Sunday, May 31, 2015

ABIM Fails to Disclose Lobbying Efforts

Shhhh.

The public wasn't supposed to know.

Neither was the Internal Revenue Service (IRS).

According to the American Board of Internal Medicine's (ABIM) most recent tax forms, they never participated in lobbying, nor spent money to do so.

Yet, according to public record, it appears the ABIM most certainly did lobby Congress as a 501(c)(3) organization and has repeatedly failed to disclose this reality to the IRS.

The ABIM's Lobbying Disclosures

Here's the information the ABIM filed with the IRS on their most recent "audited" 2013 Form 990 which includes expenses paid from 1 July 2013 to 30 June 2014 as a 501(c)(3) organization:

ABIM 2013 Form 990 Lobbying Disclosure
(Click image to enlarge)

ABIM 2013 Form 990 Itemized Lobbying Expenses
(Click image to Enlarge)

The ABIM's History of Lobbying

But searching OpenSecrets.org, a website dedicated to transparent government spending, it seems the ABIM spent quite handsomely on lobbying during its fiscal year 2014:

ABIM Lobbying Expenditures for 2014 Election Cycle
(Click image to enlarge)

In fact, the ABIM has been lobbying for years (and continues to do so):

ABIM's History of Lobbying since at least 2009

When we delve into who the ABIM paid for these lobbying efforts, we find even more interesting information.  In 2014, the lobbying firm used was Mehlman Vogel Castegnetti, Inc. (Vogel later spun off in 2014 to create his own lobbying firm and the new firm is now called Mehlman Castegnatti Rosen Bingel and Thomas) and used the following list of lobbyists:

ABIM Lobbying Firm in 2014
(Click to enlarge)
Of these lobbyists, five have current or former ties to the insurance industry (Bingel, Castagnetti, Gupta, Rosen and Zook) and one (Thomas) to the Federal Trade Commission and one (Eastman) to the Ways and Means Committee in the House of Representatives.  Needless to say, 13 of the 14 have "revolving door" relationships with one or more government offices.

These revelations are important. Recall that the American Board of Medical Specialties (of which the ABIM is but one of 24 "member boards") was magically inserted into Social Security Act 1848 (k)(4)  that deals with physician payment with passage of the Affordable Care Act in 2010. More recently in January of 2014 changes made to the ABIM's Maintenance of Certification (MOC) program that force doctors to pay them to remain "board certified" in good standing so they can remain credentialed to practice medicine with their employing hospital system and to receive insurance payments.
On January 1, 2014, the Organization revised the nature of the MOC program. The MOC program is now a continuous program based on a calendar year. Upon entering the MOC program, a diplomate must actively maintain their certification by completing certain requirements. These requirements are expected to be completed every two, five and ten years. Candidates choose to pay annually or to prepay for ten years for access to the program.
At the same time, CMS offered a payment incentive to physicians for participation in MOC.  Given the lobbying efforts uncovered here, no longer is the collusion between the ABIM 's MOC program and influential government personnel or agencies just a theory, it now appears (based on public record) to be a very real possibility. The ABIM's long-standing unreported lobbying history raises the very real possibility that the more recent leadership of the ABIM has been more concerned about creating a financial monopoly for itself (and trying to hide it) rather than truly improving patient care.

Further Questions Regarding the ABIM's Auditor

The auditing firm  McGladrey, LLC, appears to have audited he most recent financials for the ABIM. Their "responsibility statement" in the ABIM's financials states:
Our responsibility is to express an opinion on these financial statements based on our audits. We conducted our audits in accordance with auditing standards generally accepted in the United States of America. Those standards require that we plan and perform the audit to obtain reasonable assurance about whether the financial statements are free from material misstatement.
Now I'm just a practicing cardiac electrophysiologist here in the United States, not an auditor and I have no idea what "opinion" was actually "expressed" to the ABIM board members by McGladrey's auditors. But if I can find these financial and tax filing discrepancies (among others) thanks to the wonders of the internet, I think the ABIM and the ABIM Foundation needs a new auditor...

… like maybe the IRS or the Office of the Inspector General of the Department of Health and Human Services.

-Wes

Addendum: On 6/30/2015, a Lobbying Report was filed by the ABIM in accordance with the Lobbying Disclosure Act of 1995 (Section 5) terminating the ABIM's relationship with their lobbying firm Mehlman Castagnetti Rosen Bingel & Thomas, Inc.

