Saturday, December 03, 2016

Chicago's Cold December Game Plan

In June 2016, "Chicago" had a problem. A small renegade group of doctors had uncovered some dirty secrets about the Chicago-based American Medical Association's (AMA) subordinate organizations, the Philadelphia-based American Board of Internal Medicine (ABIM) and its Chicago-based mothership, the American Board of Medical Specialties (ABMS). Action was needed. It would have to be invisible to the lay public. It would take a slick, well-coordinated game plan. It would also take some money. People don't mess with The Chicago Machine.

The major players assembled in the room to get some background on the problem. They'd have to understand the depth and breadth of what was known before they could structure a counter-offensive using every option at their disposal: ties to leadership at medical journals, public relations groups, finely-tuned email lists, and buy-in from like-minded medical societies who needed the AMA's political clout on Capital Hill - the works.

There they were, all the major players in one room, looking less than happy to be there to hear me (of all people) and my colleagues who were rattled to our core at what had transpired in the bureaucratic House of Medicine for all these years.


The room took a while to fill at first, but as time for the presentations approached, they were standing room only. The early attendees looked a bit worried. Those arriving later appeared less concerned for time and money were on their side. Many of the dignitaries were introduced to me by Charles Cutler, MD, from the Pennsylvania Medical Society who had invited a few of us to attend: the President of the Board of the American Medical Association (AMA), the Executive Vice President of the American College of Physicians (ACP), members of some of the medical national medical societies. All in one room to hear me and Mr. Charles Kroll, a certified public account, give our little talks (seen here and here).

They listened intently. They asked no questions. They needed to think. Poor Lois Margaret Nora, MD tried to come to the microphone to defend her actions feebly. It was clear to them she was a liability. More senior veterans at this game would have to step in.

It was a time to marshall the considerable resources of Chicago's medical establishment's senior spin experts: the American Medical Association and their collaborators at the Accreditation Council of Graduate Medical Education. They knew they could do this. After all, it had been done before when Thomas Brem, MD testified before Congress 30 April 1969 after he was paid from "Special Account No. 4" maintained by tobacco lobbyists. (See US District Court for the District of Columbia, United States of America v. Phillip Morris USA, Inc, et al., Case 1:99-cv-02496-GK Filed 8/17/06. Page 174 of 1683. Available at: https://www.gpo.gov/fdsys/pkg/USCOURTS-dcd-1_99-cv-02496/pdf/USCOURTS-dcd-1_99-cv-02496-4.pdf ) We are beginning to see telltale signs of a similar well-coordinated plan to forward a separate, non-patient care agenda against the practicing physicians who had grown restless.

First, the leadership recognized that change was needed. Dr. Steve Weinberger, Executive Vice President of the PhiladelphiaChicago-based ACP had heard enough and wisely wanted out. He could see the writing on the wall and had given plenty of time, energy and effort to the ACP. He announced his retirement. Lois Margaret Nora, MD, JD wanted to stay on but knew she couldn't. She, too, announced her retirement but was asked to stay on until the end of 2017 to help "smooth" the transition. Or to be a fall guy. (This is Chicago, remember.)

Second, a "go live" date had to be set. 1 December 2016, just before the new US President took office, would be perfect.

Third, an article would have to appear in the New England Journal of Medicine without an accompanying rebuttal article reaffirming the importance of MOC and how hard the ABIM are working to modify it. This article would serve as the "starting gun" for all that was to occur next. In turn, Richard Baron, MD would serve, once again, as sacrificial lamb and receive a "special fee" above and beyond $800,000-a-year ABIM salary in return for "publishing" the article (see the article's disclosures). Perhaps this was because Dr. Baron and Braddock didn't write a substantial part of the it, we can't be sure. Practicing physicians would be appalled by the piece containing many non-scientific assertions. It didn't matter. They liked the use of the example where anyone can become an ordained minister online to justify ABIM's unproven maintenance of certification program as a "solid," and "valuable" standard. No one would dare comment that the ABIM's secret, black-box antiquated questions (held secret behind a thin veil of threats of prosecution for leaking those "secrets") were any more "solid" or "valuable" than those "internet based" ministry credentials. Especially if the New England Journal of Medicine didn't allow comments. Furthermore, Baron and Braddock's must make board certification sound as though it was "always" supposed to be time-limited. No one must know that Walter Bierring, MD, the unpaid organizer and first officer of the ABIM never intended the test to become a mark of adequacy to practice medicine rather than an optional sign of excellence. (See: Bierring WL. The American Board of Internal Medicine. Ann Intern Med 1937 10(12):1746-1751.) Denis M. O’Day, MD and Mary R. Ladden, BA's peer-reviewed article on the history of board certification, published the criteria of the American Board of Medical Specialties member boards that stated their voluntary nature and the requirement their tests and programs NOT be tied to the ability of a physician to practice. And practicing physicians certainly should not know about the first recertification test, taken by internists on 26 October 1974,  recommended that "no one should lose their primary certification as a result of the examination."(Meskaukas JA and Webster JD, The American Board of Internal Medicine Recertification Examination: Process and Results. Ann Intern Med 1975 82: 577-581). To provide cover to these facts, Drs. Baron and Braddock must use ABIM's usual strongman tactics and threaten "escalating consequences for unsatisfactory performance over time" in their piece. And so it was.

Fourth, that evening after the New England Journal of Medicine article appears and people have a chance to digest it, a mass email must be sent to all members of the American College of Physicians announcing their "new pilot MOC program" in coordination with the American College of Cardiology (ACC) and the ABIM that promised to "ease the burden and increase the relevance" of the ABIM MOC process. Specific details like time frame, cost, and methods must not be disclosed, however.

Fifth, more pressure must be applied. The AMA and the Committee of Medical Subspecialty Societies (based in Chicago) will coordinate with the American College of Cardiology to use the ACC's considerable financial and political clout to re-introduce the previously-suspended Part IV "Practice Improvement and Safety Modules" via an email to its members the following day. After all, it took a lot of lobbying to assure Part IV of the ABIM MOC program was woven into the new physician "value-based" payment scheme called the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). For their help, the ACC should be granted "Program Sponsor" status of the ABMS Multi-Specialty Portfolio Approval Program. The message to lowly physicians MUST be: "Participate in MOC or don't get paid, sucker!"

