Friday, April 10, 2015

Working Physicians Were Played; It's Time to Take Action

We've been played.

Played so badly it would make Goodfellas blush.

Remember these words?
"Dear Internal Medicine Community:

ABIM clearly got it wrong. We launched programs that weren't ready and we didn't deliver an MOC program that physicians found meaningful. We want to change that. …"
Doctors thought this was because of the malfeasance that was discovered in the ABIM's dealings with purchasing $2.3 million condominium's with chauffeur-driven Mercedes S call town cars and systematically funneling $30.6 million of our testing fees to an obscure Foundation that markets some version of social justice "professionalism."

Wrong-o boys and girls.

The plan all along was to shift gears and make MOC integral to how Congress would permit the Center for Medicare and Medicaid Services Congress to calculate your "value" as a worker to the health care system. Just do your practice improvement modules and walk backwards and type of a keyboard so they can get paid.

Yes, Virginia, MOC wasn't ready because MOC wasn't part of the "Doc Fix" legislation (H.R. 2) yet, but now it is.

How do I know this? Because ABMS lobbied members of the Energy and Commerce Committee in Congress to have MOC included as part of the "Doc Fix" bill in June, 2013:
We recommend that ABMS MOC® serve as a reporting pathway in the future for more detailed data on performance across the competencies. Making it possible to report through MOC will reduce administrative burden on physicians participating in voluntary professional development activities, will help to assure that there are practice-relevant options for all specialties and that quality measurement will be tied to a disciplined improvement process.
The ABIM wasn't sorry. The ABIM knew from the start that physician payment reform was on its way and a stand-alone MOC program wouldn't be needed because it would be part of the new law! Why else would they opt to "suspend" part IV for two years rather than remove it outright? (Maybe to preserve it just in case the SRG bill didn't pass?)

It's Time to Send the US Senate a Message from Front-line Working Physicians

On Monday before you start work, contact your state Senators by calling the US Capitol switchboard at 1-202-224-3121.  Don't hang up until you speak with your senator or their aide.  Tell them you have patients waiting.  Tell them you're being held up from a meeting. But get through and don't hang up until you do.  The switchboard is open 24-hours a day, but call in the morning, 8 AM EST if you can, to be sure your voice is heard. But get through.

Tell them you want all references to Section 1848 (k)(4) used as determinants of  of a "value-based modifier" struck from the bill (Addendum: this is the section that authorizes the ABMS to use their MOC program - see comments below).  Tell your Senator that if he or she can't do that, then they should vote "NO" because you'll have to pay hundreds of dollars representatives of the independent ABMS member boards every two years to practice medicine and take time away from patients to do meaningless and unproven busywork. The ABMS MOC® program should NOT be allowed to stand in the new SGR repeal legislation (H.R.2) in any form.  Tell them that such a scheme represents taxation without representation.

It is time to send the message LOUD and CLEAR that doctors will not participate in a pay-to-play scheme with the ABMS, ABIM or any other member board every two years to practice our trade.

We MUST take action NOW.

Just do it.


For those skeptical that the ABMS MOC Program is in H.R.2, I have included a few highlighted examples: Page 27 and 28, Page 35, and page 51 as a few examples. Note that HR 2 modifies portions of Social Security Law 1848 that specifies how physicians are paid. Section (k)(4) of 1848 authorizes the American Board of Medical Specialties MOC program to be a medical registry for reporting quality data.  No section of H.R.2 deletes this section and only solidifies MOC as a quality reporting registry.


American Medical Association said...

The AMA would like to address some of the myths contained in this post. We have reviewed the bill closely and have found that the sections of the legislation that Dr. Wes discusses cannot invalidate an NPI and does not require physicians to participate in MOC. Here are some clarifications on the bill to address Dr. Wes’ commentary.

1. Section 507 is a program integrity measure designed to ensure that NPIs are correct to prevent fraudulent use of an NPI in the case of identity theft or where a prescriber’s other identification (DEA number, for example) does not correspond to the NPI.

2. There has been an ongoing concern that NPIs placed on Medicare Part D pharmacy claims have included invalid NPIs that are expired, were held by deceased physicians, etc. Section 507 is intended to ensure that NPIs are correct to prevent their fraudulent use in the case of identity theft or where a prescriber’s other identification number, like their DEA number, does not correspond to their NPI.

3. Personal health care information for insurance operations and other purposes are covered under current HIPAA law; H.R. 2 does not remove existing HIPAA protections.

4. The Secretary of HHS cannot selectively punish a physician, or a physician’s patients, because of their opt-out status. H.R. 2 does not change this.

5. Physicians may choose to remain in Medicare fee for service or adopt new payment and delivery models. Like current law, there are quality reporting incentive programs tied to fee for service as well as new models. However, the options available to physicians and the potential for earning positive incentive payments would improve significantly, while the financial risk of penalties is reduced. There is absolutely no requirement in H.R. 2 for physicians to participate in MOC.

DrWes said...


