Despite Known Conflicts, ACC/HRS Endorse MOC

The Heart Rhythm Society (HRS) and American College of Cardiology (ACC), two organizations who stand to gain handsomely from their NCDR procedural registries, published a carefully-worded combined statement on "Lifelong Learning Requirements for Clinical Cardiac Electrophysiology (CCEP) Specialists" in their respective journals this week.

In a glaring ommision, the publication concerned itself with how Relationships With Industry (RWI's) were handled by the authors, but failed to address the many known RWI's of the bodies that "approved" their statement, including the ACCME, ABMS and ABIM. These relationships include the known collusion of the ABIM with CECity, Inc (held by Premier, Inc, the largest hospital purchasing consortium), the Massachusetts Medical Society and its NEJM Group, the multibillion dollar Netherlands publisher and owner of UptoDate, Wolters Kluwer, PearsonVue, and the myriad of test security companies who benefit from the unproven MOC mandate.

These are not minor conflicts.  They strike to the very core of the integrity of our profession and physicians who must place the interests of our patients before all else. Setting the "rules" for lifelong learning is not required, integrity and honesty in dealing with patients is what is needed instead. Those internal principles cannot be simply articulated in the form of a published "guideline."

This blog has carefully articulated the many civil liberties violations and ethical breaches perfomed by the ABIM (all sanctioned by the ABMS and perpetuated by the AMA) for the past four years. Financial cover-ups, tax fraud, HIPAA Business Associate Agreements that are not optional, and the use of a team comprised of a felonious "Director of Investigation", ABIM staff members, and members of the ABIM legal team to obtain physician emails covertly, so they could use that information to discredit and intimidate physicians, are our reality.  Yet the ACC and HRS have decided to turn a blind eye to the corruption because it might disturb their business model.

Using hugely conflicted certifying bodies to certify a professional position statement document is a problem the ACC and HRS have chosen to ignore to their detriment and the detriment of our professional integrity.

-Wes

Thanksgiving 2017 and the Grooming of Physicians

"Fun, flexible, and refreshing way to earn your credit! Take a break from the bird and have your hand at a few."

So said the American Board of Pediatrics' (ABP) Thanksgiving 2017 tweet seen here (now deleted).

As if family time and the true meaning of Thanksgiving mean nothing to the American Board of Pediatrics (ABP). Rather, David G. Nichols, MD, the President and CEO of the ABP, must need to assure his Christmas bonus.

Boasting that "20,000 physicians enrolled in Question of the Week" (QOW), as if there was another option for pediatricians caught in the regulatory capture vice-grip of MOC®, speaks volumes about the motivation of this organization. In fact, the real world reality is that not signing up and paying for "QOW" risks a practicing pediatrician's ability to participate in insurance panels or to maintain their hospital privileges.

The Thanksgiving message from Richard Baron, MD, President and CEO of the American Board of

Internal Medicine, was equally troublesome given the reglatory capture realities of the ABIM's MOC® program, too:

"Thank you for all you do every day."

You're welcome, Rich.

Now tell us, given the spending, financial shenanigans, and legal fees incurred by the ABIM and ABIM Foundation lately, are the ABIM and ABIM Foundation insolvent as at least one accountant suggests?

Given the realities of the ABMS MOC® program that both organizations promote, placating physicians with such messages at Thanksgiving is akin to a child molester grooming his victims to earn their trust; it's about as ethically moribund as it gets.

-Wes

American Academy of Pediatrics "Sets Sail" to Track All US Children

The American Academy of Pediatrics, (aka, "Big Brother") wants to track your children. Physicians who support the program can earn MOC® credits, too:

The Academy has set sail to be the first entity to collect, store and analyze health data on all U.S. children. The board agreed to commit $583,000 in resources from the Tomorrow’s Children Endowment to begin development of a child health clinical data registry, which is expected to unfold over five years. This unprecedented initiative, called Clinical Health Information and Longitudinal Data Registry (CHILD), is the outgrowth of two strategic plan objectives:

Use data and metrics to develop and priori­tize areas of need for child health policies. Provide state-of-the-art pediatric practice information in the context of a changing industry and professional landscape. Data would be captured through electronic health records, integrated health care systems, payers and existing pediatric disease registries. Data elements would include well-child and sick visits, chronic disease diagnosis and management, specialty care, and developmental and behavioral care. The registry also would include a patient portal to allow parents and patients to input data, while alleviating complications surrounding privacy laws.

