Tuesday, February 03, 2015

ABIM Pleads for Mercy

"Now this is not the end.
It is not even the beginning of the end.
But it is, perhaps, the end of the beginning." 



In a widely circulated mea culpa announcement today, the American Board of Internal Medicine (ABIM) deployed some chaff in an attempt to ward off a flurry of incoming Exocet missiles aimed squarely at its years-long history of corrupt and coercive financial dealings, gross mismanagement, and entirely unproven Maintenance of Certification (MOC) program by saying simply, "We got it wrong and sincerely apologize. We are sorry."

In an effort to project an image of sincerity, the ABIM agreed to "immediately suspend the Practice Assessment, Patient Voice and Patient Safety requirements for at least two years" and "hold their pricing at or below 2014 levels until 2017."  It was clear that they sense themselves becoming increasingly irrelevant thanks to the efforts of Paul Tierstein, MD and his much cheaper NBPAS.org.  To align themselves with the NBPAS, they also promised in their FAQ page "to work toward recognizing most forms of CME as fulfilling ABIM's MOC expectations for knowledge self-assessment." Better yet, they even agreed to set up a Google + community that doctors can join to discuss things!

There now, good working doctor, feeling better?  Now can we move along?

But perhaps we should ask first: Why MOC at all?

Contrary to years of propaganda promoted through pseudo-science and journal article citations on the ABIM's website, might MOC have really been created because the ABIM's consolidated fund balance dropped 43.2% from $54,009,086 on June 30. 2001 to $30,691,329 by June 30, 2013 while the Standard and Poors 500 index increased 37.7% over the same period? Said another way, maybe MOC was created because the net assets of the ABIM diminished from negative $10,930,327 to negative $43,150,390 from 30 June 2003 to 30 June 2013 while their leadership and board members did little more than pad their resumes so they could apply to the next insurance company or National Quality Forum job opening.

Or maybe MOC was created because the ABIM ran a bit short on cash because they decided to transfer $17,360,000 of physician testing fees over the seven years ending June 30, 2008 to their own shadow ABIM Foundation (that shares the same leadership) and purchase a $2.3 million condominium for themselves. (Oh, and where and when was that ABIM Foundation created, anyway? Iowa in 1999 (as the tax form says) or Pennsylvania in 1989 (as public record says)? Or should we ask?  And how did the Foundation suddenly have $52,811,298 of net assets by June 30, 2002 - less than three years after its creation?  Where did those funds come from? Finally, given the hefty balance sheet of the Foundation, why was the Foundation granted those additional  $17,360,000 from physician certification fees via the ABIM?)

Or maybe MOC was created to help fund the high salaries and lavish lifestyles of its many officers and administrative staff.  Does the President and CEO of ABIM and the ABIM Foundation really need to earn at least $7.2 million over the ten years ending June 30, 2013 while also earning additional cash on the side from multiple consultant positions?  Sorry, but for the ABIM to hold fees stable given their self-serving largess is inexcusable.  It's time for ABIM to drop its fees and cut their expenses.

And then there's the whole collusion with our professional societies whose non-physician leaders profit handsomely from educational programs that support MOC.  Too many ABMS and ABIM sycophants are earning far too much income on the backs of instilling fear amongst young physicians already struggling to pass their tests so they can maintain their job while increasingly drowning in educational debt.  To already see ABIM sycophants congratulating "the ABIM staff and board for working to make MOC what it can become" with today's announcement given these realities is unconscionable, even if they are trying to be politically correct.

MOC doesn't need to "become" anything.  It is not a legitimate physician quality registry. MOC needs to go away.

To that end, we should recognize that the American Board of Medical Specialties (ABMS) and their 24 member boards (of which ABIM is just one), lobbied Congress hard to etch themselves permanently in to the Affordable Care Act as a physician "quality" registry to affect CMS physician payments as part of our new health care law.  But if the MOC program is indeed corrupt, what does that say about this means of paying physicians for the care they provide patients?  How corrosive to the doctor-patient relationship might this program become?  Recall that the ABIM has never studied the effects that failing a physician during recertification has on the physician or the patients that physician treats.  The spin is that MOC assures physician quality. But if a physician can no longer practice because he loses his privileges to practice his art because he failed a computerized test insensitive to the physician's scope of practice, where does that leave his patients?  Why has no one ever evaluated this?  Might it never have been evaluated because the MOC program was always more about the money than a means of assuring quality patient care?