First of all, I have said NOTHING about the NPI issue you address in your boilerplate message. My issue is with the ABMS MOC program in entirety. The program is unethical, has wasted precious dollars for NOTHING of value. And the truth is, this program IS specificed in Soc Sec Law 1848 subsection (k)(4) - every bit of it.

Here's what that section says:

"(4) Use of registry-based reporting.—As part of the publication of proposed and final quality measures for 2008 under clauses (ii) and (iii) of paragraph (2)(B), the Secretary shall address a mechanism whereby an eligible professional may provide data on quality measures through an appropriate medical registry (such as the Society of Thoracic Surgeons National Database) or through a Maintenance of Certification program operated by a specialty body of the American Board of Medical Specialties that meets the criteria for such a registry , as identified by the Secretary."

Admittedly, there are other programs that can be used to satisfy "practice improvement projects" OTHER than the MOC program, but the use of ABMS MOC program SPECIFICALLY should NOT be allowed in the bill in ANY form given the recent revelations I and others have uncovered with the financial and lack of protection of human subject practices of the ABMS, ABIM and their Foundation.

Anonymous said...

Dear American Medical Association:

Why did you support Obamacare? My patients previously had a $500 deductible and now have a $6000 deductible. They cannot afford the testing and procedures that I recommend. Obamacare has LIMITED access to medical care and will cause MORE medical bankruptcies. The AMA lies to physicians and patients. I will never believe anything the AMA says. Shame on the AMA for turning its back on America all in the name of ensuring increasing revenue from the government bureaucracy!

Anonymous said...


I have a hard time believing an actual physician would A) refer to PPACA as "Obamacare" or B) fail to understand the difference between PPACA and an actual insurance plan.

Anonymous said...


It is hard to believe that the lobbyists for the AMA would be spending their time on this message board when they could be cross-pollinating the "Ready for Hillary" campaign to be announced on Twitter Sunday at noon.

Anonymous said...

OMG!!! How dare the AMA come on here defending this MOC BS!! We've got real, working doctors out here like Wes, Teirstein, Kempen etc. spending what little spare time they have trying to expose this scandal for what it is and you sell-outs that we pay to prevent BS like this from happening in the first place come on here trying to defend it? How do you guys sleep at night? Do you even remember what it was like before you sold out?? They must be promising you guys one heck of a golden parachute to sell your souls like this. Shame on you, AMA, shame on you all.

Anonymous said...

So glad you are reading. While you may be surrounded by an echo-chamber of sycophants at your meetings, realize that the average physician, yes the one who sees the bulk of patients in the real world, despises you deeply.

While you may get millions from Sunbeam (really!?), and others to shill nonsense, you will never get a dime from me.

gur. said...

LEt me warn AMA that doctors have gotten your tricks now. they can write better legislation and get them passed from senators through more honest and decent manner than your lobbying group including ABMS/ABIM etc etc.. please remind your bosses that in case AMA does not support the doctors in genuine issues then the next bill asking to scrap the existence of AMA/ABMS and all such good for nothing frankensteins (who have outlived their utility) and who think lobbying money can help them beget more more moeny will continue forever. thank you.

Anonymous said...

Dear AMA:

There's a reason that I have never sent you a dime. You stopped supporting physicians many years ago, and I recognized that when I was a resident. Again your true colors are exposed as you throw your support behind the ABMS and its member boards. These crooks have taken our hard earned money and spent it lobbying Congress to ensure that their nests stay feathered. I think the ABMS and its member boards understand that unless there is a law forcing physicians to participate in their program, it will not survive.

Bravo to Dr. Wes and all my fellow physicians for shining the light on the truth. The cockroaches are running for cover.

Anonymous said...

Dear AMA,

Do you think all physicians are so unintelligent that we can't see through the "pied-piperish" psychobabble that you and every national organization except the AAPS have been spewing at us for years now? The simple fact that MOC ever got off the ground is unequivocal proof that you are no longer the voice of practicing physicians in this country - a true representative of our voices would have never, ever let this happen, much less allow it to be written into national legislation. Using your voice to defend MOC in the face of the current scandals exposed by none other than Kurt Eichenwald at Newsweek is proof that the AMA has been complicit with this all along and hopefully will go down along with the rest of these amoral people.
Can you imagine another article coming out in Newsweek titled "AMA Shocked at Scandals Emerging at ABIM/ABMS - Joins AAPS Lawsuit to End MOC Shakedown of Physicians"? No, I can't imagine it either…..

Anonymous said...

Son - new doctor -- asked about AMA . Tried to keep my lunch down ! The chief resident suggested that NONE of the 28 residents join this scam -- can I say -- medical society ?? I do hope & pray doctors organize to eliminate this worthless tumor on medicine !!
Pleased to see some of the , above comments --- however -- there should be hundreds of comments . Please start a cyber thread -- send to all colleagues , professors ,, clinical managers , and -- our politicians !
Spring is a time of new growth -- it is time to vanish this Weed !

Anonymous said...

