Tuesday, May 30, 2017

The Alamo Reenacted: Texas Senate Bill 1148

Texas Senate Bill 1148 was a simple, hardly-noticed bill, one that promised to prevent the age discrimination against younger physicians inherent to the trademarked American Board of Medical Specialties (ABMS) Maintenance of Certification (MOC) program. The bill prevented the proprietary and unproven MOC program from being required for a physician to obtain or maintain hospital credentials, insurance panel participation, or state licensure.  It was so simple, so clear, and made so much sense, that it passed 31-0 in the Texas State Senate.

Then the bill moved to the much larger Texas House and got noticed. Like the Alamo, the bill was quickly recognized as a threat to the multi-billion dollar-a-year health care academic, quality, and safety industries. The American Hospital Association (AHA) and ABMS and American Board of Surgery (ABS) lobbies descended on the halls of unsuspecting Texas Representatives with whom they've had long-standing relationships. The legislators were caught between appeasing physicians and appeasing the largest employers in the state of Texas. Dazed and confused about what "MOC" even was, the representatives caved to the inclusion of special clauses that left loopholes for the rich and powerful organizations to re-gain control. The bill's sponsor and anti-MOC physicians who met with as many representatives as they could, fought valiantly to stem the oncoming legislative changes that weakened the bill but were outnumbered. The bill advanced to the Calendar Committee to schedule a date for a vote at the end of the crammed legislative session. The bill could have died in Committee and not gotten a date for the vote, but the word had spread. The Committee received so many calls and emails from physicians across the country they had to close their office to calls. Even the bill's sponsor pleaded to hold off on further calls. Remarkably, the bill went to the floor for a vote. Before the vote, five "points of order" arose, forcing the bill back into committee. There, more changes were made, and eventually exceptions granted to the richest, most powerful institutions in Texas on the basis that MOC was important to assure physician quality and its "practicing improvement projects" were legitimately valuable exercises to improve patient care. Only the last wall of the Alamo, the inability to use MOC for state licensure, remained as a testament to the battle.

The final wording of the bill moved on to the governor's desk for signature, cementing the MOC program as a required educational program for physicians in many of the states' largest hospital centers.

With all this happening in Texas, it was hard not to "remember the Alamo."

But while this legislative Alamo battle may have been lost in some ways, it was won in others. Practicing physicians learned a lot from this battle, no doubt patients did too. We learned firsthand who really feels MOC should succeed. We heard our fellow physicians who defended MOC on Twitter conflate initial certification with MOC, as they often do. We were struck when members of the American Board of Surgery (ABS) rallied to MOC's defense on Twitter, even as the ABS fails to disclose how much of their relatively small $8M/year revenue they earn from MOC on their tax forms.  When the legislative battle ended and the dust settled, we saw those same outspoken critics to the anti-MOC movement gleefully proclaim on Twitter that Senate Bill 1148 "excludes those world class med centers....doesn't apply to #Medschools #cancer centers #trauma centers. #NICU docs...." as if more discrimination was a good thing. No doubt the far more numerous family practice physicians, pediatricians, and internists in Texas who don't have full time nurse practitioners, residents, fellows, political sway, and NIH grants at their disposal think differently.

It remains to be seen if the Texas SB 1148 will really have an impact for practicing physicians increasingly forced to comply with MOC as doctors point to the legislation in the Medical Executive Committees and can't change their bylaws because of the loopholes for some, but not all.

As patients and physicians learn of the realities of the ABMS MOC program and are caught in its regulatory grip, they are flocking to the anti-MOC effort, not running from it. Physicians understand that those that support MOC support corruption, political cronyism, and even tax fraud. To that end, we understand MOC is not about patient quality, but instead about money. The AHA and the ABMS know this, but have to support each other as member organizations of the Accreditation Council for Graduate Medical Education. While losing MOC would mean little to the AHA, the program is critical for the ABMS's survival due to their long-standing overspending, political agendas, and pension programs.

Texas has taught us that the physician anti-MOC movement is unstoppable. It is coming, whether the insurance companies or hospital lobbies like it or not. It is just a matter of time before we educate every legislator in every state, the IRS, and the Federal Trade Commission about what MOC was and what it has become.

But unknowns remain. We want to know what the ABMS International agenda that we pay for really is, we want to know why we fund real estate companies like ABFM Realty, LLC that no-one mentions, we want to know why the leadership of these independent non-profit agencies have to make such exorbitant salaries and benefits, and we want to know why contracts to Premier, Inc, and PearsonVue and hundreds of other contractors are more important to satisfy than time with our patients. Our patients have the right to know. It is time to stop the cover-up.

We are on the right side of this and we know it, whether Texas Senate Bill 1148 matters or not.

We will never forget and neither will our patients.

-Wes





34 comments:

  1. This live oak with its strong supportive branches stands outside the Alamo museum in the city center of San Antonio. I have often been struck how some of its branches reach the ground like supportive arms and secondary roots. It is as if this tree were saying to the world this tree will stand forever. This unyielding oak at the Alamo Mission stands tall and proud as if saying from within me, "I will not fall."

    The AlaMOC movement to end mandatory MOC is like that enduring tree which symbolically stands as living testament to the courage of Americans banding together to fight for their rights and freedom. The anti-MOC movement is about physicians standing up for themselves and the rights and constitutional guarantees of all Americans, especially the rights and liberties of their patients. MOC is a yoke on the neck of all.

    All American physicians and patients, and all those around the world who already know how they are adversely affected by mandatory MOC, must stand together and resist like those who fought and gave their lives at the Alamo.

    https://www.monumentaltrees.com/en/usa/texas/bexarcounty/10571_alamomission/

    If you go inside the Alamo Mission you can feel in the hallowed silence of its halls how important it is to be integral to yourself and to what matters in life. Being true to yourself and not to give in to the oppression of those who have unfortunately sold us and themselves out to crony politics and special interests. Look at the ABMS and the member boards; they do not have one bit of real authority and yet they have captured us with deceit and falsely imposed statutory power.

