I logged on to the ABIM website last evening and was greated by this pop-up screen. It seems the ABIM is in the business of "research" at my expense to "understand how to improve health care." They are mandating that I enter my "practice characteristics" in a 15-minute survey.
Yet I have no idea what the ABIM's "research" entails, I have not been informed how that "research" will be conducted, nor how it might affect my ability to practice medicine, or if my information will be sold to other entities for a price on the basis of the ABIM's valuable "research." Since we know that the ABIM has partnered with companies like Premier, Inc (which just purchased CECity, Inc a subcontractor for the ABIM from 2010-2014) for $400 million, I would like to review the research protocol the ABIM is conducting, the risks and benefits to me for that research, and how my data will be used and protected.
The ABIM should be aware that the Department of Health and Human Services has VERY specific rules and regulations (45 CFR 46) about how "research" is to be conducted, particularly as it pertains to the protection of human subjects like myself who have increasingly found their ability to practice medicine in a hospital setting compromised unless we participate in the ABIM's Maintenance of Certification (MOC) program. We have not been given proper informed consent and, instead, find that this data entry in "mandatory for all Board Certified physicians enrolled in Maintenance of Certification (MOC)." Furthermore, physician's are aware their "MOC status" is being sold by the American Board of Medical Specialties (ABMS) via its ABMSSolutions.org website to a whole host of third parties for a fee.
Needless to say, I won't enter this information until the ABIM makes public the "research" protocol they are conducting.
Richard Baron, MD, ABIM President and CEO, needs to explain to all ABIM diplomats why they are ignoring Health and Human Services regulations on the protection of human subjects (physicians) in their collection of "practice characteristics" for the purpose of improving health care.
-Wes
Thanks for asking these questions. I've always wondered why I have to provide them with all of my information. We have no rights to refuse. The explanation provided for why they need this information is pure doublespeak.
ReplyDeleteI would love to see a copy of the report from the institutional review board responsible for approving this research. Even research on animals requires approval by an Institutional Animal Care and Use Committee (IACUC).
Shouldn't we at least have the same protections as animals?
That's now a punch line when you say "Richard Baron".
ReplyDeleteKeep answering to no one , RICH !!
Wes,
ReplyDeleteRule #1: ALWAYS click "Remind me Later"
ALWAYS
Also, you spoiled little shit, do you know what kind of experiments are being done on PATIENTS? There are so many gross human rights violations and ethics violations that nowadays people have resorted to ONLY protecting the rights of PETS not PEOPLE.
Recently, trivial offenses that hurt people's feelings who are at an extreme end of a special interest group have received special protections, and have the right to sue if their feelings are perceived to have been hurt in some way. The rest of us are research subjects. It's wrong--but be grateful you're not being screwed worse.
Best always,
L
Thank you for being a voice for all of us!
ReplyDeleteI did not fill this information out as it is not "voluntary."
ReplyDeleteThey know it is illegal, but like many things they do they try to get helpless
foolish physicians to jump through their hot torturous hoops.
Look at their demand. There is no disclaimer and there is no liability statement about their improper mandate. There is no message recommending to consult with an attorney. Any relationship with the ABMS is suspect and one should always have an attorney to consult with; one should write them letters reminding ABIM of the laws of the land that they break daily.
They are not just treading on thin ice, they have crossed the legal divide many times. Lisa is right they do grave emotional harm; they should be sued for every financial scam they have pulled. Get that money back and be done with them. Some physicians have every right to sue the ABIM for malicious and heinous treatment. But no money on the planet is enough to compensate for the pain and suffering they have caused and continue to cause.
I did not like the tone and the exclamatory way in which this "research" was demanded. I will never do what I know is wrong. They must be called out on this. The ABIM is wrong. Write them an email and have their attorneys explain how this research is mandatory and why; and if they are willing to be sued for such false and misleading statements and their continuing harassment and other harmful/illegal demands.
There is and can be nothing mandatory when participation in certification is voluntary. They have erased their web pages because the ABIM policy is a quagmire of shifting sand and bad foul water. They try to hide it all because they are in a legal nightmare fighting for their life.
Articles of Incorporation state that participation is voluntary. Their website has stated that certification is voluntary. Research participation is voluntary and cannot be mandatory - ever. This shows how negligent and uninformed they are. All of them. Their policies state this as well. It is all voluntary. Some call this a regulatory body. It is not; it is a certification/testing company. ONLY! The rest is a fraudulent show and they must be sued.