It all seemed like such a good idea at the time. Those pitiful physicians wouldn't stand a chance. The Chicago Machine was in charge. It would be easy to roll over those quiet, unassuming doctors with this plan once and for all!

And then the unimaginable happened. An unanticipated Presidential candidate won the election. Like BREXIT, the medical political establishment were caught completely off guard. None of them could imagine it happening. And even though larger and larger numbers of doctors weren't buying the propaganda of the Affordable Care Act (ACA) and MOC any longer, the AMA, heavily invested in the ACA construct, stuck to their plan to strong-arm physicians with these MOC "modifications" anyway.

Practicing doctors and their patients have been waking up to what the medical establishment have done to the middle class and the practice of medicine in America. We've been slow to catch on thanks to the realities and time required for this thing called patient care, but the reality is profound.

Thanks to Maintenance of Certification, practicing doctors are not so easily fooled any longer and with a new sheriff in town, the Machine might just have to go to an alternate Plan B in January 2017 or face some serious consequences.

-Wes

45 comments:

  1. We need some federal legislation that discourages states and organizations that participate in the ABMS MOC mandate.

    ReplyDelete
  2. It is clear corruption. Patently unethical and illicit. An affair that nobody should take part in.

    ReplyDelete
  3. There must be a moral response of conscience to oppose this. Accompanied by a swift legal action of cease and desist to oppose ABMS' restraint of trade and racketeering.

    ReplyDelete
  4. Until every state legislates an end to all mandatory MOC, as in Oklahoma or better, physicians and patients will continue to suffer from Chicago's larceny and their extensive network of professional medical bureaucrats and politicians.

    ReplyDelete
    Replies
    1. Yes, Amen! We need federal legislation on RICO grounds against all ABMS - MOC (tm) programs.

      Delete
  5. Draining Chicago, Philadelphia and Washington of all the conspiratorial chapters of the ACA swamp should be priority number one in the first 100 days of President elect Trump's administration.

    Without a dogged attack on this corruption from the new Attorney General, this evil filthy beast will raise its pervasive ugly head again in the future. Believe me!

    ReplyDelete
    Replies
    1. ABIM and ABMS - MOC is like melanoma. Even if you cut out the ABMS MOC malignancy, a Make Others Cash Green Monster, nasty cells pop up as metastases in the darndest places. Can even kill the host if not fought AGGRESSIVELY.

      Delete
  6. Colluding medical societies acting against physicians' and patients' best interests? This is not just traitorous, it should be prosecuted immediately.
    What the hell happened to ethical medical leadership.

    ReplyDelete
  7. This is unbelievable. Time to lawyer up! It is consumer fraud. Get your dues and fees back immediately.

    ReplyDelete
  8. all this MOC GRAFT and the RIFF RAFF associated with it needs to go

    ReplyDelete
  9. Dr wes, wish u the best. Hope ur hard work pays. Hope the new sheriff is not easily fooled into the organization of these mischievous bastards. Hope the judge sitting on the aaps case against moc is penalized for obstruction of justice. Hope that macra is erased from the collective memory of america. Hope the best for America. Hope moc is the lesson every American politicIan remembers forever.

    ReplyDelete
  10. no forwarding addressSat Dec 03, 03:25:00 PM CST

    out of office/DrExit message

    ABMS scheduled maintenance set for January 2017: site may be down indefinitely
    you may need to re-route your certification requests to alternative boards

    ReplyDelete
  11. democrats, republicans and independents need to work together to remove the slimy stench from the pond . . . we need to talk to our state legislators and AG's
    ABMS, AMA, ACP, ACGME, NCQA, NQF, AHRQ, JC, Pearson, Caveon too many co-conspirators to name . . .

    all these self-dealing bureaucrats with their never-ending self-inurement plans!
    bureaucracies within a stifling bureaucratic quagmire . . . a real nightmare!

    they all need to go away for good . . .
    last chance to take back our profession

    ReplyDelete
    Replies
    1. You should let PE D. Trump and his AG know about the graft and corruption affecting all doctors in America.Medical organizations like ABIM; ACC etc. should be investigated, demolished or changed to patient caring organizations.

      Delete

  12. The ABMS scam continues. News from Virginia.

    The political and financial corruption is deep and the extensive "revolving door" network is wide. Here are a few corroborating details about the ABMS folks planning on status quo in 2017: ABIM COO resigns to become chief of staff for VCU's CEO.

    In May Nkanta Hines resigned after only a year at the ABIM COO position, where he was allegedly relieving Lynn Langdon of her COO duties. In June Hines moved through the ABMS/ACA revolving door to become "chief of staff" for the CEO of Virginia Commonwealth University.

    After less than six months into Mr. Hines' new role as "chief of staff", Virginia Commonwealth University and their large health system has just become the newest sponsor in the MOC Portfolio Program.
    VCU has a huge political and financial investment in maintenance of ACA and its working partners ABMS MOC and Choosing Wisely. (see note below)
    http://mocportfolioprogram.org/blog/category/new-sponsors/
    http://www.abms.org/media/120098/vcu-joins-abms-portfolio-program.pdf

    "VCU Health System announced that Nkanta “Nick” Hines will serve as the chief of staff for Marsha D. Rappley, M.D., chief executive officer for VCU Health System and VCU vice president of health sciences, effective July 3, 2016."
    https://news.vcu.edu/article/VCU_Health_System_welcomes_Nkanta_Hines_as_chief_of_staff_to

    VCU bundled Hines' together with a new CFO in anticipation of all the financial changes in healthcare reimbursement.
    https://news.vcu.edu/article/Melinda_S_Hancock_to_serve_as_chief_financial_officer_for_VCU

    Note: In the Journal of Medical Regulation "Choosing Wisely" or ACA cost rationing is being cleverly pushed on the state medical boards by VCU health policy and politics professor. 2012. Coordinated efforts like this show how even universities with major medical schools and large health systems play into the politics of the ABMS and vice versa. These are state actors with state and federal funding acting to influence state policy.

