Wednesday, June 29, 2016

On Brexit and Maintenance of Certification

The degree to which this was a vote that was directed against the British elite is vital to understand. Politicians, business leaders, and intellectuals were all seen as having lost their right to control the system. The elites had contempt for their values - for the nationalism and their interests. This is not a new phenomenon in Europe, but it is one that the EU had thought it had banished. This is not a British phenomenon by any means. This is something that is sweeping Europe and China. It is also present in the U.S., in the figure of Donald Trump, whose entire strategy is to attack the Democratic and Republican leadership and the elite who have contempt for the nationalism and moral principles of those beneath them. It is the general process the West is undergoing, and it came to London (Thursday).

George Friedman, Geopolitical Futures

Could what has happened in London parallel what is simultaneously happening to Organized Medicine in the United States? Cracks have formed in the foundation that American physicians have trusted for years: the Accreditation Council on Graduate Medical Education (ACGME), the American Board of Medical Specialties' (ABMS), American Board of Internal Medicine, the American Medial Association, and our many of our specialty societies. Practicing physicians are looking with a new lens at "politicians, business leaders and intellectuals" who were once trusted to protect the practice of medicine and the physician-patient relationship.

Can our current byzantine system of unelected, unaccountable, non-profit health care organizations "lose their right to control" our health care system - a roughly $3.0 trillion dollar sector or 17% segment of the entire US gross national product? Will they endure under this new level of scrutiny and demand for transparency from those on the front line of health care delivery? How will these structures pivot?

How much tax fraud must occur, how many laws must be broken, how many physician personal liberties must be tossed aside before practicing physicians and their patients demand change?

You can feel the ground shaking.

The silence is deafening.



Lisa said...

This is a movement. Try to stop it and the people will push back harder. It's more than Nationalismv. Globalism. What's happening in Organized Medicine (I assume Wes is drawing a subtle analogy with Organized Crime) is more than greed. This is classic implementation of an oppressive marxist communist socialist regime. You can pick which term you prefer--all of it is deadly.

Railing against the system and how corrupt and unfair MOC is without seeing the big picture is a waste of time. You can bury your head in the sand but it won't change what is being done to you. People are dying. Many doctors practice the National Religion of Liberalism, and see progress as making sure other country's citizens are going to be fully provided for and given prompts medical attention. But Americans are denied this luxury. We even see Establishment Republicans offended that Trump said he will not let people die on the streets. Migrants are not the ones homeless and dying on the streets. We even have veterans who risked their lives for this country dying off at a rate of #22aDay--a statistic that Liberals/Democrats & establishment GOP would NEVER tolerate if it happened to a third world invader dealing drugs and raping your daughters.

I hope people will look at the bigger picture. Chicago for example has three Mexican drug cartels in operation. Does this impact medicine? I'm thinking, yes. That's just me--does it directly relate to MOC? Some of you will ask me this. But the entire point is that nothing useful relates to MOC; it is a money making scam.

Most of you are super busy and can't think through more than the details in front of your face at this very moment; understandable. Also deadly. Intentional sabotage of the healthcare system--what else can this be? Government incompetence alone can't explain this. The only good thing that's come of it is that it tested the character of America's physicians. Some of you are a lot better for it. Some of you were not in this for the right reasons, and patients will never forget this. Ever.

Some of you are fabulous, and patients will never forget this. Ever.

G. Blumenberg said...

The extent of ABIM's cronyism, conflicts of interest, and elaborate white collar crime is astounding. The level of fraud and deep corruption of the executive elites is alarming.

20/20 views said...

ABIM's Legacy of Conflicts of Interest. How ABIM works serving its own interests and personally profits by it.

Yesterday, Christine Cassel's appointee to the ABIM Foundation Trustee Jackie Judd's investment in Gilead jumped on FDA approval of a less costly hepatitis C drug "Epclusa."

How coi works at ABIM: Foundation Trustee Jackie Judd's coi: Gilead stock >100k, and financial relationship with Kaiser Family Foundation and Robert Wood Johnson Foundation. Ms. Judd went to work for the Kaiser Family Foundation as a reporter in 2003, the same year that Christine Cassel was appointed CEO of ABIM. Judd covered Medicare and Medicaid and HIV while working with Kaiser. Gilead has a strong HIV drug line.

At the same time, Christine Cassel was a board executive of Kaiser Foundation Hospitals and Kaiser Foundation Health Plans from 2002-2014 when NQF Senate/DOJ inquiries/legal actions into NQF's blatant fraud and coi forced Cassel's resignation.

The current CEO of Kaiser Permanente, Bernard Tyson, was groomed by Cassel and her cronies over many years as a favorable candidate and ally. Kaiser Foundation Hospitals and Kaiser Foundation Health Plans are subsidiaries of Kaiser Permanente.
Cassel has just been reappointed as an executive at Kaiser Permanente involved in their venture into the creation of medical schools. Kaiser Permanente has over 10 million people enrolled in its health plans. A core for-profit physicians group is entirely funded by its non-profit components.