31 comments:

x said...

dr wes, once again thanks for the hard work.

i have a question, aaps filed a case against abms/abim in anti-trust case in illinois court. do we know what happened to the case. or did abim/abms with the help of "lobbists" managed to stall the proceedings forever.

only fairness in the judicial system, is the last hope for us physicians..

Ed Rico said...

In the 4/7/2015 Newsweek article "A Certified Medical Controversy", Kurt Eichenwald writes:

'Start with ABIM’s Form 990. This is the document a nonprofit organization has to file with the Internal Revenue Service to disclose its activities and prove it deserves tax-free status. In Part IV, which appears on Page 3 of the document, the government asks a simple question on line 4: “Did the organization engage in lobbying activities?” And year after year, ABIM has answered “no.”

Unfortunately, the real world answer is “yes.” According to the Center for Responsive Politics, from 2009 through 2014, ABIM paid $390,000 to Mehlman Vogel Castagnetti, a lobbying firm. Asked about this, an ABIM representative says it complied with all rules governing IRS filings. (emphasis added)'

It's no coincidence that the last statement above was phrased the way it was. ABIM specifically did not deny involvement in lobbying activities (Kurt Eichenwald characterizes this as a "non-denial denial") and while there's little question of their arrogance, the ABIM principals certainly aren't stupid. They and their army of attorneys and tax preparers clearly believe that one or more of the Exceptions to Lobbying defined in the Form 990 instructions apply to ABIM's lobbying activities, possibly:

A communication is not a direct lobbying communication if the communication is an appearance before, or communication with, any legislative body concerning action by that body that might affect the organization's existence, its powers and duties, its tax-exempt status, or the deductibility of contributions to the organization, as opposed to affecting merely the scope of the organization's future activities.


Whether or not the above exception or any other Form 990 exceptions actually apply in ABIM's case is a matter for someone much smarter about tax law than I am, but relying on a self-serving interpretation of IRS instructions to avoid disclosing thousands of dollars, obtained from ABIM diplomates, spent on lobbying activities in an effort to influence legislation isn't consistent with Dr. Baron's protest in his 5/22/2015 E-mail to ABIM diplomates, "First, we have never made any effort to obfuscate, hide or delay ABIM's financial information". If Dr. Baron is truly serious about "correcting ... egregious and misleading charges that have been leveled against me and ABIM", I can think of no better way of accomplishing that goal than by opening ABIM's financial records to an independent third-party accounting firm, engaged by and paid by ABIM diplomates.

I'll be the first to write a check for this purpose if ABIM agrees to cooperate, whenever Dr. Baron is ready to clear this up.

Anonymous said...

Ed Rico raises an interesting point: it would be reasonable to assume that the ABIM, its attorneys and auditors considered the matter of reportable lobbying efforts when preparing its tax forms. What is not clear is whether ABIM made a 501(h) election, in which case its lobbying efforts would be evaluated under the IRS's expenditure test (which includes the exception mentioned by Rico). If it did, according to the IRS website, would it not be required to file a Form 5768 (did it?). If ABIM did not make the 501(h) election, then its lobbying activities would be scrutinized according to the IRS's alternative "substantial part" test, which looks at the facts and circumstances relating to the lobbying activity. Bottom line is that while there is no absolute prohibition against nonprofits engaging in some amount of lobbying, they walk a fine line and all lobbying activity is or should be subject to scrutiny. But beyond that, the question remains: is the lobbying that occurred considered an acceptable activity by those of us who are purportedly represented by the ABIM, and who, by the fees collected from us, provide the funding for the its lobbying activities?

Anonymous said...

An argument could also be made that despite any possible exception ABIM might claim for its lobbying activities, a nonprofit organization cannot or should not use an IRS exception to influence the passage of a law that establishes its proprietary certification as the only means by which members of a profession can practice their trade.

Ellison said...

Wes,
Again,cudos for shining the bright light of factual reporting on a once trusted organization, FIFA..., a, I mean ABIM. What are the next steps now that ABIM lacks credulity? Should we seek alternative certification until ABIM demonstrates it represents physician competence rather than itself?

Blog follower said...

Good reporting, Dr. Wes,

Anonymous said...

Are US Physicians the Only Hope for a Free Society? By Princess Valliant

Physicians live in a totalitarian society. Too busy to notice? Why?
Do you feel like a rat in a muddled maze being marched toward a concentration camp?
Or do you think you are already in some kind of miserable work camp you never conceived of when deciding to serve humanity making a good life for yourself and your family?
Where is that good life? Has someone taken it, stolen it from physicians? Are patients suddenly drawing the short stick more and more too?

