Thursday, November 09, 2017

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

10 comments:

  1. Wes, you mention using employer stipends to join alternative physician representation organizations. I am employed and thought you might be interested to know that my contract stipulates that I can use the money to join the AMA and one national, state, or local specialty society. Needless to say, my AMA stipend goes unused every year, and I spend my own dollars to join PPA, AAPS, and be certified by NBPAS.

    ReplyDelete
  2. I don't know of any patient who wants that!

    ReplyDelete
  3. The Sinsky/AMA "EHR TETHERING STUDY" has serious limitations mentioned in the discussion.

    Whole swathes of time were not documented that did, or could have related to the use of EHR. This time spent had to do with non-EHR functions that were performed, but not included in the selective log data. Patient related activity such as routine administrative tasks, which could have been delegated or performed by EHR or third party software if the technology - tasks that can be delegated such as Sinsky's company "Healthfinch" provides involving prescription monitoring, which if culled, some tasks can be delegated to lower level staff.

    There was no documentation of additional EHR related paperwork and verbal tasks on phone, which all takes time. The logs were not precise enough to measure these tasks, perhaps.

    What is amazing about this study, is Sinsky's failure to disclose her local employer, Medical Associates Clinics and Medical Associates Health Plans of Wisconsin, which provides care and insurance coverage to the regional center(s) where the study took place.

    And Dr. Sinsky does not include her ABIM and Foundation affiliations. The disclosure is important because we don't know whether the physicians and potential patient base, which Sinsky et al used in the AMA/UW study, included Sinsky's partners at Medical Associates Health Plans - or clinical physicians who were "in network" at the time of the study - and spread throughout the target area of southern Wisconsin. Several large employers use Medical Associates for the designated healthcare. These locations are located throughout southern Wisconsin.

    Medical Associates covers a 60 mile radius spreading deep into southern Wisconsin and Iowa
    https://www.mahealthcare.com/assets/pdf/Medicare_Provider_Directories/FreedomDirectory_September_05.pdf

    http://etf.wi.gov/publications/dc_content/dc_2007/local_medical_associates_2007.pdf

    None of these important facts and data were mentioned. Why not? The conflict of interests, not mentioned for some reason, appear to be an intentional omission. I would consider it a serious flaw in the study, because it raises questions and places suspicion onto AMA's motives for the study.

    ReplyDelete
  4. David versus GoliathFri Nov 10, 02:10:00 AM CST

    IN THE UNITED STATES DISTRICT COURT
    FOR THE NORTHERN DISTRICT OF ILLINOIS

    ASSOCIATION OF AMERICAN PHYSICIANS
    & SURGEONS, INC.,
    Plaintiff,
    vs.
    AMERICAN BOARD OF MEDICAL
    SPECIALTIES,
    Defendant.
    )
    )
    Civil Action
    No. 1:14-CV-2705
    MOTION FOR AN EXTENSION IN TIME TO AMEND
    By a Minute Entry on September 30, 2017, the Court ordered that Plaintiff Association of
    American Physicians & Surgeons, Inc. (“AAPS”) has until November 6, 2017, to file an
    amended complaint “to cure the pleading deficiencies discussed in the opinion” that will be
    forthcoming by this Court. [D.E. 44] However, that forthcoming opinion has not yet issued.
    Accordingly, Plaintiff AAPS respectfully requests an extension in time to file its
    amended complaint until 30 days after the above-referenced opinion is issued by this Court.

    Respectfully submitted,

    ReplyDelete
  5. En Mass Opposition to MOC

    Let's hope that the impartial judgement and expert opinion of the federal court in the land of Lincoln is more fair and supportive of individual rights and personal freedoms than what the ABMS imposes on physicians and patients with their "biased MOC science" and expensive legal power.

    ABMS MOC is an unwieldy unregulated financial and political hammer bearing down on physicians and patients, stripping countless Americans of the right to work and the right to care.

    MOC is a cunningly unique method of control supported by a corrupt "educational" Ponzi scheme.

    By investing in offshore accounts, and secretly creating international businesses the ABMS has stashed away millions of dollars for personal benefit. Created war chests.

    The ABMS and international side-car ACGME have diluted their brands through unsavory adventurism overseas.