I'm sorry, but an apology is not enough when there are so many unanswered questions and unethical practices underway by so many for so long - especially by those of our own profession who have turned against practicing physicians for their own benefit.

It is time for a full Congressional investigation into the financial, legal, and ethical dealings of the ABIM, the ABIM Foundation, the legitimacy of the ABMS's entire MOC program, and to question the inclusion of such an irresponsible and corrupt physician quality measure into the Affordable Care Act. 

You see the real story today is not about the ABIM's changes to their illegitimate MOC program.  Rather it's about how the MOC debacle has finally mobilized practicing physicians to advocate for themselves and their patients for what is right, whether the ABIM and their sycophants like it or not.

-Wes

Reference (with links to tax form financial data): In the Grasp of the Gang (pdf) via Mr. Charles Kroll




33 comments:

Dr Linda Girgis said...

Well said Dr. Wes. I will spread this far and wide.

Anonymous said...

Is this within jurisdiction of the Pennsylvania AG, the US AG and or the IRS? How can we obtain a full and transparent audit of these allegations?

Anonymous said...

Great post, thanks for all your work on this.

I believe you meant 'chaff', not 'shrapnel' BTW.

Narayanachar S. Murali, MD, FACP, FACG said...

Illegitimi non carborundum

DrWes said...

Anony 06:42 AM -

"I believe you meant 'chaff', not 'shrapnel' BTW"

You are correct. Edit made. Thank you.

DrWes said...

Anony 06:42 AM -

Attempts to acquire audited financials from the Pennsylvania AG by members of the media fell on deaf ears. The Pennsylvania governor's press secretary was more helpful. I am not at liberty to say more at this time. Just know that others are looking into this matter.

DrJay said...

Brilliant commentary. Too bad the US does not have a competent Justice Department with a shred of integrity to investigate this case of fraud, racketeering, and extortion which is the ABMS, not to mention the diversion of funds into "Foundations".

That the ABMS got cozy with the boobs who wrote the ACA is no surprise. Birds of a feather.....

Christopher Unrein, DO, FACOI, FACP, CMD said...

this is what I posted on the ABIM google community:

I am at a loss for words! I finished my most recent round of re-certification in 2012. Whew! I hate having things hanging over my head, so in January of 2013 I completed well in excess of 100 MOC points, including a practice performance module. Then all I had to worry about is the test in another 8 years or so.

But no, ABIM took away all that work with their announcement in April 2013 that MOC was changing and without any consideration whatsoever (or even an apology when I questioned them). Starting January 2014, I had zero points for my work. Did I say that I hate having things having over me? So I reluctantly complied by I doing a patient safety test with the assistance of ACP, and then set up an ABIM cockamamie 50+ question patient satisfaction survey that drove me, my staff, and the patients nuts and over six months of agony. This counted for practice-improvement and patient voice.

And now today, I find out that ABIM thinks it is doing us a favor by “suspending the Practice Assessment, Patient Voice and Patient Safety requirements for at least two years.” Are you kidding me? Do you know how much time, effort, and expense I have suffered?

I have been the victim of the unchecked power of ABIM and its arbitrary, capacious, and shortsighted decisions twice now! I am sure that I am not alone, but probably in the minority of the over 100,000 ABIM diplomates affected by these ill-thought decrees. This type of shoot from the hip type of “leadership” and behavior on ABIM’s part calls into question their professionalism, judgment, and role of being the standard bearer of the profession.

ABIM’s actions have cost me a lot, not only in money, but mental anguish, and lost time for myself and my family. There is a lot of alleged focus on physician well-being and wellness. This is the antithesis of that concept. I am angry. And I have no recourse. ABIM, too little too late.

Christopher Unrein, DO, FACOI, FACP, CMD

Ron said...