    State Medical Boards and the Problem of Unnecessary Care and Treatment

    A B S T R ACT: The overutilization of medical tests and procedures has been identified as an important
    reason for the high costs of health care in America. Because the problem of overutilization is so multifaceted
    and complex, detection has been uneven and deterrence has been erratic. Recognizing the increasing
    severity of the problem and the adverse effect that overutilization may have on patient safety and care,
    the medical profession in recent years has increased its efforts to curtail excess treatment. Several national
    specialty societies, for example, have identified certain tests and procedures that may be unnecessary
    or overused, and they have disseminated their findings to physicians and patients. The question that this
    article seeks to address is what role state medical boards should have in reducing unnecessary care
    and treatment. This article argues that state medical boards, congruent with their mission of public protection,
    should enhance their oversight, detection, and regulation in this area. Professional ethics and specialty
    society guidelines could provide the basis for disciplining persistent and egregious offenders.

    Carl F. Ameringer, PhD, JD, is a Professor of Health Policy and
    Politics at Virginia Commonwealth University. (page 25)

    http://jmr.fsmb.org/Archive/2010s/2012%20FSMB%20Census%20of%20Actively%20Licensed%20US%20Phycisians.pdf?boxtype=pdf&g=false&s=false&s2=false&r=wide

    ABMS and Choosing Wisely invested heavily in Virginia
    http://c.ymcdn.com/sites/www.ramdocs.org/resource/resmgr/ramifications/Final_Fall_Ramifications.pdf

    NQF and VCU participation in "Antibiotic Stewardship in Acute Care/Playbook"
    http://www.ashp.org/DocLibrary/MemberCenter/SICP/Antibiotic-Stewardship-in-Acute-Care-A-Practical-Playbook.pdf

    ReplyDelete
    Replies
    1. Are we surprised that Dr Christine Cassell, past ABIM leader of the MOC program, was an advisor to a First Lady, HC, in 1995 when they were formulating the infamous and failed HillaryCARE program under Pres Bill Clinton? Pennsylvania's Senator the late Arlen Specter helped foil that disaster. Did the ABIM MOC developer Dr CC learn from HC and Bill about the usefulness of money laundering as seen in the Clinton Foundation? What is the ABIM Foundation? CLEAN THE SWAMP.

      Delete
    2. It has also been the Doctor's in the trenches; WE, who have actually refused to give up the doctor-patient relationship, join the AMA BECAUSE WE HAVE NOT BELIEVED WHAT IT HAS STOOD
      FOR, as well as hold out on recertification (i.e. medicine) because we should have been grandfathered in as our colleagues in the past. Furthermore, a true, worthy physician holds herself to standards higher than any MOC board

      This was designed only for a select few to earn money and gain control and power over medicine.

      Delete
  13. It's true. Every cardiologist who has paid dues to the ACC was SOLD OUT by Richard Chazal at the ACC. ACC is in cahoots with ABIM and they are mandating ABIM MOC on every single cardiologist in the country.

    We have been betrayed by our brethren.

    Et tu, Chazal?

    Give him an email. Let him know how you feel.

    richard.chazal@leememorial.org

    ReplyDelete
  14. The ACC just sent an email informing the entire group of FACCs that Richard Chazal, the ACC President, decided to sell out the entire practice of Cardiology to the ABIM. For what princely sum?

    One can only imagine the cushy job Rich will get once he leaves the ACC as President in March.

    Chazall couldn't even keep his own group financially afloat in SW Florida. How did this traitor wind up as ACC President?

    http://www.leagle.com/decision/2006981342BR639_1907/IN%20RE%20SOUTHWEST%20FLORIDA%20HEART%20GROUP,%20P.A.

    ReplyDelete
  15. Is it a good idea to be a client of ABIM and receive continuous abuse from their elite executives and felonious "Director of Investigations" Ariel Benjamin Mannes.

    Why are physicians being kept in the dark by the ABIM, ABMS, AMA and ACP about the continuous unlawful assault on physicians' constitutional rights, due process, and invasion of privacy by Dr. Baron, Lynn Langdon via their hired felonious henchman Mannes, including his various undisclosed testing security partners and contractors?

    Will we ever get an answer from the ABIM regarding Wes' previously published question?

    "Why were lawyers from ABIM's legal team, Ballard Spahr, and Ariel Benjamin Mannes (their two-time convicted felonious "Director of Investigations") allowed to accompany Federal Marshals during a home raid of two physicians' homes that had developed an ACGME-accredited board review course? What agreement (monetary or otherwise) exists between the Dr. Rajender Arora (the director of the course) and the ABIM?"

    Why is this felon Mannes, who has harmed so many law abiding physicians, being allowed to remain working at the ABIM? Why was he hired to persecute physicians and why does he still have access to hundreds of thousands of physicians around the globe? Who does he work for and report to?

    There are serious questions about Mannes' checkered history, which hundreds of thousands of physicians and millions of concerned citizens want to know! We would like the ABIM, ABMS, AMA and ACP to address these questions.

    Ariel Benjamin Mannes was fired from the DC Metro Police in 2003 for violating privacy of a reporter in 2002 and seeking revenge on him for a critique the journalist wrote about the DC police. Mannes put a police alert out on the reporter publishing confidential information online to harass, bully and intimidate the reporter from doing his job, thus chilling freedom of the press and exposing a reporter to heinous police mischief. The reporter eventually moved as far away as possible from D.C.

    Mannes' in his LinkedIn CV misrepresents himself as a police officer with a continuous unblemished record in DC when this is extremely far from the truth.
    (He footnotes that he pursued other business opportunities for periods of absence.) The real truth is Mannes has a double felony from 2005 and was fired as a result of his convictions from his TSA job and as a nightclub bouncer. The felonies stem from the violent assault inflicted on a client of the nightclub where Mannes worked.

