Sunday, November 29, 2015

Edging Toward the Tipping Point

We've seen the "We got it wrong" messages."

We've seen the "We're listening to our members" messages.

We've seen the "changes" to board certification: from the change from permanent certification to time-limited in 1986, from dropping the requirement for dual board certification for subspecialists to the requirement for just one subspecialty certification, and from board certification being about a more "continuous" requirement for education.

And we keep hearing the excuses by all 24 ABMS member boards that they really want to change the MOC program after all of the corruption of the system has been exposed over the past two years.

But what you won't hear about from anyone involved with the Accreditation Council of Graduate Medical Education (ACGME) is anything about the money involved.

Practicing physicians are funding a profiteering racket.

This is what time-limited board certification is about, nothing more.

Proof of this can be found quite plainly at this website run by the American Board of Medical Specialties that promotes "ABMS Solutions." (video here).

ABMS "Solutions"sells "CertiFACTS Online®," "ABMS Certification Profile Service®," and "Direct Connect Select™" through Cactus, CredentialSmart, MD-Staff, and Vistar software systems.

We can see how the ABMS colludes with the Federation of State Medical Boards' (FSMB) newly-launched DocInfo service that "provides professional information on physicians and physician assistants licensed in the United States including information on disciplinary sanctions, education, medical specialty, licensure history and locations."

And now we see clearly how all of these privately-held non-profits of the 24 ABMS member boards are colluding together to prop up the very broken ABMS Specialty Board System financially:
Only CertiFACTS’ products connect professionals with board certification information that is updated daily with data provided by the 24 certifying ABMS Member Boards.
Physician ABMS board certification status, updated daily, and shot to a certification database near you. All for the low, low price of hundreds of millions of dollars a year and funded (in part) by every US physician.

It doesn't matter what new changes each of the member boards of the ABMS propose to change Maintenance of Certification (MOC).  The whole time-limited ABMS board certification is all about the money.

Always has been.

This is just one example of how the money pipeline overrides the welfare of the physician and their patients.

Between surveys, productivity ratios, data entry requirements, and now the board certification monopoly created by the ABMS,  I wonder how far the System thinks it can go before our new nation of employee-physicians unionize.



Anonymous said...

Well lets see..

They Lie
They Steal
They Sue docs--see Sara Von Muller
They Stall for time
They Fail people to up their loot
They may break Federal Law---repeatedly
They buy that condo
They pay outrageous salaries ---HELLO LYNN LANGDON !!
They try to threaten you-- see not participating in MOC


Bottom Line---


Unknown said...

A much more efficient and effective process would be a class action suit requesting immediate injunctive relief from their hold over our livelihoods. Given the web of connections this might even have RICO implications.

Anonymous said...

We need to slay this hydra and do it now!

The danger is now that they have built up all of these service companies (off the backs of dues paying physicians) their income stream is going to shift to coming from those who pay for their data "Services". When that happens the physicians will not have the club to hurt them by stopping their dues payments. It may well already be too late. The only thing that may be left is individual refusal to participate (at the risk of job loss), but this may no longer have the added clout of withholding dues money - as they may have already replaced the income.

Anonymous said...

I agree with seeking injunctive relief. I have evidence supporting RICO as do many others.

Anonymous said...

Dr Fisher:

The ABMS sham money carts now come round annually to collect from physicians. The extent of this systemic corruption is being understood and revealed slowly. The general public has little knowledge of what is happening to them; nor is there the understanding of such complex issues about what the ABMS has done to the face of medicine and the orderly honest transparent structure that once existed in medicine. Now it has turned into a corporate nightmare for physicians where there is little self-esteem and autonomy left.

The irony is that the ABIM and ABMS started out to put a little framework of order into the emerging medical specialties, not really claiming much in the way of putting out a scientifically verifiable means of certification into the subspecialty societies, which grew into the onerous boards. This was never the intention. Read the annals of the ACP and AMA.

Read the words of the founding physicians. In their historically preserved words we could even admit that the seeds of greed were there as well as the desire to create order from the beginning. But now the seeds of greed have taken over. Medicine is ruled by a chaotic bunch of executives who wrote their own independent leadership position into the bylaws to enrich themselves and carry out complex political lobbying and other corrupt machinations to the health care system to the benefit of corporations and themselves.