It is time that we update the ABIM's profile. Put them to the test. They are big zeros without credibility. No trust is possible with them. Their handshake is meaningless. Look how they spoke with "forked tongues." They broke their promise and their initial pledge to physicians and the public.
They took the core pledge of lifetime certification away and then demanded more and more time and money. They have driven us out of medicine as a result, even out of our homes if one fails their bogus stream of evaluations. They need to be evaluated. Not us.
Lies heaped upon ever increasing lies. They did not keep the original and only deal. Otherwise there would be lifetime certification today. Liars. The people at the ABMS are broken people who cannot ever change. They are emotional MOC-AHOLICS prone to serious tantrums and depression if they don't get what they want. They are SICK-AHOLICS the way they pull the legal trigger and sanction and defame without proof.
Sue everyone of these miserable politicians and prigs at the ABIM and ABMS. They all have bitten us with their venomous fangs far too long. I am tired of going into convulsions over them. They have taken away what our country was founded on. Freedom and the pursuit of happiness. I want to be free and happy. And most important, in case you don't remember, they have violated our right not to be taxed and boarded to death.
Someone who breaks a promise and pledge is no good. Everything they have done for decades is criminal and they have no no legal legs to stand on. Their take it or leave it pledge is a regulatory nightmare for us all and the word voluntary is a lie. False claims. Public fraud.
They are psychological vipers trying to defend their money and political turf.
I follow this blog only because I like ribbing on ABIM, but are there any other Cardiovascular medicine blogs that you guys can recommend that are more clinical in nature? I often wish I could hear Dr Wes' opinion on current clinical tends in CV industry/practice (ie thrombosis, HF, etc), but all his posts are so political. Any links would be highly appreciated.
ReplyDeleteIndefinitely click "Remind me Later" then if the website forces completion, document this interruption to treating patients.
ReplyDeleteIf anyone has already done the illegal survey, then it would be nice to anonymously publish the questions that were asked.
ICD10 itself is forcing EVERYONE to be a research subject. The harassment and plundering of physicians is only the tip of the iceberg. We all see news stories about rates of different diseases going down--and we all know it's because patients are not getting diagnosed and die of 'natural causes'. Lots of carnage, from doctor suicide and forced retirements to patients' lives ruined also. Only banksters are getting ahead--and globally.
ReplyDeleteSome taxing thoughts.
NQF is delinquent in tax filings. They also can't find an auditor. What gives there?
https://www.qualityforum.org/About_NQF/Financial_Statement_Audit_401k_Defined_Contribution_Plan_Audit_and_Tax_Services.aspx
Why can't Christine K. Cassel, former ABIM and ABIM Foundation CEO/President, find an auditor for the NQF for fiscal year 2015. Doesn't she have the power and skill to do that simple task? Or is her horrible reputation as a cheater with egregious conflicts of interest and negligent/questionable leadership skills following her around. Nobody wants to touch a federally funded organization with such a reputation. There are still doubts lingering about the CareFusion/Charles Denham/ChloraPrep scandal and cover-up debacle. That would be troubling to me as a reputable firm or individual. But it fits with the history of alleged fraud we find at the ABIM Foundation. Who did they get to audit the ABIM and Foundation this year?
Where are those stand alone tax filings for both organizations?
Maybe Cassel and Baron's obvious skills of covering up lobbying activities has caught up with them both. (ABIM / ABIMF and their affiliate the NQF like to lobby but do not like to report it. That is how the IRS can help them determine non-profit status, whether to continue it or to cancel it.)
Grossly negligent professional medical bureaucrats conducting national research projects.
ReplyDeleteIn case anyone did not know, the ABIM Foundation is involved in a major human research project conducted on a national and international scale. It is an cost cutting/savings experiment in how far governments and insurers can go to restrict access to medical care without producing harm or killing the medical subjects in the process. The goals are to a large extent to find the "razor's edge" of their spending thresholds.
If anyone thinks otherwise about this ABIMF "Choosing Wisely" experiment/conversation (experimenting on/with the patient population and physicians) you better consult your legislators and personal attorneys. Or go to a knowledgeable/honest federal court judge, present the facts as they really are, and ask the judge to give an immediate ruling on the legality of the implementation of the "choosing wisely" program.
Vulnerable populations are identified as critical targets in this multifaceted research program. Senior citizens, the poor, and veterans are a key part of this medical-economic research enterprise. The Robert Wood Johnson Foundation has been funneling/infusing large amounts of cash and disseminating propaganda along with the ABIMF and its other affiliates and sponsors.
