Sunday, October 07, 2018

The MOC Fight

From Medical Economics:
“Physicians are pushing legislation on the state level because they don’t trust the ABMS [American Board of Medical Specialties] and its financial conflicts of interest,” says Paul Mathew, MD, a volunteer board member of the NBPAS in Cambridge, Mass. “Many feel the only way to declaw the tiger is legislative action due to insurance companies and academic institutions having no reason to change their pro-MOC policies.” The ABMS oversees MOC for its 24 boards.
-Wes

Friday, October 05, 2018

For Whom MOC Tolls

He saw me in the hall between cases and our eyes connected, however briefly. I probably looked a bit tired, hair askew, and rushed after a long ablation case as I scurried to grab a quick bite to eat before my next case started. He was one of our best fellows in cardiology - hard working, innovative, never one to skip a clinical detail or shirk a responsibility, who clearly wanted to chat. He approached respectfully, smiling timidly, and said quietly:

"Dr. Fisher, is it true that I have to pay ABIM $155 to maintain my certification even though I passed my boards? And do I have to do this for life? I went to the ABIM website and it really isn't clear what we have to do."

I explained the ABIM's current iteration of fees and testing as best I could in the brief time we crossed paths. The ever-shifting sands of the ABIM parsed fee and "point" structures, "discounts," programs, credits, and value of participating (or not) in Maintenance of Certification have lead, I believe intentionally, to the current chaotic state of US physician Board certification. I felt sorry for him but was not surprised he was confused, especially since explaining the board process was equally difficult. I sensed he knew that speaking candidly about his concerns with others in positions of leadership might compromise his reputation as a hard-working, reliable cardiology trainee and was grateful he felt he could approach me with his concerns.

This is what US physician board certification has become: little more than a shakedown of our best and brightest to fund a bloated bureaucratic credentialing system that adds little to no value to our trainees' learning experience. After our conversation, I grabbed a salad and returned to do my pre-operative checklist for my next patient. My phone received a text message:

""They also included a discount on multi-year payment."



"$155 is my annual savings during fellowship..."

-Wes

Tuesday, September 25, 2018

ABMS and ABU Spin on DOJ Letter

Board certification of US physicians continued on its path of deceptive and misleading propaganda following the Department of Justice's (DOJ) letter issued on behalf of a request by the National Board of Physicians and Surgeons (NBPAS) in its effort to thwart the monopoly practices of the American Board of Medical Specialties (ABMS) and its 24 member boards. Despite that letter, the ongoing collusion between the member boards and the ABMS was particularly evident in the email circulated two days ago by the Executive Secretary of the American Board of Urology (ABU), Gerald H. Jordan, MD. The ABU's email attempts to spin the ABMS position as the same as what is stated in the DOJ letter by conflating initial lifetime ABMS Board Certification with the self-created separate time-limited Board certification market product (called Maintenance of Certification®):
The ABMS position that legislative interference which limits the use of physician certification is inappropriate is consistent with the position set forth in the DOJ letter. The ABMS and the ABU have always supported a fair and competitive marketplace for physician specialty certification and continue to do so, encouraging accurate comparison of our programs with other certification programs available.

ABMS agrees with the DOJ’s support of the right of patients and health systems to determine which certification programs best meet their expectations for providing information about high quality specialty care. The ABMS and ABU promote communications practices that allow the public to easily identify and compare the program standards used to certify that a physician has demonstrated, through training and assessment, that he or she in fact has demonstrated the knowledge, skill and judgment to practice in a medical specialty or subspecialty.
This continued deception of the ABMS and its member boards by conflating lifetime certification with time-limited "continuous" certification will not go unchallenged. I encourage all physicians adversely affect by their member boards complicit in this ruse to consider contributing to our ongoing legal challenge against the ABMS board certification monopoly.

-Wes

Sunday, September 16, 2018

Resident Recall - "Cheating" or Part of Free Speech?

Read the opinion piece referenced below carefully. It discusses the widespread use of "resident recall" to study for the American Board of Radiology's board certification examinations by both residents AND faculty/senior physicians:

https://pubs.rsna.org/doi/full/10.1148/radiol.12120251

Then read the back story on how the American Board of Medicine threatened internists in 2010 on the basis of the threat to their training monopoly:

http://drwes.blogspot.com/2016/06/maintenance-of-certification-medicines.html

Then ask yourself: who has "cheated" whom?

It is clear that the American Board of Medical Specialties, who continues to promote its lavish ABMS Conferences with "stakeholders" in Las Vegas (full schedule here), has a serious problem on its hands. This problem is exacerbated when it claims to work collectively with "500 professionals from across the health care community who, working together, will accelerate the transformation of Board Certification and the delivery of quality patient care."