    The names on the Alamo plaque of those who gave their lives (and the few messengers who survived) at the Alamo shows us that folks from all over America and many born in other countries were in this fight together. A fight that we won by means of a greater force that rallied together and put a stop to the tryannical overreach.

    It really is a fight against tyranny and corruption. MOC is to a large degree about stopping the malignant growth and disease in the health system stemming from non-essential bureaucratic control and greed. We are all seeing more and more the importance of standing together and fighting for what is right.

    Physicians and patients are being harmed by those with dwindling integrity and egregious conflicts of interest who appoint each other to (unlawful) positions of unaccountable authority and power. They even collect money from us (our mandatory fees) just to undermine us politically so they can work the legislative assemblies and make the rounds in our state capitols or in DC.

    Stand your ground and resist it. The larger force is gathering in numbers on solid ground and coming.

    We will not fail to restore integrity, human rights and dignity back into the profession of medicine and back into American life.

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

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  2. The text of the version that passed: http://aapsonline.us1.list-manage.com/track/click?u=30a32513ae04f5445c95f3239&id=824b6be7b6&e=2243fe6283

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  3. There is no public evidence that ABMS MOC is effective. On the contrary, there is clear evidence that the ABMS cartel and their costly MOC causes harm to the public.
    So why don't they just stop this heinous program that does so much harm to physicians and patients?

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  4. Think about how much money is being spent countering and rectifying all the ills and wrongdoing of the ABMS. It will cost billions to fix the damage they have caused.

    Look at their largest medical board certifying over one quarter of all physicians -- the ABIM. Consider how they spend their time and money. Look at the compensation packages they give to each other. Where and how can they get away with such mind boggling profligacy and racketeering.

    The ABIM spent well over a million dollars in legal fees in court this past year on a global goose hunt.

    Their director of investigations, a thug with two felony convictions and his unnamed team of 27, went hunting looking to shoot anything that flies. If it runs or flies it must be guilty, so shoot. (One of the convictions of ABIM's felon is for a gun violation in D.C.) In the present case the ABIM and their politically charged criminal attorneys tracked down test takers in Puerto Rico of all places. Their felon in command was looking for anyone who had private conversations with a double-certified gastroenterologist named Dr. A. in 2008 and 2009.

    The ABIM's felonious director illegally/improperly seized data on physicians who attended Dr. A.'s approved certification study courses. Dr A. ran a competing board review company. The ABIM was looking for communications on his personal computers from all the way back to 2008 and 2009. The ABIM must have culled through twenty years of attendance files on physicians and any communication with the business owner. This is totally absurd. It is shocking and if you knew the details inside and out any child would conclude that these thugs are bad people at the ABIM and they should have been placed behind bars long ago.

    Real people -- physicians from all over the country were being invaded being treated like criminals by an ABIM-employed double felon who had a track record as a bad cop. He was officially terminated from the police department. He was extirpated for having uncontrollable urges to harm journalists who thought they had first amendment rights and the freedom to do their job. The urge to harm came on strong, especially when the topic reported on by a journalist was local police corruption.

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  5. What utter criminality coming from an "ethical" medical board run by an "ethics professor"/"gerontologist" who passed her self off as a physician. And the ABIM does not even name their felon Benjamin M. (alias Ariel B. M.) (for good reason) on their mandatory filings to the IRS. Nobody in the world is safe from their secret police!

    The ABIM CEO's and COO waited five years to file a bogus copyright lawsuit that was time-barred and with no chance of their winning. The American Board of Internal Medicine and their contractors tried to ruin a physician from San Juan. Another discrimination lawsuit if you ask me going after soft targets with little money to fight a legal battle. (Anybody who has traveled to San Juan knows they charge you more for everything and pay you much less.) But it turned out that this time the ABIM miscalculated, because the physician's parents were attorneys. Anyone familiar with Lynn O. L. could see that this was a malicious vindictive lawsuit brought about by a frustrated CEO, COO and their disgraced office of investigations.

    Was it also not just a last ditch effort to redeem themselves for spending ten million dollars on the last legal misadventures. Everyone knows about the lawsuits related to the culling of soft targets who attended a New Jersey board review course that the ABIM approved of for twenty years. Why attack physicians credibility in 2009 when the CEO became adviser to the president of the United States as the were embarking on a mission of reforming the healthcare system at the federal and state levels is the 64 billion dollar question nobody wants to talk about.

    It is too unsettling for us to look closely at the total corruption of the medical boards and their collusion with each other and their associates to control physicians and serve the insurance companies -- who were the ones who actually wrote the ACA "on behalf of the administration and the people".

    What about the lawsuit going after the Puerto Rican physician? The lawsuit going after Dr. S R. A total bluff the taxpayer has had to absorb for the use of the New Jersey courts, and a total waste of physicians exorbitant illegal annual fees.

    When is the Department of Justice going to seize the ABIM's records and put up the yellow tape! When will a federal law be written to protect physicians from such criminals who get away with almost anything they want to perpetrate.

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  6. This counter offensive by these special interest MOC groups needs to be outflanked. We need legislation to regulate these agencies by State and Federal agencies.
    We need them to accept fiduciary responsibility and let them swallow the same damn austerity measures that are thrust on all of us. Dump the sister organizations. Stop going to national meetings. This is all about $$$.

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  7. The ABIM should have a category of expense on their IRS consolidated tax forms called "hush fund" or "general use hush money bucket". The scandals are piling up, so this fund (whatever they euphemistically call it) is getting quite a bit of use.

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  8. Regarding hush money and the ABMS member boards' "testing security division:, the ABIM/ABMS' infamous "director of investigations" is like a ship without a port. The ABIM will never let their double-felon reach shore. He knows way too much about them and how what he did with his partners to personally terrorize and crush physicians. His dubious behavior and hiding him from the public, competitors, attorneys and physicians fits in with the overall pattern of affairs at the ABMS.

