Saturday, May 16, 2015

The American Board of Internal Medicine's Land of Make Believe

Hi boys and girls!  My name is Christine Casell, MD.  I was once the President and CEO of the American Board of Internal Medicine, the ABIM Foundation, and the Institute of Clinical Evaluation.  Now I'm President and CEO of the National Quality Forum in charge of setting quality standards for every hospital in the United States. I'd like to tell you about a special place I know called The Land of Make Believe because I want you to sleep better tonight.

The Land of Make Believe is a magical place.  It has amazing superpowers and can do things no one else can.  For instance, it can telepathically transport from Iowa to Pennsylvania in the blink of an eye and without an explanation to the IRS.  And even more amazing, The Land of Make Believe has a time tunnel that can transport itself from 1989 to 1999 even though there was an IRS Ruling in 1990 without anyone knowing! That's because tax fraud doesn't exist in The Land of Make Believe.

By Choosing Wisely, The Land of Make Believe was able to use their amazing superpowers to use other people's money (like $30.6 million from practicing internal medicine doctors) to amass a pot of gold that has swollen to $79,409,497 with a fancy condo thrown in for everyone's benefit.

But the most amazing part?  In 2004 The Land of Make Believe merged with the mysterious Institute for Clinical Evaluation that was created in 1997 before The Land of Make Believe even existed!

Confused?  Don't be!  It's The Land of Make Believe!

The Land of Make Believe represents nothing but quality! That's because they don't have to worry about where money comes from or how much exists there.  Sweet-smelling smoke and mirrors are everywhere.  And those mirrors can teach you a lot about yourself. I discovered that I was so important  that I could pay myself (with the help of my many friends there) an annual salary and benefits worth $1,234,893 while also working the crowds at Kaiser Foundation Health Plans and Premier, Inc. 

"Let them eat cake!" I say. I'm from the Land of Make Believe!

But the best part, boys and girls, is The Land of Make Believe is REAL! No doubt the quality I gave to the The Land of Make Believe is why I'm in charge of the quality for every hospital in the United States!

See why you can feel safe?

Now get to bed.



Anonymous said...

Petition for investigation?

Anonymous said...

Has IRS been invited to look into Land of Make Believe, yet?

Anonymous said...

Has she made any public comment ? What's her status ? Is she under investigation or held to account for any of this madness ?

Anonymous said...

Anyone see this: "Enhancing Professionalism Through Management"-Ezekiel J. Emanuel, MD PhD WTF that "leaders of medicine have bemoaned a widespread decline in professionalism"? WTF JAMA dedicated almost the whole issue to "professionalism"? WTF is this "In 1950, when 4.6% of the gross domestic product went to health care, the average salary of a primary care physician was 2.75 times the median income, or $8800.4 Sixty-five years later, roughly 17.4% of the gross domestic product goes to health care, and the median household income is $51 900 with nearly 50% of households having 2 income earners.5 Today, the average salary of a primary care physician in the United States is 3.40 times the median household income, and some specialists earn 10 and 20 times that level.6 More importantly, the majority of physicians are in 2-income families—often 2 professional incomes—so the income gap between the average US household and the physician household is even greater. Looked at another way, many, if not most, physicians are probably in the top 1%. These numbers suggest that most physicians should have all the financial security they could—or should—ever want, yet some still have managed to falter in their commitment to professionalism."

Anonymous said...

Brilliant! This is the poster child for everything that is wrong in medicine today.

Anonymous said...

Re Anonymous' reference to Emanuel's article: stay tuned for more on medical professionalism (ie, dogma) as defined by the holy trinity of Zeke Emanuel, Uwe Reinhardt, and Michael Porter. Just think of all those eager young short white coats, lapping up their system management theories. Pity. Osler once said, "The greater the ignorance, the greater the dogmatism."

Robert Weinmann said...

IRS Form 990 for the American Board of Internal Medicine (ABIM) is a public document. It doesn't require a petition to see it or to file a complaint with the appropriate agency. As I understand how ABIM works, Christine Cassel, MD, is no longer ABIM's president & CEO. The job and title now belong to Richard J. Baron, MD. Interested parties can look at current and recent Form 990s to determine if the position got a raise. See also "Maintenance of Certification (MOC), a rising business opportunity," The Weinmann Report,, Friday, May 14, 2015.-- Robert L. Weinmann, MD, Editor

Anonymous said...