Where's the data a computer test and secret data collection scheme does anything except raise prices and stroke the egos/bank accounts of the boards' leadership?

What do these Las Vegas boondoggles do to reestablish trust in the ABMS board certification process?

The answer is quite simple:

Nothing.

-Wes



Friday, September 14, 2018

When the Walls Start Crumbling Down

From the Department of Justice via the NBPAS website:
'The DOJ explained that the ABMS Program on MOC may have the effect of “harming competition and increasing the cost of healthcare services to customers.” ABMS may do so “by imposing overly burdensome conditions on physicians who wish to maintain their certification.” The DOJ added, with respect to ABMS, “[the] vast majority of [its] board members are medical doctors”—i.e., “active market participants”—who may have incentives to limit competition through “industry self-regulation.” As a result, the DOJ warned, “there would be competition concerns, if dominant certifying bodies [like ABMS] set de facto participation requirements that did not sufficiently correspond to health, safety, or other procompetitive justifications.”'
While this letter is very helpful to the National Board of Physicians and Surgeons (NBPAS) and detrimental to the efforts of the American Board of Medical Specialties and their subsidiary boards to monopolize the physician continuous credentialing system in states' legislation accross the country, it might not be entirely advantageous to employed physicians because of this paragraph on page 14:
"At the same time, the Division discourages the legislature from interfering with unilateral business decisions—such as an individual hospital’s decision about what criteria to use for granting hospital privileges or an individual insurance carrier’s decision about what criteria to use for allowing participation in the insurer’s network, as restricted in the Workgroup’s Bill—unless a restriction is determined to be necessary and narrowly tailored to redress well- founded consumer harms or risks. ... The Division encourages the Maryland legislature to consider whether other tools, such as facilitating entry by competitive certifying bodies, can address concerns with certification without imposing restrictions on the unilateral business decisions of hospitals and carriers."
Still, this letter represents a significant blow to ABMS in their efforts to prevent NBPAS's entry into the physician maintenance of certification (or "continuous certification") market as 30 states have some form of anti-MOC legislation either pending or passed.

-Wes

Friday, September 07, 2018

Thank You, Colleagues

I would be remiss if I did not thank my friends and colleagues nationwide who contributed to our GoFundMe page to initiate our pre-litigation investigation of the American Board of Internal Medicine and the ABIM Foundation. While I was upgrading a DDDR pacemaker to a biventricular ICD today, I received a text from a colleague that we had reached our funding goal for this initial phase.

I cannot express my gratitude enough. Thank you all.

It is very reaffirming to know that others feel as I do about Maintenance of Certification and what it has done to physician autonomy, morale, and even our right to work. I know that the dollars contributed could have been used for so many other things. I hope you will soon see that it your money was well spent.

But as Winston Churchill famously said:

"Now this is not the end. It is not even the beginning of the end. But it is, perhaps, the end of the beginning."

Thanks again -

-Wes

Thursday, September 06, 2018

Video: 7007 US Physicians Weigh In on US Board Certification

From January through March 2018, a voluntary Internet-based survey of US physicians and surgeons was conducted by Practicing Physicians of America concerning ABMS Board Certification. 7007 completed surveys were available for analysis. Here is a brief video summary of many of the survey's findings as promised:



-Wes

Reference: pdf file of PPA Physician survey questions that formed the basis of this report.

Sunday, August 26, 2018

Two Surveys: US Physician and Surgeon Perspectives on ABMS Board Certification

At the beginning of this year, Practicing Physicians of America (PPA), a 501c6 physician membership organization (with whom I serve as an unpaid board member),  collected results of a voluntary survey via social media channels on ABMS physician and surgeon Board certification. The method of data collection using social media. The data collection is  novel compared to previous surveys conducted on this topic and for a while represented the largest reported survey on Board certification ever performed. We submitted the results to JAMA (and later to the Annals of Internal Medicine) in hopes they would be published. They were not. As is true with most surveys, bias was a prevailing concern.

Shortly after our survey was being circulated, the American Board of Medical Specialties introduced their own survey on Board certification to pre-chosen "stakeholders" on Board certification. In July 2018 they announced the results of their survey. They had received responses from "36,392 people, including 34,616 physicians, 1,373 non-physician providers and stakeholders involved in the delivery of health care, and 403 members of the general public." To the best of my knowledge, the text of their survey was not made available to the public.

Since we were waiting the reviews of PPA's survey for months, we were prohibited from publishing our results. After considering the reviewers' comments (which were very thoughtful), I think the odds of ever publishing such a survey of this type in a peer-reviewed scientific journal are low. Hence, the board of PPA has allowed me to announce the results of our survey publicly via this blog and (hopefully) Doximity so these results may be interpreted alongside the survey results reported by the American Board of Medical Specialties' Vision Commission. Admittedly, our survey asked different questions than that conducted by the ABMS, but the results are not only notable for their differences, but also for some similarities.

