Monday, July 03, 2017

Common Sense

Four years ago, I had to "re-board certify" in cardiology and cardiac electrophysiology or lose my ability to practice medicine at the hospital I have worked since 2001. The "de-credentialing" aspect of failing to participate in the American Board of Internal Medicine's (ABIM) self-proclaimed "Maintenance of Certification" (MOC) program infuriated me, but I was left with no choice but to "pay up and a just do it."

Like my colleague Meg Edison, MD, I seriously thought about not re-certifying at the time, but my wife intervened and suggested I'd be more effective at combating the requirement while remaining "certified" so I could not be passed off as a disgruntled doctor. So I reluctantly registered for the "program."

My! How "re-certification" had changed since 2002! As I registered, I quickly learned that I no longer just had to take a "test" to re-certify. I also had to perform unsupervised research surveys on my patients. I had to dream up a quality assurance project and test it on myself and my clinic. I also had to review volumes of information purchased from the American College of Cardiology for $1350 because if I did not pass my cardiology re-certification, I could not practice as a cardiac electrophysiologist because of the "double jeopardy" dual-board passing requirement in effect at the time. Due to the high-stakes nature of being unable to practice if I failed either of my examinations and to save time, I attended a three and a half day board review course sponsored by members the Heart Rhythm Society for another $1400. Reading the materials I had purchased was not enough. Only if I read the same material on a COMPUTER (with ridiculously slow screen load times), would I receive CME credit for my hours spent studying. All of this pulled me from the patient care I was also trying to provide, took precious free time away from time with my family, and done without any proof that MOC improved my patient's care quality or safety.

Puzzled by the complexity of the "new MOC" I had to endure, I started to investigate and write about my experience on this blog. What has transpired since beginning this effort over the last four years has been nothing short of remarkable. I quickly learned that I was not alone - that physicians across the country were just as infuriated as me. I was struck by the unassailable power the ABMS member boards had amassed over physicians' ability to treat their patients. As I kept writing and investigating, I was introduced to others who knew more than I did about the board certification and re-certification folly. I met real leaders in the fight against MOC: Paul Kempen, MD, PhD, Ron Benbassat, MD, Charles Cutler, MD, and Mr. Charles P. Kroll - a forensic accountant and fellow Illinois resident at the time - who helped me understand the depth and breadth of financial shenanigans going on.

Mr. Kroll and I eventually reviewed every Form 990 and 1023 tax document we could acquire on the ABIM and its Foundation - all the way back to 1997 (the earliest complete tax form I would find) and the years-long financial, political, and power agendas inherent to MOC became clear. Edward J. Schloss, MD (a fellow electrophysiologist) and I published the history and origins of MOC and the published veiled threats imposed on physicians if they failed to comply contained in the peer-reviewed literature. Gradually, things began to make more sense. What I was not prepared for, however, was the depth and breath of the professional societies' dependence on the program and their impotence at effecting real change. Time and time again, peer-reviewed articles and rebuttals to ABIM's publications weren't published.

With ongoing review, it soon became clear that things did not stop with the ABIM. Other ABMS member boards, the hospital lobby, and even entire departments of internal medicine at large state-owned academic medical centers appeared to conspire with the unproven need for MOC. Even the "National Committee on Quality Assurance" and one of the oldest and most influential medical societies (and owner of the New England Journal of Medicine) used MOC to create new revenue sources. Too much money was involved at practicing physicians' expense. Even the hospital lobby, always eager to the control the flow of patients to their group's facilities, were more than happy to play along when doctors brought legislation to states, insisting that MOC be tied to physicians' hospital privileges on the false promise it assured physician competency.

On and on our investigation went: from the ABIM Foundation (and the "Choosing Wisely" initiative), to the National Quality Forum, the National Committee on Quality Assurance, the Institute of Medicine, and even the President's Council of Advisors on Science and Technology! It was an amazingly intricate (and lucrative) physician education/testing/quality assurance cartel that has operated without any legitimate oversight or questioning of their actions for years.

It was clear that I (any many others) had opened an entire Pandora's box of corruption in the US medical education system and medical quality and safety empire, the likes of which I could not imagine.

At the same time, physicians from other locations wanted change, too. A petition hosted by Paul Teirstein, MD of Scripps Medical Center in La Jolla, CA garnered over 23,000 physician signatures and led him to create a competing credentialing body, the National Board of Physicians and Surgeons (NBPAS). The ABIM, feeling the pressure of legitimate competition, issued their now infamous "we're sorry" mea culpa promising to "listen" and modify the MOC program. Even the New England Journal of Medicine felt compelled to sponsor a limited journalistic "debate" between Dr. Teirstein of the NBPAS and Lois Margaret Nora, MD, JD of the ABMS. The comments were overwhelmingly in favor of Dr. Teirstein. But physicians were no longer fooled. Despite publishing these opposing articles,  physicians saw the Massachusetts Medical Society (publishers of the New England Journal of Medicinepromote their own MOC learning program: "Knowledge +". Everyone, it seemed, placed the money from MOC before the needs of practicing physicians and their patients.

Naively, I went to my professional society and raised red flags. While the Heart Rhythm Society initially appeared to take a strong public stand against MOC, hosting a debate between Fred Kusumoto, MD and Douglas Zipes, MD in 2015, there was little real debate. Dr. Zipes - a long-time director at the ABIM - refused to address anything about "the ABIM finances, fees, salaries, investments, etc." Later, it has become apparent that the revenues from MOC board review courses and the affiliation with ABIM were too important to the leadership at HRS to end their affiliation with the MOC program. Even when main stream media (a la Mr. Kurt Eichenwald from Newsweek) tried to expose the corruption in four well-researched articles on the ABIM (see here, here, here, and here), the ABIM and physician education establishment summarily dismissed all of the facts levied against the organization because Mr. Eichenwald failed to disclose his wife was an internist. (You can't make these things up.)

At the invitation of the Pennsylvania Medical Society in June 2016, I went to the AMA House of Delegates to tell my MOC story and there they all were: the chairman of the board and chief counsel for the AMA, the Senior Executive Vice President of the American College of Physicians, the President and CEO of the American Board of Medical Specialties. The room was packed as they listened, writing notes. The Pennsylvania Medical Society took the lead and bravely issued a formal "Vote of No Confidence" against the ABIM and the AMA House of Delegates later voted to end Maintenance of Certification (MOC) nationwide. There was hope, I thought.

Still, the AMA leadership failed to act to end MOC.

Many physicians would not rest. Not only had doctors become familiar with the incredible ABIM Foundation condominium story, they learned of the strongman tactics used by the ABIM in an issue of Philadelphia Magazine devoted to the ABIM controversy. Worse still, they saw the veiled threats from a Wall Street attorney levied for exposing the ABIM's felonious "Director of Test Security" in a subsequent issue of the magazine. Unfazed, brave, proactive physicians forwarded legislation across the country to end MOC as a condition of hospital credentials, medical licensure, and ability to participate in insurance panels. State after state attempted to pass legislation, only to realize how difficult it was to do so when they were fighting the hospital and insurance lobbies and colleagues suffering from Stockholm Syndrome as hospital-employed physicians.

This year, the Pennsylvania Medical Society organized another event at the AMA House of Delegates meeting to discuss the realities of trying to get anti-MOC legislation passed in state legislatures across the country. The AMA, ACP, and ABMS leadership were not readily apparent  this time. They had moved on, coordinating their message and confident in their cash reserves and lobbying team. It became readily apparent to those of us at that meeting that the insurance and hospital lobbyists would stop at nothing to prevent this legislation as intended from going forward. After all, not only does MOC remain a critical revenue stream for our bloated and overreaching US physician credentialing system, it also serves to limit competition for them as they insist this metric serves the "public" at physicians' personal and professional expense. While MOC remains in many parts of the country, through this process we have learned a lot. Multiple states now have anti-MOC laws on the books now with Texas's law going into effect 1 January 2018. Since that law was voted in to place, Houston Hospital Physicians voted unanimously to remove the ABMS MOC requirement for credentialing.
“The legislature did their job, Doctors Buckingham and Bonnen did their jobs, now all of us need to take back the autonomy we gave up when we allowed MOC,” Dr. Hampel said. “We need to vote it out of every bylaws in the state.”
So Where Do Working Physicians Go Now? 

What can practicing physicians on the front line of patient care delivery do?

We have two choices: 1) continue the status quo, or 2) organize to end the injustice. MOC is just one example of overreaching and damaging regulatory intrusion on the practice of medicine.