This is just a small first step. The ABIM and ABMS have been publicly shamed by all the financial records and articles that have recently come out. They are backpedaling now and trying to save face. Physicians are no longer afraid to speak their minds about MOC. We are on the right side of the truth here and will not rest until the MOC scam is fully revealed and abolished.

Anonymous said...

Where there is smoke, there's fire, and now possible some flickers of the flame.

Can someone pass this aong to the NYT or Wash. Post and have some very hungry reporters dig into this unsavory mess? From the resources already at work on this ABIM charade, it shouldn't take much more for the whole thing to be fully exposed.

Shut down ABIM/ABMS! And Dr. Cassel, your hands are dirty, too.

Keith said...

Wes,

Now expand this effort to all these exorbitatntly paid insurance and pharmaceutical execs, and CEO's of hospitals and other health care organizations (including the various medical societies), and we can truly start bending the cost curve of medicine.

Unknown said...

Thankyou, Wes! It is brilliant how clearly you have been presenting the case of the irrelevancy of MOC and how it is cruelly damaging the reputations of fine doctors, and limiting their ability to practice medicine and care for their families. I am so happy that we now have the sensible option of re-certification through NBPAS.
With gratitude,
Dr Rosemary Eileen McHugh, M.D.

Anonymous said...

They are sorry that they did not use the imprimatur of CMS to gradually roll this out as a quality measure; thereby, reducing physician reimbursement via the VBP (value based purchasing) edicts. ABIM will circle the wagons with the other professional societies and focus on persuading congress to incorporate their artificial measures (MOC) as a representation of quality. Expect more behind the scenes lobbying of individual state legislatures to link MOC and MOL.
No sir, the fight is not over. ABIM will lick their wounds and be sure that the next roll out will be from a much higher level. They learned a lesson that they do not have enough power to enforce their arbitrary dictates.

Alan Kogan said...

Amen!

For anyone not aware of how completely out of touch the ABIM is with the practice of medicine, in addition to their greed and avarice, please look at the "Practice Safety" (now apparently suspended for one year) module. I can't believe that the individual(s) who created this "test" have ever - not even once - had patient care responsibilities.
I agree that the MOC should be eliminated in its entirety and replaced by a system of allowable CME activities that are pertinent to the individual physician's scope of practice.

Alan

james gaulte said...

It looks like a good issue for John Stossel to report on.

Ashok Daftary said...

I am perplexed. The ACP has posted a comment lauding the management of ABIM. They gloss over and white wash everything else.
How complicit is this organization?

DrGaellon said...

I wonder what the other constituent boards of ABMS are doing about MOC, and whether physicians in those specialties are as up in arms as we are. Efforts should be coordinated to attack ABMS, and MOC across all of medicine, not just targeting ABIM.

DrWes said...

Dr.Gaellon-

"Efforts should be coordinated to attack ABMS, and MOC across all of medicine, not just targeting ABIM."

As one of my colleagues said, "First you go after Darth Vader, then you tackle the Death Star."

Anonymous said...

I had never checked the 990's of the ABIM and its foundation before

http://www.abimfoundation.org/~/media/Foundation/Financials/ABIMF%202013%20990.ashx?la=en

http://www.abim.org/pdf/revenue-expenses/ABIM-990-form.pdf

They are very interesting reading. Thank you for pointing out the weirdness with ABIM over the years.

Matthew Bowdish MD said...

The ABAI sent out something similar albeit with less pronation. I agree Wes...MOC needs to go away. Here is the letter.

M
-----------
Dear Diplomate:

Yesterday the American Board of Internal Medicine announced changes in its current MOC program and will delay for two years some of its MOC requirements. The ABIM is a very large and complex organization with over a dozen large subspecialties embedded within its purview. The challenges posed by such a complex structure are unique to ABIM. The ABAI is a smaller and more focused organization and has developed a robust MOC program. With feedback from its diplomates and others, the ABAI continues to strive to improve its MOC. The ABAI will continue offering reciprocity to ABIM diplomates. The ABAI board of directors are all meeting MOC requirements, all provide clinical care, and include several members in full-time private practice of Allergy and Immunology—activities that inform our MOC program. In addition, our Board performed an extensive survey of our diplomates views of MOC and Board processes, and is moving to address many of the highlighted issues.