Ms. Judd, a renowned journalist was appointed in 2012 by Christine Cassel to help launch the Choosing Wisely Campaign--a very controversial cost rationing plan introduced by the ABIM Foundation. There are suggestions that CW has caused deaths when the ABIM Foundation "got it wrong" on some of its aggressive recommendations. Some could argue CW is a healthcare social experiment in the works. There is no evidence of quality improvement and its systematic approach to healthcare rationing unproven. We believe CW may be an essential component of the PPACA/Obama Care/Hillary Care.

There is evidence MOC was designed by self-appointed medical politicians to subsidize ABIM's financially lucrative "self-regulation" and political control over physicians. This has led to restraint of trade and political submission to ABIM's partisan healthcare policy and Cassel/Baron/Wachter/Judd's political platform.

Healthcare costs rise with Affordable Care Act.

"Federal government spending on health care skyrocketed last year, substantially outpacing the rate of growth of the nation’s overall health care costs. The trend is largely due to the expansion of Obamacare and Medicaid coverage along with a shocking increase in the cost of biologic specialty drugs like Sovaldi for the treatment of the potentially deadly hepatitis C virus."

Gilead manufactures "Sovaldi" which costs over $84K for a treatment.

FDA just approved a less costly Gilead drug for "Epclusa" Hepatitis C combo treatment for $74K.

Jackie Judd, Cassel appointee to the ABIM Foundation

20/20 said...

Senate gets tough on Gilead's pricing of its drugs

"On July 11, 2014, the Committee of Finance of the United States Senate launched an investigation into the pricing of the hepatitis C drug Sovaldi (sofosbuvir). This was in reaction to the high cost per pill ($1,000), which raised serious questions about the extent to which the market was operating “efficiently and rationally” for this drug. In a letter to CEO John C. Martin, Senators Ron Wyden (Chairman) and Charles E. Grassley (Member) asked Gilead to provide a series of documents to the Committee, and to answer a list of questions, in order for the Committee to get a better understanding of how the company had arrived at the price for this drug.[27]"

Reed said...

Lisa, I just read an IPE column after reading your thoughts. When push comes to is the return of a deadly brand of fascism that confronts us. Thanks for your views. The ABIM and ABMS support that deadly brand of austerity.

M.E. said...

MOC is Racketeering and ABIMF's Choosing Wisely and Professionalism are Public Fraud

Wes wrote, "How much tax fraud must occur, how many laws must be broken, how many physician personal liberties must be tossed aside before practicing physicians and their patients demand change?"

ABIM's transgressions.

Laws have been broken. They defraud physicians. Baron responds to the accusations with a deafening bold silence telling us the nation's laws don't apply to the elites like him and Cassel.

But the foul smell of tax fraud and financial obfuscation lingers like a dead fish in old water. It will not go away unless the whole slimy mess goes.

They hide administrative waste and graft that fills the office air with decades of stench. Baron and Nora tell fragrant lies never from the office, but from far away. They tell us how they "got it wrong", and "sorry" with a shot of vermouth and the subtle odor of sunbathers lounging next to them, while lounging with their cronies on a Caribbean island.

They defend how they need to support extravagant lifestyles with Wall Street comparisons--supporting their greedy ABMS compensation model with other crooked non-profit offshore thieves and orgs. They spin yarns to hide their offshore accounts, risky stock jockeying, and evidence of money laundering to support their highly profitable trademarked brand of racketeering.

What's even worse, ABIM execs act like sadists with their cult of 'bloodletting' and 'sacrifice' practiced on young vulnerable physicians--while ordering caviar and champagne in their luxurious exotic rooms. They sold out everyone's civil liberties, privacy, and due process. Every physician will be crushed under the ABIM grinder in order to feed the hungry ABMS MOC millstone.

Anyone who takes the time to inform themselves of the facts in the ABIM scandals and great MOC debate knows mandatory MOC (coupled with employment and payment) must end now. The financial ruse has been exposed by Newsweek, courtesy of many honest truth tellers like Fisher, Cutler, Eichenwald and Kroll.

Going forward, I don't honestly think anyone trusts the current governance at the ABIM or ABMS to even be in charge of certifications. The corrupt heads must go.

Laurence said...

DrExit. What will it take to achieve equity and democracy for physicians?

Can physicians exercise their vote of raw democracy and exit the organized corruption represented by the overpopulated field of monetized quality assurance organizations. Incentivized QA corruption is epitomized by the ABIM/ABMS and their cash-cow system of pay-for-play called MOC?

Good luck in your movement to bring back your own democracy. Are you listening. DrExit

To understand the BrExit here is an article by veteran journalist John Pilger.

Anonymous said...

Choosing Wisely

Christine K. Cassel and the "moral imperative of conserving medical resources." Referring to an initiative paving the way for Choosing Wisely. Quote, 2011 ABIM Foundation Forum.

ABIM Foundation 2012 Forum with Zeke Emanuel, Jackie Judd, et al. Choosing Wisely and how it complements healthcare reform.