Of everything that matters time is the most important. Without time nothing is possible. Creation of anything demands time. Love, health, and happiness need time. Life withers without time. Time has been stolen. By whom? You? Did you do this to yourself in the way life is organized; or did external forces create the lack of time and no one has any control over it.
Physicians live under the rule of a fascist malevolent leadership. There is almost no joy left in medicine, it seems. There are signs of awakening and stirrings of dissent creating some action. Yes, that is troublesome to the medical elite who ride in luxury Mercedes town cars. It is troublesome for the ‘masters of time’ who work from home for 35 hours. Or from anywhere else in the nation/world where they lobby on your behalf, without telling you. Or they just suggest wonderful changes for you and your life’s work. Life-changing policies that "every patient and physician needs and wants." You know the Chicago song and dance, don’t you!

Imagine working for the ABIM. All the time in the world to create propaganda, outright lies and newspeak. Cassel called this kind of work at ABIM CEO/President her "dream job when she left the Deanship at OHSU. I thought that would be her dream job after dear Christine hired at least two associate deans to do all the work!

The Truth According to the ABIM: Please click below for your pledge of support to our credo and absolute law. And have a nice Memorial Day!
“ABIM/ABMS/NQF, CMS, NIH, ACGME, ACP, AMA etc., is the government for physicians.
In totalitarian societies the media is controlled exclusively by the government. The government is controlled by the corporation. The corporations, therefore, controls the media. Consider the New York Times, and every major news source; they are under the control of our fascist leaders like Chris Cassel, Richard Baron, Eric Holmboe, and Lynn Langdon. Try to get the NYT to print anything negative about the ABIM, or about any egregious conflicts of interests concerning our glorious Baron, or Cassel or any of our leadership for that matter. They will not. Ha!
Physicians do not make the rules. ABIM makes the rules. The government creates and supports the rules. Corporations in the past had to lobby the government and use their purchasing power; now they own the lot. Therefore we at ABIM own the lot.”
Sincerely,
Robber Baron,
Vassal of American Health and Digital Well-Being

Princess Valliant says Wake Up!
The Rich Baron is not a Castle and he is a political buffoon that can be easily attacked. It may be the last chance for physicians and humanity in this country. Seize the moment to create a new medical society that is free and serves humanity again.
Take up the sword of truth. The walls or corruption will crumble. One baron, one castle at a time! (Don't rely on Newsweek to bring down the 'Masters of Newspeak'!

Princess Valliant, MD (your humble servant toiling in the withering field)

Anonymous said...

Are US Physicians the Only Hope for a Free Society? By Princess Valliant, MD

Physicians live in a totalitarian society. Too busy to notice? Why?

Do you feel like a rat in a muddled maze being marched toward a concentration camp?
Or do you think you are already in some kind of miserable work camp you never conceived of when deciding to serve humanity making a good life for yourself and your family?
Where is that good life? Has someone taken it, stolen it from physicians? Are patients suddenly drawing the short stick more and more too?

Of everything that matters time is the most important. Without time nothing is possible. Creation of anything demands time. Love, health, and happiness need time. Life withers without time. Time has been stolen. By whom? You? Did you do this to yourself in the way life is organized; or did external forces create the lack of time and no one has any control over it.

Physicians live under the rule of a fascist malevolent leadership. There is almost no joy left in medicine, it seems. There are signs of awakening and stirrings of dissent creating some action. That is troublesome to the medical elite who ride in luxury Mercedes town cars. It is troublesome for the ‘masters of time’ who work from home for 35 hours. Or from anywhere else in the nation or world where they lobby on your behalf, without telling you. Or they just suggest wonderful changes for you and your life’s work. Life-changing policies that "every patient and physician needs and wants." You know the Chicago song and dance, don’t you!

Imagine working for the ABIM. All the time in the world to create propaganda, outright lies and newspeak. Cassel called this kind of work at ABIM as CEO/President her "dream job when she left the Deanship at OHSU. I thought that would be her dream job after dear Christine hired at least two associate deans to do all the work! After creating these new management positions our of thin air.

The Truth According to the ABIM: Please click below for your pledge of support to our credo and absolute law.