We have lost a system of accountable care replaced with a medicine run by professional medical politicians who are accountable to no one.

Anonymous said...

The Harmful Practices of the ABMS Exposed.

Medicine Tipped to the Extreme.

The good cart has been tipped over forcing all to ride in the bad cart. This has soured not only physicians, patients and unwitting taxpayers, but even the ABMS ‘horse’ sees and understands all the activity and is refusing to participate any longer. The horse is a metaphor for the heart of the enterprise. Even core member organizations baulk at pulling the corrupt load any longer.

The lack of moral turpitude within the ABMS to come out and put themselves on the line by showing real moral leadership is frightening. Members need to come forward and expose what is wrong with whole organization and why it must be either reformed completely back into a voluntary goodwill organization or dissolved all together.

Dissolution is my recommendation as the organizations within the ABMS were intended to exist for the establishment of a certain order in medicine until the underlying foundation of subspecialty practices were established. Then the organizations would bequeath the money in each to science. That is what was intended.

Now, unfortunately, the organization and administration have been stratified to exclude the very members which the organization were founded by and for—the working clinician/teacher working to uphold their oath to serve humanity and immediate communities in which the physicians served.

These organizations that make up the ABMS have become so corrupt to the degree that some members have utilized methods of control and coercion, that if known would make the public outraged and put the judicial system in a state of fury.

Millions of Americans are affected by this syndicated money scheme, because it not only enriches corrupt medical bureaucrats, but it compromises medical quality and safety in putting forth in front of the public’s trusting face a certificate and quality maintenance system—MOC-that puts making money as the first motive for executive leadership and payment in fees and unproven educational activities as the most highly stressed requirement for physicians.

Physicians have had enough of the futile exercises participating in MOC and the irrelevant data that comes now enshrouded in digital packets written in binary code with the addition of hidden subliminal money signs and "goon-thug mandates" to enforce the payment system.

Now the dark coercive aspects and money motives—that part of the ABMS secret code--have been partially leaked and exposed.

What was once voluntary certification process having little to do with science, but more to do with being a commitment to establish an orderly structure to medicine and it subspecialties cost little in money and time in the beginning. Now it is a pyramidal money scheme that has become a financial and political juggernaut. It is even a platform for conflicts of interest and trampoline for those who wish to enrich themselves further with lucrative positions on boards, corporate executive positions and highly profitable speaking engagements.

What is wrong with this?

Everything. The good cart has been tipped over. All must ride in the bad cart and pay into the scheme or you don’t get to work. Sound like the mob? Well it is exactly like the classic network of protection—only falsely represented as being done in the name of "protecting the public."

Quality and safety takes the back seat. Publicly available financial statements bear the truth of this with very low quality irrelevant educational value products and services being offered by the ABMS and proffered as the gold standard.

It is not the gold standard. ABMS is a fictitious standard bearer which produces gold for the already powerful and rich, including their executives and legal staff.

The physicians' horse has no more will or desire to pull or participate in the unconscionable activity or pull the heavy load any longer. The good horse has seen through the scam and says, "I just can't pull this crap anymore!"

Anonymous said...

Agree, this ABMS scam is hurting hard-working physicians and patients. Something needs to be done soon. The question is what. I'm not a lawyer but it's my understanding that an injunctive relief does not involve a financial penalty, but rather a command from a court to do or stop doing something. I figure that if no money is involved, it would be very difficult for a small group of physicians to find a law firm willing to help us with that endeavor. For us to find such an enthusiastic attorney, there has to be the incentive of a potential monetary damage inflicted on ABMS.

I hope someone reading this enlightening blog has the legal wisdom to provide some sound legal advice. And thank you Dr. Wes for unmasking the ABMS mafia.

Anonymous said...

Union of physicians: if docs only knew the whole truth there would be a union organized today.

ACGME's Pulitzer Prize said...

Deficiencies in Reporting and Monitoring the Improvements

Let's do lunch at the Professional Club, Wes. I'm sure we could find some common ground over a "whatever you want, man!" It's on the company tax free plan.
Schedule J Part III and II. Section O line 6 defines us and what we do a little bit.

Who are we meeting with today?

