Thursday, September 08, 2016

A Rebuttal to ABIM President and CEO's Defense of MOC

In August, Medical Economics published an interview with Richard Baron, MD entitled: "The Man Behind MOC Defends the Program Against Critics." Medical Economics then solicited practicing physicians to write a rebuttal. I accepted, but with a warning:
After exchanging a series of Twitter direct messages and e-mails with the staff at Medical Economics, much to my surprise they seemed agreeable to publish my piece  and promised to move forward with the rebuttal for both print and online versions of Medical Economics.  So I signed a "Contributor License Agreement" with UBM LLC, a nearly $2.8 billion owner of Medical Economics (among lots of other throw-away publications) and proceeded to spend the better part of an evening composing my rebuttal and submitted it a few days later.

That was August 12, 2016.

I reached out to Medical Economics yesterday to inquire where things stood on the rebuttal and received a phone call a short time later from a more senior editor that they would be unable to publish my work, especially the part that dealt with the ABIM, but would be willing to write about modifications I might suggest for the MOC program. I thanked them for their review but saw no utility in promoting "modifications" to MOC over ending the program entirely. We parted company politely.

Needless to say, I'm frustrated, but this isn't the first time this has happened. (Welcome to the realities of the Medical Industrial Complex!).

*sigh*

But one of the beauties of social media and the disruptive force of the Internet is that anyone can be their own publisher. Glenn Reynolds famously coined our ability to compete with larger publishing firms "An Army of Davids."

And so, thanks to the wonders of technology, I present my rebuttal to Dr. Baron below.

* * *

Richard Baron, MD, President and CEO of the American Board of Internal Medicine (ABIM) and the ABIM Foundation, was recently interviewed by Jeff Bendix of Medical Economics and once again attempted to defend the ABIM's Maintenance of Certification (MOC) program by rehashing his usual talking points. Dr. Baron argues that because there is an explosion of medical information out there, doctors should use ABIM recertification metric to prove to themselves, patients, and institutions that they are staying current in medicine. Dr. Baron also seems to believe that taking computerized tests assembled from a database of rehashed test questions every ten years is superior to gaining 10 years of direct patient care experience.

Unfortunately, Dr. Baron and his bureaucratic colleagues at the ABIM seem to have forgotten that practicing physicians are committed to caring for patients, not to supporting Dr. Baron’s retirement fund.

While endlessly promoting their Maintenance of Certification (MOC) program to the public, the truth is that the potential adverse effects of ABIM re-certification on physicians and their patients have never been studied, nor has the American Board of Medical Specialties (ABMS) MOC program ever been shown to improve the quality or safety of patient care (See here, here, and here), especially as it pertains to a physician's specific practice environment. Their form of assessment is, in effect, a one-size-fits-all assessment of a physician's ability to retain facts and take a test, little more. Despite these facts and thanks to heavy lobbying to the medical community by those who stand to profit from the program, practicing physicians certified after 1990 must perform this ritual every 10 years to retain their hospital privileges or be allowed to be providers for many large insurance plans while physicians certified before 1990 do not - a discriminatory practice against younger, more economically vulnerable physicians.

As a triple "Board-certified" physician in good standing who has experienced the transition of the ABIM "Board certification" credential from a voluntary once-in-lifetime designation to a time-limited one, I have experienced first-hand the irrational and humiliating process of re-certification that makes a mockery of the entire health care accreditation process. After spending nearly $10,000 to "maintain" my certifications in cardiovascular diseases and cardiac electrophysiology in 2013 for the third time and having to be scanned, searched, and videotaped to assure my integrity in a PearsonVue testing center, I decided to study the finances, practices, and financial conflicts of interest that have come to define the ABIM and (as I have since learned) much of our physician credentialing system in the United States. Some of my earlier work has already been published. In the financial analysis of the ABIM, I was joined in my effort by Mr. Charles Kroll, a certified public forensic accountant specializing in health care non-profit organization accounting who has donated over 1500 hours of uncompensated time to this review. As our analysis has continued, other physicians have quietly come forward with additional information and personal stories of the impact of an ABIM sanction when the organization targets practicing physicians they feel are cheating while attempting to study for their unproven quality metric. I have reviewed the ABIM's federal Forms 990 from 1997 to the present and other sources including the internet archive (archive.org), IRS Form 1023, Guidestar.org, Brightscope.com, Pacer.gov, and called and emailed Dr. Baron to understand why my fees were so high and better understand why Dr. Baron is able to pay himself $812,000 per year (nearly four times the typical US internist salary) while the ABIM is $50,642,980 in debt according to its most recent Form 990 (line 22, "net assets and fund balances").