Christoph U. Lehmann, M.D., FAAP, medical director of the AAP Child Health Informatics Center, and professor of pediatrics and biomedical informatics, Department of Medicine, Vanderbilt University School of Medicine, presented project details to the board, including the following primary goals:

Create substantial improvements in child health and well-being. Accelerate advances in child health. Improve outcomes for children using data. Demonstrate the trajectory of child health through adulthood. Among the benefits of this registry, Dr. Lehmann said, are tracking childhood health and illness trends, which would help draw conclusions on a number of areas, including gaps in care, treatment options and regional variations in care. The data also will help inform the creation of AAP guidelines and policies, and provide guidance to payers.

Members could use the data to help create reports for quality improvement projects, as well as for meaningful use and Maintenance of Certification, Dr. Lehmann said.

What could possibly go wrong?

-Wes

The History of the ABIM Art Collection U.S. Physicians Have Never Seen

They were the glory days; a time when the ABIM was still respected; a time before the World Wide Web and moving diplomate testing fees from the ABIM to a secretly-created shadow "Foundation" could occur below the radar.

John A. Benson Jr., MD and Harry R Kimball, MD were the first two Presidents of the ABIM appointed after the bylaws were changed to pay officers salaries. Dr. Benson was the first President of the ABIM from 1975 through 1991 and ran the organization from his home in Portland, OR, leaving his academic and clinical practice for the administrative world of the ABIM save for one long-time physician-patient he kept while serving in that capacity.* Dr. Kimball, his all-too-willing successor from 1991 through 2003, understood the number of doctors being trained was finite and paying executives would be difficult without a new business model. It was Dr. Kimball who conceived of "maintaining" one's board certification through ABIM's Continuing Professional Development (CPD) program to keep the money flowing. But the initially voluntary program flopped as doctors saw the program for what it was: an unnecessary distraction from their busy practices. So CPD would have to become mandatory. His like-minded colleagues at the American College of Physicians (who would also financially benefit) could see to that, and soon money flowed like honey. So much, in fact, that something had to be done with all that money earned by a so-called "non-profit."

It was under Dr. Kimball's direction as ABIM's Chairman of the board from 1989-1990, the ABIM Foundation was secretly created in 1989. Multiple money transfers from the ABIM to the Foundation were made to facilitate lucrative investments with (the now-defunct) 1838 Investment Advisors. For a while, it was a win-win for both corporations. So many trades were made that ABIM paid nearly a quarter of a million dollars annually for their services.

With that money flowing to the ABIM, nearly $90,000 of artwork was purchased for their Walnut Street offices in Philadelphia in 1997 and 1998. We know this because the ABIM offices were later renovated in fiscal year 2003 as the computerized testing age came to Philadelphia. At that time, the value of that art work was disclosed on ABIM's IRS tax forms (see here, here, and here).

In total, it appears $89,874 dollars worth of some kind of art adorns ABIM office walls, thanks to ABIM diplomates. No wonder they "surprised" Dr. Kimball with a black tie event and had the first "Kimball Lecture" in honor of him in August, 2004!

But then 2005 came.

The gravy train ended when 1838 Investment Advisors' fund lost 74% if its value and mysteriously disappeared:

"The silence has been deafening," said one money management executive in the region, who declined to be named. It's as if they "fell off the face of the earth," said a pension consultant, who asked to remain unidentified. One private equity veteran, who declined to be named, said it's unusual for a firm with such a long history to simply disappear. The firm traced its lineage back to Drexel and Co., a banking and investment management firm founded by Francis Drexel in Philadelphia in 1838.

Principles from 1838 Investment Advisors were holdovers from the Drexel Burham Lambert that came under investigation for illegal activities in the junk bond market for stock manipulation. Since that gravy train collapsed, another hopeful investment was made in real estate: a condominum puchase in December 2007.

The ABIM Foundation was never about "medical professionalism" or "Choosing Wisely®." It was a "get-rich-quick" scheme using diplomates' testing fees for the organization's own corporate benefit.