“ABIM/ABMS/NQF, CMS, NIH, ACGME, ACP, AMA etc., is the government for physicians.
In totalitarian societies the media is controlled exclusively by the government. The government is controlled by the corporation. The corporations, therefore, control the media. Consider the New York Times, and every major news source; they are under the control of our fascist leaders like Chris Cassel, Richard Baron, Eric Holmboe, and Lynn Langdon. Try to get the NYT to print anything negative about the ABIM, or about any egregious conflict of interest concerning our glorious Baron, or Cassel, or any of our leadership for that matter. They will not. Ha!

Physicians do not make the rules. ABIM makes the rules. The government creates and supports the rules. Corporations in the past had to lobby the government and use their purchasing power; now they own the lot. Therefore we at ABIM own the lot.”

Princess Valliant says Wake Up!

The Rich Baron is not a Castle and he is a political buffoon that can be easily attacked. The ABIM can be toppled or put back in its place. It may be the last chance for physicians and humanity in this country. Seize the moment to create a new medical society that is free and serves humanity again. Fight to keep it free.

Take up the sword of truth. The walls of corruption will crumble. One baron, one castle at a time. Don't rely on Newsweek to bring down the Masters of Newspeak!

Princess Valliant, MD (your humble servant toiling in the withering field)

Anonymous said...

Does anyone know if the ABFP (American Board of Family Practice has similar problems?

Anonymous said...

That must be one of Dr. Baron's infamous "SHARED VALUES"

How many lies will Dr. Baron fail to acknowledge ?

Time to come clean Dr. Baron.

The IM community is disgusted and have had enough.

Anonymous said...

Speaking of Lynn Langdon....

I think she needs a telethon or FUNDME acct to keep her in the style shes used to .
(sarcasm)

That is some sweet deal shes got.

W.O.R.M. said...

For some time, Wes has masterfully and courageously led us through the dense underbrush of obfuscation to the edge of the fetid ABIM swamp. The greater task remains as to how to drain it. Administrative, legislative and judicial redress are long shots, now that ABMS/ABIM authority is codified as law. Perhaps a glimmer of hope exists in Newsweek’s recent revelations, which has broadened public awareness of the issue. But it amounts to more talk. Likewise, AAPS should be applauded in their efforts to challenge the legality of the monopolistic certification/recertification/MOC process (with a change of venue to a Chicago federal court). Good luck with that.

By means of implicit threats to their livelihoods, physicians are fearful of not participating in ABIM programs or even voicing their disdain. The takeaway is simple: lose your board certificate, lose your job. So much for it being a ‘voluntary’ program. All the more poignant as the physician-employee model becomes the norm.

Beyond words, the time for a legitimate yet spirited direct action against the ABIM is now. Largely symbolic, but a first step towards emboldening the ‘silent majority’ among us, demonstrating a willingness of the rank and file to confront this autocratic self-serving entity at its own doorstep en masse. Ironically, one block away from Independence Hall.

Anonymous said...


Robber Baron, this is Princess Valliant, MD! Yes, it's me again.

Now I’m standing outside your ‘Walnut Fortress’. Yeah, I’m the one in the street with the megaphone and full body armor! Just one of the many nonperson physicians you’ve had your way with far too long! Look at the crowd of angry physicians, nurses, administrators, and patients standing beside me. Look outside your pretty tinted windows if you dare.

Still don’t get it? Here’s a brick of truth for you!
We’re furious as hell and won’t tolerate your enslavement and illegal taxation any longer. We’re sick and tired of your continued oppression, lies and false attrition. We demand freedom! Yes, nothing short of complete and total freedom!

Hey, I’m talking to you, Robber Baron. Yoo-hoo! You in there? We can't see inside your riot-proof pad. God knows where you are! Maybe in DC with the Evil Queen plotting your next attack against us? Or another slimy digital sleight of hand to extract more cash for you and your greedy clan. Is that what’s in the cards?
Where's Duke Holmboe? Oh, slinked over to the ACGME; just another revolving-door place to get rich and hide from prosecution. Langdon, you in there? How about that quarter-million-a-year spokes that never spoke. Are you in there today? Silent, huh.

Here’s another brick then! We say no more plundered money for your illegal vault and the accounts of your fat-cat cronies! Are you nervous? You should be! We know how much you've tried to hide; you've got a hell of a lot of explaining to do. You and your ilk have some accounting to do with ‘King Democracy and ‘His Royal Treasurer’ too.