By expanding my review to the ABIM Foundation and other member boards of the American Board of Medical Specialties (ABMS) (of which the ABIM has the most physician diplomats), it became obvious that the problems I found at the ABIM were endemic to most of the United States physician credentialing system under the direction of the American Board of Medical Specialties (ABMS). For instance, the American Board of Pediatrics paid a $2.4 million golden parachute to their retiring 20-year veteran President and CEO, James A Stockman, III in 2012, yet still employed him two years later for $793,438 for working just eight hours a work-week: an almost incomprehensible $2066.24 per hour. Worse still, to the best of my knowledge and belief, all of these transgressions appear to have been conveniently ignored by the leadership of US medicine’s associated member organizations of the Accreditation Council of Graduate Medical Education (ACGME), including the American Medical Association, the Association of American Medical Colleges (AAMC), and the Council of Medical Subspecialty Societies (CMSS). The House of Medicine has become deeply divided between the bureaucratic elite of these organizations and those who struggle every day to do the real work of hands-on patient care.

After writing about by re-credentialing experience in 2013 on my blog, Dr. Wes (http://drwes.blogspot.com), my dive into the corrupt finances of the ABIM began in earnest 16 Dec 2014 with my article entitled "The ABIM Foundation, Choosing Wisely®, and the $2.3 Million Condominium." Since that time, a partial list of my ongoing investigation has uncovered the following:
  • The ABIM Foundation, which was flush with over $47 million in cash when it was supposedly "created" in Iowa in 1999 (as disclosed on its tax forms from 2008 through 2013), was actually secretly created on October 17, 1989, in Pennsylvania. It has since been determined (and later acknowledged by the ABIM on their revised website) that the organization was funded by making multiple (undisclosed) transfers of ABIM diplomat fees from the ABIM (IRS Form 990's for the Foundation are unavailable for review because the ABIM had the IRS remove available tax forms after it changed the name of their Foundation from the "American Board of Internal Medicine Foundation" to the ABIM Foundation in 1999). Additional revenues were transferred from the ABIM from 1999 through 2007, culminating in the purchase of a $2.3 million luxury condominium complete with a chauffeur-driven Mercedes S-class town car in December of 2007. It remains unclear why a 501(c)(3) non-profit testing agency would purchase a condominium as an "investment" or for housing ABIM staff and directors when other cheaper options for housing exist in the Philadelphia area. The list of names of those who actually used the ABIM Foundation's condominium has never been publicly disclosed.

  • One independent peer reviewed cost analysis of Maintenance of Certification has demonstrated the average cost for an internist to re-certify is $23,607 (95% CI, $5,380 to $66,383) and cost US physicians $5.7 billion in 2015. Despite all of these facts, the ABIM and ABMS managed to lobby Congress to have MOC included in the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) as a physician quality measure even though 501(c)(3) organizations like the ABIM should have lost their tax-exempt status when they covertly participated in this activity, according to federal law.

  • ABIM's own published Maintenance of Certification pass rates from 2000-2014 have demonstrated 13.2% of physician first-time test-takers failed their examination with large and inconsistent year-to-year pass rate volatility raising significant concerns of how the pass rate cut-off point is determined each year and the ABIM's motives for testing.

  • Christine Cassel, MD, the former President and CEO of the ABIM and its Foundation from 2004-2014 earned over $8.9 million dollars over 11 years she worked at the ABIM for 35 hours per week and never disclosed her financial conflicts of interest while she simultaneously served on the boards of Premier, Inc., and Kaiser Hospital Health Plans until these relationships were disclosed after she left the ABIM to serve at the National Quality Forum. Despite these ethical lapses, Dr. Cassel still describes herself as a medical ethics "expert" and still serves as a consultant to the highest office in the land: the U.S. President's Council of Advisors on Science and Technology (PCAST) without Maintaining her own Certification status.

  • The ABIM showers their executives with lavish perks on the backs of their physician diplomat fees. For instance, ABIM paid for spousal travel fees for Dr. Cassel for the ten-year duration of her term, even as residents and fellows struggle with the high fees for their certification while having record medical education debt.

  • The ABIM website registration requirements and registration agreement used for their MOC program, ABIM and the ABIM Foundation routinely conduct "research" on physicians and their practices without a research protocol, Investigational Review Board review, or informed consent in violation of FDA and Health and Human Services Protection of Human Subject statutes. Note that the enrollment agreement (no longer found on the current ABIM website) stated: "I understand that the ABIM may use my examination performance, training program evaluations, self-evaluations of knowledge and practice performance, and other information for research purposes, including collaboration with other research investigators and scientific publications." There is no mistaking the ABIM was (and still is) conducting "research" on their diplomats for their benefit.

  • Robert Wachter, MD, former President of the ABIM Foundation, earned stock options from the IPC Hospitalist Company while serving at the ABIM Foundation. While it is unclear what role Dr. Wachter played at IPC Hospitalist Company, the company remains under federal investigation for Medicare fraud.

  • From 2010-2014, the ABIM paid a little-known company to the practicing physician community, CECity, $5,568,538 for their services. Just before leaving ABIM, Dr. Christine Cassel received $130,000 in cash and $100,000 in stock from Premier, Inc, that then announced its purchase of CECity for $400 million a short time later on August 4, 2015.

  • The ABMS plans to sell physician certification data to a multitude of parties at ABMSSolutions.com and offer subscriptions to its CertiFACTS Online product (video). Funny how Dr. Baron and his colleagues at the ABMS fail to disclose this fact to major medical journals and Medical Economics when they are interviewed or publish their articles promoting the need for physician re-certification.