    It is reported that Mannes beat his victim so badly the client had to be hospitalized. During the assault Mannes impersonated a police officer and pulled out a loaded handgun to prevent medical attention from being given to his victim. Police investigated and the case went to court. The charges: Illegal possession of a loaded firearm, a felony punishable by up to 5 years in prison and maximum fine of $5000. Impersonation of a police officer. Violent assault. Assault charges were dropped in exchange for a plea of guilty to the first two counts.

    Amazingly, Mannes puts on his CV false details and important omissions. What did Mannes put on his application when applying to the ABIM? I reckon that Mannes worked for DC police from 1999 to 2002, then was put on administrative leave pending an investigation, which led to his dismissal in 2003. He did not work as a police officer with DC Metro after that time. Yet ABIM's "director of investigations" stated he worked for them until June 2009. Mannes was hired by the ABIM in June of 2008.

    Can anyone tell such a bold lie on their CV and still be working at the ABIM? Can you tell me why in the world such a man was put in charge of investigating physicians, especially looking at the violations that occurred to civil liberties, due process, and privacy?

    ReplyDelete
  16. DC sources close to Mannes' past scandals report, "In 2003, Mannes’ four-year tenure with the force ended after an internal investigation of the Cherkis incident." Cherkis was the reporter that was bullied by Mannes. If Mannes was sacked, then why does Mannes keep insisting on 10 and a half years on the DC force.
    While Mannes was "investigating physicians attending Arora's board prep course", he claims to have been still under the employ of the DC Metro police. If Mannes was on a leave of absence, was he still receiving DC city government compensation and his full-time salary from the ABIM?

    Nothing adds up and it would appear that Mannes has a very difficult time seeing the difference between fact and fiction. Is he in denial about his devils stuffing them into body bags in the recesses of his mind. That is not a good thing for physicians if we have one more sicko at the ABIM who could turn again at any moment--a stalky muscular guy with a record of violent assault, impersonation of a police officer and past gun violations to worry about.

    I would seriously advise Dr. Baron to respond to physicians' concerns about this. Baron and his employees may not be safe with all the political, legal and financial stress that the ABIM and Mannes are going through.

    From Mannes online CV:

    "Metropolitan Police Department, District of Columbia

    June 1999 – June 2009 (10 years 1 month)Washington D.C. Metro Area

    Urban law enforcement and crime suppression, criminal investigations, community policing strategies, and municipal anti-terrorism efforts.

    Member, Civil Disturbance Unit (Presidential Inaugural, Annual WTO/IMF Protests, etc.),
    Detailed, Joint Operations Command Center (9-11, DC Area Sniper Task Force),
    Assigned to uniformed and plain clothes patrol in the Sixth Police District Substation (Anacostia),
    Mountain Bike Patrol Certified

    (NOTE: Was on extended leaves of absence 9/03-11/07 and 6/08-6/09 when many of the below management opportunities were pursued)"

    LinkedIn Ariel Benjamin Mannes
    https://www.linkedin.com/in/publicsafetyconsultants

    https://www.scribd.com/doc/99562611/D-C-Police-Department-s-Dirty-Cop-Problem-and-Tolerance-of-Misconduct-120-Examples

    ReplyDelete
  17. In the ghetto

    As the snow flies
    On a cold and gray Chicago mornin'
    A poor little baby child is born
    In the ghetto
    And his mama cries
    'Cause if there's one thing that she don't need
    It's another hungry mouth to feed

    In the ghetto
    People, don't you understand
    The child needs a helping hand
    Or he'll grow to be an angry young man some day
    Take a look at you and me
    Are we too blind to see
    Do we simply turn our heads
    And look the other way
    Well the world turns
    And a hungry little boy with a runny nose
    Plays in the street as the cold wind blows

    In the ghetto
    And his hunger burns
    So he starts to roam the streets at night
    And he learns how to steal
    And he learns how to fight
    In the ghetto
    Then one night in desperation
    A young man breaks away
    He buys a gun, steals a car
    Tries to run, but he don't get far
    And his mama cries
    As a crowd gathers 'round an angry young man
    Face down on the street with a gun in his hand

    In the ghetto
    As her young man dies,
    On a cold and gray Chicago mornin'
    Another little baby child is born
    In the ghetto

    ReplyDelete
  18. So here is the deal. The ACC and Dr. Richard Chazal are now redeploying PART IV of MOC to every single cardiologist. The one totally useless part of MOC everyone hated and everyone knew was a total waste of time- the so called Practice Improvement. This baseless exercise, non sensical waste of time and money was just rubber stamped for approval by the ACC. So for the yearly sum of almost $1000 per year, an FACC will now see how he/she will be SOLD OUT to the ABIM. So what exactly is the point of being an FACC? Where is the political advocacy the ACC was tasked to jealously protect on behalf of the working cardiologist? How much money is being transferred from the ACC to the ABIM and vice versa? Ex colleagues in his home State of Florida have strong feelings about Rich Chazal. They don't trust him. They consider him a snake in the grass. They are right.

    Who is Rich Chazal? An ex-private practitioner of a bankrupt cardiology practice and sold out through a Bankruptcy Court Hearing turned hospital employee just biding his time until retirement from clinical work which apparently is now so small folks wonder how he justifies his existence at Lee Memorial Hospital.

    Attention all FACCs who actually go to work and see patients for a living.

    The ACC and the ACC Board of Trustees just sold out our entire profession for ABIM money.
    All FACCs are being used to ensure Rich Chazal gets a cushy job in Chicago or Philly.

    Ask Chazal himself. He won't deny any of it.

    richard.chazal@leememorial.org

    ReplyDelete
  19. Remember this ACC lie from yesteryear?


    "....A second ACC Task Force led by ACC President-Elect Richard Chazal, MD, FACC, is aggressively exploring whether an alternative board should/could be developed by ACC for our members. Potential possibilities could include: new board(s); working with already established alternate boards and/or other organizations; working within or without ABMS framework; and other solutions. While working as rapidly as possible, we want to be cautious, realizing the great complexity of the situation...."