It is not okay that the ABIM secretly took at least $77 million of physician testing fees to create their own ABIM Foundation retirement fund and then offshored a hefty portion of that money for themselves. It is not okay that the ABIM, an unaccountable non-profit organization,  targeted vulnerable physicians trying to study for their examination using a known felon and their attorneys. It is not okay that Richard Baron, MD, President and CEO of the ABIM and its Foundation, earned $2 million from 2013-2015 while ABIM had $31.7 million in operating losses. It is especially not okay that the entire Accreditation Council for Graduate Medical Education (ACGME) member organizations continue to condone these activities by failing to act against them. Where evil and hypocrisy are rewarded and even called humane and good, it shows how twisted our words have become and how far corporate medicine has fallen.

As our new residents start training this Fourth of July weekend, if US physicians do not act collectively to end MOC, we condone the development of doctors that are little more than excellent sheep. Ignoring what has occurred to our profession due to our earlier indifference would risk the development of a medical education system that manufactures doctors who, as the wise professor William Deresiewicz put it, are "smart and talented and driven, but also anxious, timid and lost, with little intellectual curiosity and a stunted sense of purpose: trapped in a bubble of privilege, heading meekly in the same direction, great at what we're doing but with no idea why we're doing it." Aspiring to be excellent sheep is not in our patients' best interest. We should never forget why we're physicians and whom we truly serve.

Organizing is the only way we will end MOC nationwide and the many other intrusions created by clever unaccountable third parties behind closed doors for their own benefit.

To that end, I am not talking about unionizing. I am not talking about a partisan group to push a particular health care reform agenda.

Rather, I am talking about creating a representative member organization that does three things: (1) represents the needs and concerns of real-life practicing physicians who care for patients day to day, be they employed or in private practice, (2) acts to limit unnecessary, overbearing, and improper regulations against physicians (like MOC), and (3) works to assure that physicians are allowed to remain the principle advocate for their patients without threat from third party intrusions. Everything this organization does would be driven by these three principles.

Unfortunately our reality is that none of this can happen without money. It costs money to create an organization, hire a person to answer the phone, and pay an executive director to manage the operations while we continue to do what we love to do - care for patients. It takes money to send someone to testify in front of state legislators, the FTC, the IRS, or lobby Congress on our behalf. It takes money to develop a legal fund to combat the injustice of MOC that has occurred behind our backs. And it takes money to make sure such injustice never happens again.

Our nascent organization, Practicing Physicians of America, Inc. (PPA) which has come together on a shoestring and a prayer, has reached out to many of the leaders and organizations involved in the anti-MOC movement. Many have agreed to serve as our advisors. We have already been active on Capitol Hill, worked to coordinate the statewide legislative efforts against MOC, and testified in state legislative hearings. To continue our efforts, PPA is now formally open for membership (and donations) to bring our dream to a sustainable reality.

None of our board members are paid. For months we have donated countless hours in our spare time to this endeavor because we each believe in PPA's mission. But there's still an incredible amount left to do. We know we can't do this alone. Such an ambitious project will take a large coordinated effort from the entire practicing physician community to make this organization a sustainable reality and for it to have an impact on a national scale. Many disparate groups of practicing physicians exist with varying agendas, but none of them work as a collective umbrella group to help coordinate common needs of physicians and their patients. This is how we hope to magnify our voices. Membership is how we will celebrate our profession and collaborate with other like-minded physician groups and leaders across the country.

It is the MOC issue that has brought us together and will be the MOC issue that guides us as we forge ahead.

Take a moment to review the early version of our website, our introductory video by Judy Thompson, MD, and our MOC webpage to educate yourself. Then take a minute to become a member of PPA (or just give what you can). (For those who gave with our initial "soft opening in February" you're already "in" for the first year and will receive a code to apply when you register. Please don't despair if the system does not "know" you yet. Rest assured, your donations have helped us achieve what we have so far). For all of those who have not joined, we need your help, your voice, and your funding to act on our behalf in this anti-MOC fight and to build an organization devoted to the needs of working doctors and their patients unencumbered by special interest funding. The cost for a year is about what many pay for a monthly cellphone bill.

Many hands make light work. There is strength in numbers (this is the key: we need a lot of numbers) as we forge ahead. Each little bit helps. We should remember that only 15% of physicians are members of the AMA and AMA receives only 12.1% of its revenues from its membership. The vast majority comes from credentialing, insurance commissions, and licensure of their CPT codes. PPA hopes to represent the far greater silent majority of practicing physicians who work on behalf of their patients' best interest and want to end corrupt and burdensome regulatory intrusions.

For years physicians on the front line of patient care have yearned for an organization that speaks for them. Now the skeleton of that organization is in place. Help us grow to end the ability for unaccountable (non-profit) organizations like the ABMS, their member boards, insurance companies, and hospital groups to deprive physicians of our right to practice medicine on the basis of unproven, intrusive, and financially-conflicted programs like MOC.

Please join us. Then pick your phone and personally ask your colleagues to do the same. We need your help to make this dream succeed.

-Wes

37 comments:

Anonymous said...

The Sting of MOC and the Need for Justice and Statutory Relief

At this point in time it's painfully obvious that they ABMS has been woefully shamed and significantly diminished in stature. The medical boards, especially the ABIM, can't recover their reputations.

One of the things that raises my ire is the abuse of power and authority when ABIM took the lead in the ABMS' sting operations of 2008 and beyond with thousands of documented violations of constitutional guarantees and privacy rights resulting from their massive staged assault on physicians.

Organizing a cadre of corrupt key ABIM/ABMS executives, digging deep into their illicit secret financial pool, in 2008 created a new investigative bureau--a position invented for a conflicted double-felon with a penchant for physical abuse and publicly-documented examples of lying and harming others rights. They were not intending to anything good with this kind of man and record. Their director of investigations, a disgraced cop and felon, along side executives and teams of unethical contractors used powerful attorneys trammeling on physicians' first amendment rights.

They shredded the fourth amendment into a thousand pieces as they crushed physicians' guarantee to due process using powerful threats and legal batterings. They waged unbelievable attacks involving ABIM's secretive inquisitional sanctions panels and ordering media barrages in every publication they had access to in order to unjustly defame and malign. They did so with well-prepared press releases masquerading as journalism. The ABIM COO intimidated thousands with letters of reprimand to encourage fear and submission in a delusional display of trickery, malice, and false sense of authority. An absolutely classic display of Machiavellian abuse of power.

This is not what a testing company does. It is what a violent mercenary hit squad does.

The ABIM in coordination with the ABMS and members carried out special spy-ops on board review courses and physicians that were in direct competition with ABIM and ABMs partner organizations. What kind of mentality does such a a thing?

During Cassel-Gate--which turned into Baron-Gate with his continuance of the operation-- they conducted many repeated terrorizing attacks on physicians destroying rights and privacy with weapons of choice that no physician could conceive of. ABMS thugs behaving like an army of dark "twins of a Rambo" conducting themselves outside the norms of decency and as if they were above the law.

ABIM deceitfully and illegally seized files on physicians that no testing company or even federal bureau of investigation has the right to do. Christine Cassel was obviously feeling her oats, and abusing her power as advisor to the POTUS on healthcare.

MOC Matters said...


Riddle: What do you get when you combine a big piggy bank with a special laundromat for money?
Answer: The ABIM Foundation.

D said...

The ABIM has one of the worst human rights and discrimination records in the United States and possibly anywhere in the free world in the category of a non-profit charity.

The court records are filled with examples of racism if you want a promotion, and even discriminatory hiring and firing. They have abused clients with severe disabilities and even breast-feeding mothers. If you are harmed or abused, you cannot talk with them civilly to get what you need or deserve. You must take them to court. They will not pay unless they fear the bad media or until the court makes them pay. And if you want your restitution, they will stick a gag around your once free tongue.

I READ so much bullshit from them about talking nicely with physicians in a civil dialogue about MOC or any other point of contention, but I'll tell you if history is any guide, you are going to have to take them to court. If you look at their attorneys up close, they are a bunch of power-hungry sleazes. Maybe one or two are alright but they don't stay, and if they do they don't have much say.

Good luck!

d said...


No matter how hard the ABMS' multi-million dollar politicos try, they still can't hide the dualities, conflicted interests or obvious graft; it is all hanging out like dirty laundry for everyone to see.