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  9. The ABIM spent nearly a million dollars on legal expenses in court and outside of court last year in trying their best to keep "the felon director", who never once appeared in tax filings as employee or contractor, out of court. In the most recent court shenanigans the ABIM's "casino-land criminal attorney" first tried to conflate ABIM's "DoI" Mr. Mannes with the "CFO" Mr. Mandes arguing in the case of "ABIM versus Dr. Jaime Salas-Rushford" that Dr. Rushford's attorneys and the court had no need to bother the busy CFO Mandes who was not a party to the case against him. Courtroom deception of the most blatant yet childish form.

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  10. Mannes was eventually required to come to the courts in New Jersey for a deposition, but the ABIM managed to gag the deposition so that nobody can read it or even know that a double felon ever worked at the ABIM persecuting physicians politically and financially and destroying the ABIM/ABMS corporate competition. What a scam on top of scam on top of a scam!

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  11. The ABIM and their associates at Caveon and elsewhere will most likely keep burning through stashed money and fresh physician fees to keep their "corporate spy" Mr. Mannes from being discovered by the MSM, the larger majority of the public and physicians, but expressly they need to pay him to keep their felon from talking.

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  12. Is this how the ABIM/ABMS operates, Dr. Baron/Dr. Nora. If not tell us, because this is certainly the impression that everyone gets. The public sees the unaccountable ABIM and their unaccountable umbrella organization as racketeers and thugs. There is little that silence can do to dissuade anyone from thinking otherwise.

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  13. The ABIM slush fund is world renowned among bloggers, patients and physicians and right now is named on their IRS filings as "other expenses". Or if it is not so named their slush money flows like milk and honey from unnamed sources altogether that no federal or state agency has yet bothered to investigate and track down.

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  14. The ABIM and ABMS are operating globally and this makes things very difficult. They are in Singapore and breaking ground in Dubai, Brunei, Burma, Cambodia, Australia, and elsewhere in Europe, Africa and Asia. And I understand they are after even exploring Bulgaria secretively.

    There are too many proselytizing moves on countries to mention, but wherever you see Choosing Wisely, and ABMS luxury vacations, ABMS sponsored/affiliated Universities with MOC/CME programs are the ones to take note of, particularly the schools that have international medical programs in countries overseas such as Duke and John Hopkins. You can safely say that the country they target commercially and politically is in play as a target for ABMS MOC. Duke is in Singapore for example. Dubai has other educational partners that can be gleaned online easily.

    In short, physicians in the US through paying ABMS MOC fees are fueling their own funeral pyres and that of their colleagues overseas.

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  15. "MOC"-like recertification requirements have just hit Russia and causing pain to physicians and patients already

    (5-year recertification testing scheme just introduced that you must pass or lose your certification. No more lifetime certifications for Russian physicians!)

    No one has reported on this yet, but now MOC has hit Russia hard. To give some background, due to provider shortages physicians in Russia are compelled to work double shifts and for only several hundred dollars a month from the government. The ruble's decline further aggravated the poor conditions to start with, and places a great deal of pressure on physicians and patients in Russia.

    The pay increase promised for Russian docs (forget about it) will not be coming as the government is forced to spend more on defense (according to internal reports and the media) and less oil revenue is coming in. Physician used to be a privileged position and class in Russia getting to go home early in the past. The old stable ruble of the past had buying power and the pensions from husband and wife provided enough to live on frugally/meagerly in the Soviet Union from what is reported from locals and expats. Not now. The ruble plummeted with sanctions. And plummeted a couple of times before that over the past two decades with financial crises.

    MOC infiltrates the large Russian healthcare system and into the provincial hospitals

    Western and domestic insurance companies have put pressure on the Russian government/healthcare bureaucracy to make certification renewal mandatory with a lengthy costly test every five years now forced on physicians in Russia. You must comply or you will lose your certification. I.e., the physician will not be able to work if they don't pay-up, take time away from practice, and pass the new five-year recertification testing scheme.

    Older physicians are already saying "no more tests" on top of their CME. And they express that they will just retire rather than give in to the regime. Insurance companies/western banks and neo-liberal economic theory has been gaining ground in Russia over the past decade and exerting pressure. There is also plain old-fashioned imitation of what is perceived as a better system. Better for the bureaucrats who will prosper from it. MOC for Russia is a devolution and crippling blow to patients and physicians who face shortages of providers, hospital beds, medicine, technology, many procedures and treatments, medical supplies and almost everything else already.

    All this hardship on top of all the other problems and the bureaucratic corruption that everyone lives with there and around the globe and you have in Russia a Molotov MOC-cocktail ready to spread chaos and fire to Russian healthcare. The Russian physicians can see clearly in their minds already that "somebody is being bribed".

    The lack of reimbursement for care and treatment in areas outside of Moscow will leave the healthcare system in Russia in an even worse condition than it is in today - already scathed with the influence of insurance cartels and bankers who have their own versions of pay to play schemes and new ones coming down the pike.

    Who suffers? Everyone, except the schemers. The burdensome and onerous financial scheme called MOC has hit physicians and patients in Russia. Greater financial burdens and time away from patients compounds everything, while they redundantly study what they already are studying with CME and while practicing medicine.

    Russian healthcare is the latest domino to quietly fall in the Nordic forests of spruce and birch and the taiga with the corporate push for global financial and political domination of physicians and healthcare systems.

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  16. The ABMS' Ineluctable Display of Decades of Culpability and Arrogance

    Is the ABMS a billion dollar politico-corporate-shadow bureaucracy paid for annually by reluctant/insouciant physicians and the institutions who pay to verify doctors' certifications and MOC status?

    If so, who and what does this shadow bureaucracy serve today? National or corporate agendas or both? It certainly does not serve patients or physicians.

    One question to ask about the largest most influential of ABMS member boards, the ABIM, is this: Is ABIM a bipartisan organization appointing equal numbers of Republicans and Democrats as executives, employees and officers? Evidence points to an alarming fact that the ABIM does not even bother with having even a policy about this.