What are we discussing?
Anything else?
How about a partnership with our robust solutions supporting you? There might be a Ed R Murrow award for you down the road with a little help from a few of our other corporate sponsors.

Writers Wanted said...

We have a lot of fun at the ACGME, and as you can see we are not sadistic like the residents say, and we have a solid history of paying our executives well.
And you might just be eligible for spousal travel if you say the right things in your blog about us and our friends. We don't have to list you, you know.

Anonymous said...

Don't forget that in spite of admitting that they got it wrong and leading us to believe that MOC would be necessary they are refusing to refund any money paid to them for MOC even if the payor never took a single MOC test. I asked for my money back within a few months of paying for MOC when I realized that it was not necessary. I never took a single exam or received any service from ABIM. The reply that I got back was "No." We have your money and we are keeping it.

Yes a class action lawsuit would be a great idea. I am all for it.

Anonymous said...

Dr. Wes - thank you for all your hard work !! As well as , passionate commenters ! As outsider ( non- doc ) , but , in healthcare for a long time --- this cr_p has been going on forever ---- AMA worthlessness , as just one example . Physicians cannot organize . Sorry for that.
Besides those on this blog,,, and, hundreds who are aware ( and, angry ) ,,,,,, the rest will not / have not acted. Sheep ! No , sheep will follow --- Generally , docs are too trusting , too busy , feel others will take care of the ' non- medical ' stuff !!
Please organize . Like the class action suit idea -- could rally the ' troops '. A few leaders , an actionable rally point and Whalla !
Press -- find medical reporters,,, WSJ article ,,,yes - 60 Minutes would be great ! There is a need for a chaotic event -- something to stir the press and the rest of the docs!! What is it ??
As someone who believes medicine / nursing are the most cherished professions -- please organize ( theses reports are great ,,, but ,, now, so much rehashing of samo , samo ) ,, create a mission plan, THEN , execute !! Blessings to All !

Anonymous said...

Ask for your annual payment back from your ABMS specialty board. It is your money.

Regarding your annual "fee": if you wish to opt out of the annual payment plan you can. According to the ABIM they will even give your annual payment back. Just complain about this maintenance program after you paid and ask for your money back. They are required to return your funds.

However, you will not be listed as participating in MOC, which will/may have negative consequences for you depending on your hospital, insurer or state.
In other words good luck remaining employed or finding a job. You will be discriminated against and marginalized in your search for employment. All the adds run "must be BC or BCE." Board certified or board eligible. The legal catch here is they adds don't mention that there is another board and that board is being discriminated against and marginalized by the adds seeking employment.

ABMS policy may have changed, but last year in January, I told the ABIM that I was upset about this sudden collection after I already paid for three certificates which should have lasted me a lifetime, but instead suddenly they came with a 10-year payment plan. They said they would give the money back.

It's your money not theirs. Physicians who pay don't get it. This is truly a voluntary program otherwise it is in violation of the law. The ABMS just rigged the laws along with the powerhouse lobby at the ABIM. Hit the ABMS with complaints as they are responsible for the overall policy. They claim there is no oversight, but that is a lie on the ABMS' part.

The ABMS offices hold the key to overseeing and administering MOC. As facts emerge we see how much the ABMS is profiting from the MOC. They harvest millions of dollars from it which all equals power and maintenance of the corrupt regime and their henchmen/henchwomen resting on their baneful laurels hiding it all from you.

The strange thing here is physicians don't want to belong to this "voluntary organization" but they must. There is no choice at all, despite what they claim. ABMS is the only game in town and it is nationally syndicated to the extent that every other board or board review program is quickly destroyed legally or with complete market saturation of ABMS MOC study books and CME or ACP products.

I shudder when I look at the web of life and who is eating who.

DOJ said...

Using the Right Tool for the Right Job

The new board ABPS has not sued yet, but may do so at any time, as the ABMS monopoly is being plainly discovered and pointed out by more and more people. Where is the traction for the ABPS? There is dissent, but where is the real acceptance where it counts, in the hospitals and with the stakeholders.

If you don't have that traction yet, here is a good idea and plan:

Sue every hospital/stakeholder that does not recognize your superior certification credential and you will gain a great deal of traction immediately. I will donate as will others to the anti-discrimination anti-trust RICO fund.