How much money/net asset value did Christine Cassel squander/lose while serving as CEO of the ABIM? How much total compensation did she take from the ABIM and ABIMF? The ratio of ABIM's financial losses in relation to Cassel's obscene income was 3:1 The ABIM lost well over $30 million in assets and Cassel took away upwards to $10 million in round numbers.

Anonymous said...

Who said the silence is deafening? Many of us have silently moved the practice and procedures to areas outside the hot zone - the toxic hospital mess and still care for patients cost effectively. It is important for all of us to stop funding the scam of organized medicine. About 20% of the physicians, the "vocal majority" who are in positions like "chief experience officers" and "Chief Medical Information officer" of hospitals are the real problem. Ignore all these people and their loaded mandates. You will do fine!

Anonymous said...

Oh yeah, the NEJM jumps on board the MOC $$$ train!

Anonymous said...

At ABIM the appearance of conflicts of interest is guaranteed. In fact ethical breaches and keeping silent on their finances is the only thing that keeps them a going concern.

Truth and Trivia said...

ABIM claims as their motto:
"Of the profession, for the public."
But the ABIM's practice is:
Cheat your colleagues and defraud the public.
(And try to keep everyone asleep about it.)

Millard D. said...

Anybody know if the ABIM's felonious Director of Investigations, Ariel Benjamin Mannes, has been deposed yet? He was scheduled to be queried in ABIM v Dr. Salas Rushford v. ABIM, Chris Cassel, Richard Baron, Lynn Langdon, Eric Holmboe, et al? We are very interested to read the court transcript when it is available.

Anonymous said...

Wes, you wrote:
"Could what has happened in London parallel what is simultaneously happening to Organized Medicine in the United States? Cracks have formed in the foundation that American physicians have trusted for years: the Accreditation Council on Graduate Medical Education (ACGME), the American Board of Medical Specialties' (ABMS), American Board of Internal Medicine, the American Medial Association, and many of our specialty societies. Practicing physicians are looking with a new lens at "politicians, business leaders and intellectuals" who were once trusted to protect the practice of medicine and the physician-patient relationship."

It is more than cracks we see. Anger and disappointment toward figures like Baron and Nora are tearing away at the ABMS foundation. Trust in the ABIM leadership and their various money schemes and personal political agendas has led to outrage. The ethical crumble, tumble and and quick collapse of many of the key players from Cassel to Wachter to Baron shows us how great the ethical lapses and how fragile their moral capacity is.

A no-confidence vote resonates in most of us regarding the ABIM leadership.
We recognize the profound corruption that has set in. This corruption shows up in almost everything the ABIM and ABMS does, expounds or newly mandates.

Every day there are more reasons to exit from this massive unethical bureaucracy as we learn of even more insidious schemes to wield greater control through never ending assessment over diplomates, candidates and future candidates.

There are certainly parallels with the EU governance. The ABMS is an organization with an all powerful "commission". But like the powerless elected EU parliament, ABIM has an appointment of powerless and passive board members, who have lost their ability to think independently and exercise common sense. This "card board" and high commission of professional medical elites must go.

Anonymous said...

The rebellion in the EU is about that parliament not having any real meaningful power or independent thinking, except in rare instances, who literally get slapped down for making truthful statements that offend. Two French and Hungarian leaders come to immediate mind. The power is centralized in the hands of a few elites there too. They are now talking of creating their own army and gaining even more centralized control. If Britain does not exit soon it may not be able to leave.

That is the take away from the BrExit that physicians must understand. The ABIM, ABMS, ACGME, AMA, ACP and specialty societies are planning ways gain more control over its member states. They have plans in the works to grow even stronger from the dissent. The EU commission and their "advisors" plan to use extreme measures on its people using economic and political impetuses and other terrible means at their disposal. The parallels are striking when you look at it.

Anonymous said...

Don't think for a moment that anyone can trust the ABIM or ABMS to change and relinquish control. They will fight hard to maintain the political and economic footholds that they created, nurtured and developed over the decades. They operate now like they are a branch of government, which they are not. The ABIM has form its own form of militant bureau to scare and "handle" physicians in undignified ways.

Militant thug-like behavior similar to declarations of martial law have been imposed on many physicians. We know what this is with loss of civil rights and privacy. Deceitful manipulative policies are adapted of dealing with education for residents and physicians decided behind closed doors and then suddenly the missiles are launched from their website.

The ABIM/ABMS and partners act with more dishonesty than a big for-profit corporation. Nifty convenient friends in high places protect them in their illegal deeds and enterprises and will help them maintain control.

Physicians need to do more than just "emotional and intellectually exit" or stop paying fees. These unethical criminals in charge need to be held accountable. We should demand that their employment be terminated when we see clear evidence that they have acted unethically or have violated laws.

We are so disappointed in the ABIM leadership. The ethical lapses alone should be enough to impeach them. We are talking of those who should be held to a higher standard, because of their positions of authority and power over others. This higher standard of ethics and excellence is what we expect from all of our governing bodies and leaders.