The NQF and ABIM Foundation were created the same year in 1999. They are both patient population/ social experiments concerning austerity measures for health care recipients. The fundamental goal is primarily economic, not quality as claimed. The aim is not to improve quality as falsely stated but simply to reduce costs. The ultimate outcome is to enhance corporate profits focusing on reduced costs under the guise of patient safety and improved quality through slashing costs. The initiatives of "professionalism", "choosing wisely" and "patient safety" were promoted by professional medical bureaucrats working in tandem with their counterparts the infamous medical industrial complex with their corporate and government special interests and sponsors. Christine Cassel and Rich Baron are prime examples of this corruption.
Understanding/Exposing the NQF and ABIM Foundation (ABMS)
ReplyDeleteThe whole of the money schema of private and federal funds flowing into the NQF and ABIM Foundation has been nothing more than an experiment in cost controls utilizing sugar-coated placebos and "hard to argue with" conceptualizations in healthcare delivery.
Their experimental policies have no definitive historic or scientific proof to back them up. Their medical adventurism has no basis in reliable medical fact to warrant this gross violation of trust inflicted on the public. Inflicted on physicians and caregivers. There has been no real public debate or referendum. Only a propaganda campaign.
We understand the "patient safety" of the NQF and the "Choosing Wisely" campaigns of the ABIMF (and affiliates) to be nothing more than research experiments, based on the greed of individuals and corporations spouting political air and fraudulent quality conceptualizations.
Dr. Fisher, if anyone has doubts about any of this corrupt bureaucratic malpractice, your ABIM Foundation studies and the conflicting creation dates of 1999 and 1989 help answer this. It is more than a medical mystery for someone to sensationalize. It is life. It is about vulnerable patient populations and the physicians on the front lines who are just as vulnerable.
If we could get to the bottom of it with transparent responses from the ABIM concerning their grandiose social experiments with medicine and the economy it would clarify many things for us. But you see why it will never happen. They are already very exposed as it is. Further exposure will put their culpability in the light.
MOC and the ABIMF were a two pronged attack on physicians and the public. 1989 for MOC and the many more burdensome money/time manipulations to come. Documents could prove all this, unless they were destroyed. I believe, however, regardless of whether we discover hidden documents the public records corroborates the thesis that the ABIM conducts small, medium and grand scale research without the patient's knowledge or consent.
Even this small, yet in your face mandate mentioned above in your blog is not minor, but quite significant. It is analogous of the whole organization's activity. MOC and all the similarly burdensome mandates are the physician's coercive measures/regulatory capture which insure that their research and dangerous measures stick and continue.
But the whole of it - the research, the experimentation in corporate greed/government cost controls, the onerous costly MOC, the Foundation with its social engineering, is metaphorically speaking, a tainted needle stuck unlawfully in the heart of the medical profession. It draws out the life blood of physicians by being mandated to be ABMS subjects carrying out coercive quality measures and corporate-backed experiments on patient populations.
We support this blogger, Kurt Eichenwald, Charles Kroll, and many others in their call for a government investigation to expose as much of this organization's dangerous activities as possible. We need to stop them before more harm and ruin comes to our good people and society. We cannot accept being under the thumb of these grossly negligent and corrupt medical bureaucrats and their corporate cronies.
The leadership at these organizations lost their way long ago. They lost their integrity.
Dear ABIM:
ReplyDeletePlease update your information and the mandatory data on your physicians including the customization survey on their current practice environment, certification, MOC status, etc.
This is for research purposes only. Currently we are finding that the purchasers of our insurance policies and discounted membership service packages have been diminishing along with our dues-paying membership rosters.
In order to provide continued excellent service and personalized representation to our physician members and societies it is imperative that we have the above information ASAP.
Sincerely,
AMA President #170.5
PS Please find below our AMA Membership Benefits
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Someone made a good point that this site appears political. They are searching for medical science. "Where can I go, they ask?" But after thinking about it, and looking at what is, this site is about science. It is really the science of critical thinking that we find on this blog, Dr. Wes.
ReplyDeleteWhy do I take the time to mention this? Here's why.
What we find today is that politically motivated medical bureaucrats control "science" and "quality" with propaganda. These medical professionals are "sell-outs" to special interests and they now make "larger-than-life" sums of money in exchange their lobbying and so-called directing of "science" and "patient safety."