If you haven’t selectively destroyed recent memories in your brain, you have some other accounting to make too. No, you can’t use a simulated computer module for this. Those are just the bogus inventions of a profiteering conniving mind. Modules don’t count toward anything with us. You must endure the real test of your humanity toward those you have hurt. You’ve got to reconcile yourself with all those you’ve harmed.

Remember your evil deeds. You hear what I’m talking about? You recall yet? Is it coming back? It's that nightmare you created involving the demonization and ruination of the lives of your brother and sister physicians—all for economic and political reasons. We begin to understand now!

And you used the media like drones reining terror down on the whole of the medical community like weapons of mass destruction. This same kind of public humiliation is coming for you en mass. You can't contain it in the main stream media forever. ABIM is like a bad company on Wall Street that cooked its books presenting false realities. And you did this to your clients. ABIM and the ABMS House of Cards is blowing down, blowing down, blowing down...

Let's be clear. For these recent discoveries you must be presented before the ‘Tribunal of Rank and File Docs’. After that you must understand you will have to speak with ‘Lord of Civil Liberties’ for degrading the integrity of the judicial system. Misrepresentation of facts and motivations to ‘use’ a federal judge for your own greedy evil purposes does not sit well with us; and it did not sit well with the judge when he realized all the facts about the 'ABIM Fiefdom' and their arsenal of illegal dirty tricks.

You can’t restore civil rights once taken. Privacy, speech, home, property, assembly. No amount of money could possible compensate for all the damage you and the other vassal elites in the ‘Walnut Fortress’ have caused.
Date of discovery begins soon, unless you can keep your greedy nervous fingers in the dike. Too late, sorry...

And after the gauntlet of external justice has passed, in private you must face the "Great Judge Inside US All'. How will you defend yourself?

Princess Valiant, MD (your humble servant with legal battering rams Sarbanes and Oxley in both hands)

Anonymous said...

"These charges against the boards raise questions about accountability. Who or what oversees the certifying boards? Are there any governance standards in place? I wanted to learn whether the ABMS exercises any supervision of member boards, so I was pleased when Lois Margaret Nora, the CEO of ABMS, agreed to speak with me. I’ve included highlights from that interview at the end of this blog.

The interview with Nora persuaded me that the ABMS should consider taking a more active supervisory role in relation to its member organizations. At present, the ABMS does not appear to exercise oversight of governance procedures at its member boards or enforce any other standards of behavior. Even if the ABMS encourages member boards to make changes, though, they might resist a transformation of their longstanding culture and prove reluctant to enact real reforms. Such changes often must be imposed or motivated by outside authorities through adversarial processes.

The most effective form of external scrutiny could come from the government. For example, the Internal Revenue Service might examine the salaries of individual board employees. For tax-exempt organizations, no part of net income can “inure to the benefit” of private individuals, and excess compensation is a violation of that standard. Similarly, state Attorneys General could bring suit against officers or directors of the individual boards if they believe there have been breaches of fiduciary duty or that charitable assets have been wasted through lax oversight. Finally, the US Department of Justice could investigate the boards and the ABMS for restraint of trade or monopolistic behavior.

Or perhaps we are nearing a time when the ABMS and member boards will decide they have no choice but to change their behavior. This seems unlikely to occur as long as the boards and the ABMS fail to acknowledge the seriousness of the situation, but that may change. The process of certification has become so burdensome that purchasers of the service are threatening to abandon it in large numbers, and are vigorously seeking alternatives and judicial relief. A report from the US National Institutes of Health identifies “increasingly time consuming and demanding” maintenance of certification processes developed by the boards as a key factor “discouraging physician-scientists from maintaining their clinical privileges.” Finally, the behavior of the boards has attracted an increasing amount of unfavorable publicity and criticism from the mainstream media as well as criticism from respected senior physicians whose motives are not in question. Rather oddly, however, a recent issue of JAMA that was devoted to matters of professionalism, licensure, and certification contained almost no discussion of the large profits and salaries at member boards, instead suggesting that “the actions of the ABMS, and in particular the ABIM, in response to the concerns that have been raised about maintenance of certification epitomize professionalism.”"

http://blogs.bmj.com/bmj/2015/05/18/elizabeth-loder-us-medical-specialty-boards-accountable-to-whom-for-what-and-how/

Debbi McInteer said...

Thank you!!!

Debbi McInteer said...

All the specialty boards are controlled by the ABMS. If you think you are immune then you are dreaming.