  • Since 1 January 2014, to facilitate the coverup of its operations and to limit transparency, the ABIM no longer permits archived webpages to be stored on a regular basis on the Wayback Machine at archive.org as seen by the absence of archived webpages after that date.

These are just a small sampling of the serious problems that have been uncovered by careful review of the ABIM's actions, ongoing cover-ups, and propaganda inherent to the ABMS MOC program that Dr. Baron supports. Legal fees (all paid by ABIM diplomats) are mounting against the ABIM and the ABMS member boards as they attempt to defend an antitrust lawsuit brought against them, attempt to sanction even more physicians, and have more threats legal action from the Pennsylvania Medical Society’s recent announcement of a vote of no confidence against the organization at the AMA House of Delegates Meeting in June of this year.

Practicing US physicians don't need any more propaganda from Dr. Baron in Medical Economics promoting the ABIM's Maintenance of Certification program, we need a careful independent audit of their finances and a thorough investigation of the ABIM and their collaborating organizations by appropriate authorities to end this unjustified, highly corrupt, and conflicted ABMS MOC program nationwide.

Westby G. Fisher, MD
Director, Cardiac Electrophysiology,
NorthShore University HealthSystem, Evanston, Illinois
Clinical Associate Professor of Medicine
Pritzker School of Medicine
University of Chicago

29 comments:

MOC TALK said...

Your rebuttal to Dr. Baron's defense of MOC is literally an army of Davids!

Anonymous said...

Wow, sounds Medical Economics has suddenly begun back-pedaling. This coming after having presented arguments against MOC by its very own editorial staff. I wonder (actually I think I KNOW) who got to them? They can now go stand in the corner with the others covered with the same creeping stink. At some point - we are there already - the actions of AMA, ACP, JAMA, NEJM, and now MEC, become indefensible and very much a form of self harm.

DrPayneKy said...

Thanks so much Wes for doggedly calling out the ABMS/ABIM on MOC. Our (KY) state medical society has put forth a resolution supporting the alternate credentialing board, the NBPAS, partly in response to the mis-deeds of the ABMS. I have reached out twice to Dr Baron regarding the whole MOC program; he has asked in his letters to his minions for us to be in touch. He has never responded. The arrogance of the whole organization is beyond understanding. Keep up the good work, I applaud you.

As an FYI, I also am an EP.

Vaughn Payne
@DrPayneKy
http://vwpayne.blogspot.kentuckymuse.com/

Anonymous said...

Thank you Dr. Wes for exposing this scam and the complex nexus of crooks at ABIM and the academics in our specialty societies that have been petrified to a silence by ABIM.

DrWes said...

Anony 09:16:00 -

"... petrified to a silence by ABIM."

Well said.

It's amazing, isn't it? IRS, FTC, SEC, FBI, DOJ, AMA, ABMS, JCAHO, CMSS, and all their underlings, silent amid all the corruption and cronyism, too scared to take action or even whimper a peep of dissent. It's like a junkyard dog has them all by the balls...

Blog Administrator said...

Thank u so much Dr. Wes! Keep fighting the good fight! 'Modifications to MOC'?!?! Time to put a bullet in the head of MOC and kill it off, once and for all!

Charles Koo said...

Anonymous said...

Just received survey from Dr. Baron/ABIM - responded with a link to this blog post.

JY Dawg said...

Number one reason elites don't walk the talk --
ABMS MOC is a story of one law for the elites and another law for us.

Christine Karen Cassel mandated MOC for docs
crying from the ABIM/ACP pulpit, "docs need MOC in order to keep up."

Yet Cassel does not keep up. She does not participate in MOC, which is an unequivocal endorsement that MOC is not only a bogus money-making scam and a horrible waste of time.

But, moreover, it is recognized by former ABMS principals and professional medical elites 'in the know' to be totally unnecessary.

In fact, everyone considers MOC to be a complete distraction/diversion from real CME.

https://www.nlm.nih.gov/changingthefaceofmedicine/physicians/biography_57.html

Anonymous said...


Medical Economics why the reversal? Is Rich Baron really that charming?


Earlier, "George G. Ellis, Jr., MD, FACP, practices internal medicine in Youngstown, Ohio, and is chief medical adviser of Medical Economics," wrote:


http://medicaleconomics.modernmedicine.com/medical-economics/news/abim-time-heal-thyself

Cowards Liars Cheats Frauds said...

It is curious. Why the reversal? Could we get a statement from Medical Economics?

Dr. Baron said/read over the phone:

“Putting out a credential that speaks to whether doctors are staying current in knowledge and practice, I think overwhelming numbers of doctors want to have a way to reassure themselves that they’re doing that,” says ABIM president Richard Baron, MD, MACP. “And they want a way to communicate to their patients and colleagues and institutions that they’re doing it.” - Medical Economics Interview with Rich Baron

Every word Baron read over the phone is plagiarized -- ghostwritten and edited by his communications/chief of staff's offices. It is all total propaganda except for the phrase "I think"! And even that reference to his own non-existent cogitation was just an editorial ad lib thrown in during the scripted phone interview.