Unfortunately, when we have such corrupted individuals at the top of the financial food chain, and in leadership positions, we cannot really trust "quality, safety or science."
That problematic position we find ourselves in is in my opinion exactly why we need change now. These "sell outs" must go as they ruin everything, even the hope of medical science being untainted. Anyone who takes the time to examine dispassionately the facts, and the political lay of the land, such as we find at the NQF, ABIM, ABMS and its affiliates, we discover that money, propaganda and corporate special interests dominates it all.
Until something changes, we may have to always look at the terms "medical quality", patient safety" and "medical science" with a grain of salt and with great scrutiny and caution.
Keep up the scrutiny of "quality", patient safety, and medical science until we can have some relief, Dr. Fisher. Everyone needs to take a pro-active role in this and that would free up some of your time.
Hi Dr Wes,
ReplyDeleteABIM has sent multiple survey reminder.
Did you respond?
appreciate if you have any suggestion.
thanks
Robert Wachter wrote a recent Opinion piece in the NY Times bemoaning the overuse of performance metrics in Medicine and in Education.
ReplyDeletehttp://www.nytimes.com/2016/01/17/opinion/sunday/how-measurement-fails-doctors-and-teachers.html
What a hypocrite. He is part of a cohort of professional, non clinical, physicians running around Washington DC insisting that hard working physicians need "performance metrics" via ABIM MOC. Suddenly now Wachter an ex ABIM lackey is now saying enough is enough.
The only reason why he is jumping across the DMZ is the ABIM is being defunded by those of use who are utterly disgusted with their nasty money game. Ironically, now that folks are applying performance metrics to the ABIM exposing its weakness as an organization, that crushing scrutiny will smother the ABIM infrastructure.
Shame on you Wachter you two faced lying hypocrite.
It is time to call for the ABIM leadership and the ABIM Foundation leadership to step down.
We need a vote of NO CONFIDENCE IN THE ABIM.
Wachter is so two faced.
ReplyDelete" Burnout rates for doctors top 50 percent, far higher than other professions. A 2013 study found that the electronic health record was a dominant culprit. Another 2013 study found that emergency room doctors clicked a mouse 4,000 times during a 10-hour shift. The computer systems have become the dark force behind quality measures."
Fine... go tell your buddy Rich Baron who was instrumental at ramming computers down our throats.
Then tell Rich Baron to start coming clean and telling us what his plans are.
And also tell Baron to stop hiding like a weasel and answer questions.
“We decided to extend our decision not to require practice assessment while we work to expand the list of activities we recognize for MOC credit and seek partnerships to increase clinically relevant opportunities for doctors to engage in this important work,” said ABIM Chief Medical Officer Richard Battaglia. “Physicians can still earn MOC points for completing approved practice assessment activities, and one of the pathways for these points is through the American Board of Medical Specialties Multispecialty Portfolio Approval Program.”
ReplyDeleteABIM will provide at least a full year’s notice when the requirements are reinstated, with updates on progress being communicated through the Transforming ABIM blog, Dr. Battaglia noted.The delay, however, does not lessen the importance of practice assessment, he cautioned.
“We hear from physicians that completing these activities allows them to look at data from their practice and implement quality improvements that lead to better care for their patients and improved processes in their practice,” Dr. Battaglia said. “But we also hear from physician feedback that the MOC program should do a better job recognizing meaningful activities they are already doing in practice.”
http://www.clinicalendocrinologynews.com/practice-economics/practice-management/single-article/abim-delays-mocs-practice-assessment-requirement-till-2019/f8039bebbd09064c787fda724f9e9ce5.html
Really Rich ? Who are these physicians that like the pathetic practice assessment ?
Name BOTH of them.
Do you really think we're that stupid ?
Robert Wachter's Dressed Tripe in the NY Times "How Measurement Fails Doctors and Teachers"
ReplyDeleteWe enjoyed the Dutch illustrator's work who's art appears frequently in the NY Times. Viktor Hachmang's work, which draws attention to the opinion page gets better with each work he produces, but Bob Wachter is perhaps losing grip on his writing skills in this very unconvincing and poorly written opinion column. It appears Bob is perhaps experiencing diminishing mental and emotional coherency as well. Just read the title.
Is Wachter losing touch with the deeper parts of himself and what he truly believes in? I'm concerned with this "old geezer" - as he calls himself - that he put so much energy and time into his last major blog defending the "quality assurance cronies" at the ABIM that he is experiencing "burn-out" himself.