The ABAI does not plan any major changes to our MOC program in response to the actions taken by ABIM. However it is important that all of our diplomates fully understand our program and the efforts we have recently made, and items we are working on for the future. In response to diplomate feedback and in recognition of the cost burden they bear, as of January 1, 2015, ABAI eliminated fees for all ABAI administered MOC products including the Recent Advances module, peer and patient surveys, and the Health Stream administered safety module. Additionally, we will reimburse diplomates claiming AMA CME credit for completion of the MOC process. We have also lowered costs of the Certification and MOC examinations by a minimum of $200. The Board is also considering the burden of annual MOC costs for new diplomates and will, in the near future, examine ways to mitigate this burden.

In addition, ABAI is working with the AAAAI and ACAAI and others to continually increase options for diplomates to meet MOC requirements in ways that are clinically meaningful. In this regard we have worked to develop measures appropriate for practice improvement modules in atopic dermatitis, urticaria/angioedema, immunotherapy and sinusitis. Several of our board directors were involved in the development of the AAAAI food allergy practice improvement module. We strongly support the AAAAI registry developments and hope soon to be able to grant MOC part IV practice assessment credit for participating in this registry. Additionally, the ABAI is one of the ABMS member boards affiliated with the ABMS Portfolio Project. This Project provides part IV Performance in Practice credit for QA/QI activities performed by physicians in organizations (such as multi-disciplinary clinics, hospitals and health care systems and medical societies) belonging to it. This program is designed to decrease redundancy in demands placed on physicians and I urge you to find out if your organization belongs, and if not, to consider joining.

Anonymous said...

All moc and all requirement for board really certification must be eliminated. Cme of choice only. No Mol or moc period. Not for aim or any other board. Abms must go. Anything less and we have lost. And we will pay dearly for that loss in time with our fa miles , friends, and patient. Not to mention revenues. Don't stop the heat. Turn it up. Don't under estimate the enemy. They are nasty and have proven to play dirty. Hit back until they are gone.

Anonymous said...

I received this E-mail from AACE this afternoon:

Dear AACE member,



Over the past 48 hours, in the wake of the American Board of Internal Medicine's (ABIM) dramatic revisions in their controversial MOC process, I have listened intently to the responses of our membership and sister societies and spoken personally to Dr. Richard Baron and other leaders over the phone. The following is a summation of the American Association of Clinical Endocrinologists (AACE) position on MOC reform and our plans for moving forward:



First, AACE wishes to commend the ABIM and their Chief Executive Officer, Dr. Richard Baron, for responding to the concerns of American internal medicine groups, sub-specialty medical societies and, especially, AACE. The changes that the ABIM outlines in their February 3 diplomate email are among those requested by our organization since July, 2014. AACE has long been outspoken in our campaign for MOC reform and we are pleased to see that Dr. Baron and the ABIM are listening.



Positive reforms include:

Suspension of the MOC Practice Assessment, Patient Voice and Patient Safety requirements,
Changing the public reporting language of diplomate status,
Freezing MOC enrollment fees,
Updating the Internal Medicine MOC exam and
Improving MOC medical knowledge self-assessment by recognizing ACCME-approved CME.

However, these reforms are only first steps in converting the currently onerous MOC process into a viable and cost-effective physician activity that truly improves the quality of medical practice in this country. Like our sister societies, the American College of Physicians (ACP) and The Endocrine Society (TES), AACE looks forward to ongoing discourse with the ABIM regarding necessary further refinements in the MOC experience.



Nonetheless, unlike ACP and TES, AACE also supports the principle of maximizing choice for endocrinologists as they pursue lifelong educational goals. While AACE will continue to assist ABIM in whatever way we can to improve their MOC pathway, we will also advocate for other viable certification pathways that have relevance for our membership. We believe that a one-size-fits-all certification pathway for all endocrinology physicians is outdated in 21st century medicine. In 2015, is it reasonable to expect a world renowned clinical diabetes researcher or a full-time imaging thyroidologist to pass the same general endocrinology board exam as a fellow right out of training? At AACE, we believe that our individual members are the best judges of their own continuing educational needs and our mission is to make sure that a variety of relevant options are available.