By way of background, here are the 32 questions we asked in the PPA survey.

Here is the full paper (with some minor edits) we submitted for peer review that was NOT accepted for publication. This pdf includes the background for the survey, the methods used, the results obtained, and a discussion of those results, as well as references, figures and tables.

Similarities of PPA survey to the ABMS Survey on Board Certification:
  • Both ABMS and PPA surveys used SurveyMonkey to collect responses

  • A large number of physicians responded to both surveys. Still, the PPA survey represented only 0.92% and the ABMS survey represented only 4.5% of the total US physician population in 2016. Neither survey mitigates potential under-coverage bias and non-response bias.
  • In the PPA survey, 93% of physician respondents were board certified vs 96% in the ABMS survey.
  • In PPA survey, 80% (4973/6004) participated in MOC; in the ABMS survey, 69 percent of respondents were currently enrolled in a primary specialty MOC program, and 33 percent are currently enrolled in a subspecialty MOC program
  • Costs, burden, and the lack of true reflection of their abilities as clinicians were of significant concern to physicians in both surveys
Differences of PPA survey from the ABMS Survey on Board Certification:
  • PPA survey used logic to limit responses from clinically-active physicians only
  • PPA survey attempted to geolocate physicians by IP address and excluded non-US physicians
  • PPA survey included MDs and DOs; it is unclear how many ABMS physicians were MDs or DOs.
  • PPA survey was simply distributed to physicians via social media, not targeted groups like the ABMS survey. Heavy contributors to the PPA survey included members of the Pennsylvania Medical Society and Doximity.
  • Discontinuation of "continuous certification" was not offered as an option in ABMS survey. Ending MOC and reverting to lifetime certification with CME was offered as an alternative in the PPA survey.
  • PPA survey assessed physician perceptions of the negative consequences, contract obligations, and potential conflicts of interest of MOC; ABMS survey did not address these issues.
  • PPA survey specified physician-respondents' specialties and state of origin. ABMS survey did not.
Finally, here is a pdf of the Powerpoint presentation I presented in June 2018 at the AMA House of Delegates meeting in Chicago summarizing findings from the PPA survey.

Major Findings of the PPA Survey

7007 physicians responded (52% male, 48% female)

Demographics
  • Every US state was represented, with the largest being PA (910), CA (506), TX (504), FL (406) being the largest physician participants
  • Responses came from 24 different subspecialites, with the largest being family medicine and pediatrics
  • 19% of physicians had at least one "grandfathered" certification.
  • 65% of the respondents had 10 or more years of clinical experience
  • Of the physicians with initial ABMS board certification, 80% participated in MOC.

Major Findings
  • 90% of all respondents thought board certification should be a lifetime credential with CME used for ongoing education.
  • 95% felt MOC increases burnout.
  • 53% of respondents estimated costs (direct and indirect) were more than $4000.
  • 94% were unaware their data were being sold.
  • 80% felt IRB and informed consent should be required for research conducted by the boards.
  • 86% perceived MOC could threaten their right to work.
  • 8.4% failed a recertification examination.
    • Of the 394 physician that failed recertification, harms experienced included psychologic harms (more than 56%), 10% lost of hospital privileges , 5% lost their job, 8% lost insurance panel participation, and 17% plan to retire rather than retaking the re-certification examination.

I hope these data are informative and provide a balanced perspective of a large cohort of US physicians' and surgeons' perspectives on ABMS Board initial and "continuous" certification.

Physicians and others are welcome to use these data under a Creative Commons license (see below), we just ask for appropriate attribution.

-Wes

P.S.: Physicians desiring state-specific data regarding the PPA survey results are welcome to contact me via Twitter or email.

Creative Commons License
Survey of US Physicians and Surgeons Perspectives on US Board Certification by Practicing Physicians of America is licensed under a Creative Commons Attribution 4.0 International License.
Based on a work at http://www.practicingphysician.org.

Saturday, August 25, 2018

How Practicing Physicians Can Double Their Money

From now until we reach our contribution goal, an anonymous donor(s) has/have graciously stepped up to match, dollar-for-dollar, physicians' contributions to Practicing Physicians of America's GoFundMe page to fund the litigation factual and legal investigation and the drafting of proposed complaint against the American Board of Internal Medicine, the ABIM Foundation, their directors, executives, and perhaps others under federal antitrust laws and state consumer fraud and deceptive trade practices acts to bring an end to MOC™ nationwide.