Or is he simply playing us for fools again with more "dressed-up tripe" pretending he is one of the working class on the front lines who knows what it is like to actually practice medicine. Or that he can at least relate to what it means to be ordinary bloke walked-on by the pro medical bureaucrats who assess and test us daily.
In this half-articulate attempt to be a sympathetic, "quality advocate" Wachter slips up a bit and his disguise drops off as he echoes a familiar popular, but false, political refrain for us. Bob sings, "America, I feel your pain." In this case he stumps to the most "sacred and human" of all professionals in America - the physicians and teachers who are tested and assessed to death. I'm afraid if he crossed the demilitarized zone on the side of the phycians and teachers, it is as a shill for the new CMS director, Andy Slavitt, whose conflicts of interest might make Wachter's board positions and hundreds of thousands of dollars look pale in comparison.
"Of course, we need to hold professionals accountable. But the focus on numbers has gone too far. We’re hitting the targets, but missing the point," says Wachter.
"In medicine, doctors no longer make eye contact with patients as they click away," referring to the digital health record that creates such burnout among physicians - over half of them!
Bob continues, "Last week, Andy Slavitt, Medicare’s acting administrator, announced the end of a program that tied Medicare payments to a long list of measures related to the use of electronic health records. “We have to get the hearts and minds of physicians back,” said Mr. Slavitt. “I think we’ve lost them.”
But Wachter failed to tell us anything real at all in his opinion page. In fact Slavitt was speaking at a JP Morgan conference full of insurers and key special interests, not physicians. Read below for what Slavitt, a former Goldman Sachs investment banker and conflicted United Health Group insider really said.
"The Meaningful Use program as it has existed, will now be effectively over and replaced with something better. Since late last year we have been working side by side with physician organizations across many communities — including with great advocacy from the AMA — and have listened to the needs and concerns of many. We will be putting out the details on this next stage over the next few months,"
You can read the rest below if you want Slavitt's corporate-backed outline.
http://blog.cms.gov/2016/01/12/comments-of-cms-acting-administrator-andy-slavitt-at-the-j-p-morgan-annual-health-care-conference-jan-11-2016/
Can't Wachter tell the truth even once and make it the whole truth and nothing but the truth? I guess he would be eroding further in mental capacity if he did make such a slip of tongue and practiced real transparency rather than lying and covering for his politically and financially-aligned cronies.
ReplyDeleteNon-disclosure is the same as lying. Really Bob, in the NY Times! C'mon, man, who are you trying to fool? And look at the negative comments.
Blogger's Opinion
Here is an article/history of Andy Slavitt's conflicts of interest and why Bob Wachter has a need to push him through the confirmation hearings without telling us the whole truth about this CMS acting director and all that "bad conflicted actors" that are tied to and Slavitt, Wachter and Cassel. Read about United Health Group's subsidiaries and what Slavitt did with/for himself and them.
http://www.theamericanmedicalmoneymachine.com/judgment-day-in-washington-why-andy-slavitt-must-not-run-medicare/
https://en.wikipedia.org/wiki/UnitedHealth_Group
Anon wrote:
ReplyDelete"The only reason why he [Robert Wachter] is jumping across the DMZ is the ABIM is being defunded by those of use who are utterly disgusted with their nasty money game. Ironically, now that folks are applying performance metrics to the ABIM exposing its weakness as an organization, that crushing scrutiny will smother the ABIM infrastructure."
The ACA sits on Obama's desk ready to be rescinded in major parts. Clinton, an exponent is ready to be indicted for (negligence) concerning espionage laws. Unfortunately it is the law she must be indicted. Her career is over, when it happens. More importantly Hillary has abused her position and benefited the Clinton Foundation. Much worse. Sanders wants to raise taxes in a recession. Biden garners little support. I would say that a Republican presidency is inevitable. Whoever is elected as the next president will be someone that will rescind the ACA. It was a bad deal that the voter did not understand or want. I personally would like to see the rule of law restored where banksters and politicians do not get away with "murder".
Wachter's new found conversion to "love as the measure of all things" is delightful to hear, although it is quite disingenuous coming from him. It is way too much scooped up from someone else's sufferings and realizations in life.
It is too late to change the political landscape that he and others manipulated with fraud and corrupt practices concocted by he and other "bad apples."
The ends does not justify the means.