Nor will their highly-paid propagandists, as hard as they might try, ever turn any of their crooked executives into a nice girl or guy.

Lisa said...

As I've mentioned before, grandfathering is a tacit admission that the standards prior to affirmative action were significantly higher.

Does that mean MOC is the answer? No, it's a lucrative bandaid to suck physicians dry by people who may not have been able to get into medical school at all under previous standards. People are claiming that there is no record of MOC participation by leaders who force these exam scams on the peons who do patient care--and they list "gerontology" as their area of certification. This is the test that is easy enough for the affirmative action hack to pass so that the medical profession isn't completely embarrassed by the physicians it produces. Let that sink in...

Wes, you're a lucky man that the wife intervened and got you to just do these tests. Having said that, I would note that you put more energy into all of your anti-MOC efforts than MOC itself. That's not wrong. I'm just saying, compare hours put in. Is it any wonder when you tweet photos of a date it's you and Jay Schloss getting together, but never you and your wife on a date night? Let that sink in...

Keep fighting for what you believe in though. This is ridiculous to drive physicians into early retirement with unreasonable requirements. You are cutting people open so you pretty much have to stay current in your professional education. There are other doctors who really just seem to remember four things from medical school because that's what they usually see in their practice. Get stuck with one of those as a patient and you have to explain things to them that they really should already know. (I don't go for an office visit unless I really am ready to outsource this to someone else, so I never need Tier 1 technical support on a medical condition.)

Be well and make sure you're spending enough time with your wife, silly.

A fortunate patient said...

For goodness sake. You are calling for a union. And through it may take some time to adjust to that idea, I hope you will quickly escape the 'denial' phase, and go on and fight the good fight and win the battle against your corporate oppressors. Who knows - maybe one day you will see a way to support a teacher's union, a public service employees union.

I wish you well.

July 4th MOC Report: Elitism and the Rise of "Corporate Fascism" in America said...

"Maintenance of Certification (MOC): the Elite’s Agenda for Medicine
Kenneth D. Christman, M.D. Journal of American Physicians and Surgeons Volume 18 Number 3 Fall 2013." [Excerpts]

"MOC is a key part of the elite’s agenda to seize control of medical decision-making, for their own financial self-interest, under a false flag of “quality.”

Physicians and patients must thwart the intrusion of these 'stakeholders' into the sacred
patient-physician relationship."

"The elite, by constructing a nearly seamless, amorphous network of semi-private agencies (including the AMA), have been able to exercise control over the proletariat*, all in the name of 'quality.'"

"In reality, however, their actions have drastically diminished quality by replacing highly qualified practicing physicians with paramedical personnel."

"The elite have infiltrated virtually all levels of government, influencing legislation and rule-making that confiscate substantial portions of their fellow physicians’ incomes, while
enhancing their own."

"This activity is accurately termed 'fascism,' which the American Heritage Dictionary defines as 'a system of government that exercises a dictatorship of the extreme right,
typically through the merging of state and business leadership.'

"In other words, this is a system of government giving preferential treatment to a select group."

Footnote
*"The proletariat (/ˌproʊlᵻˈtɛəri.ət/ from Latin proletarius) is the class of wage-earners in a capitalist society whose only possession of significant material value is their labor-power (their ability to work).[1] A member of such a class is a proletarian."

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


This article above clearly indicates that we have an obtrusive infiltration/intrusion into healthcare by agencies and their agents that are unhealthy and undesirable. The preponderance of their unwholesome and deleterious activity is only a few decades old, yet it is devouring healthcare's finite financial resources at an alarming rate of increase.

MOC is central to their scheme. The aim is to impose an arbitrary "maintenance of control" via a myriad of contrived mandates involving quality measures and quality improvement protocols. MACRA is connected to this.

MOC is contingent on a mandatory "maintenance of cash" in order to consolidate power/control over physicians and patients by a very concerning and growing nexus of public/private partnerships and special interests.

Call it/them what you will, but "they"are illegal bodies exercising illicit control over healthcare to the detriment of the patient and physician. These illicit bodies are colluding enterprises of new invention who inure themselves and profit from their self-appointed and self-centered activities beyond our ability to comprehend.

They operate under the radar and in the shadow.

We cannot as a [free] representative republic [and democratic society] allow this to continue or western civilization as we know it [or imagine it] will be over.

The dimensions and scope of the problems we face are beyond the typical divisions of party politics. 'We the people' may have very little time to address this grave condition in which we find ourselves.

We must all work together to correct the imbalances and excesses of an 'elitist controlled government'. An 'ECG' thrives on division, even creates and manipulates division to its/their own advantage.

Adami said...

Well said, Wes! Very impressive gains so far, let's keep it up. The ABMS MOC system (as mandated by the ABMS, boards and their partners) is corrupt and there is no way that we can allow it to continue. It is unlawful and it violates the professional ethics that the ABMS boards must adhere to. Truth and the law are on our side, so who is holding back the tide?

Anonymous said...

https://www.consumer.ftc.gov/features/feature-0030-pass-it-on

The FTC warns the American public of these top scams. Let's take a look at them one by one and examine how the ABIM, ABMS specialty boards and its umbrella organization ABMS* match up with using scam techniques for personal gain.

1. Identity Theft: "voluntary" certification and MOC data and primary source profile information coerced out of physicians and sold by member boards and the umbrella organization where "you pay for it" involuntarily with mandatory fees. Christine Cassel, et al illegally seized thousands of physician files and emails under false flags of "copyright" and "maintaining integrity". This scam was perpetrated purely for financial gain and political posturing . A double-felon, contractors, and an associate attorney were specifically hired and a bureau of investigations was created to conduct the false flag attacks.

2. Imposter Scams: Masquerading as a testing corporation, professional medical politicians use the member boards and umbrealla organization like political action committees with lobbying done without reporting to the IRS by the ABIM, the largest specialty member board.
CEO politicians pretending to show up for charitable work involving ABMS core mission when in fact they instead dwell in other states and the District of Columbia reporting to special interest groups and corporations without proper disclosure to the public, clients and IRS. A total scam.
Hiring a double-felon to patrol the hundreds of thousands of physicians without disclosing this. Utilizing a known felon convicted for impersonation of an officer of the law and gun violations. Passing such a person off to the courts to represent investigatory fiction as facts is/was pure fraud involving scamming the courts, clients and public. Scamming the media with fake news reports. This is not an exhaustive list, but continues with examples year after year.

3. Charity Fraud: The city of Philadelphia determined that the ABIM is not a public charity because it gives nothing to the public. None of the member boards are charities, but for profit enterprises feigning to be charitable enterprises serving the public, when in fact they serve themselves. They 24 medical boards and umbrella are self-wheeling, self-appointing, self-dealing, self-inuring, and politically motivated enterprises.

4. Health Care Scams: The entire ABMS is a healthcare educational scam not unlike a Ponzi scheme. See criticisms to MOC comparing it to such schemes.
The ABIM transferred money, which some liken to money laundering, in order to inure executives at the ABIM with extra cash and benefits. The Choosing Wisely campaign has been a scam funded by partner organizations such as the Robert Wood Johnson Foundation and Consumer Reports with highly questionable motives and results. Some critics argue that the organization serves special interests both public and private creating windfall profits and savings for corporate and government agencies, but just confusing healthcare issues and needs. Compromising the patient and physician relationship.

Anonymous said...

ABMS scamming the public - continued

5. Paying Too Much: A protection raquet has been created allowing groups such a the ABMS and AOA to charge exhoribiant fees and to get their services and fees mandated by sister organizations in one of the biggest healthcare educational racketeering scams in the history of the world. The protection goes to the highest corporate levels and these influential bodies appoint and influence legislators, the White House and legislation.
Elites creating their own governance within a pseudo shell.

6. "You've Won" Scams: "We're listening" charades and "we are transforming for you" scams to manufacture new ways to entrap clients into paying more money more often, such as 10-year recertification (which bribed older established physicians with "grandfather clauses") MOC pr0gram and the two-year online testing regimen offered as a way to keep up and keep the feds out of "our self-regulated" industry. Self-inuring and wholly unaccountable executives make up this phony "our regulated industry" and not physician clients. There is absolutely no client representation at all. "You have won the right to pay forever and be tested to death in exchange for 'voluntary; participation in their racketeering schema or else you cannot work and/or get paid."

