Wednesday, July 27, 2016

Moving Forward With Ending MOC

Legislative action at the level of state medical societies to end requirements for participation in the unproven American Board of Medical Specialties (ABMS) /American Board of Internal Medicine (ABIM) Maintenance of Certification (MOC) program is moving ahead swiftly nationwide. Draft proposals for language for resolutions to end MOC at both state and federal levels can be found here (state - Word file - Enter your state name/medical society name at asterisks as appropriate) and here (federal - pdf file draft copy). BOTH are important.

I would encourage all working physicians to adapt these proposals presented by Ellen McKnight, MD of the Florida Medical Association and present them to your state medical society/association so they may be  adopted whole or in part.

Together, working physicians can end this unnecessary requirement imposed unilaterally by members of the ABMS, ABIM, and collaborators within the Accreditation Council of Graduate Medical Education (ACGME) and Accreditation Council of Continuing Medical Education (ACCME).

Wes Fisher, MD


Anonymous said...

FLorida MD.

It is about time each state takes action.
NO FBI, DOJ, Attorney General are going to do anything.

Thank you for the FMA initiative for Florida Physicians !!!

Lots o money lots o power said...

DrExit is the only real AMBS solution.

End game: the politics of money and power said...

How did we become completely subservient to this opaque bureaucratic regime?

"One Ring to rule them all . . . and in the darkness bind them.”
J.R.R. Tolkien, The Lord of the Rings

Quintilles says "KaChing" said...

"Get With the Guidelines" - Afib - initiative converts EPs into data entry personnel for the AHA and HRS" - Wes Fisher

"Web-based Patient Management Tool provided by Outcome, A Quintiles Company, Cambridge, Mass."

Healthcare earnings Quintilles beats expectations shares are up today in trade

Quintilles set to benefit from Hillary Clinton's Health Care Plan

"Democratic presidential candidate Hillary Clinton's health care plan, released over the weekend, could have a positive impact for some companies in the medical hardware and development market, says Evercore ISI.

From Clinton Plan

Clinton also wants to clear out the backlog of generic drug applications in the FDA and shorten the seven-year exclusivity period granted to biosimilar drugs. Muken says this should accelerate production by companies making these drugs and drive business for contract research organizations (CROs).

"Additionally, the plan's intention to hold drug companies accountable and require value-based studies to justify the high drug prices could accelerate pharma's adoption of real-world data services," he said. "This adoption could provide CROs another avenue of growth outside the traditional clinical trial outsourcing and is one of the reasons highlighted by Quintiles' (Q) management for the Quintiles/IMS Health (IMS) merger."

Quintiles/IMS Merger

Postcard from stroke association

Big Brother Gettin Bigger and Richer @ ur exempt said...

ABMS is Getting Even More Onerous. Adds “My Physicians Alert” List(s) and "Search by State Licensure" and NPI Number" in order to make it easier for their goon squads to investigate and prosecute you. Led by their all-star cast of talented Caveon spies, privacy lawyers, investigators, and unvetted convicted violent felons. Special unethical "directors of investigations" like Ariel Benjamin Mannes hired to violate your privacy and destroy civil rights . . . they will lie to get their intended financial and political results.

New aggressively-priced features added to "ABMS Solutions" from the ABMS fee-based subscription login site . . .

"About this Product
• Due to database changes made on 06/29/2016, you will receive alerts for all the physicians included in your “My Physicians Alert” list(s).◦If your My Physician Alerts frequency is set to daily, please ignore this list.
◦If your My Physician Alerts frequency is set to monthly or weekly, you can disregard any records that have 06/29/2016 in the Last Biographical Change column.

• NOW SEARCH WITH NPI NUMBER AND ACTIVE STATE LICENSURE! Under the PHYSICIAN ADVANCED SEARCH tab you’ll find individual search windows to enter both of these data points to increase your matching results.

