell a voluntary "Continuous Professional Development" accolade program failed to recruit enough physician interest, the ABIM created a wholly new market product for itself, time-limited board certification (later branded as "Maintenance of Certification®" or MOC®), forcing physicians to purchase this product or lose their specialty certification. It also alleges ABIM induced hospitals and related entities, insurance companies, medical corporations, and other employers to require internists to be ABIM-certified to obtain hospital consulting and admitting privileges, reimbursement by insurance companies, employment by medical corporations, malpractice coverage, and other requirements of the practice of medicine. As an indication of ABIM's illegal tying and monopoly maintenance, the suit claims, is that the ABIM is able to charge inflated monopoly prices for MOC®, increasing the fees it generates from MOC® 276% since 2000. Each of the plaintiffs have claimed substantial harm caused by MOC®.

A link to the full Complaint can be found here.

-Wes

Tuesday, December 04, 2018

Doctors' Right to Privacy: Is MOC Collapsing Under Its Own Weight?

On Saturday, 1 December 2018, the American Board of Internal Medicine (ABIM) suffered a meltdown of its highly touted "Knowledge Check-in" ("KCI") alternative to its mandated Maintenance of Certification® (MOC) program.
At 09:45 AM, Saturday, December 1, 2018, during the ABIM Internal Medicine Knowledge Check-In (KCI) administration, Pearson VUE – ABIM’s exam delivery provider – experienced network instability issues that affected hundreds of physicians scheduled to take the Internal Medicine KCI exam.

As a result of these issues, over a period of approximately two hours, physicians were unable to start the KCI, and those who were in the process of testing were unable to proceed.
"KCI," a program that requires continuous payments to ABIM of $155 per year per US physician, was heavily promoted by ABIM as a "kinder, gentler MOC" that physicians could perform in the comfort of their own home, provided of course, that the physician's computer met ABIM's exacting standards. If not, the physician was required to pay an additional $130 to take their MOC examination at a PearsonVue testing center. Sadly on Saturday, hundreds, if not thousands, of US physicians (we really don't know) - all of whom had already funded millions upon millions of dollars for expensive executive salaries, benefits, and contractor expenses to the ABIM for years - lost another of their few precious free weekends staring at computer screens like guinea pigs for academic medicine's biggest income redistribution Ponzi scheme, MOC®.

Not surprisingly, after a lackluster apology, the ABIM tried to deflect blame to someone else: Pearson VUE.
“We at Pearson VUE take full responsibility for Saturday’s disruptive outage of service for ABIM’s Internal Medicine Knowledge Check-In. ABIM did everything they could to help us – and support you – during this time. It was our system that had these issues. As we have promised them, we promise you that we are taking additional steps in order to prevent this from happening again. We are extremely sorry for this unfortunate and rare occurrence and also apologize to the ABIM organization for the disruption and surrounding issues this may have caused. We are committed to continue working in partnership with ABIM in the care and handling of this incident.”
Calls made to ABIM assured physicians that only Pearson VUE was involved in the online proctoring. But there is an important disconnect in the announcement made by ABIM about this incident. Note that the press release issued to the public mentions that physicians at home AND at Pearson VUE testing centers were affected:
At approximately 9:45 AM (EST), on December 1, 2018, ABIM began receiving reports from Pearson VUE and individual test takers that they were unable to begin the exam or were unable to continue it if they had already started.
Their explanation is incomplete.

Might the problem have gone beyond Pearson VUE since individuals at home were similarly affected?

Recall that security of ABIM's examination is of utmost importance to them. They've even had a "Director of Test Security" and even sent their own director of test content to spy on physicians attending a board review course without their knowledge and later sanctioned or suspended over 130 physicians' board certification certificates accusing them of "cheating" in 2009. At that time, the same Director of Test Security for ABIM also worked for a litle known test security firm, Caveon Test Security. It was David Foster, PhD, CEO and President of Caveon Test Security, who was also a Chief Scientist at Kryterian Global Testing Services that touted the security and reliability of their patented keyboard and eyeball monitoring services to the American Board of Pediatrics Foundation on 15 May 2015. It was Kyterion's home testing platform that the ABIM's entire KCI initiative was based.

ABIM diplomates like myself want to know what role the link to Kryterian Global Testing Services had in the events of December 1, 2018 KCI meltdown. ABIM is obligated to come clean on this issue, since it appears more than just testing was occuring that Saturday in December. If the link to Kryterion's keyboard and eyeball tracking technology were involved, physicians' privacy rights may have been violated as well in the name of test security during this latest MOC® debacle.

-Wes

Saturday, December 01, 2018

ABIM Fees Place Physician Bank Accounts on High Continuous Suction

The American Board of Internal Medicine's (ABIM) ongoing seemingly endless changes to their Maintenance of Certification® (MOC®) product is affecting physicians who re-certified a short five years ago - like myself.

Let's review precisely what has taken place since time-limited certification was implemented by the ABIM in 1990:
  • From 1936 to 1990, ABIM Board certification was a lifetime credential.

  • From 1990 to 2005, ABIM ended lifetime certification, and began issuing only time-limited certification to physicians for those certified after January 1, 1990, requiring re-testing (and renewed payments to them valued at more than a thousand dollars) every 10 years.

  • In 2006, "Maintenance of Certification," a product rebranded from "Continuous Professional Development" (note the similarities of these two linked webpages) was implemented. MOC was later trademarked by the American Board of Medical Specialties who stipulated programatic alignment from ALL physician subspecialty boards and required them to perform additional practice performance tasks and earn 100 "MOC points" AND re-take their board certification test every 10 years. Additional fees were often required to earn points from "MOC-eligible" courses.