7. Campaign Materials: Ask Christine Cassel, Richard Baron, Lois Nora, Kevin Weiss as they have stood before legislative bodies and changed the way corporations and CMS conducts its activities as revolving door agents; and consider the back channel lobbying and partisan healthcare agendas that the organizations and their corresponding societies have been engaged in. We can certainly not call these charitable non-profit enterprises when finance and politics are first and center state. They hire veteran politicians and Wall Street bankers and merger and acquisition specialists and not practicing physicians to build an empire of power and finance. Refer to tax filings of each.

*ABMS according to its bylaws is accountable for its member boards improprieties and breaches. See tax filings 2005, 2006 and 2007 for their amended bylaws. ABMS to my knowledge has not put any member board on probation.

Don't call the umbrella org to report anything, they will just bury it. Contact the DoJ, the FTC, IRS, and the OIG of the HHS to report these illegal actions against the interests of the American people.

They are harming their clients and the public. Look out for the victims (everyone) and report it.

Anonymous said...

ABIM's verified lists of certified active physicians is littered with physicians who do not meet the minimum requirements for certification. This minimum requirement as stated by the ABMS and ABIM is to hold an valid license to practice medicine. If a physician has no license, no practice, and therefore, has not been practicing medicine, how can such a physician be even minimally competent in a specialty? In short, how can such a physician, for example an physician administrator or like a physicians who no longer practices medicine at all but works for a executive search company such as the ABMS contracts with. A former physician working for a lobbying group is another example. How can such a physician be called ABMS certified by the definition established by the ABMS and their member boards?

It used to be that certification was a rite of passage for practicing physicians before the age of such a preponderance of full-time physician politician/administrator/bureaucrat/lobbyist/Wall Street capitalist/pharma marketeer. In the past a practicing physician, as it is today, was one learning everyday, studying and caring for new patients. Seeking new ways to care for patients and new pathways to knowledge. A physician was responsible for one's own life-long learning as set by the state and in conversation with one's peers, which included co-workers/team's/institution's needs and a myriad of other considerations.

Having the ABMS interfere makes matters much worse as there meddling and money schemes are increasingly bizarre and complex with the nightmarish demands getting more exhasperating and impossible at every stage of their power excursions with high finance and political intrigue.

This whole process of certification needs to be clarified by physicians who must take a clear stand and let the ABMS know what that is. My stand is that the whole certification process needs to be simplified back to the place we were before MOC was invented as a scheme for revenue capture and enhancement.

What we see the ABMS and the member boards doing is tantamount to fraud of the most sophisticated and consciously malicious kind. They are not focused on what they should be doing, which is certifications for life. The fraud and covering over for the fraud has to end. It has to stop now.

I do not know of a single objective thinking, non-conflicted physician that does not want the mandatory MOC scamming to stop immediately as the AMA HOD resolved. The hole the ABMS keeps digging for themselves just gets deeper every day. Soon there will be only collapsing walls and suffocation under the massive weight of their corporate conflicts, political intrigue, financial and educational fraud.

They used to call it graft and the feds came in to take care of such criminals and schemers.

"ABIM Certification Guide

ABIM Board Certification demonstrates that physicians have met rigorous standards through intensive study, self-assessment and evaluation. Additionally, certification encompasses the six general competencies established by the Accreditation Council for Graduate Medical Education (ACGME) and sets the stage for continual professional development through values centered on lifelong learning. In order to be certified, a physician must:

Complete the requisite predoctoral medical education
Meet the training requirements
Meet the licensure requirements and procedural requirements
Pass a certification examination"

Information on becoming ABIM Board Certified:
https://www.abim.org/certification/default.aspx

A wee-bit more about fraud and conspiracy to commit fraud at the ABIM said...

ABIM potpourri of hypocrisy and fraud

Puzzling "facts" about ABIM's Hospitalist Certification Tracks(s) and their most conspicuous former Board Member Robert M. Wachter (Christine Cassel's right hand man)

First fact is that the "father of the hospitalist movement" Robert M Wacther is not board certified in the ABIM's Hospitalist specialty. Why is that? Is he not sure he could pass the test? Or is it because he cannot take it for free? Does the father not care about his "baby". Where is the ABIM's professional approach of leading by example? I'm afraid the list is too long here to outline all of the ABIM's potpourri of hypocrisy and fraud.

Wachter was the ABIM's cheif "go-to-guy" on the BOD roughly during the same tenure as Christine Cassel and well into his protege's tenure, that is to say, Dr. Baron's presidency. Bob found Rich in a nationwide search. Duh?

Bob Wachter was also the chief go-to-man for things like purchasing a luxury condo with town car and chauffeur with the ABIM Foundation's "cleaned up" money. You remember the "big pinata" paid for from docs overpriced fees transferred to the "big piggy bank". That is also known as the big "War Chest". And boy was that term right on.

Bob approved of the "bird nest" luxury palace for Christine Cassel and her (rich fly first-class for free hubby) to stay at during her/their infrequent visits to Philadelphia and the ABIM's offices where she made nearly 10 million dollars in cash benefits. Cassel did all this "ABIM work" while sucking up to the healthcare industry for many millions more in cash and stock. Some say that the condo was also a love nest for board members and such. You can ask Bob about that as he kept a complete list of all occupants including himself and his girl.

I believe there is a tax category for that kind of tit for tat.

Maybe Bob Wachter could release the complete list and tax references at some point when he gets a chance or just a few details from his memory. Maybe Dr. Baron or Chris Cassel could add a few more names of those who utilized "Dickey's Dacha". Or was it the "Cassel Gate break-in headquarters"? I'm sure that Benjamin Mannes, the ABIM's felon investigator has more than a few thumb drives with a great deal of data he could supply to the DoJ. Lynn Langdon, the former COO, an even better source.

Passing the fraudulent buck on to investors said...

Conflicts of interest and cheating?

"Nothing wrong with that", says Bob Wachter. He believes in doing the same thing himself, especially after Bob (IPC fraud case) and Chuck Denham (NQF/ChloraPrep fraud case) were caught in "safety chairmen" scandals. Nothing like doubling down on the verbal support of egregious conflicts of interest when you are involved in the same kick-back programs too.

There is nothing like getting paid simultaneously with state and federal money also. AHRQ and UCSF.

Did you know that Wachter was audited by the IRS, according to a twitter posting and photo of the IRS packet. The date of the tweet was during the period the Feds announced the IPC investigation. The DoJ was not pursuing individuals only the company unfortunately and was not connecting the dots as they should have with the players involved. This unwelcome auditing request was tweeted by a New York Times best selling author and Times healthcare reporter. Fresh out of the postal box. That's real-time reporting.

Hospitalist movement and ABIM's new certification

Bob Wachter was a critically involved component in the new Hospitalist certification(s) for the ABIM internal medicine diplomates and candidates to follow up on.

Another lucrative test and other expensive MOC test in the pipeline? How about those specialist hospitalist tests that are here now or coming?

A new legit specialty all meant more money for the ABIM and more money for Bob Wachter, IPC, Adam Singer, and UCSF who all had stakes in the popular hospitalist movement. Of course, it all reeked of scam and deception with the contemporaneous DoJ False Claims/billing fraud investigation of IPC the Hospitalist Company. Wachter was a highly compensated Safety Chairman and consultant for IPC The Hospitalist Company.


SDLeonard said...

The American Board of Surgery just announced a complete revamping of their MOC policy with this New Direction for Continuous Certification

http://www.absurgery.org/default.jsp?news_mocchange0717

The fine print remains to be seen, but in a nutshell they extended from three years to five the licensure/CME/practice information updates, and are offering documented CME alternatives to the 10-year secure recertification exam. It would appear to be everything so many of us have hoped for.

The outcry from Surgery diplomates and the action of legislatures such as Texas' obviously had a role in this, but we all owe Wes Fisher a debt of gratitude for relentlessly shining a spotlight on the corrupt, tyrannical, arrogant, utterly wrongheaded behavior of the ABIM in particular, but really all the ABMS boards.

I hope the other boards fall into line!

DrWes said...

SDLeonard -

Thanks for the kind words, but I would be very cautious before feeling elated over the Am Board of Surgery's new MOC pathway. Several points: (1) MOC has never been independently shown to improve patient safety or quality over doctors with lifetime certification. Does MOC assess a surgeon's dexterity or operating room ingenuity, or merely test their ability to memorize material? I would argue computer tests are hardly able to capture a physician's operating room's skills, experience, and is just a one-size-fits-all utopian dream of competency by the Am Board of Surgery.