Dear AMA,
What the hack are you talking about? What is NPI and why does it have anything to do with the original post. You are as clueless about frontline physicians as your post here exemplified.
Where is ABIM and ABMS? Why are they not here to defend themselves and send their goons to defend them?

Anonymous said...

@ Anonymous

Wow. If Chief Residents are starting to see the light, this could be the tipping point…..

Anonymous said...

Wes, your message here is not clear. You need to write a blog post SPECIFICALLY outlining the issue. I read your highlighted sections and there was NO mention of MOC so I'm not entirely sure what the central issue is. I read the SSA site you linked to and found the ABMS reference but the law does not mandate this.... please re-write and use examples from the H.R.2 that support your case.

DrWes said...

Anony 3:37PM-

Clearly, you don't get it. MOC of any kind is a inherent flawed, unproven, wasteful, and time-consuming program that has never been proven to be superior to years of clinical experience with standard CME. Further, I and others have uncovered years of financial and tax fraud malfeasance with inappropriate use of our testing fees, fraudulent tax filings, and the like. Furthermore, the ABMS and their member boards have a civil suit filed in federal court against them for possible anti-trust violations in accordance with the Sherman Act. Unfortunately, when the ABMS lobbied Congress to have MOC included in HR 2, they conveniently failed to mention these facts. Working docs are fully aware of these facts, however. Yet MOC as a program is a perforating measure for physicians. Given these issues, why? Isn't that careless law writing?

I don't want our good Senators to get egg on their faces when this whole bill collapses. I'm trying to do my civic duty to point out the egregious behavior of these unaccountable non-profits that have snuck into the ACA and use fear tactics to guarantee their high salaries in the name of quality.

MOC as a registry for physician "value" determination MUST be struck from the bill.

DrWes said...

Heh, iPhone spell-check error: "perforating" should be "performance" in my last comment.

Anonymous said...

Hi Wes, with regard to my earlier post, I'm not debating the supposed value of MOC and you don't have to sell us on why MOC is flawed. I get it. But if you're asking us to write our Senators then we need to very clear about our concern so we can sound intelligent.

What I asked of you was to point out EXACTLY what you think we should identify in H.R.2 and find distasteful. Again, I read all your (highlighted) links and the SSA page but do not see the mandated issue of concern. I don't clearly see where it says MOC is mandatory. If I don't see this then it's likely many other people don't see the problem. Please advise.

Anonymous said...

Hi Wes, I look at this more over the weekend and I still cannot find the evidence to support the position you posit. It's clear that the ABMS advocated for years and made attempts to get their programs into the law:

But recent analysis by AMA, MMS, and many other societies have clearly debunked your concerns that they were successful:

You know, it's easy to believe something when you WANT to believe it... and I WANT to believe you, but we need to be more evidence-based to draw firm conclusions. Until you can provide targeted data, I think your discussion overstates the results as the bill is written. MOC does not appear to be mandated.

DrWes said...
This comment has been removed by the author.
DrWes said...

Anony 12:37 -

You said: "You know, it's easy to believe something when you WANT to believe it... and I WANT to believe you, but we need to be more evidence-based to draw firm conclusions. Until you can provide targeted data, I think your discussion overstates the results as the bill is written."

You then reference the Massachusetts Medical Society's analysis as "fact" regarding the contents of HR2 but failed to disclose their clear conflict of interests for promoting MOC as part of HR 2:

As I said before, having MOC even included in the HR 2 bill AT ALL without evidence of its value to improved health care and as part of ANY quality metric is flawed.

MOC in any way should not be in the bill AT ALL. That's my point.

Anonymous said...

Hi Wes,

Ok, so "MOC in any way should not be in the bill AT ALL. That's my point"

Great, so we agree. Good thing it does not appear to be in the bill.

Here's the current text:

Now please point out EXACTLY where in THIS bill, H.R. 2, that the ABMS MOC is even mentioned.

I agree that some nebulous certification process is mentioned a few times but I'm trying to work with you here. You still haven't pointed out the data where the ABMS MOC program is specifically mentioned. This is a reasonable question if you expect anyone to write their Senator to effect change.

DrWes said...

Anony 05:17 -

Note that the ABMS MOC program is specifically named in Social Security Law 1848 (k)(4) and was added there by the Affordable Care Act's modification to the law in 2010. All of the various sections specific to the MOC program were also included as a requirement for a medical registry in section (m) as well.

Now, take the pdf of the current law before the Senate (here it is: )

Then use the pdf search feature to search for "(k)" and "(m)" and see all the instances you return. NONE of them remove section (k)(4). There are 13 references to section (k) (also known as the ABMS MOC program) and 43 references to section (m) (which outlines the various "parts" of the ABMS MOC program, including the secure exam, survey collection, etc.)

Then search for "certification" and you will find 5 hits for that as well.

The reason you don't see the ABMS MOC program anywhere in the bill is because you were not supposed to know that this law only MODIFIED the existing law that already contained the ABMS MOC program. Unfortunately, BECAUSE H.R.2 does not REMOVE section (k)(4) from the EXISTING law, it remains by NOT being mentioned.

Clever, huh?