Max G. said...
This comment has been removed by the author.
Anonymous said...

ABIM changes exam score report, updates MOC exam blueprint

http://www.clinicalendocrinologynews.com/news/news/single-article/abim-changes-exam-score-report-updates-moc-exam-blueprint/c9522ffeb2cdc550b671da031ae7eb02.html


see article

You can put LIPSTICK on a pig and call it Monique, but its still a PIG !!!!

Thomas Nielsen, MD, MSEE, FACC said...

I am a cardiologist in Alabama. I stood up last week at our annual Alabama ACC meeting and told Rich Chazal, the incoming president of the ACC, and Shal Jacobovitz, the ACC CEO, that long ago the AMA failed us, now the ABIM has failed us, and even the ACC has failed us.

He had the gall to tell us that we should be working with the ABIM/ABMS because trying to get out of their corrupt MOC schemes is "complicated". He says that the ACC reviewed the ABIM books and they were "clean".

They both also defended the ACC support for MACRA, because he said that "we needed to end SGR". Yes, and we got a poison pill in MACRA to do it - they did not see it that way. MACRA puts in place APMs - the rules have not been written yet, but essentially, the hospital/ACO will get paid, take whatever they want, and give the doctor whatever crumbs are left. If you don't join an APM you have to demonstrate "quality" - and who gets to define that, under MACRA? the National "Quality" Foundation led by Christine Cassell, who just golden parachuted out of the lead spot at the ABIM.

It is time for physicians to reclaim the doctor-patient relationship - including the documentation and payment - from all of the bureaucrats and bean counters out there, be they MDs or not.

Anonymous said...

Every minute ABIM exists it menaces the world, and someone dies or gets neglected medically. I'd chant that at Capitol Hill!

Physician lives matter. Patient lives matter! Wasted MOC time, stress, distraction & limited access = < death, < morbidity.

Physicians who actively treat patients/academic clinicians, and others need to take control of the ABIM board & vote to dissolve this evil!

This society is free only to the degree that we live that way and make it so.

I heard Bucky Fuller speak once in a huge crowd. He was trying to engage people to act in life and not be just spectators. He walked up straight to me with his eyes bulging through his thick glasses and said, "Look up at the huge chandelier directly above the people sitting in this room. If you saw it was going to fall and hurt people, you would not sit there and think about it; there's no time, you would jump up to help people get out of the way!"

We need to end this ill in society that hurts us and everyone that breathes!
We the People paid for their evil building, their clothes, their food, cars, their computerized madness, the spying, the fallacious copyrighting of medical science, the lawyers, the demonization. This is a autocratic culture that will not change ever. It will never be democratic. It is a skinny building full of politicians who stole money and put it in a dump truck called ABIMF and drove off with it. Just to dump more and ever increasing horror on our heads. It is a society that kills us and it destroys life in the name of beneficence and the public trust. It is time to take our lives, time and money back. And choose to live NOT UNDER but WITH sensible, reasonable democratic control of our lives, CME and medical decisions.

Anonymous said...

ABIM's "Proclamation of Change"

Courtesy of Princess Valliant, MD Your humble interlocutor of truth, liberty and justice for all. Tearing down the walls of inequality. Vanquisher of greed and graft. Exposer of murderous evil powers lurking in the shadows of this good earth.

See below in part II for a transcript of the ABIM's "Proclamation of Change" authored by Robber Baron of the Walnut Fiefdom. He is sponsored by his elite cartel of 'kind thieves' and ‘gentle team members', which comprise the ‘deadly committee of the whole'. See Part II for Baron's thoughts, policies toward reduced burdens, and other physician considerations.

This will be followed by a special holographic guest appearance from the NQF’s top expert and head. Yes, a rare live appearance from the National Quackery Forum's own DC Castle. Sorry we are not taking any questions today. See Part III for DC.


Anonymous said...

A Brief Message from the ABIM: (Courtesy of Princess Valliant, MD.)

We are very pleased to announce our “shared proclamation policy” initiative (SPP) regarding the “enhanced order of physicians” (EOP). Details and expectations regarding the much anticipated and highly acclaimed SPP is posted on your “universal work screen” (UWS) this morning. We want you to know we have been listening to you! So we have reduced your responsibilities. As of the close of “night duty” (ND), physicians have “restricted access” (RA) to “shared corporate decisions” (SCD). It is our hope that this will increase free time for “maintenance of certification” (MOC). Yes, we did hear your valued suggestions and we responded!