When the ABMS claims that certification is voluntary it is a verifiable lie. They must change their wording to say it is mandatory for employment in most institutions. It is required by most insurers/stakeholders. That is the correct labeling. Required by policy/mandates of law. Sue to have the false claims removed that ABMS certification is voluntary. It is absolutely untrue.

ABMS is a monopoly and we have corruption on every level to thank for it. Sue the ABMS and every partner hospital and insurer that requires ABMS' "voluntary certification." Make the monetary damages worth it. As a great politician once said to the New York Times when they wrote something untrue. "If you don't retract that statement, now, I will own that Newspaper, when I am through suing you!"

The AAPS is already suing, but Chicago ABMS cowards have their antitrust claim against them "cysted-over" and AAPS' volcanic claims are dormant at the present time by ABMS' stalling tactics.

It is the finger in the cone technique. They don't know they are risking more than a finger once the eruption starts. Better get out of the way! It's rumbling now.

Personally, I believe the AAPS has an outdated case and their counsel may be sleeping on the job, as there is much more data on the corruption discovered about the ABMS. He has been lulled to sleep by the powerful tool known as "keeping it all on the lowdown." Until nobody cares at all about the claim. Well, this is an old traditional tactic of the mobsters, but there are feds sniffing around right now at who is handling these cases and why it is just sitting there. Why was the case moved to Chicago from New Jersey?

The AAPS is an insect in the ABMS Chicago skyline. But, who knows, powerful new and infectious information may be coming that will change the course of ABMS history. They are so smug to not even remember how one little mosquito bite can infect the whole organization.

Their complaint as someone explained to me could easily be taken up and expanded upon by an ambitious team of federal lawyers specializing in racketeering. The facts are there to support a RICO claim against the ABMS.

PIS said...

Public Integrity Section: Elite Criminal Division of the Department of Justice.

An Open Invitation from the Public to Investigate (A little background)

For those federal attorneys with future political or resume-building plans ABMS is really the starting group for you to get some media coverage. The case may be a cake walk. They have dull-witted insider counsel hired to protect them and they have an amateurish, but outrageously compensated executive "team".

Their staff is populated by revolving door ACGME personnel who know nothing about real residency programs and even less about law and medicine. That will come out in court under cross examination.

Yes, ABMS is the perfect target for launching your career. You may even get a commendation from the president for cleaning up the dirty business of racketeering in the bureaucracy of quality assurance, which everyone knows already is a total scam. Professional medical politicians and partners involved have influential friends. (Hint.)

Strangely, I don't even think that ABMS leadership and board communicate well together, because of the extreme wrongdoing they are engaged in. Each party will/must retain outside counsel to protect themselves, insulate themselves from the knowledge of the conflicts of interest and extra-curricular business activity. That is costly. No wonder they earn so much.

This is a vulnerability--poor communication skills and amateurish methods of covering up their activity, even though the ABMS is totally unregulated without transparent responsive governance.

The liability and total cost for the ABMS and its elite membership group gets higher by the day the more we know and discover. (Case against the ABMS is already prepared in many aspects.)

The implications of the ABMS MOC scandal and alleged racketeering profiteering would make a good case for the US Attorney and the following special team of federal prosecutors.

We wish the Department of Justice, the federal investigators and prosecutors well in their present and future endeavors. We stand shoulder to shoulder with you in your pursuit of public crimes and their political/corporate ramifications.

You might ever uncover some dirty federal agents in the lower ranks. (Clue.)

This one's for you! It's a career builder.

Anonymous said...

Foul is fair and fair is foul!

The DOJ and IRS have been pursuing corruption vigorously oversees where there is also a great deal of money flowing perhaps illicitly. Accounts have been frozen, hundreds of millions in assets seized. We need that kind of ambition and passion directed here at home as well. We applaud the DOJ and IRS for their outstanding work abroad.

The case I referred to is totally unrelated to ABMS issues, but I found the journalist's closing comments to be perhaps appropriate and representative to the ABMS/ABIM scandal that is like a witches brew for the uninformed public and overly burdened medical providers.

"The whole Shakespearean drama highlights how the [executives] have been politically marooned. It’s the security apparatus that’s making day-to-day decisions."

Anonymous said...