(2) MOC is increasingly tied to a physician's ability to practice his or her trade (via hospital credentials or ability to receive insurance payments) without any evidence of its validity - hence, it amounts to regulatory capture - you have to "pay to play" with this scheme. Should an unaccountable entity like ABSurgery have such authority over your ability to practice medicine? What do they really know about each surgeon's capabilities?

(3) What does this program cost? Note that the cost of the program appears nowhere in their promotion or FAQs that accompany their marketing materials and press releases. Am Board of Surgery, like the ABIM, is stockpiling retirement assets but is running out of operational monies because of their hefty administrative salaries. In my review of MOC's history, it was not created because doctors were incompetent and unwilling to learn, it was created to generate revenue for the ABMS member boards and their cronies.

Until the financial shenanigans and conflicts of interest of MOC are fully understood, I would be reticent to hop on any new permutation of the MOC brand, because (in my opinion) the entire MOC enterprise is just about the vast revenues it creates for the elite educators that rarely see patients.

SDLeonard said...

Wes,

I agree with everything you say. There is no evidence that any of the recertification/MOC process has ever ensured better care for anyone by any physician. I would strongly support going back to the way it was until two years before I was board eligible -- finish an approved residency, take the boards, and you're certified for life, and trusted to stay current by any appropriate means and subject to local peer review. I believe the ABS board members are less venal and less positioned to get rich from MOC then the ABIM board, which perhaps is why they were more amenable to pressure from us peasants when we began waving pitchforks.

I guess I was just feeling selfishly glad that it appears the MOC process for surgeons will henceforth be less burdensome, and hopefully less expensive. At 70 years old, I've certified once and recertified three times, and was not going to take the exam again in 2019. I'm working only part time doing minor, outpatient surgery, and nothing I do requires that I maintain certification. But if it's easier, and can be accomplished with CME that I would likely do anyway, I'll continue to play the game.


I'll continue to support any organizization, AAPS, Practicing Physicians of America, whoever, that pushes for more sweeping reform. But I'm also relieved that it appears to have gotten significantly better for surgeons. I hope it does for internists and cardiologists, too.

Anonymous said...

Are donations to PPA tax-deductible?

DrWes said...

Anonymous 09:34AM -

Sorry I did not include this info in the above post. Donations to PPA, Inc (a DE-based C-corp with home office in TX) are not deductible as a "non-profit charity" expense (i.e., we elected NOT to organize as a 501(c)(3) to facilitate our ability to lobby on behalf of practicing physicians) but may be deductible as a "professional society membership" expense. Please consult your accountant/tax advisor.

Anonymous said...

The ABMS Wolters Kluwer UpToDate connections

What kind of company is Wolters Kluwer? Read below for a brief description.

"Earn ABIM MOC points with UpToDate - Wolters Kluwer
American Board of Internal Medicine (ABIM)-certified physicians can now use CME credits earned through UpToDate to fulfill ABIM Maintenance of Certification (MOC) point requirements.

Benefits of UpToDate CME for ABIM MOC:

Earn ABIM MOC points -eligible CME at the point-of-care
Increase opportunity for professional development
Save time, money and resources
UpToDate CME for ABIM MOC is available to registered UpToDate Anywhere users and individual subscribers. It’s integrated with the same streamlined online platform that UpToDate physicians use to accrue and redeem CME.

To learn more, watch a quick video overview of the submission process"

Wolters Kluwer, 230 Third Avenue, Waltham, MA 02451
Copyright © Wolters Kluwer | All Rights Reserved

Wolters Kluwer
https://go.wolterskluwer.com/US-MOC.html

"About Wolters Kluwer

Wolters Kluwer N.V. (AEX: WKL) is a global leader in information services and solutions for professionals in the health, tax and accounting, finance, risk and compliance, and legal sectors. We help our customers make critical decisions every day by providing expert solutions that combine deep domain knowledge with specialized technology and services.

Wolters Kluwer reported 2016 annual revenues of €4.3 billion. The company, headquartered in Alphen aan den Rijn, the Netherlands, serves customers in over 180 countries, maintains operations in over 40 countries, and employs 19,000 people worldwide.

Wolters Kluwer shares are listed on Euronext Amsterdam (WKL) and are included in the AEX and Euronext 100 indices. Wolters Kluwer has a sponsored Level 1 American Depositary Receipt program. The ADRs are traded on the over-the-counter market in the U.S. (WTKWY)."


The bulk of the shareholders for Wolters Kluwer are in the UK. But who are he investors and what do they want? Pearson and Pearson Vue are based in the UK and the financial backers of these companies want more than modest growth. That model does not fit in with a certification testing company and its umbreall organization. One has to understand the many ways a financial/educational relationship with the ABMS there are and how it compromises healthcare and honest business practices.

We can see the same greed at work with the creation of MOC. We have another example of just how ambitious for money the profligate elites within the ABMS and their accomplices are.
The conflicts of interest are real. They are here now and they are affecting the ability of physicians to do their jobs treating patients.

MOC is a core issue in helping create this fraud and corruption. MOC is the Trojan Horse for special interests. It has beguiled and threatened us for too many years. We understand the harm it does. Mandatory MOC must be stopped immediately.

Amelioration does not go far enough. Appeasing statements and cosmetic alteration only protracts the pain and agony for millions of patients and hundreds of thousands of physicians. Mandatory MOC needs to end today.

Global MOC BLOCK said...

Pinnacles of Corporate Power - MOC around the clock with UHC-I and JC-I

United Healthcare International with the Joint Commission International, ACGME-International, ABMS-International, and AAMC GHLO - footholds around the globe. https://www.aamc.org/services/ghlo/institutions/

Let's not forget to mention the chapters of the ACP selling memberships and MKSAP products internationally.
https://www.acponline.org/about-acp/chapters-regions/latin-america/brazil-chapter/news-meetings

UHC Global: Does this combination of hospital and insurer spell trouble for physicians and patients? Look at the huge expansion of UHC in Brazil. And around the globe! The Joint Commission Interational has a strong presence in Brazil and in many other countries. ACGME-I and the ABMS are typically not far behind when they can manage their way in.

UHC in Brazil growing its business
http://www.startribune.com/unitedhealth-is-growing-its-business-in-brazil/360616571/

UHC buys 90% of Amil in 2012 (large Brazillian healthcare provider/payer)
https://www.wsj.com/articles/SB10000872396390444897304578044390351511894

JCI Joint Commission International
http://www.jointcommissioninternational.org/about-jci/jci-accredited-organizations/?c=Brazil&F_All=y

ACP Chapter in Brazil
https://www.acponline.org/about-acp/chapters-regions/latin-america/brazil-chapter/news-meetings

The ACGME and ABMS have already taken Singapore and created a hybrid ACGME/ABMS accreditation and GME program with ABMS certification there.

United Healthcare International has teamed up in the Middle East with Dubai along with the JC-I, ABMS and ACGME
http://insurance-technology.tmcnet.com/topics/insurance-technology/articles/276587-united-healthcare-international-forms-partnership-offer-insurance-coverage.htm

UHC "Within our US network are 83% of all available hospital beds and two out of three available doctors and healthcare professionals."
http://www.uhcglobal.com/global-markets/uk-and-other-markets/

Pearson: no more rabbits out of a hat said...

Pearson sells it last family jewels to prop up education business - business margins down

Pearson and its stock have been under pressure from core educational business declines and fleeing institutional investors as earnings keep missing expectations and shares tumulting, sliding 30% this January. Shares dropped and skidded on the exchange floor tarmac with the announcement of a substantial dividend cut as core educational business flounders.

Today shares stumbled another 6% with the announcement Pearson is selling a 22% stake in Penguin Random House to it majority owner Bertelsmann for just under 1 billion dollars. Pearson will retain 25% and gets divvies on the dividend rights on the shares it sold with the expectation that Bertelsmann (with a 75% stake) can now double the leverage on its Penguin holdings to pay Pearson.

Rather precarious move to be on the edge of a cliff and expect your partner to go out on a limb with you holding a penguin egg between their legs waiting for your profitability to return.

What's this mean for certification and MOC testing at Pearson centers? MOC has been a key growth driver from dramatic increases in ABMS MOC and international certification fees paid to Pearson over the past decade as physicians and other professionals are forced to do MOC. so the pressure will be on from the UK company for their ABMS agents and other testing program elites to lock in MOC. They will try to increase revenues for MOC and other testing with a price increase at some point in the picture to keep pace wit inflation, but primarily for capital outlays in online proctored platforms, tech personnel and proctors.