After four years of bring this issue to my readers on this blog, the AMA, and state legislatures, too many questions and conflicts of interest remain about the financial and political shenanigans of these organizations. While the ABIM claims they have "listened," they still have failed to stop the ability of the proprietary ABMS MOC™program from potentially affecting a physicians ability to retain hospital credentials and insurance payments if they don't pay for the program; in other words, their right to work.

Hundred of physicians have been adversely affected by this program already. For every physician who drops out of medicine because of refusal to play along, approximately 2000 patients are affected in turn.

So please give generously. After all it's a "two-for-one" special going forward!

Thanks everyone (and thanks to our special donor(s))!

-Wes

P.S.: Again, here's that link to donate: https://www.gofundme.com/practicing-physicians-of-america

Wednesday, August 15, 2018

MOC's Greatest Lesson

Yesterday, I read with interest the American College of Obstetricians and Gynecologists widely circulated piece authored by Lucia DiVenere, MA entitled, "MOC: ACOG's role in developing a solution to the heated controversy" published in the August issue of OBG Management. By carefully listing the numerous physician concerns with MOC (costs, relevance to practice, lack of data to improve care, relationship to licensing, employment, privileging, and reimbursement), the article reinforced many of the issues on this blog while being simultaneously crafted to sound as if ACOG was really "listening" to physicians concerns about ABMS Maintenance of Certification (MOC).

It didn't take long for me to realize the article was really about the tired trope that the "ACOG asserts the importance of maintaining self-regulation." The leadership within the ACOG and Ms. DiVenere herself can hardly be described as "self" as far as working physicians are concerned. Ms. DiVenere is Officer, Government and Political Affairs, at the ACOG and OBG Management contributing editor. And while she "reports no financial relationships relevant to this article," her very job may have depended on writing it.

Which leads me to MOC's Greatest Lesson that it consistently teaches working physicians, both young and old: In medicine, it is okay to lie, cheat, and steal.

I do not say those words lightly. Everything MOC touches is corrupt. For a once simple medical accolade to be allowed to secretly morph into a one-billion-dollar-a-year enterprise and physician cudgel to fund the bloated bureaucratic and political aspirations of the Accreditation Council for Graduate Medical Education is beyond me. Yet this is precisely where working physicians find themselves. Are these the ethics to which we want our young doctors of tomorrow to aspire? Should they model turning a cheek the other way to ignore the implications of these actions on our patients just so specialty societies can maintain handsome salaries, political power, and "self-regulation?"

Despite all that has been uncovered by following the money, I still can't believe it's taken one simple GoFundMe page three months to raise $150,000 from working physicians to fight this corruption.

It seems MOC's Greatest Lesson has been taken to heart.

-Wes



Saturday, August 11, 2018

On Trust

Elizabeth A. McGlynn, PhD, immediate past chair of the ABIM Foundation and Vice President for Kaiser Permanente Research and Executive Director of the Kaiser Permanente Center for Effectiveness and Safety Research (CESR) with Richard Baron, MD, President and CEO of the American Board of Internal Medicine,  at the 2018 ABIM Foundation Forum on "(Re-)Building Trust"
Recently, the ABIM Foundation hosted a webinar entitled "(Re-)Building Trust." Oh, the irony. The fact they need to have such a conference is telling of the dire straights the staid and outdated medical credentialing complex has become.

As physicians who funded the ABIM Foundation, why do we fund such nonsense?  The American Board of Internal Medicine has never sufficiently explained why this organization felt compelled to use over $78 million of physician testing fees to create the ABIM Foundation or how and why it uses that money. Is it really to fund such conferences?  Or might conferences like this really be a distraction for the real reason the ABIM Foundation was created: their retirement fund. By the way, whatever happened to those funds shipped off to the Cayman Islands? Why will we lose our privileges at hospitals or insurance payments if we don't pay into this scheme? And why is the ABIM Foundation colluding with Kaiser Permanente directors? What does Kaiser get for this relationship?

If physicians trusted the ABIM, we would not have to ask such questions and the ABIM Foundation would not have to hold conferences on "re-building" trust.

Three years ago, Richard Baron, MD issued the now infamous: "We got it wrong" mea culpa press release when the 2014 iterations of Maintenance of Certification (MOC) foisted on US physicians resulted in a powerful working physician backlash. Lots of soft-shoe, "listening," and MOC program changes have occurred since then. But in reality four years later, little has changed other than parsing our payments into annual aliquots rather than a single lump sum every-10-year payment. The growth of fees is back on schedule, climbing an incredible 276% in the past 18 years.  Even the ridiculous Part IV of MOC is back as before.

It is hard to trust any business, especially a nonprofit organization when they ignore the customer.

We should not lose sight that physicians are the customer of ABIM, not patients. We pay for their medical accolade and the paper certificate that ABIM issues when we successfully complete our initial Board certification and (now) subsequent MOC requirements.