The Physicians Union

The number of employed physicians has reached a saturation point where docs need to unionize. Unfortunately there is no other way as many phycians see it. They have been scammed and beaten down from every direction. Regulated and controlled to the hilt.

There is no one left to advocate for the patient with the physician "out of the way."

I guess it is time to unionize. The need is definitely here. Here's another reason below.

One of the reasons Chris Cassel, former ABIM head, was forced out of her egregiously unethical and lucrative board positions with Kaiser and Premier was because an outraged healthcare union boss representing 5000 employees in California screamed bloody murder over the conflicts of interest. We just learned also about the hospital standards under the direction of the newly appointed Chris Cassel and investigations into the wrongdoings of several associates connected with the NQF.

Severe fines were meted out by the DOJ against a highly conflicted company that lied about the safety of its products, which would catch fire in hospitals. You all remember. Sal Rosselli is speaking below about Cassel who was forced to step down from the Kaiser board.

"The National Union of Healthcare Workers, whose members include 5,000 Kaiser employees in California, said it welcomed Cassel's move.

"This is a victory for patients and caregivers and a victory for transparency in the top echelons of the healthcare industry," Sal Rosselli, president of NUHW, said in a statement.

“The National Quality Forum plays a huge role in our hospitals by defining the ‘best practices’ that our caregivers use. Healthcare workers and patients need to be certain that money from giant HMOs like Kaiser isn't corrupting NQF's decision-making process.” "

And further, from a former Yale medical chief in a 2013 article about doctors unionizing.

"When doctors occupy a service niche like the chambermaid in Las Vegas or the school teacher in Chicago, the expectations and compensation of the physician-worker will be defined in ways that may make the benefits of collective bargaining appear very attractive."

--from Fisher's embedded article referenced above.

Anonymous said...

I agree that we are approaching the tipping point, and I'll help push the load over.

All of the 'updates' are not really meaningful but serve as a stalling tactic until the stealth time-bomb of MACRA goes off.

Citadel Assurance Company said...

A wise physician can recognize that disease is destroying the health of all the ABMS executives. Every subspecialty--all 24 and the top leadership.

It is very strange how the ABIM executives are in total lockdown afraid of their own people. They are no longer people involved in medicine, just a dollar business. Harvesting dollars. It is the strangest reality, beyond any fictional book's ability to relate for a reader to understand.

When we view ABMS from outside, it is a conundrum how the "citadel of quality assurance" could breed such inward sickness and psychological filth. The leadership I'm sure would like to be free of such corrosive corruption, but the latch of freedom for them is locked. Money rules. It is the rule of money that defines the ABMS.

They see the outside world with contempt! That is a shame.

Perhaps some want freedom. Oh, but the money is just too good. And maybe the stakeholder, the masters of the ABMS are too greedy to let anyone walk out the door intact. It might be one of those firms you have to die within--resigning to a narrow and negative definition of life--never able to leave.

But there are some very fine vibrant younger people, I notice, mostly women, doing all the real work to organize and manage while the executives just sit on their cash and protection. Why don't they share a portion of that wealth with those who deserve it more! And stop taking so much and demanding everything from physicians.

MOC is a fakery; it's just for the money. The "up to the minute credentialing" of who is participating in MOC or not is just so laughable it hurts.

What's coming next for the ABMS.

Not only will the ABMS executives be without a job soon, they will be reviled by society. A few egregious offenders in the bureaucratic machinery will even go to prison. It is the law that will decide ultimately, not physicians. It is a powerful vision, but the public is complaining grumbling already.

The future is now, not tomorrow. What the ABMS fears has come. The "darkest day" has already come, but the buffering cushions prevent them from feeling it.

Before that time takes over, restructure the pay schedules, take less and give more. Show appreciation for the women who serve so admirably; give them what they are worth. Don't treat them as just desk clerks. Give them even more than you think they are worth. Life is too short to be a "Scrooge."

There is not much time left for the ABMS to end MOC; to turn the big ship around.

The ABMS cannot keep both fists tight in the clutch of greed for money and power.
One hand must open or the ABMS will lose it all. That is just a law of life.

Ed Rico said...

These corporate terrorists will never admit to any wrongdoing, as demonstrated by the non-stop party line about "improving" MOC when there is no objective evidence of benefit to physicians or patients, only to ABIM/ABMS. Apparently, it's easy once you trade your self-respect for a mountain of cash.