It appears Pearson has purchased an online Proctoring platform and is utilizing it already in online proctored settings with certifications and so on. But there is a catch. You system really has to pass a lot of hurdles at home. Here is a sample of what to expect as the ABIM goes to two year online MOC tests as an option to the ten-year. Either way it looks like Pearson will get the nod and the MOC money. Read the technical requirements and upgrades you system will need for the online testing courtesy of Microsoft. Mine system was knocked out of the qualifying hurdles after the first two paragraphs. Bottom line, physicians and whoever else does the online at home/in office proctored test will have to dish out a lot of money to the tech industry from operating system to purchase of a whole new system. LOL!

https://www.microsoft.com/en-us/learning/online-proctored-exams.aspx

Further reading on the marketing strategies and how it fits with the MOC scam and Pearson's/ABMS dire need for cash flow to bail out their sinking ships.

http://www.learninglight.com/remote-proctoring-invigilation-market/

Anonymous said...

Pearson VUE expands exam delivery with ProctorCam acquisition
Minneapolis, MN, June 3, 2015 – Today, global computer-based testing leader Pearson VUE announced the acquisition of ProctorCam, a leading online proctored testing platform. The integration of an online proctoring solution will enable Pearson VUE clients to extend the reach of their testing programs to remote areas and expand the breadth of their programs.

https://home.pearsonvue.com/About-Pearson-VUE/Press-Room/2015/Pearson-VUE-expands-exam-delivery-with-ProctorCam.aspx

Doubly Felonious Presentations at the ATP Conference 2015 said...

The 2015 ATP conference on tech innovation involving testing and security features the double felon Ariel B. Mannes, aka Benjamin Mannes, the undisclosed "director of investigations" for the ABIM pushing the next generation of MOC testing utilizing his partners online proctored testing platform.

Mr. Mannes is moonlighting with total disregard for ABIM's ethics policies and conflicts of interest "rules" selling Kryterion online proctoring services and products along with his conflicted partners at Kryterion's sister organization, the testing-security/online spy company Caveon. Both companies were founded by David Foster.

Mannes claimed to be a testing security manager at Caveon while he worked full time for the ABIM/ABMS as "director of investigations". Another undisclosed ABIM/Ballard Spahr contractor was with him. They really wanted to keep all these conflicts of interest in the background, but it is too late. They are exposed and so is their morality and crimes against people to line their pockets along with the ABIM/ABMs executives and healthcare testing industry.

Association of Test Publishers ATP Innovation 2015

This is what the felon Mannes and his legal partner Marc J Weinstein--formerly with Ballard Spahr--the same man who clandestinely violated physicians constitutional rights and privacy working closely behind the scenes with ABIM's Mannes in sanctioning and suing many physicians for attending a non-ACP board course in New Jersey or New York. Weinstein claims to have helped procure the ex-parte writ to break in to Arora and Katchedourians homes to seize personal property and countless files on physicians to persecute them.

Weinstein, Jacobs, Cassel, Holmboe, Baron, Mannes and several others were intrumental bringing about the demise of competing board courses in a lucrative NE markets.

Now in 2015 we find Mannes and Weinstein selling testing security and online proctoring products together at ATP Innovations 2015 hoping that the ABMS medical boards will use these products. This is a new low even for the ABIM as we see in other conferences these two partners are joined by other complicitors from the ABIM executive staff and even at other conferences related to other ABMS specialty boards.

"One Partner, One Platform For All Your Certi cation Needs.
Kryterion’s Webassessor™ is an certi cation management platform that enables you to:
Choose from our multiple delivery methods:
Self-publish test forms at no additional cost, anytime
Administer exams and reports instantly
Custom branding consistent messaging
Global testing center network
Unproctored delivery
Client proctored delivery
Online proctored delivery
Paper and pencil delivery
A FULL-SERVICE TEST DEVELOPMENT AND GLOBAL DELIVERY COMPANY © 2014 All Rights Reserved.
1.800.580.4032 Sales@KryterionOnline.com www.KryterionOnline.com"

Here are some of the joint presentations to prove the points above:

"Learning from Disruption –
How Industries are Rapidly Evolving
and the Trends They are Setting
Presenters:
*William Dorman Kryterion, Inc.
*David Meissner Kryterion, Inc.

followed by

Security at the Forefront
Presenters:
Jennifer Semko Baker & McKenzie
*Jennifer McGlashon Kryterion, Inc.
*Roddy Meade Prometric
Neal Kingston University of Kansas
*A. Benjamin Mannes American Board of Internal Medicine
Bob Whorton NCEES

Exam Security Incident
Response Workshop
Presenters:
Marc Weinstein Dilworth Paxson LLP
*A. Benjamin Mannes American Board of Internal Medicine
Aimee Hobby Rhodes CFA Institute
*John Fremer Caveon Test Security

Working a Case: Best Practices in
Conducting Exam Integrity Investigations
Presenters:
*A. Benjamin Mannes American Board of Internal Medicine (ABIM)
*Marc Weinstein Dilworth Paxson LLP

Using Secure Item
and Test Designs
to Protect Your Tests
Presenters:
*Jamie Mulkey Caveon Test Security
*David Foster Caveon Test Security
*Steve Ferrara Pearson School

8 reasons to be suspicious of ABMS/Pearson/Caveon/Kryterion said...

Looking in the rear-view mirror at the MOC scam, the story reveals a pattern of fraudulent business practices

One of the reasons large ed/testing corporations like Pearson are doing so poorly now is people recognize the story of fraud behind the testing scam they put forth with "common core" and "MOC". Wall Street and Main Street take a look back with 20/20 vision in the rear view mirror and reject them.

After raking in billions early on in their karmic misadventure we can clearly see how Pearson invested in, placed their bet on, and lobbied heavily for their very own "common core" testing. Now the company is bleeding cash spending way beyond their means. Just like the ABIM. They bet on MOC and invested heavily into it . Lobbied for regulatory capture. Now they too are bleeding at the gills. It is another sterling example of the tail wagging the dog.

The US is Pearson's largest testing/educational market. They poured a lot of money into influencing the outcome of their investment in OBE and common core. Now the parents and children are rebelling. The teachers have had it, even martyred themselves by going to prison rather than admit guilt in a sham trial where the wrong folks were on trial. Now the states are passing protective legislation. Choosing their own path. Not that of the corporation with its profits. The federal government has eased up.

The ABMS finds itself in a similar fight for its revenue stream, one they lobbied to capture in the ACA. Now physicians and nearly two-dozen states are in revolution rejecting the MOC scam, passing protective statutory language.

Oregon has one part of that language right in the anti-MOC legislation, where they cover their bases, not knowing if the ABMS or AOA will even be a going concern in the future. Oregon includes the phrase "or any succeeding organization" trying to mandate MOC. We don't know if they will survive their own deceit, lies and fraudulent actions. I recognize that I will never be confident in trusting the ABMS or any of its member boards. I consider it the scam of the century perpetrated masterfully (for a while) against patients and physicians.
Self-dealing professional medical politicians wearing respectable cloaks, hiding behind those phony opaque masks, and talking out of both sides of the mouth, makes for the worse kind of criminal in my book.

They clandestinely plundered the organizations and used them for political and corporate purposes that they were never intended for. In the pocket of special interests back and forth through the public and private revolving doors.

https://www.wsj.com/articles/pearsons-bet-on-common-core-fails-to-pay-off-1479830401

Another big reason is that Pearson encouraged a big brother Orwellian police state mentality along with Caveon and other such unvetted third party spies, forensic data experts, and inquisitioners who come in at the slightest hint of testing anomalies with their standard contract.
https://www.forbes.com/sites/maureensullivan/2015/03/18/when-does-parcc-test-security-turn-into-spying-on-kids/#1cd1a5693146

Dot said...

Greed has destroyed the ABMS, just as it has perhaps destroyed Pearson.

Anonymous said...

After all ABIM's outrageous displays of deception, self dealing, over-reach, and stepping outside the law, how dare they feign to measure or test anything except how to conspire and scheme.

Medical Deep State said...

Looking more closely at the gold standard

Who invented MOC and why? What is the real history behind certifications and why did this "movement" arise during the 1930's? Was it political, financial, or both? Did the appearance of specialty certifications have anything to do with the instituting of social security in 1937 and the growth of the health insurance industry and HMOs? Where are the factual histories? The critical analyses?

