Thursday, April 03, 2014

Mandrola: A Time-Out for ABIM MOC Mandate

From (registration required), John Mandrola, MD calls for a "time-out" for the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) mandate:
The matter for debate is whether the ABIM method - and to be frank, it's arm-twisting tactics - is the best means to achieve physician quality.

Doctors are taught to be skeptical of evidence. Here, there is simply no evidence to judge. We can't know whether this brand of medical education achieves improved patient outcomes. Maybe it will. Maybe it will not. Or, perhaps it could make it even worse. How could aggressive education and measuring quality make things worse? Think heart-failure metrics and an 89 year old, who, a week later presents with a broken hip from all those evidence-based pills. I have many more examples, but I promised brevity.
Read the whole thing.

Some additional thoughts and suggestions to the ABIM:
  • Given the unproven nature of the MOC process to assure physician quality and the ethical breeches created by the ABIM's proprietary process, "board certification" as defined by the ABIM should revert to a lifelong certification to put the ABMS and its subsidiaries in competition with all the CME sources available.
  • The new ABIM MOC rules that are now set to go into effect 1 May 2014 can cause "sudden and unanticipated" revoking of Board Certification based on failure to completely comply with MOC at ANY TIME. This should not be permitted.
  • Since state medical boards are all headed by physicians, the marketing my the American Board of Medical Specialties and the ABIM that physician perform their MOC process to prevent government agencies from providing an alternative to their MOC process is pure propaganda. There are many many government and private agencies that monitor physician performance including hospitals, insurance companies, CMS, Medicare, Medicaid, trial lawyers, the Better Business Bureau to name a few.
  • The ABIM's "board certification" is based on test-taking ability and not patient care metrics. As such it cannot be considered a patient care quality measure of any kind and should not be tied to CMS Physician Quality Reporting System (PQRS) payments to those who care for Medicare patients.
I believe it would be in the best interest of the ABMS and ABIM to listen the the growing chorus of dissatisfaction that is currently echoing throughout the country. I know many physicians are already boycotting the process. Until the ABIM and ABMS change their policies this boycott will continue, especially since doctors know that the incomes of these societies are being directly paid by their physician fees.

Just sayin'-


Here's a link to an anti-MOC petition underway.


Anonymous said...

'We at the ABIM are incredibly smart (much smarter than you). We are here to protect your patients from incompetent physicians like you. If you oppose our Draconian plans, it only serves to re-enforce your own incompetence. Actually, this is only our first step towards a daily interrogation of practicing physicians prior to seeing patients. Resistance is futile.'

medicine for real said...

Wholeheartedly agree. But beware. Doctor-patient trust is already at a very low point. While we doctors rail against the system, other people are likely to see our wrath as avoidance of accountability. They will say we have our own interests, rather than the patients', at heart. They will say we are lazy, or trying to cover up something, or afraid that our incompetence will be revealed to the world.
The ABIM is as political as any other regulatory agency. They are likely to hear the haters before they hear the doctors.

SteveofCaley said...

I don't care - I gave up. I let it expire. They win.

Anonymous said...

SMURF YOU anonymous!!!

Anonymous said...

You at the ABIM are NOT incredibly smart, if you were all of your board members would be a 100% certified! You are simply corrupt avaricious hypocrites who care nothing about patient care!!! WE WILL CONTINUE TO FIGHT YOUR IMMORAL AND UNETHICAL SCAM!!!

Anonymous said...

The public needs to be told that the bill to feed ABMS bureaucracy is eventually paid for from their own pockets. The doctors somehow need to earn that money first before handing it over to the racketeers.
I am among the unlucky ones who have certificates in multiple specialties (3), and I am not about to continue renewing at least one of those. If that's the "improvement" they are so proud about, then so be it.

Anonymous said...