    Such a policy would be awkward as it is abundantly clear that the ABIM has been used as a slush fund for partisan political and corporate agendas led by professional medical politicians and state actors like Christine K. Cassel, Robert M. Wachter, and Richard J. Baron. All devout and fanatical democrats. Cassel for example is a globalist and adventurist who played a big part in the failed healthcare reforms of the Clinton administration and the successful passage of the ACA during the full term of the Obama administration.

    This is more than troubling when we look at how all three individuals have exploited the ABIM and ABMS money and power. It is illegal and unethical by any interpretation of US law and commonly accepted norms of morality. It is patently one of the most blatant examples of public fraud and education farce of the first rank.

    The executives have no shame or remorse about this, so the only recourse is to indict them for their crimes (there is ample publicly available evidence to convict) and to prosecute them to the fullest extent of the law. The recovery for the government should be enormous as billions of dollars have been swindled out of physicians for decades. Civil lawsuits to recover money by physicians who have been cheated should be flooding the courts.

    Walter Bierring founder of the ABIM in 1936 and president of the AMA from 1934-35 contended that the ABIM was created to serve in the capacity of certifying physicians in lieu of what the governments in Europe would legislate. This is quite true and because the ABIM and ABMS member boards' leadership has often had revolving door employment or advisory positions with the federal and state government (and paid revolving door positions with the corporate healthcare milieu) it is not hard to make a case that the ABMS and its member boards (including executives) are state actors. This opens up a plethora of constitutional violations and charges against them all.

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  17. State Actors and the Art of Snake Charming the Medical Profession and the Public

    A snake biting its own tail

    Walter Bierring, as a progenitor of the FSMB, was editor of their publication for decades and gave frequent congressional testimony in shaping national health policy and law. Bierring died in 1961.

    https://www.google.com/search?tbm=bks&hl=en&q=walter+bierring+testifies+before+congress

    FSMB lecture series bears Bierring's name. At the commencement of the 1969 FSMB lecture series the president of the FSMB invoked the AMA 1961 resolution honoring Bierring. The following discussion on the politics of licensure, certification, recertification and interestingly the suppression of "cult medicine" (chiropractors) to keep them from getting medicare funding is historically revealing. Controlling state licensing regarding "cult practitioners" was openly discussed.

    These chiropractors are some of the same "snake charmers" that the ABIM wished to suppress in 1936 during the Great Depression. The ABIM was not just about bring order to specialty medicine, it was also about hard times and suppressing the competition. For historical reference, the "snake charmer" (fakirs, ascetics, entertainers) from India and elsewhere have been confused with Kundalini Yogis who actually considered the "energy of the spine" as a powerful healing spiritual force cultivated through esoteric meditation and devotional practices. Chiroprators have been confused as "snake charmers" perhaps for their treatment of the spine. (The spine has been associated with the snaking energy coiling up the spine. I have never heard of chiropractic schools teaching kundalini or fakir philosophy in googling the origins of chiropractic.

    http://jmr.fsmb.org/Archive/1960s/FederationBulletin(Vol56N5).pdf?boxtype=pdf&g=false&s=false&s2=false&r=wide

    Medicare paid out nearly a half-billion dollars for chiropractic in the year of this article below 2014. That might be close to the same amount that the ABMS swindled out of physicians for pushing their MOC philosophy. As there is no science supporting either chiropractic or MOC I would venture to say "tongue and cheek" that a billion was wasted on "snake charmers".

    https://www.forbes.com/sites/stevensalzberg/2014/04/20/new-medicare-data-reveal-startling-496-million-wasted-on-chiropractors/#5eede8de68c8

    Speaking of charmers and state actors, Bob Wachter was under government contract (a US state actor) working for the AHRQ while he went to help out the British with their rollout of an electronic health record for the National Health Service. Bob recommendations have been primarily that they need to spend more money and take more time. Since Wachter's last consultation the NHS was held ransom by the WannaCry virus. This weaponized virus created by US intelligence services escaped from the NSA/CIA by being hacked.

    Which security firm or companies will Dr. Wachter call in to fix NHS' outdated XP operating system with its many gaping security holes? Bob's answer again. More money and more time.
    It's probably one of those ABIM-type executive positions where you get paid millions of dollars for wasting money and ruining things.

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  18. The ABMS Comb of "Related and Disregarded Entities" and the 24 Specialty Member Hives
    (Spotlight on the ABMS Research and Education Foundation - creating MOC programs and a qualifying program for state licensure with the FSMB.)

    The ABMS mission is global hegemony over physicians by tightening ABMS' proprietary "quality measurement" and "quality improvement" nooses.

    Anti-trust abuses, monopoly, and collusion with various well placed NGO's have deceived physicians and the public to create a working environment with non-statutory policies/mandates and regulatory capture as key elements to control physicians and attempt to secure MOC's continuity and lucrative revenue streams.

    Without MOC the ABMS and its member boards would face severe financial contraction and possible collapse. Certification markets reached saturation levels after the 1970's.

    Reinforcement of ABMS MOC is one of the critical roles of the ABMS Research and Education F.
    MISSION STATEMENT of the ABMS Research and Education Foundation:

    "The mission of the foundation shall be to support the scientific, scholarly and public education purposes of the American board of medical specialties (1) by encouraging and conducting research to improve the capacity to measure, assess, and evaluate the educational, scientific, clinical and professional qualifications and performance of physicians engaged in the practice of medical specialties: (2) by conducting educational programs and disseminating information to the public to assist its recognition, evaluation and understanding of the significance and importance of initial certification, of sub certification and of maintenance of certification of physicians engaged in the practice of medical specialties: (3) by fostering national and international cooperation and the exchange of information related to initial certification and maintenance of certification and physician continuing professional development."

    The ABMS has five related and disregarded entities listed on schedule R of their IRS tax filings.