There are many within the US medical board credentialing system who feel otherwise; for them, they are there to serve "the public." Yet this deflection is little more than a propaganda message created to justify their use of our money for their political and financial purposes.

When we see our funds continuing to be wasted at Las Vegas convention venues for American Board of Medical Specialties meetings with their "stakeholders" we realize that this old-school attitude of colleague disrespect and self-importance is endemic to the entire US medical board certification and medical credentialing industry. Hard to re-establish trust with overt demonstrations such as these.

-Wes

PS: Wonder what you can do to change things?  Donate here and get a free book at the same time! We're 78% of the way there!

Monday, August 06, 2018

Moving Mountains By Example: Doctor Inspires Others to Fund Anti-MOC Legal Effort

In a reaffirming gesture of solidarity, San Francisco cardiologist Michel Accad, MD has offered to supply an electronic copy of his book "Moving Mountains: A Socratic Challenge to the Theory and Practice of Population Medicine" (seen on Amazon) free of charge to anyone donating $50 or more in the next two weeks to our legal effort to end the onerous and unproven ABMS Maintenance of Certification (MOC™) program nationwide.

 Dr. Accad's affable and insightful personal blog (Alert and Oriented) and podcast (Accad and Koka Report) co-produced with Philadelphia cardiologist Anish Koka, MD, have garnered wide physician followings by respectfully and thoughtfully discussing timely issues that matter to doctors. (My recent 46-min podcast discussing this funding drive with them can be heard here).

While the sponsor of the legal effort, Practicing Physicians of America (on whose board I serve), has already reached over 75% of the $150,000 funding goal, I hope Michel's generosity will inspire many other physicians to join this funding drive in hopes working physicians of all ages can help end - once and for all - the expensive, onerous, and corrupt ABMS MOC™ program that has the potential to unjustly limit a physician's right to work.

-Wes

Sunday, August 05, 2018

Federation of State Medical Boards Attempts to Legislate Away Liability

In a press release, the Federation of State Medical Boards (FSMB) announced their support of the “Occupational Licensing Board Antitrust Damages Relief and Reform Act of 2018 (H.R. 6515),” introduced by Rep. Mike Conaway (R-TX) and co-sponsored by Rep. Lamar Smith (R-TX). According to the press release:
H.R. 6515 eliminates fiscal antitrust damage liability for state licensing boards-including state medical boards- their members, and staff who are acting within their statutory mandate to protect the public. Currently, board members and staff are exposed to personal liability and treble damages for actions taken as part of their service on a board. The lack of protection has had a chilling effect on the willingness of some individuals to serve on boards, causing some board members to resign for fear of personal financial liability.
It is interesting that this new bill attempts to circumvent the 2015 Supreme Court decision that held professional boards could not make decisions that potentially violated antitrust laws and quashed competition. The justices, in an opinion by Justice Anthony Kennedy, agreed with the government’s claim that although state entities are usually exempt from federal antitrust laws, the exemption did not apply because the board was not actively supervised by the state and because it was made up of self-interested private businesses.

The FSMB President and CEO, Humayun Chaudhry, DO, MACP has quite a history of working with similar self-interested private businesses.

In fact, Dr. Chaudry has long supported the notion of Maintenance of Licensure (MOL) that required Maintenance of (board) Certification (MOC®) and "lifelong learning." Chaudhry chaired a CEO Advisory Council (comprised of a slew of non-governmental U.S. medicine regulatory organizations) that advised the FSMB's Board of Directors and worked with an FSMB MOL Implementation Group (with Richard Hawkins, MD, the current President and CEO of the American Board of Medical Specialties (ABMS), in 2009). That group recommended that physicians actively engaged in the Maintenance of Certification (MOC) program of the American Board of Medical Specialties, or the Osteopathic Continuous Certification (OCC) program of the American Osteopathic Association, should be recognized as "substantially in compliance" with any MOL program that is adopted by a state. Because of this tie between MOL and MOC, the activities of the FSMB in the state of Ohio were met with formal opposition from the Ohio State Medical Association in 2012.

No wonder the board members from various state medical boards have resigned from their positions out of liability concerns. They understood there is credibility to the Federal Trade Commission's concerns that were upheld by the U.S. Supreme Court.

Legislators (especially Rep. Mike Conaway and Rep. Lamar Smith) would be wise to realize that the multi-million dollar FSMB has financial conflicts of interest that may cause more harm than good to our patients.

-Wes

P.S.: Like the FSMB, ABMS collusion with state medical societies regarding MOC® is also evident in this recent ABMS press release.