However, you are still expected to follow the “ethical practice model” (EPM) of "choosing wisely" (CW) with patients, using your “designated doctor’s aid” (DDA). Furthermore, in order for a “wise decision model” (WDM) to actualize in your practice you must realize the “shared decision model” (SDM) in your “daily work flow” initiative (DWF). “Corporate Medicine Educators” (CME) will be in “complete control” (CC) over “medical decisions” (MD). This will, we know take a great burden off our highly prized and motivated teams of physicians! “All decisions” (AD) concerning “cost, payroll, benefits, and policy” (CPBP) will be made by an “all decisions committee (ADC).” Please memorize the new terms ASP.

We’ll see you for MOC lunchtime (MOCL) to hear your praise of the reduction in work requirements as mandated by Congress HR132908769876 and all the “new order” improvements for the “perfect work day” (PWD).

Just to remind you:
EXCLUDED in the “new order” (NO) effective as of 1975 order of ABIM policy of “static in perpetuity” (SI) (‘revitalized’ into law 2015) are “investigative medical science” (IMS) and the “human conscience” (HC). These do not interact well with the “perfect static order” (PSO). You are highly encouraged to practice “verbal excellence” (VE) to help maintain the “correct newspeak society” (CNS).

And as you enthusiastically requested, Mainstream Media (MSM) will revitalize all thought and opinions to reduce your need to participate in worrisome conditions as they may arise. Right now our main task is to focus and let our highly specialized units keep searching your homes and cavities for the terrorists that lurk on the surface of our dear shimmering planet and yes even “terrorist implant control systems” (TICS) inside your bodies. Remember there is nothing to fear except fear itself and failure to notice and report “abnormal people” (AP).

Our self-sacrificing “all enforcing units” (AEU) have helped reduce more unnecessary use of bandwidth in the “most glorious spectrum” (MGS). This leaves more for our “indispensable leadership” (IL) to guide you wisely and effectively in everything. As you may know our military specialists are utilizing more bandwidth for your protection from “kinetic types” (KT) and this will also keep your costs of delivery down. “Black and white reality” (BWR) of “domestic and global affairs” (DGA) and “digital therapeutic hypnosis” (DTH) will help maintain order in the progression toward and maintenance of the “static perfection of society” (SPS).

The “New order of reformed managers” (NORM) will guide you through your duties today as always at the “flow stations” (FS) after “briefing and share huddle time” (BSHT). Physicians as “medical servers” (MS) are playing the foundational and pivotal role in maintaining “perfect international order” (PIO) by rooting out and removing all waste and useless debris from that perfect order. You may turn off your “universal screen” (US) now and “GO TO WORK” (GTW).

Have a perfect work day and a memorable 4th of July weekend!

Robber Baron ABIM's champion of real change fighting for you.

Anonymous said...

But wait we have a transmission coming in from DC…

brought to you by Princess Valliant, MD, (Freedom in Media; Freedom for Life!)

All rise for a few words from our illustrious leader, DC Castle, founder and head of the National Quackery Forum (NQF) (forum to stamp out quackery in medicine). DC, our glorious creator of initiative HR2009 to destroy all conflicted physicians is coming in view now via holographic universal imaging (HUI).

“My fellow diplomates of "wisdom's principled choice" (WPC), before I get started, I’d like to remind everyone “MOC additive donations” (MOCAD) are currently being accepted for the DC Castle Legacy Foundation, which will be bequeathed in your honor to “excellent physicians for global medical hegemony” (EPGMH) foundations. Please memorize and digest the following VE (verbal excellence) for the “efficient MACRABIOTIC intake” (EMI) into our “perfect medical community” (PMC) in serving the well-fashioned and obedient “society of helpful energetic eager people” (SHEEP).

And now the direct holographic wisdom verbatim from the DC Tzaritza of "streamlined quality measurement” (SQM). Hear ye! Hear ye! Please bow before your "Personal Hologram". (PH)

“The provisions that allow for continued funding of the quality measurement enterprise in HR2 2015 are a key building block of this important transition (as outlined above) and will also facilitate work to continue advancing measurement science.”

“Ultimately these efforts will not only help people get better healthcare, but also will reduce costs that strain patient, purchasers, and the system overall.” —NQF, “Live Office of Verbal Excellence” (LOVE)

With all certified sincerity,
DC Castle
National Quality Advisor, NQF
RW Johnsonian Chair for the Unregulated Office of Policy Management
ACP Master of Ultimate but Sensible Order in Medicine
Supremely Humble Servant to 'King Democracy'
Author of no less than 2,000,000 voluminous tooms in the name of geriatric science

Anonymous said...