How did certification and MOC eventually become rigid mandates tied to employment and insurance payments, when the ABMS assured everyone and still states in their written material that all testing has always been and still is voluntary? How can such fraudulent statements be allowed to remain uninvestigated by the FTC? It is bold consumer fraud. The DoJ should investigate along with the OIG of the HHS to get to the bottom of "who conspired with whom" to create the conditions for this fraud and larceny. Those responsible for creating and sustaining this fraud must be held accountable.

If certification was ever the "gold standard" for "medical competency", as the ABMS claims, it was ephemeral at best. From the very first 8-question essay test offered by the ABIM in the late 1930's--which all 27 candidates passed--to the marathon multiple-choice all-day extravaganzas in "medical esoterica" today--where 27% might not pass--times have really changed. Esoteric credit default swaps and naked shorts trading gold ETFs have replaced honest investing, just as uniquely worded copyrighted test questions and MOC business have replaced honest exchange of medical science and academic testing. It has all put a negative slant to lifelong learning. There is fraud, capital gains, offshoring of profits and less focus on medicine among the executives. Mergers and ABMS Solutions scamming with physicians data money down in Atlanta, real estate purchases, side deals with private equity that nobody has even suspected. Something has to give.

I'm afraid that bold claim that ABMS certification is "the gold standard" has been challenged and downgraded today, maybe even relegated to realm of myth. Direct and instantaneous access to relevant and specific medical knowledge has done its part to destroy that decades-old claim. Access to knowledge has put authoritarian governance and elitist educational theories into question. The "we are listening" elite are in a fight to keep their lucrative executive compensation packages and "golden parachutes". They are "promising the world" to hold on to "cush" jobs mostly serving as corporate agents for the healthcare industry. This should be exposed by a thorough investigation of their own personal financial dealings and that of their organizations and the related ones.

Anonymous said...

Getting back to the gold standard (of lifetime certification)

The ABMS has already done the bulk of the work to dislodge themselves from their aloof authoritarian positions on their own. They have done this with almost absolute negligence pure hubris, and more than a few lies. They have pushed themselves off their own monopolistic kleptocratic thrones. There is nothing like hard-core corruption, stonewalling when asked direct pertinent questions, strong-arming, violations of one's dignity, privacy and constitutional rights to turn everyone off.

And there is always that infamous corporate no-no. Financial obfuscation and IRS misstatements. That will erode and possibly destroy trust in a company forever. The conflicts of interest between the executives and the healthcare industry and their bold-faced denials of any wrongdoing have become a farce. One spectacle after another.

We don't need the "Inquirer" when we have the ABIM/ABMS with their scandals, press releases and Twitter feeds.

Stealing $70,000,000.00 in excess certification fees and hiding the money secretly in a bank account "loosely registered" as a "foundation" should have been the straw that broke the camel's back! But it was a clandestine event. The CFO and CEO (who would not sign his name to it) was long gone. By the time anybody thought to examine the propriety and legality of it, the documents were "routinely destroyed" shredded and buried in a Philly landfill. And the new signatory of the "new foundation" made sure of that. (CC)

And when they conceived MOC and shoved that fool's gold down our throats, that was the last straw. That onerous expensive and useless Ponzi-scheme called MOC, once exposed for the financial scam it was, brought physicians and the public to the boiling point. MOC and the totality of carefully propagated lies has brought everyone involved to the breaking point.

How do you fight a "medical deep state", or an "oligarchy of the elite", without organizing an creating a force strong enough to oppose it? It takes time and money and experienced people to fight. The Practicing Physicians of America has already proven itself with its grassroots fight to be effective. Before PPA was formed, it appears to me, individuals within it helped get anti-MOC legislation into the state assemblies and passed in several. Many intelligent and brave people came forward to present facts and problems with MOC to their representatives.

There needs to be more of this candid open opposition to the financial scheming and intellectual oppression of the ABMS.

I don't believe one organization is enough, but this is a good seed starter for "we the people" to grow in organizations like the PPA, NBPAS and others. The AAPS has been very effective and consistent for a very long time in speaking out and questioning, looking out for the public's interest. All this should spark others to come out of the woodwork and fight for something worth fighting for--something good, something real, and something that is our own which represents patients and physicians.

Instead of letting the banks or investment houses (one and the same today) work your money mostly on their own behalf without much interest, put some of your money into the fight and support those organizations and people who are fighting and working for you. Most of these people are working for free. It is not easy or cheap to fight the insurance and hospital lobby. Support them and support yourself.

ABMS Pearson PLC Update said...

When Dr. Wes wrote about Pearson PLC in 2014, 75% of their lobbyists had previously held government positions. 6/8.

The most recent statistics with "opensecrets" reveal that now 100% of Pearson's lobbyists have held prior positions with the government. 7/7

Among Pearson's advisors/board of directors are many pharma executives, defense contractors, and private equity advisor(s) (Blackstone Group). I find this array troubling for its implications. For example, Blackstone Group acquired TeamHealth at half its previous year's offer price. Why? Blackstone/Biomed/GlaxoSmithKline have transacted a nearly $350 million sale for Genome outside of DC where GSK will have its global vaccine facility. Blackstone has been increasing its healthcare investments. There have been undisclosed partnerships/advisorships/governement involvement in the past, such as Christine Cassel had and several others in the ABMS revolving door. Under the circumstances the entirety of the ABMS and member boards should be placed under scrutiny. All employees, staff and associations should be disclosed.

Type in under organizations Pearson PLC
https://www.opensecrets.org/orgs/summary.php?id=D000068157

Nadia Gomez said...

Very well written. I congratulate you on your investigative efforts. It seems like a lot of work hours & extreme dedication. I am an OB/GYN and our board ABOG also requires MOC annually after our written and oral boards for physicians certified after 1986.
The written exam was costly as well as the oral boards, and yes, if you fail any of them- other than paying again, the time you spend on them is even more costly! Although I agree that it is a money driven practice and perhaps corruption, physicians should continue some sort of life long learning to remain uptodate. Perhaps lowering the costs or making it free. Unsure what the solution is but we must need a system in place to have doctors accountable for their continued learning.

sdlmd said...

Nadia,

Doctors are and have always been accountable for their continued learning. All state medical boards require some documentation of continuing education, and of course institutional committees monitor the quality of doctors' care. There is no evidence that supports the notion that the enormous expansion of documentation and testing by the ABMS boards over the past 30 years has had any positive effect on the care patients receive from board certified physicians.

The boards' initial purpose was to induce doctors to pursue approved training in the specialties they chose to practice, and they performed that function very well. They should have left it at that.

Madhu said...

"The boards' initial purpose was to induce doctors to pursue approved training in the specialties they chose to practice, and they performed that function very well. They should have left it at that."

We agree and believe states do a credible job monitoring and holding physicians accountable for keeping up with CME and in many other ways!

Anonymous said...

I really have a problem with how much ABOG charges for everything. You'd think that they'd be happy with certification and the huge costs and burden to prove competency, but no. They want the pound of flesh added on to the already onerous test tax. Have we not learned anything or learned to respect rights and our equality since the Magna Carta, US Constitution and Bill of Rights. Have we tossed all the religious teachings down the elevator shaft?

I have a great deal of debt from education and travel expenses. Certification and now MOC puts additional stress on me and my husband. My family sees MOC like another creditor sending us a bill - one I feel that I don't deserve. The MOC payment and "testing until we drop" tax is just another big scam.

The sheriff of Nottingham coming with his tax men while the real and just leadership is away or sleeping.

I'm not OBGYN, but part of ABIM loop and hoops . . . they all really should bring those fees down! I thought ABIM was the worst, but after looking ABOG, the jury is out. They are bad to worse. That's is not complimentary to ABIM or ABMS, when you look at ABOG's obfuscated financials.

After looking at the financials (990 tax filings for ABOG, Inc. I discovered that the bulk of the revenues were not in the actual certification tests, but in "application fees" and not in the exam, test experience or payments to Pearson Vue.

There was no transparent breakdown of revenues. Very concerning. It makes me suspicious and there was no mention of MOC revenue at all. At least the ABIM does this, so we can see how bad the damage really is. That is shady accounting in my view the way they make this opaque in their accounting.

In 2015 ABOG made $13,753,830.00 in "application fees".
They made $1,919,795.00 in examination fees.
Plus $467,995.00 in diplomate and fellowship fees.