Saturday, July 28, 2018

The ABIM Has Lost Their Marbles

From the institution that secretly funded itself with ABIM diplomate fees to the tune of over $78 million that culminated in the purchase of a $2.3 luxury condominium for itself complete with a Mercedes S class town car, and offshored funds to the Cayman Islands,  comes this news release:
The 2018 ABIM Foundation Forum will consider the importance of trust in health care – and how to build and maintain it – against a backdrop of political and social turmoil and all-time lows in Americans’ trust in institutions across society.
Make no mistake: this is our physician Board re-certification money they are playing with.

At the very least, the optics of such a conference are horrible given the ABIM Foundation's past.

I hope everyone will make good use of the hashtag #abimf2018 on Twitter and then contribute to our legal fund to permanently end this shameless gaslighting of US physicians and our patients.

-Wes

Wednesday, July 25, 2018

Board Certification: From Marketing Accolade to False Idol

I'm Board certified.

So is Carmen A. Puliafito, MD.

So is Farid Fata, MD.

So are plenty of other Medscape "Best and Worst" physicians from 2012-2016.

So what is "Board certification?"

Truth be known, it is little more than a marketing accolade.

And for a while, it worked.  Doctors took board certification examinations to market themselves as competent in their field. They would take a written or oral examination created by their peers to demonstrate to others they knew their stuff. And while it remained a lifetime designation, it had some legitimacy. In reality, however, it was up to the residency training programs to train the physicians and verify they knew their stuff.  Hospitals used to verify credentials by calling residency programs and verifying doctors participated. They had large credentialing departments that kept everything on file.

But competition between hospitals vying for patients soon grew fierce and hospital marketing departments jumped on the credentialing bandwagon. Soon billboards would appear: "Come to see our board-certified specialists!" and the race was on.

Lawyers joined the fray, too. "My expert witness is better than your expert witness - see how many board certificates he has?"

Truth is, we love this crap. Just look at how many nurse practitioners are "board certified" now!

In the 1960's to 1970's, the American Board of Internal Medicine recognized how lucrative this craze could be, but they had one big problem if they were going to make certifying doctors a full-time business: the number of doctors out there was finite. (It was about that time the board members started paying themselves). They also saw how much money the American Board of Family Medicine, founded in 1969, was generating using 7-year time-limited certifications.

But the ABIM knew internists would be on to them changing the rules for board certification from a lifetime to time-limited credential. So they first tried making a voluntary "super accolade" for internists, called the "Advanced Achievement in Internal Medicine." Needless to say, after four attempts that garnered progressively declining enrollment, the AAIM concept flopped. It was Lynn O. Langdon, MA (a non-physician and Chief Operating Officer of the ABIM) who declared the "End to Voluntary Recertification" and time-limited certification was born with the threat of "uncertain circumstances" if doctors did not participate.

Needless to say, with the help of conflicted members of the ACP who stood to make handsome returns from the Medical Knowledge Self-Assessment Program (MKSAP), they were off to the financial races. And what a race it has proven to be: a nearly $1 billion dollar-a-year enterprise for the entire ACGME.

Unfortunately, no one has ever stopped to study what happens to skilled, competent, board-certified doctors that fail their computerized "re-certification" examination or fail to garner enough "MOC points" to sit for their examination. No one asks about the damage this time-limited credential is having on our physician numbers and access to care. The money is too important to the system.

Not long ago, the chairman of our cardiology division had to relinquish his role as a teacher to medical students because he refused to re-certify in cardiology while also being "certified" in interventional cardiology. (He could keep performing catheterizations and stent placements and remain credentialed thanks to the change in double jeopardy rules that changed just in the nick of time). How many medical students lost out on his experience as a result? Are we happier that medical students are now being taught by younger (time-limited) Board-certified physician instructors rather than life-time certified physicians with decades of experience in the field?

Doctors and nurses know the truth. That's why when seeking out a "quality" physician for their own care, they NEVER ask if a colleague is board-certified since board certification is now a false idol - a hoop to complete whether they're competent, ethical, or not.

We know that it's now far better to ask a trusted colleague or health professional when seeking care because there's much more to being a "quality" physician than holding a computer-generated "certificate."

-Wes

Reference: Fisher WG, Schloss EJ. Medical specialty certification in the United States - a false idol? J Card Electrophys October 2016; 47(1): 37-43.

Wednesday, July 18, 2018

US Physician ABMS Board Certification: From Voluntary to Mandatory

The American Board of Medical Specialties (ABMS) is very careful to claim their version of "Board certification" is a "voluntary process," otherwise, this Chicago-based non-profit 501(c)(6) organization might be accused of anti-trust behavior.

"ABMS Maintenance of Certification" and "ABMS MOC" were registered by the ABMS in the US Patent and Trademark Office August 21, 2007 after filing the terms February 23, 2007.

MOC for ABMS has value.