    1. ABMS International, LLC, a holding company.
    2. ABMS Singapore, LLC, directly controlled by ABMS International
    3. ABMS Solutions, LLC, providing certification solutions for credentialing entities
    4. Multi-Specialty Portfolio Approval Program, promoting physician participation and competency
    5. ABMS Research and Education Foundation, mission statement above

    Looking at the IRS tax filings for 2013-2015 reveals the purposes for the ABMS Foundation and plans/thinking.

    In 2013 MOC played heavily into "research/development" finding solutions/programs assisting to embed/entrench MOC into public and private thinking and practice. The Foundation appears to be primarily a MOC "ministry of propaganda". Transfers of cash to the Foundation were made in 2013, 2014 and 2016 from the ABMS. Section III on page two shows a range of activities for each year.

    Of note in 2013 is the collaboration with the FSMB to design a program to determine qualifications for state licensure.

    They also worked with the CCME on creating a CME program.

    In 2015 QI activities for Medicare/Medicaid were also explored through a partnership with the Network for Regional Healthcare Improvement.

    In 2013 the Multi-specialty Portfolio Approval Program was created with 501(c)(3)public charity status applied for. Financial losses each year were reported with revenues lagging behind expenses. In 2015 they had 162K in revenues and 540K in expenses. The new "director" David Price of MSPAP was given nearly twice the revenue for nine months on the job bleeding the ABMS? for 262K. It is not clear where the money was/is coming from to keep the failing enterprise called the MSPAP afloat. Last time I looked they were subsidizing the program for most of its clients on a get in now free pay us later approach. Membership bribes? Incentives?

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  19. Declining MOC Revenues, Specialty Boards' Difficulty Paying the ABMS Member Dues, ABMS Transfers to the ABMS Foundation and ABMS Multi-Specialty Portfolio Approval Programs

    IRS filings reveal the ABMS is a delicate house of cards ready to fall

    In 2013 the ABMS Multi-Specialty Portfolio Approval Program received $1,887,000 in contributions, gifts, grants from "related organizations." They do not say where specifically, but we can safely say it was from the ABMS parent. They claimed revenue from programs and services (research and education) $638,634. Total program expenses were $1,768,240

    In 2014 AMSPAP received $1,338,000 in contributions, gifts, grants from ABMS. They claimed revenue of $384,742. Total program expenses were $795,860.

    In 2015 AMSPAP received $5,000 listed under contributions, gifts, grants under the heading "all other contributions, gifts, grants, etc, not listed above". (Strangely, there is nothing listed above. All blank.) Program revenues were $60,871. Total program expenses were $591,456.

    In 2016 AMSPAP received $1,300,000 in contributions, gifts, grants from the ABMS. (According to 2015 tax forms the money was already allocated for 2016.)

    The ABMS has transferred a total of $4,530,000 in contributions, gifts, grants to its related non-profit "research and education" foundation during the years 2013, 2014, 2015, and 2016.

    The total transfers for four years averages out to $1,132,500 to AMSPAP on an annual basis.

    It is rather strange to see a non-profit 501(c)(6) parent company ABMS and its 501(c)(3) charitable Foundation ABMS AMSPAP in control of three LLC's, which do not qualify for non-profit status.

    In 2015 four ABMS employees received compensation from the ABMS and form "other reportable compensation" drawn from the ABMS AMSPAP Foundation totaling $132,000. (ABMSF and AMSPAP)
    Salaries paid out by the ABMS Foundation totaled $667,777.

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  20. The ABMS "Honey Comb" (six combined entities)

    "Taxable" disregarded entities
    1. ABMS International, LLC, a holding company.
    2. ABMS Singapore, LLC, directly controlled by ABMS International
    3. ABMS Solutions, LLC, providing certification solutions for credentialing entities
    2015 Total income $8,278,000 Net assets end of year $6,306,533

    "Tax-exempt" status related organizations
    4. Multi-Specialty Portfolio Approval Program, promoting physician participation and competency
    5. ABMS Research and Education Foundation, mission statement above
    6. ABMS parent company

    ABMS 2015 net assets end of year $16,675,500 (mostly in held equities and cash)
    ABMS Foundation net assets -$1,292,000
    ABMS MSPAP net assets -$378,000 (based on expenses and revenues only, filing not available.)

    The ABMS sub-contracted with the American Board of Surgery in 2015, giving their board member nearly a quarter of a million dollars $231K for test development in Philly, PA

    They paid a similar amount $261K to the American Board of Ob and GYNE in Dallas, TX.

    If the ABMS did not receive membership dues from the 24 specialty boards totaling $7,314,000 annually, the corporation would burn through all its investments in a little more than a year.

    The ABMS is truly a delicate financial house of cards. The ABMS cannot sustain itself at current levels/expenditures - not without creating solid new growth models. I wonder what their risk managers are telling them?

    Incidentally the ABMS paid PriceWaterhouseCoopers nearly $1,000,000 (922K) for "management consulting" in 2015.

    Shhh! Don't tell anyone how dire the situation is for the umbrella and its member boards.
    It's hailing hard and the windy city is bending back the spokes.

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  21. ABIM: Shadow Police of the ABMS

    What was that big fat bonus to Lynn Langdon for? (COO Langdon was Mannes' boss.)

    It would be appropriate and fitting at this time for the ABIM's communications officers (past and present) to prepare statements about their infamy, lies and cover-up, and all the other egregious issues they are so silently derelict about addressing.

    In case you did not know, Mannes is famous for targeting and intimidating at least one journalist in DC for writing about the police corruption there (2002-2003). Mannes was reprimanded and fired for his violations against the reporter and did not actively work as a police officer again as far as we know. Contrary to what his CV states.

    By 2005-2008 Mannes was a known convicted double felon. There was no appealing his crimes. He was in a violent altercation at a nightclub where he worked as bouncer. Three charges, two court convictions. Mannes was moonlighting against his TSA railroad job at the time. He was fired form both jobs for his terror and felonious mischief that everyone is sufficiently shocked about already. Aggravated assualt charges were dropped in a plea bargain. Mannes would be convicted as a result of a DC gun charge (illegal possession of handgun - a powerful "terrorist fighter's" classic with a huge clip) and he was convicted of "impersonating a police officer".