Wachter's blog 3 years ago (1/18/13) noted in an article about flu shots, "After decades of being pampered, many physicians have come to believe that rules and requirements are fine for others, but not for us. " He quoted Atul Gawande, author of The Checklist Manifesto, as stating that "discipline in following prudent procedure and in functioning with others... is a concept almost entirely outside the lexicon [of medicine] What is needed… is discipline." Wachter goes on to state that "Too many clinicians have learned to say, “I don’t want to do that” in code, instead saying, “What’s the p-value?”: passive aggressiveness wrapped in the garb of evidence-based medicine." http://community.the-hospitalist.org/2013/01/18/making-clinicians-get-flu-shots-more-important-than-simply-preventing-the-flu/
ReplyDeleteThere are many issues with Wachter's
hard-nosed, unloving 2013 blog. While Wachter apparently experienced "pampering", many of us have instead experienced extensive passive-aggressive behavior from non-physicians that impedes our ability to provide good patient care. Both Wachter and Gawande appear to confuse checklists with discipline. Wachter's dismissal of a request for evidence as "passive aggressiveness wrapped in the garb of evidence-based medicine", appears to be an attempt to preempt any questioning of the elite...
In his current NYT opinion, Wachter, as the superb and motivated politician he is, appears to recognize the burnout caused by these measurements including MOC. Time will tell if he will support his fellow physicians in stopping MOC and other valueless measurements. We will need evidence rather than dismissal.
Jane Orient pointed out Wachter's blog to me: http://www.aapsonline.org/index.php/site/article/aaps_news_february_2013_-_top-down_decisionmaking/
Robert Centor had a nice blog on Dec 25, 2015 about MOC. http://www.medrants.com/category/medical-rants/page/2 Centor's idea to "Have practicing clinicians decide on a curriculum. Experts could propose new concepts, studies, tests, drugs, etc for the committee to evaluate and prioritize" has potential. If the goals of ABIM are credible, they will enable practicing physicians to develop a tailored curriculum and superb inexpensive high-quality CME to HELP physicians stay on top of what they need to know.
Anon 03:23 above makes the observation from Dr. Centor's blog with regard to development and implementation of a recommended curriculum and supporting CME. I agree with this concept, but why should ABIM have a protected monopoly for participation in this structure instead of specialty societies like AACE, ASN, etc where the actual expertise is found? We can debate whether it makes sense to continue ABIM's previous role of supporting initial certification vs terminating ABIM in recognition of the original goals of ABIM's founding fathers, declaring ABIM's 50+ year mission complete, but I don't believe there is a continuing need or role for ABIM in the 21st century for life-long learning beyond being allowed to complete with all of the other providers of ACCME-accredited CME. If physicians would find their CME offerings valuable, ABIM can survive in modified form, otherwise they can fade into the sunset as another historical footnote.
ReplyDeleteAnon 03:23 above makes the observation from Dr. Centor's blog with regard to development and implementation of a recommended curriculum and supporting CME. I agree with this concept, but why should ABIM have a protected monopoly for participation in this structure instead of specialty societies like AACE, ASN, etc where the actual expertise is found? We can debate whether it makes sense to continue ABIM's previous role of supporting initial certification vs terminating ABIM in recognition of the original goals of ABIM's founding fathers, declaring ABIM's 50+ year mission complete, but I don't believe there is a continuing need or role for ABIM in the 21st century for life-long learning beyond being allowed to complete with all of the other providers of ACCME-accredited CME. If physicians would find their CME offerings valuable, ABIM can survive in modified form, otherwise they can fade into the sunset as another historical footnote.
ReplyDeleteIt's helpful to look at the context of Donabedian's "love" sentence quoted by Wachter…
ReplyDeleteDonabedian A. A founder of quality assessment encounters a troubled system firsthand. Interview by Fitzhugh Mullan. Health Aff (Millwood). 2001 Jan-Feb;20(1):137-41. http://www.ncbi.nlm.nih.gov/pubmed/11194834
INTERVIEWER: "We have all experienced the rapid commercialization of health care in recent years. How do you feel about this?
DONABEDIAN: I have never been convinced that competition by itself will improve the efficiency or the effectiveness of care or even that it will reduce the cost of care. I think that commercialization of care is a big mistake. Health care is a sacred mission. It is a moral enterprise and a scientific enterprise but not fundamentally a commercial one. We are
not selling a product. We don’t have a consumer who understands everything and makes rational choices—and I include myself here. Doctors and nurses are stewards of something precious. Their work is a kind of vocation rather than simply a job; commercial values don’t really capture what they do for patients and for society as a whole.