    In the Middle East and Asia they tarnished their reputations bowing to the god of foreign money, while suspending the rigorous methods of medical science. Ignoring the voice of conscience, they cajoled dictatorships and fiefdoms with "whatever you want boss" certifications in regions where heinous human rights violations occur on a daily basis.

    In Singapore the ABMS created an international "shell company" with expensive offices that were later abandoned. In the "Lion City", the "land of the paradise papers", they experimented on healthcare systems. The ABMS created a hybrid (compromised) model of certification, based, not on the American standard, but on "vital healthcare needs based on local popular demands and political conditions". These local conditions include the double standard of not requiring recertification or MOC for diplomates, while their partner ACGME rewrote and threw out their own US guidelines by blessing virtually unlimited hours of hospital and clinic service for the Singaporean residents and fellows.

    Bending to the whims of authoritarian regimes abroad, while making physicians and patients bend to their iron authoritarian fist in the United States, the ABMS has after decades of corrupt practice, a new modus operandi and quite revealing new motto.

    "Of the money for the money", which means the ABMS and ACGME allow their copyrighted science and trademarked educational theory to go wherever the money blows.

    Since their creation in the 1930's the ABMS medical boards have lost all memory of that original voluntary and charitable purpose. Now they come with lawyers, risk managers, hedge fund specialists, leaders without term limits who push brutal authoritarian models at home in the US, while they kiss the royal rings and bow to money abroad.

    Turning two blind eyes to their commitment to healing and medical science the ABMS and side-car have declined to the point that one can readily say, the entire ABMS and ACGME is suffering from massive retinal detachment. All is in darkness for them and consequently for all vulnerable American diplomates and candidates who are forced into their pay-to-play scheme.

    This sorry state exists, because of avarice for money and a pathological need to control.

    The usury and abuse of others persists because the ABMS/ACGME leadership can't see anymore who they once were and who and what they served.

    Volunteers offering a voluntary certificate for life - being "of the profession and for the public".



    ReplyDelete

  6. As the AMA House of Delegates resolved, we resolve to end MOC immediately

    ReplyDelete
  7. The unfavorable conditions persist because the whole body of the profession has not stood up to the ABMS and their partners with sufficient mass. Let them know that mandated MOC must end immediately. We will no longer put up with unacceptable conditions - MOC tied to licensure, insurance reimbursement, or conditions of employment.

    ReplyDelete
  8. When did the AMA, ABMS, ABIM, Pearson and Wolters Kluwer announce their merger agreement?

    Walters Kluwer was lobbying for healthcare reform in 2009, the year after they purchased UpToDate. https://en.wikipedia.org/wiki/Wolters_Kluwer

    WK Open Secrets was active in Healthcare Bills
    https://www.opensecrets.org/lobby/clientbills.php?id=D000068004&year=2009

    Wolters Kluwer Open Secrets healthcare lobbying and lobbyists representing them
    https://www.opensecrets.org/lobby/clientlbs.php?id=D000068004&year=2009

    WK Teaming up with "AMA and Osteopathic residencies" spend a bundle save a bundle of text books
    http://wolterskluwer.com/company/newsroom/news/health/2014/06/wolters-kluwer-health-announces-ebook-promotion-that-saves-medical-residency-programs-a-bundle.html

    AMA and Wolters Kluwer teaming up in emergency preparedness (2007 natural disasters, terrorism)
    http://wolterskluwer.com/company/newsroom/news/2007/05/announcing-a-new-partnership-between-the-american-medical-association-and-lippincott-williams--wilkins.html

    Fair Copyright in Research Works Act
    https://www.congress.gov/bill/111th-congress/house-bill/801?q=H.R.+801

    Fair Copyright in Research Works Act (Wolters Kluwer hired lobbyists to lobby on behalf of Wolters Kluwer Health)

    "Shown Here:
    Introduced in House (02/03/2009)

    Fair Copyright in Research Works Act - Prohibits any federal agency from imposing any condition, in connection with a funding agreement, that requires the transfer or license to or for a federal agency, or requires the absence or abandonment, of specified exclusive rights of a copyright owner in an extrinsic work.

    Prohibits any federal agency from: (1) imposing, as a condition of a funding agreement, the waiver of, or assent to, any such prohibition; or (2) asserting any rights in material developed under any funding agreement that restrain or limit the acquisition or exercise of copyright rights in an extrinsic work.