"Power tends to corrupt and absolute power corrupts absolutely" - Lord Acton

Anonymous said...

Interview with LM Nora, MD, MBA, by phone with an ABMS monitor listening in. Link below. There were also pages of well prepared talking points and legal staff involved.

If the interview is broken down and analyzed, which I did, it amounts to one fundamental lie that MOC has benefit. This is the propagated corporate talking point according to ABMS/corporate funded research.

All the data is broken down in this interview into intelligible parts that might appear plausible to an unthinking audience. The thinking part of humanity says that insouciance is the ally of absolute corrupt power. (If there is such an absolute expression of power on our small planet.)

Closer to reality. The ABMS is not absolute in its corruption nor does it have absolute power.

But it is an absolute fact that the ABMS is corrupt. Money is the motive behind the majority of decisions and policies, not safety. It is an absolute indisputable fact that the ABMS is a financial/political fascia of franchised monopolies, which comprises a macro-economic network of economic relationships. This overlay of conflicted parties creates and interconnected muscle over the entire healthcare system by controlling and manipulating physicians and everyone else through the power of money and maligned authority.

The ABMS is not a safety net for the public, but rather a government/corporate power structure that is designed to provide "trickle-down austerity" to the patients and destroy the promised patient "bill of rights,". By taking away the rights of physicians the rights of patients have been sequestered in a new "medical/financial divide" that must first be analyzed, understood and repaired.

Simpler systems with responsiveness and transparency are needed, not an obfuscated healthcare megalopolis such as the ABMS aids and abets. Healthcare reform has many masks and faces but the speaker above is absolutely correct when he expresses that it is a brand of "corporate terrorism" that has left the once-working underlying infrastructure in quite a messy "bombed-out" state.

This interview with ABMS head Nora is one corporate lie after another until the interview concludes. The spirit of medical science and non-profit nature, humanity, and foremost the time-bound charter of the specialty societies/"boards" with the physician and public has been shattered by their greed and need to protect that vast testing empire.

Take the money out of the ABMS/testing/security/ equation and all Americans (and those in Singapore and Abu Dhabi, etc.) would be much better off without the "safety" or "protection" we have come to know as the ABMS "umbrella."

One is left realizing that even the CEO of the ABMS is controlled. One more victim in the war against the patient and their hard working physician/provider.

The only question for me that remains in this analysis is whether Dr. Nora is controlled absolutely. Or any of the other executives who were introduced into these specialty clubs by the stroke of ABIM Chairman Thomas Brem's pen in 1965, just shortly before the Social Security Act of 1965 was about to pass by overwhelming margins in both chambers of House filled with our elected representatives. The ABMS resulted from the exodus away from non-profit, apolitical organizations to for-profit/political strongholds from that point going forward.

Some scholar smarter than me will analyze the details, but it is an absolute fact that the organizations of the ABMS became for profit companies when the independent executive was added to mix. All checks and balances were destroyed from then on.

Corruption absolutely, Mr Rico.

doctor ellen said...

Anonymous said...

U of Tennessee Law Professor Glenn Harlan "Instapundit" Reynolds: "Organizations are run for the benefit of those who run them."

Res ipsa loquitur.

Review of ABMS Systems. said...

Review of ABIM. ABMS complaints department, where are you?

ABIM complaints?

I have too many to list here.
Does the ABIM have a customer service department.
I want to lodge complaints against the ABIM directly.

ABMS complaints?

Do they have a customer relations department?
I have multiple complaints to lodge against them as well.

My first strong complaint against the ABIM and ABMS is that certification and MOC are not voluntary as they advertise.

Certification and MOC are absolutely compulsory or you can't work in most circumstances. Unless you are grandfathered and ignore the ABIM and ABMS altogether.
Some boards at the ABMS allow this like ophthalmology.

The organizations of the ABMS have become so corrupt and unethical that I don't want any association with them. I can't be a part of their despicable money scams and political schemes.

Hello, ABMS! Please provide me with the phone number for customer service?
Hello, ABIM! Please give me the phone number for customer relations?

I have multiple complaints and want to write a bad ABIM review about how horribly they treat physicians and patients.

How about setting up two new email addresses at all medical specialty boards of the ABMS.

For example: