The ABIM, Its Finances, and the Great Collusion

Yesterday, Newsweek Pulitzer-prize finalist and reporter Kurt Eichenwald pulled back the curtain on the Great and Powerful Oz of medical credentialing, the American Board of Internal Medicine (ABIM) when he meticulously dissected the organization's most recent financials. In his piece, Eichenwald laid bare the "trickery," cronyism, and greed that has come to define the ABIM that has been led by a few self-selected "Untouchables" of our profession.  The details are outrageous for a non-profit espousing "medical professionalism:" $1,712,846 million to the outgoing President and CEO Christine Cassel, MD, an estimated $860,926 to the current Present and CEO Richard Baron, MD, lack of disclosure of lobbying efforts, tax filing discrepancies, to name a few. The story is so disturbing on so many levels, yet so important, that I encourage all to read it.

In response, Richard Baron, MD sent an emotional  e-mail to all ABIM diplomats yesterday that was in large part a rehash of his disagreements with Mr. Eichenwald's reporting.  He also attempted to dispute two of the allegations made by the most recent Newsweek story:

First, we have never made any effort to obfuscate, hide or delay ABIM's financial information. It's publicly available on our website. Second, no one is trying to hide salaries. I earned $688,000 in compensation in 2014 and $55,000 in deferred compensation (payment of which is contingent upon completion of my five-year contract). That is more than I ever made in 30 years of independent community practice of internal medicine and geriatrics, but it is set by my Board to be comparable to what CEOs of similar-sized health-related organizations earn.

By now it is almost silly for Dr Baron to claim they "never made any effort to obfuscate, hide, or delay ABIM's financial information." No where does the ABIM website discuss its transfer of $30.66 million of physician testing fees to the suspect ABIM Foundation from 1998-2007, the purchase of a $2.3 million condominium complete with a chauffeur-driven Mercedes S class town car in December 2007, the continued contradiction in the ABIM Foundation's creation date (1999) that  conflicts with public record (1989), why the condominium's depreciation was lumped in with "condo expenses" and classified under "program service expenses", nor that the "rent" that the ABIM pays the Foundation for the condo's use does not show up on tax forms as such. I asked him to explain these issues in December of 2014 and only received world class obfuscation of the facts. (Update: And then there was the stunt where they tried to withhold six key schedules from their consolidated financials with Foundation, only to publish them after public ridicule). Was he aware of his actions? Given what we've repeatedly observed regarding his inability to address ABIM diplomats financial concerns regarding the ABIM, it's hard to think otherwise.

More telling was Dr. Baron's pitiful disclosure of his salary and "deferred benefits." It is clear that Dr. Baron is so far removed from the realities of patient care today that he has no concept how entitled he sounds, especially for someone running a non-profit organization that has crushed 139 physicians' professional lives with the past Arora test-preparation scandal to protect their monopoly while they enjoy their lavish salaries and creature comforts all provided with tax exempt status.

Mr. Eichenwald learned of Dr. Baron's follow-up e-mail to ABIM members and broadcast his rebuttal via Twitter. In that thread he gave details on his interaction with the ABIM and their avoidance of the issues. (Details can be read on Jay Schloss's Storify of the tweets.) I'd like to think Baron will accept and offer to be interviewed by Eichenwald, but I know it will never happen - the ABIM's lawyers won't let him.

It's Not Just the ABIM

As twisted, deceptive, corrupt and disappointing the financial story of the ABIM and its Foundation has become, it's only the tip of the iceberg. We should recall that the American Board of Medical Specialties (ABMS - a separate 501(c)(6) non-profit) owns the trademarked Maintenance of Certification® program which the ABIM as one such member board helps administer. The ABMS serves effectively as a "business league" for its 24 member boards, much like the NFL lobbies for its football franchises (in fact, the NFL has the same tax-exempt designation). The ABMS lobbied Congress about the self-proclaimed merits of their branded MOC® program while paying their director,  Lois Nora, MD, JD $779,487 to earn government contracts and to assure the ABMS (with the ABIM as a testing entity) remained in the Affordable Care Act as a physician quality registry (see Social Security Act 1848, Section (k)(4)). The monopoly power of the ABMS regarding physician credentials prompted a pending suit alleging possible anti-trust violations. The fact that the ABMS or the ABIM has never studied the socioeconomic, psychological or physical toll upon physicians (and their patients) who fail the trademarked MOC® re-certification examination is telling and speaks to the blatant disregard of those tested.

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The interconnected relationships of Christine Cassel, MD, Richard Baron, MD, the National Quality Forum, the ironically named "Seamless Care Models Group" in the Center for Medicare and Medicaid Innovation, a component of the Centers for Medicare and Medicaid Services (CMS), reeks of a sophisticated kickback scheme using doctors and their requirement to pay MOC® fees every two years to the ABIM (and other member boards of ABMS) that assures their largess and perpetual cozy employment opportunities. Why else are doctors increasingly required to  participate in MOC® to remain credentialed with their hospital employer? Might this have been the reason the ABIM board felt Dr. Cassel warranted her $1.7 million take from the ABIM for working just a thirty-five hour work week and serving as a consultant to Premier, Inc and Kaiser Foundation Health Plans and Hospitals?

Because of the revolving door between the members of ABIM, the American College of Physicians (ACP), the Accreditation Council for Graduate Medical Education (ACGME), Joint Commission on Accreditation of Hospital Organizations (JCAHO), ABMS, and the American Medical Association (AMA), (with the exception of ABIM, all of these organizations are located in downtown Chicago) is it any wonder that program directors in hospitals must participate in MOC?  Likewise, is it any surprise that our most vulnerable newly minted physicians must enroll in the unproven and heavily marketed  Maintenance of Certification® program before they are even "board certified" for the first time?

Mr. Eichenwald is correct when suggesting that it is time for the "Federal Trade Commission and the Justice Department to investigate whether the ABIM is engaged in a restraint of trade by driving doctors out of business if they don’t pay up. It is time for the IRS to investigate whether the ABIM is a nonprofit or a business." I would add that the ABMS and ABIM should be investigated by the OIG of the Department of Health and Human Services to determine if the MOC program is a carefully contrived pay-to-play scheme using the US government as imprimatur.

Irrespective of the legal plays that are now likely to take place,  US physicians must immediately stop paying for MOC® and insist their local medical executive committees remove MOC® as a condition for hospital credentialing or, at the very least, make enrollment in NBPAS.org an alternative to the corrupt ABMS MOC® credential. Otherwise, practicing physicians will be working to potentiate the existence of this very broken program.

-Wes