Dr Dick: The obvious strategy of the ABMS will be to imply that we are lazy and don't wish to maintain our knowledge. But we are required to maintain CME by State Boards for licensure.
Questioning the mercenary motives of the ABMS in imposing further requirements does not mean we disagree with keeping up with current practice. We need to make that crystal clear and we need to boycott the ABMS in unison until they pay attention.
We need to make it clear to the "public" who they claim to be interested in protecting, that all this extra time taken preparing for inane exams detracts from patient care. We need to say again and again that the process is not evidence-based and that those imposing it are not themselves recertifying.

Anonymous said...

To Dr baron

AT this point its time for you to make another video.

its time for you to acknowledge:

1. MOC is totally rejected by physicians
2. Your support of MOC might be called into question in light of your $ 800,000 salary
3. we are not frustrated..we are angry and disgusted.
4. the cost of $ 200-400 a month is simply not true.
5.Patients and peer physicians don't give a rip about MOC or recertification.
6. you asked for feedback...and YOU GOT IT !! 17000 physicians stood up and said "ENOUGH" !!! You cannot ignore that forever.
7. abim HAS ENGAGED in changes without a whit of its endless effects on your customers.
8.Your proof of studies of how wonderful MOC is, has some major conflicts of interest.
9.There is some really deep seeded mistrust of you and the abim.
10. time to talk about other alternatives.

dr baron.... you may have "heard us" but are you listening?

you should every month make a video and come clean.

the puppet game is over.

one lawsuit has been many more will come?


the truth will set you free.

Anonymous said...

You can just hear them at ABIM and ABMS..

" Those ungrateful bastard doctors !! How dare they question what WE decide what THEY need. So let them get 20,000 signatures...who gives a shit. We'll send out Richey Baron and talk about how wonderful MOC is and that we "heard" them and we will look into their complaints..... over the next couple of decades.

And they complain of the money??...Those damn internists should be happy we don't raise the fees EVEN MORE !! How do they think we can pay $ 800,000 a year to our spineless mouthpieces.

And sure we have no "evidenced based" proof that MOC does anything but do they think that will stop us?? It never stopped us before.

And they should thank us for that new great public service campaign of CHOOSE WISELY...BOTH people who are aware of this campaign thinks its great. And THEN we get to tell these sob internists 'see, the people want MOC!'.

And if any of those docs get out of line, we can say they had cheated and take them to court , with our league of lawyers. That will scare the shit out of the rest.

Yup, we got them by the balls."

Endless Lies
Unchained power

Your ABIM.

Our motto:

"We will screw you any way we can"

Anonymous said...

Well, the ENDOCRINOLOGISTS are pissed off too.

see letter dated 6-30-14.
they met the ABIM today.

The ABIM is hearing it from everyone.

Anyone see Richey Baron or is he in hiding still?

Anonymous said...

Dr Wes

I know you don't know but you been more up on the latest than the rest of us.

If you had to guess WHAT and WHEN will be ABIM Response to

20,000 signatures.
AMA vote

WILL the ABIM fold, dig in their heels or cut the difference ?

Just wondering what you think ?

DrWes said...

Anony 02:12 pm -

I'm afraid the ABIM has made it clear they have no intent to change their current plans. The AAPS lawsuit continues to course its way through the Cook Country court system here in Illinois. (It was moved there from New Jersey). Unfortunately, this is in the back yard of the AMA, ABMS, and ACGME, all who have vested interests in the outcome. Still, the AAPS has a good team and the case presses on. I suspect this suit is still years away from conclusion - they're still legal wranglings occurring regarding the discovery phase for this case (the ABMS and AMA aren't too happy about disclosing e-mails, accounting trails, etc.)

Let's just say nothing will happen fast, but I sense that the leadership of these organizations were not expecting such push-back from physicians to be so coordinated. You can bet they're looking hard at options going forward if the case against the ABMS and AMA sides with the plantiff, then I think they'll have no other choice but to compromise...


Anonymous said...

Dr Wes..

What your opinion of the ABIM recent letter?

Is it worth anything or just throwing us a bone?