We also know Ms. Margaret O'Kane, founder and President of the non-profit "National Committee on Quality Assurance" and that created and owns the Healthcare Effectiveness Data and Information Set (HEDIS). HEDIS is a tool used by more than 90 percent of America's health plans to measure performance on "important dimensions of care and service." We also find that Ms. O'Kane was a "public member" of the Board of Directors of the ABMS and advertised the importance of the ABMS MOC program "to patients and the pubic" by video and implies the ABMS board's actions assures improved "outcomes" for patients.

So it should come as no surprise that some of those payers who stand to benefit by limiting patients' access to care (in this case, Blue Cross Blue Shield of Michigan) have made initial ABMS Board certification mandatory for physicians on their panels:


(Click to enlarge)

While claiming MOC as a requirement for physicians to receive payments because it assures their  "quality," BCBS of Michigan does not demand the same of mid-level providers like physician assistants and nurse practitioners without similar subspecialty training. Additionally, physicians who received their "Board certification" before 1990 and are farthest away from their training are not required to perform ABMS Maintenance of Certification to remain on those same insurance panels, introducing a hypocritical and discriminatory double-standard that financially benefits insurers and hospital systems (more insurance claim denials and cheaper staffing requirements).

ABMS is the puppet of the insurance companies, just as they were the puppets of Big Tobacco in the 60's.

The IRS, FTC, and SEC need to get serious about investigating this ruse.

Why?

It's compromising patient care and our patients' access to care.

-Wes

P.S.: If you haven't contributed already, please consider donating to the legal fund sponsored by Practicing Physicians of America that hopes to bring an end the ABMS Board certification/MOC monopoly nationwide.






Thursday, June 28, 2018

A Critical Review of the ABIM Knowledge Check-In Program

This video is a first attempt at something new. I look forward to your thoughts. (Yes, as always, the comments are open).



As a professional physician who has devoted his whole life to helping others, the introduction of the American Board of Internal Medicine's (ABIM) latest iteration of Maintenance of Certification (MOC), called "Knowledge Check-in," is maddening. Knowledge Check-in continues the humiliating and embarrassing pre-test body search (now in the comfort of our own home or office), higher fees, and (as I review in the video above) places physicians at a very high risk of identity theft. Having doctors acquiesce to this nonsense every two years just so they can keep doing their job shows how low the independent non-profit ABIM (and all other American Board of Medical Specialty member boards that subscribe to this approach) will go to keep their cash flow going. They're not "listening" to physicians as they promised, they're using a classic strongman approach to market physicians as "cheaters" before caregivers, just as before.

If you feel as upset as I do that this is no way to perform physician education, please join our effort to end this costly and unproven re-certification program nationwide for all subspecialties by contributing to our GoFundMe page.

-Wes

Monday, June 25, 2018

Rent-Seeking: ABIM Shows Us How It's Done

The new ABIM fee schedule was published online for 2018, and physicians should pay attention. Like the classic shell game played by a New York street hustler, there are lots of hand motions and movements in the new cartoon video produced by the ABIM that explains the new fees that cleverly hides the MOC fee increase. And here's how those "fees" are coached on their website:


But what physicians should understand now is the "MOC Fee" does not include the "Assessment Fee."  Here's what that additional "Assessment Fee" gets you that's NOT included with the "MOC Fee" above:


When one tallies all this together, here are the real 10-year costs for MOC in 2018, according to the ABIM website:

While the ABIM seems happy that "MOC fees have not increased since 2014," let's look at what they've done since 2000:


We should all have this kind of year-to-year return on our investments! Here we are, paying all of these fees, just so we can keep our jobs and insurance payments coming.

We now see how ABIM has been "listening" to practicing physicians: rather than addressing these exorbitant costs, the ABIM keeps adding to them by dividing them into pieces and making up new fees so the fleecing of US physicians can continue. 

It's time to end this charade. If you haven't already, please help.

This expensive rent-seeking behavior to fulfill political and personal agendas must end nationwide.

-Wes



Wednesday, June 13, 2018

More Changes Are Coming to MOC!

Today in Medscape, we learn that even more changes are coming to MOC.

The simple answer to the "will physicians get relief" is, of course, no.

Here's the comment I left, just in case it does not get published, that explains why they won't get relief from the changes proposed:
This entire charade - ALL of MOC - is NOT about physician's continuing education, but about using our Board certification and re-certification status/scores/demographics/SSN, etc - in other words, our DATA - as a pseudo-"quality" indicator for Big Business. Big Business includes Blue Cross/Blue Shield and Premier, Inc., the largest group purchase organization for the nation's hospitals. In not mentioning this, Medscape perpetuates the gaslighting of physicians that has occurred for years on a massive scale - (but then, they, too have their corporate conflicts). Physicians have tried to play nice and go with the flow at first, but now the situation is untenable, in large part because the member boards have wound their financial strings around the MOC bicycle spoke so far, they can't unravel it.