    What "lethal" legal and investigatory/spy weapons was Mannes playing with at the ABIM/ABMS when he impersonated an officer - albeit clandestinely for his bosses, Cassel, Baron, Langdon, Weiss, Nora, Holmboe, the testing-security cartels and the lucrative testing industry who all pulled his strings?

    How and why did the ABIM hire this man! And for what purposes did they create a totally new position for him? Physicians are put through the ringer and Mannes skates through the door as a corporate spy and to investigate physicians. What a hypocritical and criminal action on the part of the ABIM and ABMS. The ABMS also hired Mannes for his "investigatory skills".

    When the 2008-present physician roundups and pogroms calmed down somewhat focusing primarily on what appears to be Puerto Ricans, breast-feeding mothers, disabled physicians, African Americans, Hindus, Muslims, and Koreans, and other soft targets, Mannes apparently was getting his masters degree in how to manage folks. Corporate management??? Is Mr. Mannes next in line for Lynn Langdon's former job as COO?

    Or will he succeed Judi Cassel as chief of staff, human resources director, and chief ethics officer. Dr. Baron probably won't give up his position without a fight. But because an ambitious thug like Mannes has the goods on everyone (not just his soft-target physicians and helpless IMG's, which he made a market for himself out of) anything is possible.

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  22. ABIM's Chief Medical Officer is PriceWaterhouseCooper man. He is Wall Street with a medical degree. He is also, not without significance, a longtime insider at the National Committee for Quality Assurance (NCQA), which is just another QA organization designed as a front organization in order to serve self-dealing executives and corporate special interests. The ABMS and its cronies, such as the NCQA, have nothing to do with serving "public safety". Who are the real stakeholders of the ABMS and who is subsidizing the corruption?

    In fact, MOC is a worse scam than anyone is saying out loud or in public. The organizations and their executives are public frauds. Corrupt organizations like the ABIM and their well-connected associates are no different than the phony front organizations one may have read about in the news from time to time -- "good" organizations that claimed with bold-faced lies to be protecting wildlife in Africa, only to find out years later certain well known organization and some of their executives were public frauds. One world famous "ecologically-minded organization" was actually involved not in saving animals, but in poaching endangered species to fund a continuation of apartheid in South Africa. They were also running guns in order to help fuel their political agendas, adventurism, and maintenance of corrupt and brutal power. Take a course on the history of South Africa from an objective instructor, or go online and get a better picture of such scams and see (by analogy) just what US physicians are paying into with MOC.

    Unfortunately it is not just MOC that is fraudulent, but almost the entire ABMS elitist culture. The ABMS should be totally gutted and reformed in order to protect the public. One must be diligent and inform oneself and work hard to bring about the necessary change. It may take longer than you think. In a disposable fast-food culture we are highly susceptible to propaganda and the media. We must relearn what we have lost of our humanity and understand that sometimes real change may not even occur in ones lifetime.
    But MOC is obviously so wrong and the forces behind it preservation so corrupt it should be a no-brainer to everyone and an easy legislative fix. Unless MOC serves such powerful evil forces that nobody can understand. Evil that wishes ill on humanity.

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  23. Read "Who makes insurance companies require MOC?" (See blogger comments about federal fraud cases against WellCare, Humana and longtime NCQA partner Andy Slavitt head of Ingenix. Ingenix was bought out by United Health Group. Ingenix was re-branded as Optum by UHG.)

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

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  24. What is the foreign policy of the ABMS? What are the political views of Lois Nora? Does the ABMS have a mission in foreign affairs? If not why are they penetrating centers around the globe? And why are they spending physicians fees and fee-based data, which they sell for international involvement?

    What is Lois Nora's relationship with the Chicago Council on Global Affairs? She was a key speaker with them recently. It is a fair question as physician fees pay the specialty board dues to the ABMS umbrella organization in Chicago.

    Is the ABMS a political organization acting in domestic and global affairs on behalf of any special interests?

    https://www.thechicagocouncil.org/basic-page/board-directors

    https://www.thechicagocouncil.org/basic-page/health-next-generation-agenda#Education: The Foundation of Health

    Head of the Chicago Council on Global Affairs since 2013. Ivo Daalder was Ambassador to Nato during Obama's term in office. He oversaw the Nato attack on Lybia. Under the Clinton Administration Daalder had an active participation on the security council during the Nato invasion of Yugoslavia. (Lois Nora was appointed CEO of ABMS the same year as Daalder 2013.)
    https://en.wikipedia.org/wiki/Ivo_Daalder

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

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  25. Thomas J Nasca, MD, MACP, the CEO of the ACGME and ACGME International does not participate in MOC (American College of Graduate Medical Education Founded 1981,

    https://en.wikipedia.org/wiki/Accreditation_Council_for_Graduate_Medical_Education)

    What message does the ACGME CEO non-participation in ABMS Maintenance of Certification send about MOC's relevancy to med students, residents and fellows in the US and around the world?

    T Nasca, MD Bio
    http://www.acgme.org/About-Us/Board-and-Staff/Executive-Staff/Executive-Staff-Bio/ArticleID/15/Thomas-J-Nasca-MD-MACP

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  26. Since 2009 the ACGME International has been implementing a global strategy.
    http://www.acgme-i.org/About-Us/Message-from-the-ACGME-I-Leadership#pfvideo_player_1258

    Global Mission: Bringing value and the assurance of outstanding medical education to the world
    http://www.acgme-i.org/About-Us/Message-from-the-ACGME-I-Leadership#pfvideo_player_1258

    The Mission
    http://www.acgme-i.org/About-Us/Mission

    The International Review Committee
    http://www.acgme-i.org/About-Us/Review-Committees

    Where we are: Singapore, Qatar, UAE, Lebanon, Oman, Haiti, Saudi Arabia, Panama
    http://www.acgme-i.org/About-Us/Where-We-Are

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  27. What is the ACGME International doing in Lebanon accrediting the AUB?