  • In 2013, the ABIM imposed more burdensome changes to MOC, not only having to re-take their examination every 10 years, but a "MOC activity" had to be completed every 2 years with patient safety, patient "voice", and survey modules or "Practice Improvement Modules" performed every 5 years and they also had to accumulate 100 MOC points every 5 years.

  • Now the ABIM requires internists to pay not only an annual program fee to participate in MOC, but  an "Assessment Fee" for MOC examinations. Internists can sign up for Knowledge Check-in examination every two years, or still take the 10 year examination.

Through self-serving rule changes, the ABIM has become a tax-exempt for-profit money machine that has placed physician bank accounts on high continuous suction. They coerce physicians by  threatening them with the loss of their credentials or ability to receive insurance company payments to keep the money flowing.

We know why: thanks to their own hubris and avarice, they are failing financially. They have lost the trust of US physicians. And are a partisan organization beholden to the Medical Industrial Complex, not patients.

Given then above information, I believe the ABIM's tax-exempt status should be revoked. Their fees have skyrocketed from $795 to $2200 over 18 years (2000 to 2018) - or 276% - while providing the same product, "certification" of working internists since 1936, nothing more.

-Wes



Sunday, November 25, 2018

ABIM To Diplomates: Merry Christmas! Participate in MOC or Else

This weekend, I received this orange notice from the American Board of Internal Medicine (ABIM) in the mail:

(Click to enlarge)


At first I was going to ignore this flier, since I am board certified until 2023 in Cardiology and 2024 in Cardiac Electrophysiology.

But then I read the reverse side of the flier, and noticed this threatening sentence:
"Your deadline is approaching, so we wanted to follow-up on the email reminders we've sent to you about earning 100 MOC points by 12/31/2018 to stay certified." (emphasis mine)
(Click image to enlarge)

It appears the ABIM will revoke the "time-limited" certification(s) I have paid for through 2023 in Cardiovascular Diseases and through 2024 in Cardiac Electrophysiology because I have refused to earn 100 Maintenance of Certification® (MOC®) points by 12/31/2018.

Must diplomates who have "pre-paid" for their certifications now ALSO have to participate in MOC just to maintain their pre-paid certificates?

I certainly hope not. If so, things could get ugly very quickly for everyone involved.

-Wes

Tuesday, November 06, 2018

Ending MOC Nationwide

Continuing education for physicians is important (and we've been doing it all our lives on our own), but when working physicians' right to care for their patients is threatened by unaccountable non-profit testing organizations that have serious undisclosed conflicts of interest, we will take action.

 -Wes



P.S.: Patients, doctors: want to help? You can still donate.

Saturday, October 27, 2018

MOC as Physician Stick and Carrot

Remember when the American Board of Medical Specialties (ABMS) Maintenance of Certification (MOC®) was sold to physicians by our specialty societies and ABMS member boards as a "pathway to know that they are staying current in the medical knowledge they use to treat patients and make important care decisions daily?"

Congress was sold the same thing in 2013:
"ABMS MOC® is a system of specialty-specific assessment and professional development activities that require medical specialists to reflect on their practice performance, identify gaps, and adopt new practices to improve care."
It seems physicians and the public were purposefully mislead. MOC® was always a stick that is now being introduced as a carrot to direct physician behavior.

Yesterday, Blue Cross and Blue Shield of Michigan announced (via their friends at the Michigan State Medical Society), that lowly family practice physicians, internists, and pediatricians that are "designated" patient centered medical home physicians won't have to participate in MOC® after all:
"Effective Jan. 1, 2019, the board certification status of family medicine, internal medicine and pediatric practitioners will be reviewed annually. If their board certification status has lapsed and they are a designated patient centered medical home physician, Blue Cross will grant an exception and allow the practitioner to remain in their Blue Cross and BCN managed care networks. This exception does not apply to new practitioner enrollments. Blue Cross and BCN will continue to require all providers to have board certification upon initial enrollment for affiliation."
Meanwhile, the ABMS "Vision Commission" tap dances and distracts by seeking more public comment 2019 timeline magically appears, just as the transition to Medicare's next unproven "value-based" physician pay model is implemented.

Patient care value?

Now you see it, soon you won't.

-Wes

Sunday, October 21, 2018

The Fallacy of dEthics

Meet dHealth (video).

dHealth is digital, algorithmic, group-based health care delivery using blockchain technology.

Who are the dHealth promotors and visionaries? The exact same ones who lead the ABIM and ABIM Foundation in 1999 when it set out to "define medical professionalism" for us. Their final product, the 2002 Physician Charter on Medical Professionalism still stands tall as the guiding light of dEthics for much of organized medicine.

dEthics demands that devotion to the best interests of each individual be replaced by an ethic of devotion to the best interests of the group for which the physician is personally responsible.

dEthics is now driving corporate medicine. Data control. Information control. Education control. More with less; profit before person.

No one saw this more clearly that Dr. Richard Fogoros on his now quiet Covert Rationing blog:
The intent of the 2002 Charter on medical professionalism was to repair the problem (i.e., to cure the “frustration”), not by confronting the forces of evil doing the coercion, but rather, by simply changing medical ethics to make bedside rationing OK. And that’s just what the document did, though only after careful re-editing to make this radical change to medical ethics sound as benign as possible.
dHealth is the next great hope. The vision for world health sees blockchain technology allowing nurses (video) to access to a "complete file" of a patient's health information and to "see into the future in health" to deliver scalable care worldwide remotely using corporate dEthics as their guide.

What could possibly go wrong?

-Wes

h/t: to james gaulte at the Retired Doc's Thoughts blog.