Wes, I am planning to take our opposition of MOC and support for NBPAS to our hospital MEC then on to Trinity Health, which is an 80-hospital health system. I was told that I need to better explain why NBPAS would serve as a valid certification of physician competence. I know and have stated all the limitations of Recert and MOC, but I am having trouble fleshing out the rationale supporting NBPAS. Can you help with a blog post?

DrWes said...

Anony 12:38PM-

I think the only reason for NBPAS.org certification is as an alternative to the more costly, unproven, and cumbersome ABIM MOC credential for hosptial credentialing purposes. The American Board of Medical Specialties (ABMS) have monopolized the certification and re-certification process for US physicians. Realize the ABMS construct, AMA, American Hosptial Association, Council of Medical Specialty Societies, American Osteopathic Association, and the American Association of Colelges of Osteopathic Medicine and all member boards of the American Council of Graduate Medical Education. Increasingly, insurers are insisting on the MOC credential despite no evidence to support evidence of improved outcomes for patients. Instead, the lack of a competitor to oppose the ABMS MOC program has allowed them to demand high prices for their tests, unaccountability to the public and professionals who fail the examination, and support for an uncertain political agenda that supports the organizations before it supports the working physicians.

With the exposure of the ABIM/ABMS financial scandal, legitimacy of the MOC program for patient care has been lost. It will take many months to years to unravel the corrupting influence of these organizations to our profession of medicine, but I am quite certain the changes at hand will accelerate the process.

Hope that helps.

Anonymous said...

Epitaph on ABIM’s tombstone: "BC" an unscientific antiquated myth.

ABMS gravestone reads: "MOC" a proven fraud.

Some incidental epitaphs:

"I came humbly. I built modestly. Those greedy slothful DOCS killed it all."

Front: "Bows and flows of angel hair." Back: "And ice cream castles in the air."

Hush little docs now don’t say a thing, Mommy's gonna sell you a MOCing thing. And if that MOCing thing don’t sing, Mommy's gonna still have her diamond ring.

Anonymous said...

Thanks Wes. I think we, as physicians, have to flesh out the argument for supporting NBPAS better. I think that allowing physicians to get back to attending to our primary mission of patient care, or research/education if applies, will have to be emphasized. I think the case AGAINST the ABMS industrial complex and their flawed recertification/MOC product has been well made so far. I agree that this may be the beginning of the end. But I can imagine that large health systems and insurance companies want to find an external body behind which they can hide, and say that this 'certification' means that their physicians are somehow better. Until we can make a cogent argument FOR the NBPAS, we will continue to struggle. Never mind that no other profession is subjected to this type of hollow process, and that physicians in other countries are not subjected to this. And that there is no real evidence supporting its benefits.

PGYx said...

Thanks for taking time to detail these developments. The MOC process is a pay-to-play racket designed to make money for the certifying organizations. It does not ensure a physician is up-to-date in his/her field. I trained under and work with physicians who universally pursue excellence, but recently encountered a doctor who really doesn't read or attempt to keep up in her field. Unfortunately, I do not believe the MOC process weeds these docs out of practice.

Not an internist, but my specialty board has backed off of plans to mimic the ABIM certifying process. Thanks to all the docs who managed to organize and rally together to effect positive change. Now if we could just keep that ball rolling for other issues that affect us all, we just might be able to take back our profession from administrative wonks who currently control healthcare.

Anonymous said...

ABIM/ABIM Foundation Auditor McGlardrey. Stated Deficiencies:
See link to Inspection of McGladrey's deficiencies by the
Public Company Accounting Oversight Board (PCAOB)

http://pcaobus.org/Inspections/Reports/Documents/2014_McGladrey_LLP.pdf

David Ramsey said...

Thanks for sharing the information about ABIM fails to disclose lobbying!

Paul Kempen said...

NO wonder the FTC has never jumped on the ABIM in spite of clear evidence of restraint of trade-they pay the leaders $$$$$:
Of these lobbyists, five have current or former ties to the insurance industry (Bingel, Castagnetti, Gupta, Rosen and Zook) and one (Thomas) to the Federal Trade Commission and one (Eastman) to the Ways and Means Committee in the House of Representatives. "