In 2015 there were 1261 ABOG certifications issue according to ABMS. That's an average cost, which can be easily calculated to be $1523 in revenue generated per candidate. But look at all the actual testing and application fees ABOG charges. It is mind boggling and debilitating to look at. Just look at all the non-essential billing.

If ABIM was obfuscating with deferred accounting and debt, ABOG is also, and they appear to be doing a good job of covering up where all the money is coming from and where it is going. Unless you get out the spade and dig in the rows where they tap down financial details at the end of the rows or bury the movement of money altogether to make it appear elsewhere, like real estate.

Anonymous said...

After looking at the following fee schedule, you can easily see what I mean about how they can bring those charges down.

QUALIFYING EXAMINATION FEES
September 1, 2016 to October 14, 2016 5 pm CDT $1500
October 15, 2016 to November 18, 2016 5 pm CST $1500 + $360 late fee= $1860
November 19, 2016 to December 16, 2016 5 pm CST $1500 + $840 late fee= $2340

CERTIFYING TEST FEES: APPLICATION FEES
February 1, 2017 to March 15, 2017, 5 pm CDT $840
March 16, 2017 to April 15, 2017, 5 pm CDT $840 + $360 late fee = $1200
April 16, 2017 to April 28, 2017, 5 pm CDT $840 + $840 late fee = $1680

CERTIFYING TEST FEES: EXAMINATION FEES
July, 2017 to August 1, 2017, 5 pm CDT $1025
August 2, 2017 to August 15, 2017, 5 pm CDT $1025 + $395 late fee = $1420

MOC Fees: Years 1-5 and 6 not taking MOC Examination
ACOG Fellows and Junior Fellows (25 CME credits for Part II) $265
Non-ACOG Fellows (25 CME credits for Part II) $265 + $390 = $655

MOC Fees: Year 6 taking MOC Examination
ACOG Fellows and Junior Fellows (25 CME credits for Part II) $265 + $175 = $440
Non-ACOG Fellows (25 CME credits for Part II) $265 + $390 + $175 = $830

SUBSPECIALTY WRITTEN CERTIFICATION EXAMINATION FEES
September 1, 2016 to October 14, 2016 5 pm CDT $1945
October 15, 2016 to November 18, 2016 5 pm CST $1945 + $320 late fee= $2265
November 19, 2016 to December 16, 2016 5 pm CST $1845 + $815 late fee= $2760

RE-ENTRY EXAMINATION FEES
$765.00 - This is a non-refundable combined examination ($500) and 2017 MOC fee ($265). The fee must be paid at the time of application. Applications will be processed when payment and all required documents are received.
MOC Fees: Year 6 taking MOC Examination
ACOG Fellows and Junior Fellows (25 CME credits for Part II) $265 + $175 = $440
Non-ACOG Fellows (25 CME credits for Part II) $265 + $390 + $175 = $830

https://www.abog.org/new/n_fees_deadline.aspx

Something seems amiss in their accounting when you look at the numbers and published facts.

I just don't get how application fees can amount to six times the actual examination fees!

Why should anyone be forced to pay for an exam qualification fee?

And why the steep application fees? The CEO makes nearly 700,000 for a working in a tax free state! First class travel.

All these prices seem totally over the top and uncalled for! And so do the anti-trust violations associated with MOC. And add in the preferential pricing. ACOG and non-ACOG Fellows have different pricing. Twice as much. Ouch! Price gouging. And MOC every 6 years.

Anonymous said...

How much does the ABOG oral test cost? Can someone tell me that? And why do I see some physicians' certifications expiring in three years and not six.

What I see so far really gets me angry. How can this be tolerated. Wes will probably look at their financials and discover all the hidden organizations that pass money back and forth to each other, all at the same Texas address. Only one - the American Board of OBGYN Educational Foundation. I could not find it listed properly by name in the tax forms. So it makes it hard to study their financial statement, if you can't find it. The Foundation is the only related entity that is properly identified on the tax returns in schedule R. They should include all of the related and unrelated or disregarded organizations. Even ABMS does this.

These unlisted entities toss millions and hundreds of thousands back and forth to each other. The "Foundation" appears to be holding millions of dollars in real estate assets, while the parent company claims only a fraction of the real estate assets. These people have plenty of investments in stock and "other investments", probably offshore as well, since they don't specify. "Mutual funds" does not tell us anything.

Can somebody get a hold of their investment holdings and tell us what they are or post the information. Thanks to the women who posted so politely, but I have to say ABOG is dishing out a lot of financial pain causing people to tighten their belts, while ABOG is getting fat.

Look at the fraud for yourselves and tell me if you can find the "related organizations" listed with their finances.

ABOG put 550,000 into one of these related (but unlisted) organization as a "grant". The org "Exxcellence Foundation" is in their own offices. They gave money to themselves. See if you can find the tax filings! And see if you can find the tax forms on their "International" organization.

It will take you more time than anyone has to see the whole of this organization and how it operates and who all the operators are. How could the PPA even make a dent in understanding all the complexities and financial dealings of opaque organizations like ABOG.

And try to figure out who the quarter of a million grant was from marked "anonymous" that paid for private educational sessions with anonymous specialists. Who was invited or informed of such special opportunities that appears to have been limited to 24 lucky physicians. This kind of secret activity with funds and "education" makes me uncomfortable.

ABOG also gave 1,600,000 to the Foundation and the Foundation gave them back 4,100,000. This kind of fraud with hard working physicians money just can't continue. It just makes one sick.

Here's a starting point to see how far you can get in figuring out the complete holdings of the four or more organizations that comprise ABOG, Incorporated.
https://projects.propublica.org/nonprofits/organizations/340787715

Anon said...

Inspiring essay, Wes!

I agree with SDLMD and Madhu! States are vigilant and hold us accountable with CME and more. Feds are monitoring us through CMS, DEA, and NPI. FSMB has continuous monitoring looking for blemishes, even updating profile data. AMA does this as well and more. We have continuous monitoring by background check/consumer reporting companies at work taking more $. Every three months payers want you to attest to what was true just a few days ago.

Physicians fear of lawsuits, insurers, hospitals, online performance scores. Cerner and Epic monitors and flags you. MACRA, meaninful clicks, QM & QI. The pharmacies send automated memoranda questioning your use of a generic drug, not just expensive ones. Questioning you over patient supplies. Administrators come round for meetings.

There are way too many money-hungry mouths making a mess of the pie biting into your work from every direction. Not just the money/quality assurance guys. Too many greedy mouths spoil the cake, just as too many cooks spoil a broth.

Ultimately, there's no proof of improved outcomes from doing MOC compared to lifetime certified docs who don't participate in MOC. Baron of the ABIM says there is "no robust evidence" that MOC improves outcomes. Christine Cassel, the former lead dog mushing ahead without proof pulling the MOC money-sled, said all along that there is no science to back MOC's mandate.

Anonymous said...

FYI ABOG changed the names to their testing process, which makes everything confusing unless you are keeping up with their site reading their bulletin and are unlucky enough to have to pay their annual MOC fees and doing the frequent busywork "quizzes" and so on.

The "basic qualifying examination" is the written exam. You become and active candidate once you pass that test at a Pearson testing center. $1500

The oral examination has many qualifying conditions connected to license, active practice and hospital relationship, etc., first. The test is very grueling and they try to corner you with oblique questions and are extremely snitty about your case presentation for their review has to be done in Dallas is now called the "basic certifying examination". If they don't like your case presentations you will have to pay again and try the next year. If they like your CP but do not like your answers you will have to study and do it again. Passing this takes a year of prep and study. If you pass you are then a diplomate.
Pass rates are much lower than advertised when you consider the two tests together. The oral exam has two parts and compound that with the written test that equals three times as much opportunity to fail. $840 application fee and $1025 for the test. Even though the test is in Dallas, you don't know where you are.

Sub-specialists repeat the process of a written exam (BQE) at Pearson. Then you do the oral exam (BCE) with yet another application fee and separate test fee with trip to Dallas. $1945 for the written exam only.

Caution: testing periods can cause extreme stress and have been know to lead to extreme fatigue, lack of sleep, nervous disorders, marital problems, divorce, disease, suicide, and other major negative side effects. MOC has prolonged this into continuous stress syndrome CSS and turns medicine into a vicious cycle of payment and misery.

One person in the past took the test over 25 times before they passed. It became a fixation and this ruined that person's life. Today you have stricter guidelines. Three times for the oral is the limit. You fail the oral boards you must do TEP or back to square one with the basic qualifying exam.