It's worrisome to learn that this illustrious psychopath has fooled so many people for so long to make it all the way up to the top of the bureaucratic ladder to occupy now a key position in an organization supposedly in charge of "ensuring the quality of the healthcare" provided in this country. What kind of moral qualifications she has for that?
Hope to see soon an end to this scam of epic proportions.
I just guess she targeted physicians because she's convinced "that's where the money is"?

Anonymous said...

In the "Land of Make Believe", there are unicorns that flatulate regulations and leprechauns doling out pots of gold to consultants (Dr. Cassell) and expert witnesses (Dr. Doug Zipes).

When Gruber created exchanges collapse in the paradise of Hawaii costing $200M, quickly revert to the standard complaint that doctors are overpaid and undertested. This is necessary to maintain the Sybaritic lush lifestyle in the "Land of Make Believe".

Anonymous said...

The art of cheating wisely to elevate tax evasion to a high level of professionalism

Anonymous said...

Dear Wes,
Firstly, I do not think you need to apologize to Dr. Zipes for calling him out on his prior ABIM relationships he neglected to disclosure voluntarily. Quite frankly, his generation of physicians is partially responsible for this ABIM mess. In my view, this generation of older physicians assumed that their decisions and business practices would be cloaked by the White Wall of Silence that has shrouded much of Medicine. They assumed that the deferential behavior afforded to them by legions of physicians would automatically be extended to their dirty little money game. They assumed they could be clever enough to gain the backing of the Federal Government to amplify their profile and to enrich themselves and their cronies all the while making the lives of younger physicians more burdensome and more complicated. Suffice it to say, the professionalism that Emanuel, Zipes, Baron et al all claim as the focus for their political behavior has been utterly negated by their financial hypocrisy and their distance from any clinical relevancy. Isn't it ironic that Emanuel suggests that the pursuit of income by clinicians is somehow the root cause of waste in healthcare yet there is thundering silence when it comes to the massive salaries these non clinical professional administrative physicians earn and their pursuit of a multimillionaire's lifestyle?

Quite frankly, when was the last time Drs. Zipes, Emanuel, and or Baron took call and when was the last time they physically took care of a patient? If it has been a great number of years since they were clinically active, how on Earth can these talking heads pretend to know what it is like to walk 10 miles in our shoes? How in the world can they proclaim themselves as "experts" in what it is like to be a contemporary clinical physician?

Let's all be honest with ourselves. There are two classes of physicians- there are those who actively take care of patients and those who pretend they know what it was like to take care of patients and choose to make a living off the sweat equity from testing fees, consultant fees at malpractice lawsuits, and or lecture stipends at conferences. The days of the older high profile ex-academic physician trying to wind down their careers by transitioning from active patient care/teaching/research to this obscene form of administrative leadership position via regulatory agencies has been widely exposed by SoMe and the Internet.

The latest JAMA issues has articles from the treacherous leaders from the ABIM and ABMS. I find it amusing that much of their verbiage is dedicated to the history of the ABIM and the hundreds of years of tradition that have sculpted the organization. What they fail to recognize is that ancient history of the ABIM and the ABMS is currently meaningless. That is of utmost importance is their last TEN YEARS of milking the system for money, their greed, and their assumption that somehow no one would notice that they are living high on the hog of every resident, fellow and clinician who are the ones rolling in at 2AM to take care of dying patients in the hospital.

Shame on the ABIM and the ABMS. Shame on all of us for allowing these characters to take advantage of our collective deferential behavior.

And I agree with your sentiment Wes. This is the end of the beginning. This is a revolution and those who pretend to hold the interests of the working class physicians but then use us to enrich themselves with money and power will be cast aside like the traitors that they all are.

Anonymous said...

Recall to that Baron and Cassell don't have to recert in IM as geriatrician (a convenient bypass not afforded other sub specialties - coincidence ?). Also, Zeke isn't even board certified ! Total hypocrisy !

Anonymous said...

Sounds almost like a RICO case

silver556 said...

Whining will get us docs nowhere. The only way we can stop this madness is to stop being cowed or bullied by these self-aggrandizing organizations and stop participating in their extortionist plots. The conspiracy theorist in me is on high alert, I do believe there is a concerted effort to destroy doctors and elevate "providers" in their new scheme. All will be well until they actually need a doctor to perform a life saving procedure. Get your RNP to manage porphyria, lupus, or a ruptured appendix. I'm sorry but blackmailing us will lead to commensurate action where we refuse to treat.