• "NEW MAINTENANCE OF CERTIFICATION (MOC) REPORTING LANGUAGE EFFECTIVE OCTOBER 15, 2015: A physician’s MOC program status will now be reported as to whether or not a physician is participating in MOC. This replaces the current language that states whether or not a physician is meeting MOC requirements. The new language is a result of feedback from a combination of MOC stakeholders including physicians, specialty societies, and ABMS’ own qualitative research into how to achieve greater transparency and clarity within the MOC program and its descriptions. You will begin to see this reflected in Certifacts Online profiles beginning October 15, 2015."

• "Some ABMS Member Boards have implemented certification standards which specify that board certification is contingent upon meeting the ongoing requirements of Maintenance of Certification (MOC). Accordingly, these Member Boards no longer issue certificates with specific end dates to certification. Annual primary source verification on or immediately after the reverification date is necessary to accurately determine a diplomate's current certification status."

"Notice: It is up to the user to determine if the physician record obtained from this service is that of the physician being sought."

"With the exception of our Medical Specialists Online (MSO) product, all information as presented by ABMS Solutions products are approved for business use and are considered Primary Source Verified (PSV) and meet the primary source verification requirements as set by The Joint Commission, NCQA, URAC and other key accrediting agencies."

ABMS New Board of Directors 2016-2017

Anonymous said...

ABMS Solutions and potential ABIM conflicts of interest

"With the exception of our Medical Specialists Online (MSO) product, all information as presented by ABMS Solutions products are approved for business use and are considered Primary Source Verified (PSV) and meet the primary source verification requirements as set by The Joint Commission, NCQA, URAC and other key accrediting agencies."

NCQA mmh? Where have I read about the "National Committee for Quality Assurance" recently. It was the profile of ABIM's new deceitfully/fraudulently presented physician's advocate for ABIM, the Chief Medical Officer, Richard Battaglia. Battaglia worked for the NCQA for over ten years as a member and chair of the Review Oversight Committee as well as a surveyor. That sounds like an egregious conflict of interest. This is the typical way that the ABMS stays in power by brokering their employees through a wide net of revolving door partner organizations.

ABMS, ABIM, NCQA, HEDIS, Quality Compass and RRU's said...

ABMS Revolving Door Partnerships and ABIM's Egregiously Conflicted Executives
How and why the ABIM/ABMS obscures the truth.

What is the NCQA and what do they do?

It is not surprising ABIM's new "CMO" Dr. Richard Battaglia, worked for the NCQA for many years before moving over to PwC - PricewaterhouseCoopers. On new ABIM Chief Medical Officer, Richard Batagglia's LinkedIn CV and at the ABIM website, this latter employment is not mentioned at all by the ABIM and the name of PwC is not clarified by being written out as "PricewaterhouseCoopers" for a viewer to understand. Dr. Baron intentionally obscures this on his website and in their "press".

PwC is an international financial institution with nearly 40 billion in revenues and NOT a physicians' multispecialty clinic or HMO as Dr. Baron would seem to imply by his 'sleight of hand' about Richard Battaglia being a clinical physician that is going to listen to ABIM diplomates about improving MOC / ending its mandatory nature and a great many other concerns. You have to read very carefully and go online to get any honest thread or clue.

So, the takeaway from the spin by ABIM on their new CEO is only more disappointment. It is all classic ABMS subterfuge and fables from their largest medical board, the ABIM. More stonewalling and delay of explaining the past financial obfuscations and money transfers. It is business as usual at the ABMS.

Just look at the structure of the NCQA with HEDIS, Quality Compass. It is all newspeak financial language coming from the NCQA and we can see how they make truckloads of money with quality assessment via "Relative Resource Use" and other fees. See the links below.

More on the ABMS and NCQA said...

"HEDIS & Quality Measurement » HEDIS and Quality Measure Improvement » HEDIS and Relative Resource Use (RRU) » Quality Compass: RRU + Quality Index"

"What is Relative Resource Use?
Relative Resource Use (RRU) measures indicate how intensively plans use physician visits, hospital stays and other resources to care for members identified as having one of five chronic diseases; cardiovascular disease, COPD, diabetes, hypertension and asthma. When evaluated alongside quality measures, RRU measures make it possible to consider quality and spending simultaneously."