The ABIM is so frightened of answering real questions that everything is AIR JORDAN with FLASHING LIGHTS at ABIM. They cannot win in a fair game in real life.

CW said...

War stamps for medical care - the physician as a war-torn stamp

Anybody need a wake up call? After eight years of Obama/Hillary/Cassel/Gruber et all healthcare mismanagement, we have a war-time health plan with apparent medical rationing for all.

We are serving like human war stamps, forced to ration and conserve in the way we deliver care to our patients. Insurance companies and the government send us back in line to wait, seeing how they will respond to our requests for the patients meds or tests - yes or no?

Our stamps they say are no good, or good for only half our patients today. Or the government makes us justify every other test and procedure; and every other medication and surgery. Endless paperwork that rations out the care like a ration stamp - further limiting the time we have for a patient.

Then there are the stamps that limit care because we are required to click endlessly until we pass into a rage over the monotonous uselessness of expensive clicking as we see it is way passed time to catch the bus.

Oh damn, I forgot my pass. On the bus, I realize that MOC is just another way of rationing my time like a stamp. Choosing Wisely/Consumer Reports it says on the billboard as another damn stamp passes before my eyes - propaganda stamps.

At home a little food but no time for who am I or the family. No time for that, I have notes to finish. Even my family time is rationed out like a stamp.

That old junkyard dog's got me too!

Anonymous said...

NQF/Charles Denham scandal (DOJ) and IPC the Hospitalist Medicare Fraud Whistleblower Lawsuit (DOJ)

Christine Cassel worked with Bill and Hillary Clinton from 1992 to the present on partisan healthcare reform, which was universal healthcare including a paperless EHR. The Clintons and Casell never stopped working together. Cassel, while working for the Obama White House on a rehash of Hillary Clinton's version of universal health coverage, was caught in a conflicts of interests scandal. Cassel was caught while she was embroiled in dealing with a profiteering/kickback/cover-up scheme involving herself, NQF, DOJ, Chuck Denham - co-chair of the Safe Practices Committee of the National Quality Forum NQF 2009-2011, Richard Baron - NQF board member 2009-2011), Kaiser Permanente, Premier, Inc., and so on. Cassel was forced by the media, ethicists and the public to resign from her board positions but not from her position at the NQF. Christine Cassel was part of the Clinton presidential healthcare advisory in the late 1990's that started the NQF. Why was Christine Cassel moved over to the NQF in 2013?

Why did Bob Wachter write so much about the Chuck Denham/NQF affair? How did Richard Baron seem to skate through the DOJ investigation as his NQF board position coincided with Chuck Denham's kickback scandal. Why did the DOJ end the investigation and settle for 40 million dollars and a small fine to Mr. Denham without making any indictments. There are many questions that surround this NQF scandal that involved their safety chairman, Chuck Denham?

"National Quality Forum (NQF) is a United States-based non-profit membership organization that promotes patient protections and healthcare quality through measurement and public reporting. It was established in 1999 based on recommendations by the President's Advisory Commission on Consumer Protection and Quality in the Health Care Industry. NQF’s membership comprises over 400 organizations, representing consumers, health plans, medical professionals, employers, government and other public health agencies, pharmaceutical and medical device companies, and other quality improvement organizations. NQF has helped develop guidelines on palliative care."

Coinciding with the Chuck Denham/scandal scandal a whistleblower lawsuit was brought forward in 2009 claiming that IPC, the Hospitalist Company had engaged in massive Medicare fraud on a national level in 28 states. This came when the Hospitalist movement and the new certification/MOC program was being establish. In 2014 the DOJ intervened in this scandal. Bob Wachter has a strong interest in the way this case would turn out because he was on the board and worked as a leadership team trainer. As an advisor and direct trainer of the leaders Wachter would have had to have known about the pressure to overbill and see far too many patients in a day than physically possible. As a specialist in healthcare technology Wachter would have had a profound interest in the real-time monitoring of each physician as they made their hospital rounds. It is fair to say that Robert Wachter profited and participated with Cassel in the cleaning up the NQF/Denham scandal, but was actively involved in helping IPC unload their company to Team Health so that, upper management, UCSF and Bob Wachter could keep their money and distance themselves personally as far away as possible from the IPC Hospitalist Company Medicare fraud case when the DOJ intervened.

Richard Baron might give us some insight on his participation or help in covering-up these two far-reaching scandals. Only a small superficial investigation was made of the NQF scandal, and the IPC Hospitalist Medicare fraud suit is still in discovery. Why do we see Cassel, Baron, Wachter embroiled in scandal, yet like Ms. Clinton and her husband they manage to avoid prosecution.

Anonymous said...

NQF/IPC Cassel-Wachter

https://en.wikipedia.org/wiki/National_Quality_Forum

http://healthexec.com/topics/finance/doj-joins-whistleblower-suit-against-national-hospitalist-company

https://www.justice.gov/opa/pr/government-intervenes-false-claims-lawsuit-against-ipc-hospitalist-co-inc-alleging

https://www.justice.gov/opa/pr/united-states-settles-false-claims-act-allegations-against-patient-safety-consultant-and-his

Team Health Holdings said...