In this spirit, we invite all our members to visit the newly formed National Board of Physicians and Surgeons (NBPAS) website at www.NBPAS.org and to consider this new certification alternative for lifelong learning. Use of this pathway will likely require your political activism with local hospital credentialing committees and insurance carriers, but the journey to a freer and more openly competitive certification system in the United States is likely to improve the process for all. Dr. Paul Teirstein of the Scripps Clinic in San Diego is spearheading the NBPAS effort and recently delivered a very persuasive argument for his alternative pathway at our January AACE Board meeting in New Orleans (click here to review his slide presentation). I encourage the entire internal medicine community and especially AACE members, to investigate the NBPAS website with an open mind and to sign up if the pathway meets your needs.



In summary, AACE exists to serve your needs as practicing physicians and we will continue to advocate for credible certification pathways that enhance the endocrine care that you deliver to your patients.


Sincerely,




R. Mack Harrell, MD, FACP, FACE, ECNU
President, American Association of Clinical Endocrinologists



Sounds like the path for endocrinologists is clear, as recommended by AACE.

Arbi Khodadadi said...

Please call the ABIM at 215-446-3500 and demand a refund for MOC fees. If they refuse, please file a complaint to the Philadelphia Better Business Bureau. Yes, they are listed and supposedly have an "A+" rating.

Blog Administrator said...

The time has come to put a bullet in the head of MOC once and for all!

And the current ABIM leadership needs to all resign - effective immediately!

Steve O' said...

Mikhail Gorbachev made a sincere and honest attempt to reform the best practices of Russian Communism, when he realized that it had failed and that fact could not be hidden from anyone. He agreed to reform.
In the spirit of Jefferson, bravely practiced there but rarely seen here, the citizens responded by unplugging the machine and completely walking away, and not looking back.
They had faith that they could produce something from scratch that far surpassed the sad bureaucracies of the Warsaw Pact. And they did.
What makes Slovenians braver than Americans these days?

sueneo said...

American Board of Derm had a similar freak out going on--there's been bitter complaining in the Derm world too, with crony/nepotism sham companies serving as the exclusive patient survey vendor, etc. I'm done with them. Buh Bye. Solo private practice needs this like a fish needs a bicycle....




2015 Component IV Changes in MOC

November 18, 2014


Dear Dr.


As you are aware, the American Board of Medical Specialties recently granted specialty boards the flexibility to make meaningful changes to Maintenance of Certification (MOC) that help streamline the process for practicing physicians. As a result, the American Board of Dermatology has made changes to simplify Component 4 of the MOC program.

Beginning January 1, 2015, the six activities previously required during every 10-year MOC cycle for Component 4—two peer surveys, two patient surveys, and two quality improvement projects—are being reduced to just two. You’ll recall that moving forward, diplomates must complete either two quality improvement projects, or one quality improvement project and one survey, with one exercise completed in years 1-5 and the second in years 6-10. Changes to your MOC table are scheduled to occur in 2015 with the launch of our new website and database.

Since announcing this change for the coming year, we’ve been working to develop a set of policies that are equitable to all—regardless of where you may be in the MOC 10-year cycle—including those of you preparing to take the 2015 MOC exam.

For those of you who have already completed one survey (peer or patient) and one QI project, or two QI projects, congratulations. For those of you who have completed three or more Component 4 requirements, well done. Regardless of where you are in the cycle, you have fulfilled all requirements for MOC’s Component 4 for this 10-year cycle.

For those of you who have not yet completed one survey (peer or patient) and one QI project, or two QI projects, you now have more time to do so. Due to these changes, you now have until the end of year five to complete one exercise and the end of year 10 to complete your second. Diplomates planning to take the 2015 MOC exam, however, must complete at least one Component 4 exercise before December 31, 2014.

The Board recognizes the many demands on physicians’ time and is committed to refining the MOC program to ensure it fosters high-quality patient care while minimizing unnecessary or duplicative processes. We believe these changes allow more time for diplomates to focus on what’s most important—the health and safety of their patients.

If you have questions about the changes and how they may impact your MOC status, feel free to contact the ABD office at abderm@hfhs.org.