Systems awareness and systems design are important for health professionals but are not enough. They are enabling mechanisms only. It is the ethical dimension of individuals that is essential to a system’s success. Ultimately, the secret of quality is love. You have to love your patient, you have to love your profession, you have to love your God. If you have love, you can then work backward to monitor and improve the system. Commercialism should not be a principal force in the system. That people should make money by investing in health care without actually being providers of health care seems somewhat perverse, like a kind of racketeering."
Meg Edison’s recent online article about MOC states: “MOC is a toxic stress that is literally killing doctors. The worst part is the boards have heard our voices, yet they keep pressing forward. Their unflagging defense of MOC in the face of what they know it’s doing to our colleagues is not a simple error of knowledge; this is a breach of morality.” http://rebel.md/you-say-you-want-a-revolution/
And now unethical research exposed by Dr Wes?
Robert Wachter and the "Grey Lady" (New York Times)
ReplyDeleteA brief snapshot and review of Wachterian political definitions and pragmatic slogans of dissuasion.
On the definition of what "public deception" is: If Wachter or his partners are guilty of scandalous actions, it's not fraud or money laundering,
"It was just politically dumb." Dirty money is wiped clean. No prints only pre-digital docs left behind - destroyed.
On the definition of "conspiracy" in the sense of conspiring to push "harmful innovations" on the public by experimenting with taxpayers' and physicians' money: If Wachter or partners collude to make handsome personal profits and gain political traction from their experimental innovations,
"It's not a 'conspiracy'. It's America."
On the definition of "HIT" and its pragmatic use to control politics and money flow: If Wachter and his cronies act with negligence causing the demise of truth through dissemination of unproven propaganda they consider it laudable to contract a "HIT".
Examples:
Wachter responds reproachfully to this NY Times article by Julie Creswell which is critical of the EHR companies and how they "lobbied in" the New Digital EHR Age making the largest companies and their executives huge Wall Street-style profits and compensation.
Small companies were pushed aside and took what we now understand was as a "real hit".
http://www.nytimes.com/2013/02/20/business/a-digital-shift-on-health-data-swells-profits.html
Bob Wachter's article "The New York Times gets it wrong on Health IT" (with disclosure that Wachter's wife writes about health and IT for the New York Times.)
http://www.kevinmd.com/blog/2013/04/york-times-wrong-health.html
"The Times (full disclosure, my wife Katie Hafner, writes about healthcare and technology for the [NY Times] newspaper) has covered HIT, including its glacial pace of adoption, responsibly, up to now. The Creswell piece, by failing to acknowledge the value of healthcare IT, the absolute necessity of wiring our healthcare system, and the fact that a federal program to kick start this process was a perfectly reasonable policy approach, was unbalanced and unfair. While a cautionary note is welcome, one could come out of reading this article clamoring for a Congressional investigation of the HITECH program and of the activities of Epic, Cerner, and Allscripts. If our goal is to find ways to create an improved, and ultimately less expensive, healthcare system, such a response would be unwise, even counterproductive."
To Ed Rico from anonymous:
ReplyDeleteI agree with you, except I'm not sure the specialty societies should have a monopoly, either. I think there should be some kind of real peer review process, where physicians practicing in a similar practice determine what CME they need, and what they need to know. Some of the subspecialty societies are ruled by academics who are increasingly out of touch, but seem to think that practicing physicians need to know the details of their esoteric research.
Previously on this blog, there was a cardiologist who worked in a rural area who could take care of MIs, and triaged appropriately to a higher level of care. He failed his cardiology board recertification because he did not study enough, and was not up to date in the procedures he referred out, procedures he could not do at his community hospital. If he knows what he doesn't know and refers out appropriately, should he lose board certification? I don't think so.
ABIM's idea that 10% or more of practicing physicians should be deboarded (fail the test), and are not competent to practice medicine, and that is determined by a multiple choice test, is ludicrous. We all know competent physicians who fail, and incompetent ones who are good test takers. Agree that ABIM has served its purpose, but there may be more productive discussion about how we can keep each other up to date if we are not at an academic mecca, as these folks seem to be destroying the practice of medicine.
By the way, it looks like ABIM changed the survey so it's no longer research, but still mandatory if you want to enroll in MOC:
ABIM MOC Practice Characteristics Survey ...