Wes, you wrote:
"Robert Wachter, MD, former President of the ABIM Foundation, earned stock options from the IPC Hospitalist Company while serving at the ABIM Foundation. While it is unclear what role Dr. Wachter played at IPC Hospitalist Company, the company remains under federal investigation for Medicare fraud."

IPC company SEC filings clarify Bob Wachter's roles and lucrative compensation.
I will follow up and post filings and pertinent sections if they have not been scrubbed from the internet. Many of the old links do not work/inactive.

If you go to Robert Wachter's blog the link to IPC financial filings with the SEC is broken and goes directly to the acquiring company Team Health. So the easy path to get information of what Bob Wachter's role was and compensation is made more difficult. Perhaps Wachter could update his blog with a direct link to the SEC IPC Health, symbol IPCM.

However in Team Health's filings in a Def 14A proxy statement the company discusses the current IPC lawsuits and status. I will give you a link below. Mentioned besides the DOJ whistleblower Medicare Fraud suit, the State of Florida is investigating their Florida affiliate IPC Florida for Medicare fraud. Also there is a shareholder fraud case involving how quickly they cashed in and did not consider the shareholder value. They did not seek other bids to try and sweeten the pot.

Wachter's stock holdings are mentioned on page 62, and 102.
https://www.sec.gov/Archives/edgar/data/1410471/000141047115000063/ipc-2015417xproxy.htm

Litigation is on pages 41-44.
https://www.sec.gov/Archives/edgar/data/1082754/000108275416000054/tmh-201510k.htm

Bob egregious "financial biases" said...

SEC Filings IPC Healthcare (The Hospitalist) Def 14A 2014 (contains compensation)

page 5

"Robert M. Wachter, M.D., age 57. Dr. Wachter has served as one of directors and as chair of our quality committee since August 2013. Dr. Wachter is a professor and associate chair of the Department of Medicine at the University of California, San Francisco (UCSF), where he directs the 60-physician Division of Hospital Medicine. Author of 250 articles and six books, Dr. Wachter coined the term “hospitalist” in 1996 and is widely considered the “father” of the hospitalist field, one of the fastest growing specialties in the history of modern medicine. Dr. Wachter currently serves as a director for the American Board of Internal Medicine Foundation. He is also the past president of the Society of Hospital Medicine, and the immediate past-chair of the American Board of Internal Medicine. Dr. Wachter received a B.A. from the University of Pennsylvania and a medical degree from University of Pennsylvania School of Medicine. He was a resident and chief medical resident at UCSF, a Robert Wood Johnson Clinical Scholar at Stanford University, and studied patient safety in England in 2011 as a Fulbright Scholar. Dr. Wachter is board certified in internal medicine. Dr. Wachter’s qualifications to serve on our Board of Directors include his many years of experience as a professor and associate chair directing the 60-physician Division of Hospital Medicine, his many years of service on the Board of Directors of other healthcare related organizations, and his deep understanding of hospital medicine, patient safety, and healthcare quality. In 2015, Modern Healthcare magazine ranked him as the most influential physician-executive in the United States."

pages 7-8

"Quality Committee. Our quality committee oversees clinical quality, professional liability (malpractice), physician leadership and physician retention. In particular, the quality committee is responsible for (1) monitoring our performance on established internal and external benchmarking regarding clinical performance and outcomes, (2) overseeing our adoption and implementation of policies and procedures designed to provide quality patient care, (3) overseeing the Company’s programs 7 and initiatives to develop physician leadership, including local leadership at the practice group level, (4) overseeing our adoption and implementation of a system to allow us to respond to federal, state, internal and external reports of clinical quality of care issues and review periodically whether such system functions adequately, (5) overseeing the Company’s malpractice claims management process and related mitigation efforts, (6) investigate, or ask our legal counsel to investigate, any matter brought to the attention of the quality committee within the scope of its duties, and obtain legal advice for this purpose, if, in its judgment, that is appropriate, (7) overseeing our physician retention and job satisfaction initiatives, (8) handling such other matters that are specifically delegated to the quality committee by the Board of Directors from time to time, and (9) reporting regularly to the full Board of Directors."

"Our quality committee consists of Dr. Wachter, who serves as chairman of the committee, Dr. Cooper, Dr. Federico, Dr. Singer, and Mr. Taylor. Our Board of Directors has adopted a written charter for our quality committee, which can be obtained without charge by contacting our Corporate Secretary at 4605 Lankershim Boulevard, Suite 617, North Hollywood, California 91602, (888) 4IPC-DOC (888-447-2362) or through our website, located at www.hospitalist.com."

Charles Koo said...