    The American University of Beirut has just settled (with an apparent admission of unintentional wrongdoing) a fraud lawsuit with the US government for $700,000.00.

    AUB was accused of supporting terrorist organizations, while receiving USAID grants since 2007. The ACGME launched its international mission in 2009.

    What is not clear in the report is if USAID directly or indirectly supported AUB and the ACGME's efforts to accredit the university and maintain its working relationships. Were the ACGME-I Review Committees in danger, involved in any way in working with any of the parties involved, or were called as witnesses.

    Who exactly is paying for the ACGME to be in Lebanon? And what are the costs involved?

    "ACGME Accreditation for American University of Beirut (AUB) Reinforces, Reflects 150-Year Mission"
    http://www.acgme-i.org/About-Us/Accreditation-Stories/Accreditation-Story-Details/ArticleID/149/Accreditation-for-American-University-of-Beirut-AUB-Reinforces-Reflects-150-Year-Mission

    US DOJ versus AUB (March 2017, settlement.)

    "As alleged in the Government’s Complaint and set forth in the parties’ settlement agreement, both of which have been filed in Manhattan federal court:

    Since at least 2007, AUB has received monetary grants from USAID to fund various university projects and programs. As a condition of receiving those grants, AUB submitted certifications to USAID each year in which it represented, inter alia, that it “has not provided, and will take all reasonable steps to ensure that it does not and will not knowingly provide, material support or resources to any individual or entity that commits, attempts to commit, advocates, facilitates, or participates in terrorist acts, or has committed, attempted to commit, facilitated, or participated in terrorist acts.” In these annual certifications, AUB further represented that “[b]efore providing any material support or resources to an individual or entity, [it] will verify that the individual or entity does not appear . . . on the [SDN List].” The annual certifications defined “material support and resources” to include, among other things, “training, expert advice or assistance, . . . [and] personnel.”

    https://www.justice.gov/usao-sdny/pr/acting-manhattan-us-attorney-announces-settlement-american-university-beirut-resolving

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  28. According to IRS filings for 2014 the ACGME International, LLC on schedule R had income of $3,560,458. Year end net assets tallied $3,896,000.

    The ACGME International expenditures and investments internationally totaled $3,199,612

    $1,577,007 East Asia and Pacific (expense)
    $843,637, Middel East and N. Africa (expense)
    $4,484 Centrl America and Carribean (expense)
    $774,484, Central America and Carribean (investment, without explanation)

    Executives were granted club dues/business lunches (untaxable) and first class airfares with spousal travel.

    $1,061,540 went to the CEO Thomas Nasca, MD
    (certified grandfather not participating MOC)

    $610,869 was paid out to SR. VP Kevin B Weiss, the former ABMS CEO.
    (grandfather, not participating in MOC)

    $549,538 went to SR. VP Eric Holboe, the former ABIM strongman.
    (MOC status, ABIM website shows EH to be participating in MOC. However the 2012 recertification test and location of test is still unverified for Mr. Holmboe.)

    http://www.guidestar.org/FinDocuments/2014/363/698/2014-363698130-0c26d361-9.pdf

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  29. Diplomatic ties broken over Qatar's support for terrorism and harboring terrorists

    Is the ACGME going to pull their accreditation of Hamad Medical Corporation in Qatar? Was ACGME International (a for profit enterprise) turning a blind eye to Qatar's blatant support for Isis and other terror groups. Joe Biden warned us two years ago of Qatar's involvement in state sponsored terrorism. Our state department warned us and is warning us again today. It is curious and senseless at the same time, and one just can't understand why the ACGME would pick Qatar as a partner. If we look at the human rights records alone of some of the countries they have chosen like Saudi Arabia it turns the stomach how many innocent heads have rolled.

    Are they out of their minds? Or have they just lost their heads?
    https://www.theguardian.com/world/2017/jun/05/saudi-arabia-and-bahrain-break-diplomatic-ties-with-qatar-over-terrorism

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  30. ABMS-I, ACGME-I, JC-I and US Foreign Policy (Or corporate foreign intervention?)

    Who does the ABMS, ACGME and Joint Commission serve? The public? Self-driven profit motives? Special interests? These are important questions. We must look closely at these organizations and how they have evolved into what they are today and how they interact with government and corporations.

    Whatever one concludes there is a clear pattern both domestically and internationally. The leit motifs or themes are control of healthcare (and physicians) for corporate profit and political power. Control over physicians is a critical ingredient. The ACGME plays a large role in this. Certification a key part, but MOC is perhaps the most critical component, because it has allowed additional money to flow into the coffers of the ABMS (and affiliates) creating much of the corruption we see and the dissatisfaction that physicians and the public are having with the whole shady business model.

    Now we have another part of the business model that is revealing itself. The expansion into international markets. Looking at the specific "global marekts" one has to ask who and what does the ABMS, ACGME and JC serve?

    Specifically, are the American Board of Medical Specialties (International), American Board of Internal Medicine, American Board of Pediatrics (Global Initiatives), American Board of Emergency Medicine, American Board of Pathology, Accreditation Council on Graduate Medical Education, and the Joint Commission (International) serving foreign policy in a tit for tat arrangement for a lucrative piece of the Middle East and Africa? [Also according to tax forms the Asia Pacific Regions and Central America and Caribbean.]

    Are they really serving foreign policy or are they violating foreign policy and human rights issues in what they are doing with their global expansion. Given the concerns for terrorism in the region, the ABMS, ACGME, and JC have gotten themselves trapped in the middle of a foreign nightmare. It appears they support heinous regimes with egregious track records for supporting terror and violating human rights. All for money and control of lucrative markets? This part is apparent. Whether they are piggy-backing off of US foreign policy, that is for our government and the executives to explain to the public transparently. We have a democracy and it is my opinion we need to be informed as voters and taxpayers (or clients) to participate in our government.