Survey Instructions. The following survey asks a series of questions about your current practice(s). Some questions address your experience in general and across all of the settings where you may work, whereas some questions specifically address your experience in the main setting where you work most often. Please read and answer each question to the best of your ability.
The approximate time to complete the survey varies and can take up to 20 minutes depending upon your type of practice
This survey is completed by all ABIM-certified physicians enrolled in Maintenance of Certification (MOC). Sign in to ABIM.org at any time to update it with changes in your practice.
Your responses will be kept confidential and will be used to help improve the quality of ABIM's programs and will have no effect on your certification status.
Before enrolling in the Maintenance of Certification Program, you must complete the following Practice Characteristics Profile
Ha! So they removed the verbage on research. You obviously poked them in the eye on that one Wes. Good job!
ReplyDeleteI suggest that everyone just answer randomly or (if you've got enough bile and gall built up) to just straightline answer it. Always pick option one or somesuch.
Ya "listening" ABIM? We now know you are! Your coerced data ain't gonna be worth a pile of bat guano.
A word of caution about ABIM trademarked "MANDATED BS SURVEYS",
ReplyDeleteespecially the all new "WE ARE LISTENING SURVEYS".
According to computations of forensic accountants, these surveys are obviously a byproduct of the bogus need for more MOC money.
Assets are evaporating and revenues are decreasing, while costs are increasing - mostly due to rises in the number of executive positions and sky-rocketing financial compensation.
Couple this with grandiose political ambitions and their personal greed and it creates the perfect storm for the nightmare to continue.
I personally do not want one more minute of relationship with these current ABIM/ABMS liars/deceivers or their self-appointed predecessors - the frauds who invented it all. Do you?
It is all just more waste of time. ABIM elites are deceiving physicians into believing that they are included in the new medical order - a medical hierarchy where professional medical bureaucrats get more and more power and money.
If one studies what is going on there are already increases in organizational complexity and the unfettered number of new and improved "administrative rebranding" - aka "operational restructuring" - which take the practicing physician out of the loop forever.
Here's a legitimate survey question: Would you as a certified physician like to see a DOJ/IRS/OIG/AT investigation into the gamut of illegal and unethical practices and activities of the ABIM?
Would you as a certified physician like to see a similar DOJ/IRS/OIG/AT investigation involving the ABMS and the other broken spokes of the WINDY CITY'S MEMBERHSIP CARTEL - facetiously known as the "umbrella of protection"?
Send you responses "in care of" -
ABIM "I WANT MY MONEY BACK NOW" Foundation
510 Walnut St
Philadelphia, PA 19106
Can someone send Wes a screen capture of the new mandated questionnaire - ex the survey remarks? Could you post this "new questionnaire" as an addendum, Wes?
ReplyDeleteI find it hard to accept these "shape-shifters" at "ABIM Policy Central" in Philadelphia.
Code of Federal Regulations Title 42, 482.12(7) “Ensure that under no circumstances is the accordance of staff membership or professional privileges in the hospital dependent solely upon certification, fellowship, or membership in a specialty body or society.”
ReplyDeletehttp://www.ecfr.gov/cgi-bin/text-idx?rgn=div5;node=42:5.0.1.1.1;cc=ecfr#se42.5.482_112
Anon Fri Jan 22, 08:06:00 PM CST:
ReplyDeleteNow we need the insurers onboard. With all the federal money floating at hospitals, if insurers go against federal law, then they would be violating federal law. Right?
Is the phrase "dependent solely on certification" clear? Or is the keystone some hidden "shot in the back" legislation that nobody could adequately understand or predict?
Funding the ongoing forensic investigation of the ABIM and ABIM Foundation.
ReplyDeleteI recommend the continued forensic investigation of the ABIM's finances.
In this endeavor I support Charles P. Kroll, who keeps us informed (and entertained) about the financial activities and analysis of the ABIM and its associates. Mr. Kroll has been pivotal in bringing to light most of the financial irregularities of the ABIM and its Foundation.
Many have already donated to this worthy non-profit watchdog's cause. I believe it is our cause also as responsible stewards of medicine.
I recommend supporting this forensic accountant with a donation. A donation is also a vote - a clear message to the ABIM that MOC and the ABIM/ABMS's less-than-transparent practices must stop. Being vigilant of their finances is a critical aspect of this process. Please add your voice with a supportive donation.
https://www.gofundme.com/forensic-accounting
https://twitter.com/CharlesPKroll