I took the ABIM MOC questionnaire and sadly, the ABMS/ABIM have chosen to totally ignore calls for re-pricing their fee structure to exclude the massive monetary waste. Their strategy is a game of attrition- ABIM leaders continue to believe they have no obligation to address its fiscal and fiduciary irresponsibility and ethical misbehavior. Here is where we stand. ABIM MOC has no good data it does anything to enhance our profession and is any better than CME. The genesis of ABIM MOC is a byproduct of delusional, physician political-administrators aspiring to become power brokers at an uber-national level. In this attempt at becoming medical politicians, they abused their peers and colleagues who are in the trenches taking care of sick patients. ABIM MOC is overpriced. The ABIM profits are being plowed by this oxymoronic "non profit organization" for creature comforts, massive salaries, and other really eye popping misbehavior. (Is anyone happy the ABIM sold the $2.3M Center City Condo at a massive loss?) The great unspoken atrocity is the abuse of our young doctors- the residents and fellows. Approximately 50% of ABIM's operational budget is drawn from initial certification- money from graduating housestaff, a wholly impoverished cohort. This future generation of physicians saddled with historic levels of debt and with little voice in this matter is the ABIM HQ dynamo. Who is defending this disenfranchised population? Why is there such apathy from the ACGME and the AMA when tens of millions of post tax dollars are sucked clean out of the wallets of EP fellows, ID fellows, Senior residents et al for an organization that is essentially a future burden and liability to their careers? And what of the shady, head shaking misbehavior? Private investigators and spy webcams? Ugly civil lawsuits against the Diplomates? The construction of competing organizations like the NBPAS and the AAPS? Cayman Island and offshore money transfers? Convenient omission to the NEJM about COIs? Cash windfall golden parachutes from the IPC, NQF sponsored NGO stipends and other transactions spun from the medical-power broker veneer sold to Wall Street and Washington DC? All the while, the American Taxpayer is subsidizing this process via an IRS non-profit status. High profile, political laundering with Newsweek accompanied with tit-for-tat exchanges with an award winning journalist?

This is a sad state of affairs. The sharp, rotting stench emanating from this organization appears to be getting stronger by the quarter. For those who still believe that the ABIM and the ABIM have no obligation to respect the rank and file Diplomates, for those who believe that this organization's prognosis is stable, perhaps we should reflect on the current state of affairs.

When in the history of Medicine have we witnessed such white-hot, rage and strife toward the ABIM? When have clinicians ever sought relief by passing multiple anti-MOC State/Commonwealth Statutes? When have we ever seen AMA resolutions calling for a reformation at the ABIM? When have we ever seen any civil litigation against our own organizations? When can anyone recall a time when a medical organization operationally uses private investigators and ex-police officers to probe the Diplomates and is attempting to gain access to webcams of physicians? When was the last time, a broad swath of physicians who prior to this event were total strangers, is freely and happily crowd funding anti-MOC legal defense funds and forensic accounting? When was the last time State Medical organizations are positioning themselves to seek legal relief from a sister organization in the same Commonwealth? The ABIM MOC is too expensive, user unfriendly and this willful ignorance of the finances is enraging the Diplomates. It is clear, amply evident, there is room for fiscal improvement at the ABIM and the ABIMF. If you cannot honestly address this manifest defect, the fate of this entire process will reflect this.

Charles Koo said...

Let's look at the data. This is from Dr. Wachter's blog and a poll he authored.

http://community.the-hospitalist.org/pollsarchive/

Archived Polls


Regarding the need for Maintenance of Certification,


A process like that of the NBPAS (basically, licensure plus 50 hours of CME) should suffice for MOC (65%)

I don't believe there should be any MOC requirement (19%)

A more rigorous process, including an exam of some type, is appropriate for MOC (16%)

84% vs 16%.
And yet, somehow, these data have no meaning to the ABIM.

Anonymous said...

Charles Koo: Great points. "The genesis of ABIM MOC is a byproduct of delusional, physician political-administrators aspiring to become power brokers at an uber-national level. In this attempt at becoming medical politicians, they abused their peers and colleagues who are in the trenches taking care of sick patients. ABIM MOC is overpriced."

The ABIM misrepresents itself as a non-profit. That's clearly incorrect. It is for-profit. They claim to be apolitical. They are entirely political. The entire ABMS including the umbrella organization (under Cassel, Baron, Wachter, Stockman, Weiss and Nora) are for-profit corporations. These medical boards hire their own groomed top medical politicians who are polished up to move even further up the political/corporate ladder.

Even worse, the ABIM along with the other Chicago/Philly medical board powerhouses have created a monopoly. That monopoly has been guilty of, not only price fixing on their certification services, but working behind the scenes to get MOC mandated through lobbying and high level government (and corporate) influence-pedaling. And there is clear evidence of ABMS price-fixing on MOC across the board, as well as those "once-upon-a-time" lifetime certifications shoved down the throats of debt-ridden docs telling them with their boat loads of propaganda that it is the price of admission and MOC is the price for showing everyone and yourself you are keeping up. It a political crime family and network of affiliated organization involved in political corruption and corporate criminality.

How about the protection part. Just like the Chicago and Philly mobs we thought purged ourselves of in classic order this ABMS "Cosa Nostra" ("our thing") brought in the enforcers. They already owned the testing turf, but just for insurance to satisfy the worries of the testing-security industry, Wall Street, Insurers, Hospital organizations, the NQF, ACGME, CMS and their government cronies brought in the hired expendable felons and dirty lawyers - fall guys to do some of the dirty work.

