A Critical Review of ABIM's Recent MOC Changes

In its never ending push to preserve the lucrative Maintenance of Certification (MOC) revenue stream, the American Board of Internal Medicine (ABIM) once again announced a "new option" to complete their corrupt MOC program to beginning January, 2018 (corresponding press release here).

The real details of the new option were sketchy and only promised the following:

• Take the form of shorter assessments that doctors can choose to take on their personal or office computer—with appropriate identity verification and security (emphasis mine)—more frequently than every 10 years but no more than annually;


• Provide feedback on important knowledge gap areas so physicians can better plan their learning to stay current in knowledge and practice and;


• Allow physicians who engage in and perform well on these shorter assessments to test out of the current assessment taken every 10 years.

What was not mentioned was the following:

• What this "new pathway" will cost and


• What "identify verification and security" tactics will be proposed to maintain control of the American Board of Medical Specialties' (ABMS) proprietary MOC program.

Let's break these two unmentioned issues down, since they are increasingly at the crux of the corruption at the ABIM and ABMS.

COST

While I do not know what the "new pathway" will cost, we should note that the changes promised by 2018 only provides another way doctors can provide funds to the ABIM. Their proposed "change" does not remove the requirement for the clinically unproven re-certification MOC metric or its secure examination. Importantly, the new proposal does not address prior fraudulent tax filings or secretive funding of their ABIM Foundation from physician testing fees. What we can be assured, however, is the ABIM is desperate for cash to fund its operations and protect its tests. Given what we now know about the ABIM financial burn rate, it is safe to estimate that the ABIM needs to extract at least $200 per year from each and every internist in the United States (and maybe $300/year from specialists) to maintain their current cash flow.

Look for cost of ABIM's MOC program to be $200-300 per year for physicians irrespective of the various "options" or "pathways" the ABIM constructs to fulfill its MOC re-certification requirement.

TEST SECURITY

This is where things get interesting.

Test security is everything to the ABIM. Without it, anyone could replicate their process or "steal" their copyright-registered health information. Few details of how the ABIM plans to perform "identity verification and security" are forthcoming with their latest press release. But one thing we know, the ABIM will continue to have physicians entrap themselves in contract language promising secrecy and to observe obscure "pledges of honesty" before performing any MOC testing.

How might they protect their tests? Well, let's look at one of the test security options available to ABMS from a little-known test security firm, Kryterion. It seems Kryterion would monitor physicians who opt for the "at home" option using a webcam and microphones. According to Kryterion's Terms of Service, physicians will be asked to scan the room using their webcam before sitting before the computer with a live proctor on the other end of the line:

The Kryterion Certified Online Proctors (KCOPs) are trained to watch and listen for any unusual behaviors from the test taker. For example, unusual eye movements, removing oneself from the field of vision and making atypical noises are all noted and a behavior alert is sent to the test taker, depending on the business rules you set. The test taker is required to acknowledge the alert before continuing with the test and the KCOP resumes or stops the testing process, depending on the action you’d like us to take.

What legal action does the ABIM or Kryterion plan to invoke if they feel my eye movements are questionable? Yet this is the reality of "secure testing" that the ABIM might utilize. And as we've seen, it appears the ABIM is all to happy to deploy their lawyers on physicians at the slightest hint of a "testing irregularity" to extract even more revenue from physicians and to protect their monopoly.

Sorry. but I don't want Big Brother in my house. If this is how the ABIM plans to assure I'm compliant with my continuing medical education just so they can extract more revenue from me under the threat of litigation, they've got another thing coming.

ABIM has still not addressed its financial transgressions, multiple corporate conflicts of interest, high salary structure, and fraudulent tax filings. Unless and until these issues are addressed, look for the practicing physician community to avoid further interaction with the corrupt ABMS MOC program irrespective of any further changes to their MOC program the ABIM might propose.

-Wes