    ReplyDelete
  20. Dr. Wes

    The following was written by you in reply to a comment about your blog dated June 16, 2009. The title was: An Open Letter to Patients Regarding Health Reform. I draw your attention to the second paragraph.

    Abraxas-

    Wow. Please get your facts straight. For the record, I served in the United States Navy for 13.5 years as an active duty medical officer and completed over 26 years of service in our government health care system before retiring from the US Naval Reserves. I left the service because I was underpaid relative to the private market. I do not own a Bentley, Jaguar, and am a salaried employee of our health care system (yes, I do receive "productivity" bonuses when I work extra-hard). My salary, as such, is determined by market forces and not is not part of any "insurance" conspiracy, other than that imposed by the bureaucratic requirements of Medicare and Medicaid, of who 85% of my patients are covered by.

    And yes, Medicare's trust fund is set to become insolvent "somewhere between 2016 and 2018." Wy doesn't the government fix Medicare's problems first, rather than imposing whole new unproven entitlements for which they have not determined a way to fund?

    Now, if you can support your assertions, I'm all ears. Otherwise, stop reading medical blogs. It's clear they're bad for you.
    Mon Jun 22, 01:47:00 PM CDT

    I would suggest this answer in response to your question of why the government doesn't fix Medicare's problems...

    Government doesn't fix it because the Republicans don't want a fix. They want to kill this "entitlement" that citizens have paid into all of their working lives and that has entitled their grandparents, their parents and if they are over 65, their own healthcare. The Democrats did make an heroic, but imperfect, effort at fixing Medicare. The legislation is called ACA and it extended the life of Medicare much beyond your stated timeline of between 2016 and 2018.

    Further evidence that Republicans don't want to fix healthcare is their present predicament of how to handle ACA now that they have to govern and not just yell "repeal and replace" for six years without making any plan for a workable replacement.

    I don't think it is going to go very well.

    ReplyDelete
  21. "Sample Letter to ABPM Primary Boards on Scheduling a 2017 Addiction Medicine exam.
    Dear American Board of ___________________________ As a certified physician of the American Board of__________________, and a physician who treats patients with addiction, I am pleased that addiction medicine is now recognized as a medical subspecialty by the American Board of Medical Specialties (ABMS).
    With addiction medicine as a recognized medical subspecialty, there is the opportunity to strengthen the physician workforce to treat a disease that affects 1 out 7 people.

    As an ABMS certified physician, I understand that I must sit for and pass an addiction medicine board exam to be recognized as an addiction specialist. The American Board of Preventive Medicine (ABPM); however, manages the timing and schedule for future addiction board medicine exams, and it has not yet set a date for the first examination."

    ReplyDelete
  22. Bipartisan, bicameral legislation spawned the monster called "MACRA" in 2015. Bipartisan, bicameral legislation should kill it quickly in the beginning of 2017 before it rears its ugly head and takes a hellish bite out of medicine.

    If MACRA puts its sharp claws on the profession called "physician", the traditional "doctor-patient relationship" will essentially disappear.

    If the "physician" disappears the ABMS umbrella and 24 boards, along with the medical societies, and their banal quasi-regulatory agencies will soon be phantom mirages in a desolate desert dotted with bureaucratic ghost towns.

    The ACA is already destroyed, bent like a psychics spoon; snapped in half by the will of the people.

    ReplyDelete
  23. ABIM COI Report

    Dr. Baron's 'Henchman Chief of Staff' and 'Political Action Committee Commander' at ABIM, Suzanne R. Biemiller, states on coi form "no conflicts to report" . . .
    http://www.abim.org/about/executives/disclosure-of-external-relationships-executives.aspx#biemiller

    She reported what? Wait a minute!

    It is unlikely that the ABIM's Chief of Staff, Ms. Biemiller, forgot she was married to one of the most powerful attorney's for the British pharmaceutical industry giant GlaxoSmithKline. His name is James Robertson McCrae. JRM is a longtime corporate counsel for GlaxoSmithKline plc in Philadelphia.
    Interestingly, McCrae is serving as key counsel and policy advisor in the luxurious complex of Philadelphia offices, which his spouse Biemiller and Mayor Nutter helped acquire for GLAXO after a "no strings attached monetary gift" was given to the City of Philadelphia.

    Biemiller/McCrae wedding announcement 1994. A lot of years of marriage to forget!
    http://www.nytimes.com/1994/06/12/style/weddings-suzanne-biemiller-james-macrae.html

    "Suzanne Biemiller, MPP, Chief of Staff, Dr. Richard Baron's Office

    "Ms. Biemiller works within the President’s Office as the Chief of Staff of the American Board of Internal Medicine. In that role, she has direct responsibility for overseeing the function of ABIM's Governance Affairs section and is responsible for monitoring and coordinating all activities at ABIM. She serves as a key representative of Dr. Richard Baron, ABIM's President and CEO, and supports communication among all of ABIM's leadership team members, chairing the Senior Executive Team. She initiated ABIM's community-centered design strategy, which was approved by the Board of Directors in February 2015 and leads the Communications department on an interim basis.

    "Before coming to ABIM, Ms. Biemiller worked as the First Deputy Chief of Staff to Philadelphia's Mayor Michael A. Nutter, and previously served as his Interim Chief of Staff and Director of Policy and Planning. In these roles, Ms. Biemiller led the Nutter Administration's $1.86 billion effort to sell the Philadelphia Gas Works—one of the last remaining municipally-owned gas companies in the United States—and she was the point person in the Mayor's office for long-range planning, PhillyStat (the City's performance management system), and other strategic initiatives. As a consultant to the Mayor's Office of Sustainability from 2008-09, Ms. Biemiller developed Greenworks Philadelphia, the Administration’s award-winning sustainability strategy.