We exposed that the ABMS hired a dirty goon-thug/private investigator (felonious protector of the ABMS politico-financial realm) by the name of Benjamin Mannes - aka A. Benjamin Mannes and Ariel B. Mannes who in 2005, after committing aggravated assault, was found packing an illegal loaded firearm (a weapon that he pointed at people in the street), and impersonation of a police officer, Mannes was arrested by real DC police. And then in a plea bargain got he the aggravated assault charges dropped. But ABIM's goon ended up with two felonies and then he re-emerges as the protection for this medico/political syndicate and shady Democratic party's lucrative corporate enterprise. (the latter name Ariel. B. Mannes has the DC felony convictions.) It all fueled their healthcare reform ambitions with rich revenue streams and no needs or worries for their politicians to lobby, pressure, and spread their decades-old political propaganda 24/7 and entertain in the privacy of their luxury condo. Who was entertained in that condo and in what fashion remains a mystery, but it is clear that ABIM/ABMS silence tells us the rest of the story - it was used for no good purpose.

Mannes worked for both the ABIM and the ABMS just for the record. It is on his customized online CV, on which Mannes lies about his police record and grossly misrepresents how many years he worked for the DC police. Gross lies. And this goon's testimony and signature to Judge Curtis Joyner in 2009 opened up the fishing expedition that ended up violating privacy laws, civil liberties of physicians - with all the endless persecution, demonizing, sanctioning, and suing tens of thousands of physicians and keeping permanent files on all of them.

It is and was for the past decade political and financial strong-arming all courtesy of the ABIM/ABMS based on a lying double felon's "investigation"!

Injunctive relief from ABMS MOC said...

We do have laws to protect citizens and consumers. These laws need to be enforced.

It's time to go to the emergency room and get that junkyard dog's lockjaw out of your private life and terminate the evil management at the junkyard for theft. All the crap in their yard belongs to us, anyway. Even the illegal "foundation". Imagine since 1989 physicians have been aiding and abetting grand larceny and money laundering. It is time to use the correct words in the American language for what a thing is and the reality. I agree with Wes, we should not mince words, especially because the junkyard dog is mincing up our privacy, civil liberties, pursuit of happiness, and damaging the fabric of patient care in America.

The ABIM/ABMS' dirty junkyard dog belongs to criminals and that is the truth. Criminals belong in jail so the public can be protected and crime is discouraged - not rewarded with 1.7 million deferrals of justice. (Christine Cassel walked out the door of a non-profit test company with $1.7 million in tax deferred earnings.)
If the ABIM Foundation (where the ABIM hid its profits) is worth 80 million dollars, Cassel took over 10% of the value of the company with her in accrued compensation and deferred money ($1.7 million) with her. Cassel created a financial downward financial spiral that the organization will not recover from. Rich Baron is lying through his teeth about the financial soundness of the organization. This is all public fraud and public fraud needs a thorough and complete investigation.

I am not waiting for it. I am insisting. Others must insist and make their voices heard. Get an injunction (injunctive relief from a federal court until there is a thorough criminal investigation and its conclusion) to stop MOC requirements and any mandatory payments to keep certification. Not just the ABIM but the entire ABMS. It is nonsense to accept the strong-arming of criminals. Start the lawsuit now. The numbers support overwhelmingly that MOC is a scam and not respected. The ABIM is not worthy of any respect or trust. Zero! The ABMS is not separate, they share the same criminal people, board members, and felonious approach - every one of the 24 medical boards.

Stop MOC now! Immediately! There is nobody there with reason and conscience to discuss anything with. I am not amused and I am not entertained, nor am I fooled by by their decades of political and financial activities. You know, at least NPR (which I support) has bylaws where they have to hire Democrats and Republicans to the board and leadership. All the organizations they have affiliated with in their political crime family are Democrats. As such have violated all the long-standing tenets of decency, morality, and political neutrality in our country. Every one of them need to go.

How did it get away from them? It did not. Decency, morality, and neutrality were abandoned by them! Even those we consider to have some real fiber have passively condoned everything and they are guilty for it. What they do they do by careful personal financial planning and intention political design. I hope the next attorney general has the guts to bring the whole damn scam crashing down. I'm voting for it and will follow through.

Anonymous said...

Thanks Dr. Wes for your relentless efforts to expose that cloaca named ABIM/ABIM Foundation and its other ABMS-protected partners in crime. It's more than clear now what their real motivations are. I just hope to see justice served.

IPC's False Claims/Medicare Fraud Lawuit said...

To "Bob (Wachter's) egregious financial biases": "Our (IPC's) quality committee consists of Dr. Wachter, who serves as chairman of the committee, Dr. Cooper, Dr. Federico, Dr. Singer, and Mr. Taylor."

According to the SEC filings posted above concerning the quality committee's roles and responsibilities and who was on the committee the top four defendants in the "United States ex rel. Oughatiyan v. IPC The Hospitalist Company, Inc., et al., No. 09 C 5418 (N.D. Ill", should be Quality Committee Chairman Bob Wachter, CEO Adam Singer, Dr. Cooper, Dr. Federico and Mr. Taylor - all members of the Quality Committee.

https://www.justice.gov/usao-ndil/pr/us-files-lawsuit-against-ipc-hospitalist-company-alleges-overbilling-federal-health

Consider that Bob Wachter was in charge of the search committee to hire the successor to Christine Cassel as CEO!
http://www.kevinmd.com/blog/2015/07/dr-robert-wachter-in-defense-of-the-abim.html

Assoiciation of Test Publishers said...