    Defines "funding agreement" as any contract, grant, or other agreement entered into between a federal agency and any person under which funds are provided by a federal agency for the performance of experimental, developmental, or research activities.

    Defines "extrinsic work" as any work, other than a work of the U.S. government, that is related to a funding agreement and is also funded in substantial part by, or results from a meaningful added value contributed by, one or more nonfederal entities that are not a party to the funding agreement."
    Congress.gov

    ReplyDelete
  9. In the end criminal behavior and addiction to power and greed costs you, if the truth leaks out.

    ReplyDelete
  10. "EHRs in the era of MACRA, October, 12, 2017 - AMA Wire"

    "While it’s been a long—and sometimes rocky—road implementing electronic health records (EHRs), there’s no question that they’re here to stay. Their role is increasingly important under the Medicare Access and CHIP Reauthorization Act (MACRA), which is transforming the payment model and impacting the way we practice medicine." - AMA

    https://wire.ama-assn.org/practice-management/ehrs-era-macra

    Does that sound like a friendly message from the AMA to physicians and patients? I'm asking if the AMA is advocating for docs and patients? Their words sound more like a poorly disguised marketing/advertising campaign for the healthcare industry and government?

    In fact the AMA does get substantial funding from the government.

    Page 21 of the AMA 2016 audit (by Deloitte) tells us how much money AMA received from the government. They received from the United States Health and Human Services - HHS - in 2015 about $1.5 million for various projects.

    PCPI

    AMA and PCPI ("Physicians Consortium" for Performance Improvement shares the same address as AMA and related orgs.) https://www.amainsure.com/about-us/contact-us.html

    After looking more closely at the AMA, one does not get warm fuzzies from their AMA/CMS info-commercial on "EHR in the era of MACRA", especially when one looks at who they give grant money to: PCPI (Physician Consortium for Performance Improvement comprised of ABMS, Leapfrog, United Health Group, and their consortium of MOC business partners.)
    https://www.thepcpi.org
    https://www.thepcpi.org/about-pcpi/leadership/

    PCPI Headquarters (Physician Consortium of Performance Improvement)
    AMA Plaza
    330 N. Wabash Ave. Suite 39300
    Chicago, IL 60611-5885

    AMA/CMS/PCPI/ECQI
    https://ecqi.healthit.gov/measure-stewards/american-medical-association-convened-physician-consortium-performance-improvementr

    AMA funding fro "IMAP"

    And in case you did not know, just like the ABIM Foundation, the AMA gives money to the George Soros organization the "Institute of Medicine as a Profession" (IMAP)

    "Alliance for Health Policy" - formerly the Alliance for Health Reform
    ("The Alliance" also received grant money from the AMA. They have offices right across from Booz Allen Hamilton on "Eye Street" in DC. Surreal. http://www.allhealthpolicy.org/

    How much do exectutives make at the AMA?

    What does the average VP make at the AMA? $400K - $900K. And the president? $2 million?
    https://pp-990.s3.amazonaws.com/2017_01_EO/36-0727175_990O_201512.pdf?X-Amz-Algorithm=AWS4-HMAC-SHA256&X-Amz-Credential=AKIAI7C6X5GT42DHYZIA%2F20171121%2Fus-east-1%2Fs3%2Faws4_request&X-Amz-Date=20171121T071017Z&X-Amz-Expires=1800&X-Amz-SignedHeaders=host&X-Amz-Signature=ac4e1be4f813f94f006b81341ab4fe0ec6e243838cfba0d7af77f9f73ac2d336

    IMS Health

    Did you know that the AMA has a business relationship with IMS Health, the company that has been sued over collecting and selling anonymized patient prescription information. AMA paid them for consulting services in the amount of $958,773 in 2015.
    https://en.wikipedia.org/wiki/IMS_Health#References

    In looking at all of the above, I am not sure that the AMA ( in concert with the ABMS, ACP, insurers, big hospitals, accreditation companies, quality-testing cartel and medical societies (who are looking forward to making a great deal of money from data collection) are not the progenitors of MOC and MACRA who pushed the government hard to get funding for EHR and coerced physicians to pay for their own regulatory capture. (MOC)

    ReplyDelete