    So what do physicians think? What do patients make of this mess. Is the healthcare industry marketing itself through the above mentioned US charitable NGO's? Are they be considered for-profit agents of special interests and corporate brokers helping to expand markets?
    Think of the billions of dollars tossed around in the Middle East as they expand their healthcare, while other countries' health services are being blown to bits. Along with their people. We are not playing politics, but raising a very human question.

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  31. Who got the NCQA to ensure that the insurance companies require MOC? When? Who did it?
    Whose schema did it serve?

    Was it people like the former CEO of the ABMS, Kevin B. Weiss, MD who worked for the NCQA? Or Dr. Richard Baron, CEO of the ABIM who had a big role with the NCQA. Or was it the NCQA CEO, Margaret O'Kane, who makes close to 800K per year "serving the public" at a charitable non-profit NGO?

    In fact all these people mentioned make money that is unbelievable for being a public servant. The money tells us they must serve something else. Something bigger that just the patient or "we the people".

    It is astounding how many executives at the ABMS, 24 Specialty Boards, ACGME, NQF, NCQA, Joint Commission and so many other "quality assurance" organizations of new formation have had revolving-door appointments (employment) between each of these affiliated organizations and the government. Christine Cassel, CEO of the ABIM, for example, appears to have had a key role in hundreds of healthcare NGO's at the same time. And while serving a high position in the federal government and taking money from the healthcare industry. Doesn't it make you wonder what is really going on. Don't you want to know how the "whole business scam" works and not just MOC.

    The whole of healthcare is in crisis and these critical QA NGO's, who have put the strictures on everyone in America, are playing brokerage house politics and James Bond adventurism in other countries overseas. I'm speaking about the lack of focus and transparency coming from these bloated shadow bureaus.

    The Barons, Noras, Holmboes, O'Kanes and Cassels of the world are killing healthcare in America -- not making it better. What are we going to do about it?

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  32. ACGME failing in its most important Milestones - integrity, transparency

    One thing struck me recently. Nobody knows how or why any of overpaid execs get chosen for the job "serving the public". For example, the CFO for the ACGME who does the tax filings has a degree in biology and then somehow got a degree in management. How do you get to be a CFO keeping track of hundreds of millions of dollars without being a certified accountant or student of finance with a degree first.

    Not to disparage anyone, but look what someone curiously writes about ACGME's CFO, Mr Ogunkeye, on their website. (Mr. Ogunkeye is also the SR VP in charge of ACGME-International. That is why what they wrote and left out selectively struck me.)

    "Mr. Ogunkeye’s broad experience and history of success in administrative finances and strategic planning and management will fortify the ACGME at its base, enabling the organization to thrive in its continued efforts to enhance and bolster graduate medical education in the U.S. and abroad.
    As the ACGME looks to the future of medicine and accreditation, the addition of Mr. Ogunkeye provides a keen strategic eye, a critical new perspective, and a fresh approach to the nuts and bolts of operations and finance, both domestically and internationally.
    Mr. Ogunkeye has a B.S. in Biology and M.S. degrees in biology and in health care
    administration.

    That would not raise my curiosity or inquisitiveness, but when the ACGME media relations/communications officer "communicates" vaguely that "Mr. Ogungeye has served on a number of non-profit boards which include physician practices, a governmental authority, an international agency, and an insurance captive," that's when I believe it is important to actually tell us what "government authority", what "international agency", and what "insurance captive" they are referring to in his work and volunteer experience.

    It becomes apparent these organizations leave out just enough detail to say nothing, and just enough to satisfy requirements that they did mention that so and so worked for the State Department, FBI, CIA or USAID. What insurance company might be an important thing to know. It's just the same as the ABIM leaving out that their Chief of Staff's husband was a critical executive at one of the largest pharmaceutical companies in the world. How much stock do they own?

    Or how much dilution do they cause to their brand by watering down their educational integrity. Even Weil Cornell Medicine has been criticized roundly for this same dilution of brand and value of their education. Same thing with the ACGME in Beirut. Nobody can believe it after the terrorism scandal and everyone plays dumb.

    So what are these NGO's doing overseas when American healthcare is in crisis! It's not any different as if the president of the United States suddenly decided he might like to "rule" in Saudi Arabia (or Qatar) and the US simultaneously. The president will drop the ball here when his attention is divided by being there. Look at how the ABMS, ACGME, JC and other partners are trying to "rule over" many countries not just two or three.

    ACGME CFO, VP ACGME International
    https://www.linkedin.com/in/john-ogunkeye-1b746382

    http://www.parksquare.com/uploads/insights/ACGME_-_John_Ogunkeye.pdf

    http://www.globalhealth.northwestern.edu/education/funding/index.html

    https://wikileaks.org/plusd/cables/08DOHA400_a.html

    http://www.royalcollege.ca/portal/page/portal/rc/common/documents/events/imelf/2015_IMELF_biographies.pdf

    http://www.hopkinsmedicine.org/news/media/releases/john_ogunkeye_to_head_hopkins_clinical_practice_association

    Which ABMS CEO is affiliated with this school?
    http://www.globalhealth.northwestern.edu/education/funding/index.html

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  33. It would be hard to believe if the ABMS, ACGME, and Joint Commission denied knowledge of Qatar and Saudi Arabia's "clandestine and logistic support to Isil and other radical Sunni groups in the region."

    As Secretary of State Clinton in August 2014 said:

    “We need to use our diplomatic and more traditional intelligence assets to bring pressure on the governments of Qatar and Saudi Arabia, which are providing clandestine financial and logistic support to Isil and other radical Sunni groups in the region,” Ms Clinton wrote.

    Mr Assange noted the US government had never acknowledged governments of Middle East nations had financially supported Isis, instead arguing such support was isolated to “some rogue princes using their cut of the oil money to do whatever they like, although the government disapproves”, according to the WikiLeaks founder.

    According to the Clinton Foundation, the Saudi Arabian government has donated between $10m (£8m) and $25million since the foundation was set up in 1997. Last month it was reported the government of Qatar offered to donate $1m to the foundation in celebration of Bill Clinton’s birthday.

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  34. Our state department warned us and is warning us again today. #Brio

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