Ayn Rand, anyone?
"I quit when medicine was placed under State control, some years ago,” said Dr. Hendricks. “Do you know what it takes to perform a brain operation? Do you know the kind of skill it demands, and the years of passionate, merciless, excruciating devotion that go to acquire that skill? That was what I would not place at the disposal of men whose sole qualification to rule me was their capacity to spout the fraudulent generalities that got them elected to the privilege of enforcing their wishes at the point of a gun. I would not let them dictate the purpose for which my years of study had been spent, or the conditions of my work, or my choice of patients, or the amount of my reward. I observed that in all the discussions that preceded the enslavement of medicine, men discussed everything – except the desires of the doctors. Men considered only the ‘welfare’ of the patients, with no thought for those who were to provide it. That a doctor should have any right, desire or choice in the matter was regarded as irrelevant selfishness; his is not to choose, they said, only ‘to serve.’ That a man who’s willing to work under compulsion is too dangerous a brute to entrust with a job in the stockyards – never occurred to those who proposed to help the sick by making life impossible for the healthy. I have often wondered at the smugness with which people assert their right to enslave me, to control my work, to force my will, to violate my conscience, to stifle my mind – yet what is it that they expect to depend on, when they lie on an operating table under my hands? Their moral code has taught them to believe that it is safe to rely on the virtue of their victims. Well, that is the virtue I have withdrawn. Let them discover the kind of doctors that their system will now produce. Let them discover, in their operating rooms and hospital wards, that it is not safe to place their lives in the hands of a man whose life they have throttled. It is not safe, if he is the sort of a man who resents it – and still less safe, if he is the sort who doesn’t."

Blog Administrator said...

Rich Baron, Nora, et al = Ellswiorth M. Tooheys!

Anonymous said...

On page 9 of the above link you can learn more about the pecuniary machinations of Dr. Zipes as he wields his titles in a pugilistic fashion to destroy the professional lives of physicians.

Don't expect to see Dr. Zipes moderating a session as the protagonist advocating for regulations to limit expert testimony fees. Dr. Zipes only argues for regulations that don't effect his earnings.

Anonymous said...

Not sure if anyone is following this but another study has been released refuting the Choose Wisely campaign recommendation of only revascularizing the infarct related artery during acute MI.

It only took 2 short years to show that the morons at ABIM (who are ostensibly responsible for assessing our knowledge) are absolutely clueless. This further proves the illegitimacy of this institution.

Rather than Rich Baron apologizing, he needs to be accountable for the foibles of the ABIM.


sneezerdoc said...

Seriously the IRS needs to look into this!!!!

Anonymous said...

I noticed that the ABIM has stopped listing recertification, so recertification means nothing.
I was board certified in IM in 1993 and recertified in 2003, but did not recert in 2013.
Now only my initial IM board certification is listed... even though I am only not meeting MOC for one year.

My father was initially board certified in 1958. He was in academic medicine, and chose to recert in ~1970s, but only the initial certification is listed.

If recertification is an accomplishment, why is it now deleted? To protect those who are grandfathered, and just signed up for MOC. Such hypocrisy.

Anonymous said...

The tension between Grandfathers and Grandchildren is divisive and a distraction away from the real problems with ABMS/ABIM.

Initial certification should be life-long for all diplomates. Recertification and maintenance of certification in its current and past form is valueless and a fraud in my humble opinion.

There are many other pathways in existence to demonstrate competence in a particularly field outside the purview of the ABMS monopoly..

As an aside, my U.S. Attorney friend tells me that the investigation should be initiated by the Justice Department in the jurisdiction where ABMS/ABIM is located. Philly? Chicago? Who knows a U.S. Attorney in the city of brotherly love or the windy city?

Allen Kinlser said...

This discussion happening about the ABIM has been fantastic. I am looking to be an active participant in trying create change with this movement. I am in full support of life long eduction, quality improvement and excellent health care. I don't support nonsense, greed and corruption. Where is a good/useful place to start? My state medical board, insurance companies, government elected representatives etc? The ABIM seal of approval does not mean quality. There is a lot of talk about physicians fighting this, but a large scale physician boycott is unlikely to happen if ones hospital privileges, malpractice coverage/rates, insurance reimbursements are tied to being board certified by the ABIM. I don't see anything happening quickly from the stand point of the justice department, IRS, et al.

How can we as practicing physicians move this from discussion to action?

Anonymous said...

It appears that Christine K Cassel MD does not have a National Provider Identifier or NPI number, that unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS), required for those who see Medicare/Medicaid patients, and for HIPAA regulations since 2007. This suggests that she has not practiced medicine since 2007. [There is a PA named Christine Kay Cassel in Rhode Island, but this appears to be a different person.]