    "Prior to joining the Nutter Administration, Ms. Biemiller worked for The Pew Charitable Trusts as a Senior Program Officer. While there, she managed the creation of the Philadelphia Research Initiative, produced a number of reports on the city's prospects and challenges and oversaw the start-ups of local and national policy initiatives and non-profit organizations.

    "She currently serves as Vice-Chair of the Board of the Community College of Philadelphia.

    "Ms. Biemiller graduated from Williams College and has a Master's degree in Public Policy from Harvard University's Kennedy School of Government."

    ReplyDelete
  24. ABIM's failure to report conflicts of interest: Suzanne R. Biemiller

    ABIM Chief of Staff, Suzanne Biemiller (age 51) claimed "no conflicts of interest" with any medical company on her disclosure form.

    Wrong! Biemiller's husband, James Robertson Macrae, is legal counsel and public policy advisor for GlaxoSmithKline in Philadelphia.

    Biemiller's spouse has had a high ranking position working for GlaxoSmithKline for many years. This should have been disclosed voluntarily for the sake of transparency given Biemiller's top position as Chief of Staff. Chief of Staff is second in rank to the CEO. Biemiller's position touches all departments within the ABIM; she was even made interim head of the communications department.

    The ABIM Chief of Staff should also voluntarily disclose any investments in GlaxoSmithKline plc she may own. I find the lack of transparency and full voluntary disclosure troubling at the ABIM.

    http://www.abim.org/about/executives/disclosure-of-external-relationships-executives.aspx#biemiller

    James Robertson McCrae works as longtime corporate counsel for GlaxoSmithKline plc in Philadelphia.

    http://pview.findlaw.com/view/3366600_1

    Comment on ABIM's Chief of Staff's COI and the other sundry ongoing or buried scandals the ABIM, ABMS, AMA, ACP, ACGME fail to acknowledge and address:

    The whole affair reeks with conflicts of interest and financial self-dealing with both Baron, Biemiller, Langdon, Cassel, Mannes, Holmboe and the rest of the ABMS/ACGME gang still having much to hide. This is another example of lack of responsible stewardship at the ABIM.

    ReplyDelete

  25. The most important things involving coi, professionalism and ethics don't get addressed in lieu of ABIM, et al's, more important self-dealing activities, i.e., signing off on big paychecks, golden parachutes for each other and revolving door job opportunities within their improper utilization of non-profit organizations and abusing the financial boons resulting from not-for-profit status. An oligarchy consisting of a few corporations, individuals and special interest stakeholders have a monopolistic hold and influence over the "quality assurance" networks.

    What are they really doing there at the ABIM, ABMS, AMA, ACP and the myriad of other medical societies besides campaigning and lobbying for special interests, political entities and serving themselves? Then throwing in a little window dressing to make it all look like they are working for the common good.

    What are all the extra-curricular activities about; what are they engaged in with all our money? What gives them the right?

    Why do these organizations engage in and support the immoral persecution of physicians spending tens of millions $$,$$$,$$$ to protect their financial empire and political power. Why is the MOC debate still lingering when it has proven to be a disaster with thousands of physicians and millions of patients falling victim to its unintended consequences. AMA Delegate physicians have spoken to end mandatory MOC.

    Why does the MOC restructuring talk continue? Backward looking individuals with $$ signs in their eyes just simply cannot let go of their easy luxurious Dr. Do-Little lives and the special interests that breath down their backs for a piece of the MOC revenue pie? The ABIM/ABMS 'Director of Investigations' Mannes has his self-serving fingers and third-party special interests hands all over this revenue. Yet their is still no shake-up involving the clearly-reported ethical breaches and financial corruption.

    In the ABMS and friends efforts to achieve maintenance of control over physicians, what part do "exotic luxury vacations", obscure real estate clubs and offshore hedge funds have to do with creating a certification test. Why do these symbiotic organizations support continuous use of strong-arming, obfuscation and cover-up to maintain their control of clients, members and cash?

    With MOC there is no evidence of benefit, yet there is clear proof of harm to physicians and patients. There are personal and medical cost associated with that harm. There are potential legal damages not just in the millions, but in the billions of dollars.

    Who is going to pay the damages for that "high stakes" harm?

    WHEN ARE THOSE RESPONSIBLE FOR THE GREATEST HARM GOING TO BE HELD ACCOUNTABLE?

    ReplyDelete
    Replies
    1. I agree with you. They should abolish the MOC which serves no purpose. CME is the best route to improve competency, because it is prof.knowledge need oriented.

      Delete
  26. Rob MacRae GSK (looks like software? typo above turned MacRae into "McCrae")
    I agree abim/cos and gsk/bribery lawyer relationship is significant and should have been disclosed.
    https://www.linkedin.com/in/rob-macrae-1230529
    http://pview.findlaw.com/view/3366600_1
    http://www.nytimes.com/1994/06/12/style/weddings-suzanne-biemiller-james-macrae.html

    ReplyDelete
  27. Welcome to the Hotel 'Quality Assurance'

    On a dark desert highway, cool wind in my hair
    Warm smell of colitas, rising up through the air
    Up ahead in the distance, I saw a shimmering light
    My head grew heavy and my sight grew dim
    I had to stop for the night

    There she stood in the doorway
    I heard the mission bell
    And I was thinking to myself
    'This could be heaven or this could be Hell
    Then she lit up a candle and she showed me the way
    There were voices down the corridor
    I thought I heard them say

    Welcome to the Hotel California
    Such a lovely place (such a lovely place)
    Such a lovely face
    Plenty of room at the Hotel California
    Any time of year (any time of year) you can find it here

    Her mind is Tiffany-twisted, she got the Mercedes bends
    She got a lot of pretty, pretty boys, that she calls friends
    How they dance in the courtyard, sweet summer sweat
    Some dance to remember, some dance to forget

    So I called up the Captain
    'Please bring me my wine
    He said, "we haven't had that spirit here since nineteen sixty-nine
    And still those voices are calling from far away
    Wake you up in the middle of the night
    Just to hear them say"

    Welcome to the Hotel California
    Such a lovely place (such a lovely place)
    Such a lovely face
    They livin' it up at the Hotel California
    What a nice surprise (what a nice surprise), bring your alibis

    Mirrors on the ceiling
    The pink champagne on ice
    And she said, 'we are all just prisoners here, of our own device
    And in the master's chambers
    They gathered for the feast
    They stab it with their steely knives
    But they just can't kill the beast

    Last thing I remember, I was
    Running for the door
    I had to find the passage back to the place I was before
    'Relax' said the night man
    'We are programmed to receive
    You can check out any time you like
    But you can never leave!