Edward P Tyson, MD said...

Sadly, the AB of Family Medicine has stuck by its guns and does not believe the concerns apply to the ABFM.
Ed Tyson

Dr.D said...

From: help@theabfm.org
Subject: American Board of Family Medicine responds to Internal Medicine's MOC announcement
Date: February 5, 2015 at 2:01:30 AM

The American Board of Family Medicine
The American Board of Family Medicine is aware of the current debate throughout the medical community regarding the value of Maintenance of Certification (MOC). On Tuesday (Feb. 3), the American Board of Internal Medicine (ABIM) announced a significant review of its MOC program. Specifically, the ABIM is reviewing its Part IV products (Quality Improvement Modules, e.g., PPMs, Metric) and determining the applicability of these products to their subspecialty physicians. We applaud the ABIM and its commitment to moving toward the 2015 Program for MOC standards as accepted by all ABMS Boards. While we are fellow members of the community of medical boards, ABIM and ABFM serve different populations and have approached MOC differently. The ABFM is looking closely at ABIM's changes and the reasons behind them.

At this time, the American Board of Family Medicine is making no changes to the requirements for maintaining certification.

ABFM remains committed to implementing the ABMS 2015 Program Standards. We continuously assess our certification requirements, including examinations and MOC activities to continuously improve. Through our website, emails and social media, we will keep you abreast of current processes and policies for both initial certification and MOC. These communications provide opportunities for you to engage with us in a dialog to address our mutual commitment to the health of our patients and our communities.

Kanwar Partap Singh Gill said...

Do you imagine being disciplined Based on this Big-Data?
These artificially created, self-proclaimed watch-dogs of standards need to be eliminated – completely and irreversibly. I don't trust ABMS and its affiliated board. They are detrimental to the profession of medicine. They will kill our kid’s dream of becoming doctors and having a good life. They need to go. No discussion and no negotiations. If we let the evil to persist, our future generations won't forgive us.
State medical boards of our PEERS on the other hand not only regulate us and uphold standard of care but they also discipline when needed. So far they have done a decent job and I faith in them. My patients feel the same way. Engage every patient. Tell them what's going on. Spend money on promoting awareness. It will pay in the long run. Trust me. Patients are the best allies in the fight against ABMS. You can spin this the way you want to. Take control and act.
ABFM have moved their Certification exam into the month of April of the year most of us would graduate from residency (i.e. 3 months before the actual residency completion in June). Rest of the boards would soon follow this time-line. In next 1 to 3 years they would attempt to make "taking" the exam a requirement for graduating while still you are still in residency (even if you fail). In next 3 to 7 year they would make it requirement to "pass" the exam to graduate from residency. There goes your employment, credentialing and licensing with it. They are planning strategically. That’s why they need to be uprooted or, at least for the time being, kept without fertilizer and water (i.e. your MOC money). It's OK to plant some weeds (like new national boards) around them to check their spread. Weeds can be eliminated if they start to become a problem using a similar strategy but with lot less effort. The intent is to check their current spread and influence while continuing to take steps to chase them out of the corridors of decisive control of the professional trade of medicine.
If you don't act, your fate may be same as was of Dr. Sarah Von Muller MD. Read this http://www.paed.uscourts.gov/documents/opinions/11d0254p.pdf.

Dr Rosemary McHugh, M.D. said...

After reading the comment of Dr Kanwar Partak Singh Gill, I realize that MOC and re-certification need to be stopped completely, for the sake of future young doctors. It is enough to certify once to be Board Certified. Doctors are among the most responsible of individuals. Doctors deserve respect. It is the duty of the physician to determine what continuing medical education we need for the needs of our patient base.
I am so grateful that my fellow physicians are uniting against this abuse by the ABIM.
Sincerely, Dr Rosemary Eileen McHugh, M.D.

Anonymous said...

I am a quadruple certified cardiologist ( IM, cardiology, HF and EP). How much more does the abim need from us?
Abim is clueless and corrupt.
Stop them please

Christopher Russo said...

There is blood in the water ! We must not let up.

Anonymous said...

There is blood in the water ! Don't let up.