Here's an ABIM free association test. A word or phrase will be given. Say the first word or phrase that comes to your mind in response.

Top ten ABIM free association words/phrases

Word: Moc. Response: money scam
Word: ABIM Foundation. Response: money laundering
Word: ABIM. Response: political action committee (for Democratic party)
Word: Christine Cassel. Response: cheater
Word: Richard Baron. Response: CMS, NQF corporate shill
Word: ABMS certification test. Response: prison frisk
Word: ABIMF 2.3 million dollar condo. Response: Dickey's dacha
Word: Robert Wachter. Response: Medicare fraud
Word: Choosing Wisely. Response: expensive medical rationing propaganda
Word: Lynn O Langdon. Response: Sarah von Muller
Word: A. Benjamin Mannes. Response: felon goon squad (hired June 2008)

Proxus and Granatt HR, LLC said...

Extra free ABIM word association test

Word: ABIM Human Resources Department. Response: Performance Improvement Plan (PIP)

Word: ABIM Human Resources Managers. Response: racial discrimination (blacks)

Word: Donna L Campbell HR Director. Response: embarrassingly incomplete CV 2006-2008
https://www.linkedin.com/in/donna-l-campbell-sphr-shrm-scp-b525227

Word: Jeff Green, Proxus HR. Granatt Hr LLC. Response: Granatt HR, LLC employee Donna L Campbell, racial discrimination case Wyatt vs. ABIM Case 2:10-cv-01366-PBT
Document 1 Filed 03/29/10 Pacer.gov
https://www.linkedin.com/in/jeff-green-mba-25a2636

Word: Black lives matter. Response: not to ABIM, Donna L Campbell, Lynn Langdon and Christine Cassel

Word: ABIM Rewards Program (ABIM RP) Response: Donna L. Campbell given full time employment as Human Resources Director April 2008

Word: ABIM hire a felon goon squad program. Response: June 2008, A. Benjamin Mannes
https://www.linkedin.com/in/publicsafetyconsultants

Word: ABIM discrimination lawsuit. Response: Former HR Manager replaced by white male and lawsuit settled out of court 2010 in favor of racial discrimination victim

Word: ABIM Human Resources Director. Response: Langdon/Cassel/Baron/Holmboe utilize HR director and goon squad creating police/surveillance state for ABMS.

Word: ABIM v ABR, Dr Arora, Kachadourian, and John Does 50. Response: fear mongering, demonization, political control and persecution of physicians

Word: ABIM. Response: shut it down for heinous acts and criminality beyond belief

Anonymous said...

Frightening!

Anonymous said...



MOC recertification exam should be removed. ABIM should offer Time unlimited certification for all boarded physicians .MOC takes physicians way from active practices ,reduces time for patient care and creates unnecessary stress . Replacing 10 y testing with the new ABIM proposal to offer 2 y or 5 y testing is not physician friendly and indicates that ABIM is not responding to physicians complaints .

Michael West said...

I looked at their self-serving survey on MOC, which was only about modifications to their program. They only want doctors to write in with suggestions for changes, not to suggest that the whole MOC program is unnecessary and should be eliminated. I fear that too many doctors are stupidly complying with giving these profiteers suggestions/ammunition to be used against us all eventually. I joined the ABPAS two years ago and hope everyone does also. More hospitals need to accept that certification, but also we need insurance companies to accept it as well, since that is the other necessary half of the equation.

S Shah said...

This is indeed egregiously criminal behavior. I just spent close to $4000 on a board recertification course, trying to cram useless stuff into my already tired and sleep-deprived brain. It is high time that ABIM is prosecuted and its onerous exam discarded.

It really gets my goat that I have to now pay another $1000 + to stay 'certified and employable' by an organization with such blatant disregard for ethics in its own structure and functioning.

Anonymous said...

Thanks so much, Dr. Wes.
You are the GREATEST for taking the time to do what you are doing on our behalf. I know it must take a lot of your precious time, so you are a hero.

I know for sure that much of the material that we spend so much time to complete is pure BS. On some of my clinical MOC stuff I had to do before I could sit for the last board exams, I wrote in hostile answers about aliens and just randomly checked a bunch of boxes and I passed easily. ALIENS! PASS!

Aside from the BS part, the rest of it is simply not evidence based. But based on my own personal n=1 study, I found that the prep and the exam did nothing to improve my knowledge, attitude, or skills. In fact, it actively prevented me from learning things that I NEED to learn. But it did relieve me of the burden of my extra dollars and hours of life--I used to have way too much time and money, but thanks to them, I have less now.

Again, I just wanted to express gratitude to you, and I hope that physician leaders like yourself will rise up and take back the profession. Someone needs to tell the rest of us grunts what we should do to help.