    ReplyDelete
  28. I received a phone call the other evening from a colleague who was asking for my advice about how to deal with hospital credentialing. He wanted to hire an intelligent, gifted, and well experienced interventional cardiologist for his practice, but he was not able to extend a job offer because he was not able to make things work out at his hospital. Because I had been in similar circumstances he wanted my help in finding a way to make this work.
    The man he wanted to hire has worked as an interventional cardiologist for over twenty years. He has been in the trenches through many of the advances in interventional cardiology and understands the ins-and-outs of stents, how to place them, potential problems that may arise in during cases, and how to handle all sorts of emergencies when dealing with a patient whose life literally is in his hands. He is the kind of person who I want to take care of me should I ever have a heart attack.
    So what is the problem? Why can this man not go to work at this new hospital? Has he had a stroke? Has he suffered some sort of mental breakdown that has made him unable to practice? No. The only reason he is not able to do his job is because he decided to do something else for a while and has not been in the cath lab for two years. Now the hospital is not willing to credential him unless he first performs seventy-five cases. But he is not allowed to do the cases in the hospital, unless he is first credentialed. So he has to find another hospital in which to do the cases, but then he will likely find the same problem there. The only easy way for him to get the cases needed would be for him to do fellowship training over again, which is ridiculous.
    He has found himself in the modern day version of Catch-22. Insane bureaucracy. Why do hospitals require these cases? Well, a group of people at some time sat in a room and said that someone who was working as an interventional cardiologist should have done at least seventy five cases over the past two years.
    Where did that number come from? There may be an actuary that at one time may have calculated the actual risk of a bad outcome based upon the numbers of procedures that an interventional cardiologist had performed in the previous two years. Thus a threshold can be found. But does that number actually mean anything? These numbers often appear arbitrarily based on some risk assessment and benefit model, but to the physicians involved the numbers used often appear to be pulled out of thin air, and my gut tells me that these numbers just get passed around between hospitals as some sort of a consensus figure, not necessarily derived from any specific empiric knowledge.
    That is what the hospital by-laws state. And why do the by-laws state that a person who everyone agrees is fully qualified to practice, and could step into the cath lab with minimal problem, needs to go back to square one? Lawyers.


    sacredcowonaspit.com

    ReplyDelete
  29. So common sense flies out the window. Forget doctors policing their own. Forget about the old practice of 'proctoring' where the doctor can come and do some cases under supervision to make sure that his or her skills have not degraded. Now we have to listen to hospital and insurance company bean-counters who wouldn't know their left anterior descending coronary artery from their inferior rectal artery how to practice medicine. This is the fall-out of Obamacare, and more generally the fall-out of an out-of-control bureaucracy put in place by both political parties over the past twenty five years.
    Who watches the watchers? We must be vigilant in determining the best way to protect patients from potential fraudsters, but at the same time we must protect ourselves from the same menace. In exactly the same way as the credentialing system has been tainted, the Maintenance of Certification (MOC) system had been corrupted. MOC should ideally be a place where doctors can obtain knowledge without the threat of losing hospital privileges or insurance company compensation. But where the corruption of the credentialing system has been to reduce risk for the hospitals and insurance companies, the corruption of MOC has been for the financial benefit of the people who are running the system.
    Unfortunately, our masters at the American Board of Medical Specialties (ABMS) and all of their counterparts, which in my case includes the American Board of Internal Medicine (ABIM) and the American College of Cardiology (ACC), just do not get it. Like the sea change in presidential politics we are undergoing a transformation of the willingness of fellow physicians to blithely follow along with the MOC program.
    Yes, there are valuable bits of knowledge in the program, and this type of learning can be an important part of medicine. But the current establishment in place is deeply corrupt. Just as the poisoned well taints all of the fruits of the orchard, just as water contaminated with bacteria can result in entire batches or product lines being recalled, the valuable parts of the MOC program have been spoilt. These products are polluted, infected, rotten, and diseased, and we must be done with them completely to rid ourselves of their putrid stench.
    We may build some new system in place of MOC, but until we have a full house-cleaning at the ABMS and the ABIM we will not be rid of the smell. It is time to fumigate and eject this redolent fetor which fills the ranks of our ‘leadership’. End MOC now. End MOC today. Rid medicine of this fraud, this embarrassment, this menace!

    sacredcowonaspit.com

    ReplyDelete
  30. Point of information: The American College of Physicians (ACP) is headquartered in Philadelphia.

    ReplyDelete
  31. Seeing ABIM's broader political picture and misuse of physician fees. Are 990 tax forms hiding ABIM's slush funds? There are allegations of the Nutter administration while Suzanne Biemiller was mayor Nutter's staff chief. Is Baron's new chief of staff innovating with the ABIM by creating new slush funds or just trying to hide the old ones? What does "other" really mean to a tax exempt organization that has gotten no real scrutiny from the IRS ever. Since her appointment during the beginning of the presidential campaign cycle of 2016, I find it highly suspicious, if not a corruption of the ABIM's mission statement, that the new chief of staff for the ABIM has zero medical background, but is in charge of the ABIM's most vital divisions and departments.

    Who really controls the ABIM/ABMS?
    What dangers lie ahead if the ABIM is not purged of its leadership and replaced with non-partisan "active duty" physicians working on a voluntary capacity.

    Embroiled in financial and political scandal at the ABIM/ABMS -- a micro-image. Suzanne Biemiller brings conflicts of interest into an organization already laden with financial and political conflicts. How do they get away with it year after year?