"For purchasers, a key insight of Quality Compass® RRU + Quality Index is that, unlike some goods and services, the level of resources that plans expend to care for members and the quality achieved are weakly related. In some instances, quality and resource use appear to be inversely related (i.e., higher quality is associated with lower resource use). Therefore, quality and resource use should both be considered when comparing health plans."

"How Can Relative Resource Use Help?
Understanding the value of these measures requires both cost and quality information. NCQA’s HEDIS performance measures reflect quality; however, when it comes to cost, little information is publically available."

"When linked with HEDIS quality data, RRU measures help members, plans, employers, benefit managers and other interested groups, make informed choices about health care services. Members get a more detailed look at the value of services they pay for, while plans can see how effectively they use resources, compared to other plans, when delivering health care.
◾Calculating a Quality Index
A summary of how the quality index calculations are performed on HEDIS Effectiveness of Care (EOC) measures used with the RRU. Common RRU Questions
◾FAQs about RRU and what the results mean.
◾RRU Fact Sheet

"NCQA's "Relative Resource Use" (RRU) measures help illustrates how services like doctor visits and hospital stays relate to quality. They reveal that, overall, the amount of services used to treat people often has little to do with the quality of their care."

"RRU + Quality Index

1 User, 10 Users, 20 Users, 25 Users, 30 Users
Commercial (2016)$895, $1295, $1795, $2295, $2795
Commercial (2016) with Data Exporter $2095, $3095, $4,395, $5,595, $6,795
Medicaid (2016) CSV download file $595, $895, $1,195, $1,495, $1,795
Medicare (2016) CSV download file $595 $895 $1,195 $1,495 $1,795"

- See more at:

NCQA STORE! said...

Anonymous said...

We were promised a certification for life by serving the profession and the public. What a big lie. Instead we end up serving the profligacy and partisan politics of Robert Wachter, Christine Cassel, Jonathan Gruber, and Richard Baron.

We were promised universal healthcare by them as good as US Senators get. That has proven to be an even bigger political fib and myth.

Instead we get Killary Care - a universal Dickensian bureaucracy created by greedy out-of-touch medical politicians flaunting secret Gruberesque policies that become codified into law.

The ABIM and ABMS have all been lying and behind closed doors laughing at us calling us all stupid for being such gullible sheep.

Now we have hordes of disgruntled patients and angry click-clerk physicians. An anti-MOC revolution trying to find time and energy to oppose it while navigating flow stations, bottleneck wrecks and 'nouveau riche' gods rising out of the ash of brittle paper charts.

We are goose-stepping into the age of accountable corporate rule underwritten by the big banks and steered by the new masters of techno fascism. The callous leaders are elites accountable to no one.

The corruption and excesses are no longer tolerable. MOC is the result of corrupt greedy politicians and quality assurance NGO's run amok.

Speaking of Corruption and Strange Bedfellows said...

Wes, you wrote on your blog:
"Look at all of the friends of the ABIM who welcome CECity's services: Johns Hopkins Medicine, the American Osteopathic Association (AOA), Merck, the American Medical Association (AMA), Aetna, The American College of Physicians (ACP), Premier, the ABIM, NextGen, Athenahealth, and Optum. These are just a few of ABIM's corporate bedfellows. The AMA has no interest in what doctors really want or need. The AMA has no interest in ethics or what's best for patients.

The AMA and the ABIM only have interest in what's best for the AMA and the ABIM."

We agree! There is a glut of quality assurance organizations all competing with each other, vying for a piece of the healthcare MONEY PIE!

NCQA Portal said...

NCQA and ABMS are rewarded for following/campaigning "Choosing Wisely" initiatives (Lower cost equals higher quality.)

ABCs of Value Based Care – Implications for Research -- QUINTILES
Francis X. Campion, M.D., FACP
Real -World & Late Phase Research
January 2015

"Reduce, then Eliminate (Unwarranted)Variations in Care and Costs" - QUINTILES

•The affect of value and quality incentive programs on clinical practice
•The affect of large provider organizations and electronic health records (EHRs) and disease registries on research
•EHRs’ role in patient and specialty healthcare association registries for quality improvement and research
•Facilitating enrollment in clinical trials using clinical decision support (CDS) in EHRs
•Using patient portals developed for patient care in clinical trials (e.g. patient reported outcomes / PROs data collection)

Lipid Society (Powered by Cecity in association with ACCME, QUINTILES. And so on.