That is, until it wasn't.

-Wes

* Interview with Dr John A Benson, Jr, MD, conducted April 27, 1999, page 18.

Combating MOC Abuses

Thanks to the Orlando Medical News for their comprehensive coverage Tuesday on the American Board of Medical Specialties' (ABMS) Maintenance of Certification (MOC) scandal.

Physicians' best approach to collapse the current ABMS monopoly on credentialing standards remains mass non-compliance.

Employed physicians (like myself) are finding noncompliance impossible without jeopardizing their employment, since many hospitals require their physicians to be "board certified" in their specialty. Since ABMS no longer "recognizes" lifetime certification as a valid credential (except for older "grandfathered" physicians who obtained their board certification before 1990), younger (more economically vulnerable) physicians risk the loss of employment if they do not participate in MOC and agree to the ABMS's "HIPAA Business Associate Agreement," becoming little more than data entry clerks for the lucrative insurance, pharmaceutical, and hospital industries.

Is this really what our patient's want?

I don't think so. Most patients I know would like to see their doctor look them in the eye rather than at a computer screen. Most want to be viewed as humans rather than a data profit center. And all of them want to spend more than 8 minutes with their physician.

So how do physicians combat MOC? How do we preserve our ability to work without having to make extortion payments to the ABMS and their member boards just for their political and personal benefit?

The fight against MOC continues on many levels, but it is a long, difficult, and expensive David-vs.-Goliath battle:

1. The development of an alternate certification board that is affordable and does not require physicians to comply with the ABMS/ABIM HIPAA Business Associate Agreement and comprised of highly-respected unpaid members of the physician community who understad the conflicts of interest inherent to the ABMS member board construct and is gaining acceptance hy hospitals accross the country.


2. State-by-state legislation efforts outlawing the use of MOC as a condition of insurance panel participation, hospital privileges, or state licensure.


3. Persuing other legal avenues, including anti-trust and class action suits against members organizations of the Accreditation Council for Graduate Medical Education, among others.

I would encourage employed physicians who are given a professional stipend from their hosptial systems for professional society memberships to seriously consider using some of those fees to join Practicing Physicians of America in lieu of other conflicted professional and subspecialty organizations as we continue to push back against the MOC mandate (an example of to testimony and evidence provided the Ohio Health Committee here). Other areas to contribute include becoming certified by NBPAS or contributing to their advocacy efforts. It costs nothing to join the Facebook group Physicians Working Together, too. That group offers lots of productive ideas on how we can work collectively to restore the integrity of our profession.

It is only through a corrodinated effort from a large portion of the working physician community that our freedom to truly work in our patient's best interest without unnecessary and unproven third party interference can be restored.

-Wes

The Hidden Message Coming From the AMA

This morning I received a press release from the American Medical Association (AMA) that said "New AMA Research Finds One in Five Physicians Ready to Reduce Clinical Work Hours." The press release pointed to "new research" (sorry, it's behind a pay wall) that appeared in the Mayo Clinic Proceedings from "experts" from the AMA, Mayo Clinic and Stanford University. The lead author of the research was Christine A. Sinsky, MD of the AMA.

But what Dr. Sinsky fails to disclose in her article in the Mayo Clinic Proceedings, is she is also a Director of the American Board of Internal Medicine (ABIM) and a member of the Board of Trustees of the ABIM Foundation, serving as the Vice Chair. This is not a minor lapse in disclosure, since the ABIM Foundation and the entire national Maintenance of Certification debacle may become one of the largest medical education corruption stories in modern medical history. Funneling over $78 million dollars for ABIM testing fees behind physicians' backs to fund the ABIM Foundation appears of little importance to Dr. Sinsky. She is more concerned about our psychologic well-being rather than the behavior of the Foundation she runs with our Maintenance of Certification (MOC) cash. This corruption renders Dr. Sinsky's arguments why physician burnout is at an all-time high mute moot. Turning a blind eye to the facts only deepens physician frustration with our current bureaucratic leadership.

If Dr. Sinsky is so concerned about physician burnout, why isn't she the leading spokesperson at the AMA insisting the leadership there end MOC as it was resolved by the AMA House of Delegates in 2016?

Perhaps it's because she's too conflicted to understand the problem.

-Wes