    As a Democrat I find it hopeful that a new tough AG will bring some law and order back into our quality assurance bureaucracy. The past administration did nothing but bury the corruption.

    Embroiled in scandal Hillary Clinton did not win the election. That was good news for Americans. Philadelphia's former mayor Nutter, a Clinton surrogate, has dodged his share of scandals also -- the latest over the creation and improper use of a charity fund with a city slush fund set up during his two terms in office. Auditors have only looked at two years and did not like what they found so far. They will probe back to 2007/2008.

    This may get interesting for the ABIM's chief of staff, Suzanne Biemiller because this was under her watch as top administrator, communicator, community planner, and troubleshooter for mayor Nutter.

    ReplyDelete
  32. Nutter did not get his appointment to a federal cabinet position in Transportation or HUD, or so it was rumored that a Clinton administration would appoint him. Would he bring his former loyal chief of staff Suzanne Biemiller with him as deputy?

    Clinton did not win, but the "Democrats" and "Clinton 'ACA' Cronies" retain control of the ABIM/ABMS and affiliates.

    This has been the case for decades and this illegal usurpation and use of non-profit organizations is outrageous. They self-appointed and thus self-perpetuated control of the orgs turning almost the entire "quality assurance industry" into highly partisan political action think-tanks-cum-lobbyist agencies with their own personal slush funds.

    Who has profited from it? People like Christine Cassel, Robert Wachter, Kevin Weiss, Lois Nora, James Stockman III and Richard Baron. It is time for vital change in healthcare in slashing many of the useless harmful bloated bureaucracies. No change is possible without eradicating many of these organizations altogether, or at least removing the vermin within who seek to retain and maintain control at all costs, and who are eating us alive.

    With Richard Baron as CEO, Suzanne Biemiller as Chief of Staff, and Lynn Langdon as "Senior Advisor" lurking in the shadows they made sure that win or lose the White House they maintained control of the ABIM.

    (MOC appears to have been mostly the Maintenance of Clinton healthcare reform policies, which predated the Clinton administration. This bureaucracy funds politics and greedy bureaucrats who engaged in politicizing the "quality assurance" industry. These were the "Thomas Brems", the "John Bensons", and "Harry Kimballs" who helped their cronies seize control over healthcare's "assurance industry" by means of stealth, soft power and money -- lots of it.

    Key organizations like the ABIM/ABMS need to be purged of political partisanship, corporate cronyism and the deep corruption that festers within.

    We agree that MOC must go.

    ReplyDelete
  33. Scandalous! ABMS negligence and malfeasance sponsored by corrupt corporate entities too-big-to-fail. Bad karma to bail them out by paying their bloody MOC money.

    ReplyDelete
  34. Just stop paying these pricks! My board certification "expires" at the end of this month. I have not and will not comply. If everyone just stopped playing along, the boards would die very quickly. Good God, stand up for yourselves!

    ReplyDelete
  35. The new ABIM contracts and policies take complete advantage of vulnerable candidates and diplomates.

    The contract text rambles on with page after page of entrapment. Recent legislative passage of ABMS-friendly copyright laws (and regulatory capture which the ABMS lobbied for), puts physicians in an unreasonable position. Such false premises for "keeping up" is beneath human dignity. Placing such an extreme burden and tension on physicians puts a great deal of unnecessary pressure on them. This willful evil to procure profit on the part of the ABMS might land some, not just in civil court, but in prison. It is all in the contract if you carefully read it. You go to jail or pay out big if there is anything irregular in your testing behavior - as seen in the surveillance video or a physician's forensically-analyzed response patterns. Or if you have a suspiciously good score.

    But the ABMS and Pearson have been fixing that suspicious problem too.

    New test-scoring algorithms are creating dramatically unscientific and dynamically random scoring results; this is fraud, but the ABMS/ABIM are not accountable for their own errors and irregular behavior. They are not accountable to anyone other than their own powerful network of elites who in turn serve their special interests.

    The ABIM wants control of physicians badly. But they are losing this battle, because they have been exceedingly greedy executives and politically hubristic. They let their guard down, because they thought everyone would believe in their wall of lies forever. Now the ABMS empire and emperors are vulnerable. Their gargantuan dollar-wise greed gave away their true colors.

    They revealed their love of money above all else. The obvious political manipulations behind closed doors exposed their 'other' foolish games.

    To give the ABMS even one dime is to participate in a crime against the humanity we must uphold within ourselves. They have made a MOCkery of fundamental humanity and they have created a MOCkery out of medical science.


    ReplyDelete
  36. I was going through my bills and paying online and before I even realized what I was doing I had paid my 2017 ACC dues.

    I have now sent them the following letter:

    I would actually like for you to refund my dues. I no longer wish to be associated with an organization that repeatedly undermines its members interests in order to enrich itself. The horrible way in which you have handled the MOC issue only reveals you to be part of the corruption. I hope that with our new president the Attorney General will investigate the ABMS, the ABIM, and the ACC and tear you all apart. Many of you need to go to jail.

    Please issue my refund for my 2017 dues of $935. If you refuse to do so, I will get claim fraud with MasterCard. I will then file suit against the ACC for fraud.

    Thank you,
    Thomas Nielsen, MD, glad to no longer be FACC

    ReplyDelete
    Replies
    1. Suggestion: Send a tweet to Donald Trump and his AG They should know the corruptions of the Medical Assoc. you described above.

      Delete
  37. My reply to ACC Dr Chazal and the ACCPAC


    Thank you for your email.
    However the ACC took a position supporting ABIM MOC. There has been no support for clinicians like myself in this regard. I can not afford to financially support any medical organization that has a goal to burden me with ABIM MOC.

    As such I am firing the ACC. When you folks decide to restore your moral and ethical compass in the right direction I might decide to give the ACCPAC money.

    As far as I can see the ACC is very wealthy. To solicit money from clinicians and then stab me in the back is outrageous.

    Thank you for hearing me out.

    Sent from my iPhone

    ReplyDelete