QUINTILES claims no financial conflicts of interest...

ABMS Goon Squad said...

Don't you even think of cheating the ABMS out of their sadistic pastimes of thuggery and skullduggery! They love to mete out the unjust punishment.
Why else would the ABIM under Christine Cassel and Richard Baron hire a violent felon to represent them in court, but they don't let him come anywhere near the public. If the media got wind of the corruption at the ABMS the people still would not know who the ABIM or any of these "powerful and important" quality assurance boards are.
Here is what happens when you innocently advertise on your website that you are certified, but in fact you were expired for eight months without knowing.

Anonymous said...

Florida MD
One can advertise Board Certified(in your specialty), by NBPAS !!!

CW Liability said...

"Reduce, then Eliminate (Unwarranted) Variations in Care and Costs" - NCQA

What we know so far

ABIM's Chief Medical Officer, Richard Battaglia, who reports directly to Dr. Richard Baron should quickly get moving to the "eliminate" MOC. Enough of the "sorry we got it wrong" litany, it's time to actually end all mandatory MOC - immediately - as was recommended by the AMA House of Delegates.

Every day of delay to end mandatory MOC increases the likelihood that the ABIM/ ABMS will be administratively dissolved by the courts after the truth comes out about what the organization has been doing to cheat the government, public and rank and file physicians.

Revolving-door employment practices serve to obscure wrongdoing and cheat the five to seven-year statutes of limitations on most white collar crimes but not on capital offenses.

You Have Chosen Poorly said...

Choosing Wisely and MOC

One important issue with "Choosing Wisely" campaign is that it is an obvious experiment in social/healthcare engineering. CW is unstudied and therefore an unwise choice for a failing medical board (with a vote of no-confidence) engaged in reckless mismanagement of their testing and certification programs to take on an even more dangerous and perilous endeavor - namely, to control medical costs through untested social propaganda, and quasi-scientific political policy directed at controlling physician, provider and patient behavior.

Who's Initiative said...

Is there an independent agency monitoring Choosing Wisely with a database set up to mine for bad outcomes. If so, who is responsible for providing that information to the state medical boards? Or CMS? It would be a wise choice imo to do so.

Here's why.

There have been reports of deaths that I am looking into from failing to prescribe antibiotics in states with strong CW advocacy. There is strong external pressure and grant money given to state medical societies, hospitals, and HMO's, and so on.

Two of the top five recommendations examined - reduce the frequency of routine mammograms and do not over-prescribe antibiotics.

What was once a prudent precaution to prescribe antibiotics, for example, has perhaps seen the medical wheel of fortune from this turn into a game of Russian roulette. I do not advocate waste. No, I am in favor of wise, prudent and responsible medicine. But in an environment of physician shortages it becomes very apparent that many provider judgments are being swayed by CW and there are consequences. It is simple cause and effect. Is it fair to call it a form of gambling or holding a gun to the head and rolling the partially-filled chamber.

It may be more than fair to say that it is gambling with America's health. Powerful organizations and businesses are pushing CW with a disturbing zeal.

Consumer reports has teamed up with the ABIM/ABMS/ACP/AMA/RWJF and other affiliated organizations and foundations to encourage the practice of medicine according to "Choosing Wisely". These are powerful rich organizations with a great deal of sway with the government and media.

There have been some alarming reports of women dying of breast cancer going all the way to stage IV without received any screening or treatment whatsoever. It is not fun for a coroner to discover such a woman's body with clear clinical signs and wonder how this could have happened.

How did it happen? Have we gone too far with the cost-rationioning of CW and allowed the pendulum to swing too far toward accepting a more than usual number of grim outcomes -- where families are left without an important member suddenly and without warning. What part has the shortage of highly skilled physician providers played in this, also?

What can we attribute to the waiting periods trying to get in to see a physician and not just a PA or NP? We should all look around and be honest at what is happening and the profound possibility of various unintended consequences.