Nowhere is there mention of corruption and political activities that have occurred with the member boards, the $2.3 million condo purchased by the ABIM Foundation, the spousal travel, the $1.7 million Golden parachute Christine Cassel MD received from the ABIM when she left to join the National QUALITY Forum.

It's time to end the corruption. But myself and others can't do it alone. We need your help. Please visit our GoFundMe page and learn how you can contribute to pre-litigation investigation and the development of a legal complaint for fraud against the ABIM, the ABIM Foundation, and its leadership and others:

https://www.gofundme.com/practicing-physicians-of-america

Thanks-
Seriously, I can't do this alone.

-Wes

Tuesday, June 12, 2018

Churning Pseudoscience

Recently, two papers published by authors at the American Board of Internal Medicine (ABIM) appeared in the mainstream medical literature that purported to provide evidence to the value of their Maintenance of Certification program.

The first was "Associations Between American Board of Internal Medicine Maintenance of Certification Status on a Set of Healthcare Effectiveness Data and Information Set Process Measures" by Bradley Gray, PhD, Jonathan Vandergrift, MS, Bruce Landon, MD, MBA, James Reschovsky, PhD, and Rebecca Lipner, PhD in the Annals of Internal Medicine. The other was "The American Board of Internal Medicine Maintenance of Certification Examination and State Medical Board Disciplinary Actions: A Population Cohort Study" by Furman McDonald, MD, MPH, Lauren Duhiggt, MPH, Gerald Arnold PhD, MDH, Ruth Hafer, BA, and Rebecca Lipner, PhD published in the Journal of General Internal Medicine.

Both of these studies' senior author was Rebecca Lipner, PhD, a testing psychometrican who currently serves as the Senior Vice President for Assessment and Research at the ABIM earning $435,990 per year. Last year's tax records also disclose Dr. McDonald, ABIM's Senior Vice President "Academic and Medical" earns $419,497 annually for his services. The other author's salaries are not disclosed, but we can imagine their salaries are not zero.

The first study by Gray et al, is a cross-sectional design and used observational data. As such, its results only reflect associations and not definitive indicators of a causal relationship (acknowledged in the limitations section by the authors). The second study by McDonald, et al. is another observational study and cannot determine causality either.

So why are ABIM diplomats funding so many "association" studies? Given the cost of producing these studies, might the ABIM be churning pseudoscience to forward their own agenda rather than forwarding helpful public policy or medical science? Not disclosed in their "Conflict of Interest statements is the fact that ABIM sells our board results and "status" via the American Board of Medical Specialties (ABMS) to others via ABMS Solutions, LLC. As such, these publications serve the organization's undisclosed covert agenda and should be called what it is: very expensive propaganda.

With our current era of the proliferation of predatory journals, it is clear we also have an era of proliferation of predatory publication that supports the needs of our ABMS member boards that is not in their diplomates' best interest as well.

-Wes





Monday, June 11, 2018

Recap: Dr. Wes Goes to 2018 AMA Annual Meeting

It was a rainy day in Chicago.  I elected to take the commuter train downtown to avoid the traffic well before my scheduled presentation for the PA Medical Society at 9AM. After leaving the Ogilvie Train Station, I walked to the cab station to hail a cab to the Hyatt Regency. It was then I saw this Facebook ad at the train station:


Such irony.  There I was, heading to the AMA House of Delegates to speak on this very issue and how it has adversely affected physicians.

"MOC is not about physician education, it's about our data."

-Wes

To view the entire presentation, you can view the live stream of the talk here. (Sorry about the quality, it was my cell phone that was only dropped once...)

Please consider giving generously to our GoFundMe page to begin the process of ending Maintenance of Certification™nationwide.

Tuesday, June 05, 2018

Everybody Knows a Frank

Frank is one of the smartest people in his cardiology division. He's bright, congenial, and capable of citing the latest clinical trial on the best imaging study to detect hibernating myocardium. He loves learning. Frank is the guy you used to confide in the doctors' lounge (that doesn't exist anymore). Others knew what a good guy Frank was too; Frank was nominated to write and edit questions for the nuclear medicine boards. Deep down inside Frank knows the boards are a problem. But he's afraid that if someone were to implicate his medical society as colluding with the boards, he'd see himself as being partially responsible for losing the one scientific meeting he attends each year where he can re-connect with colleagues and maybe learn something new.

At another center, Frank is the Chairman of the Department of Medicine responsible for the day to day workings of a large urban hospital system. He is a highly respected member of the Internal Medicine community, author of 14 books on the principles and practice of  Internal Medicine, and a beloved bedside instructor to generations of internal medicine residents. He also serves as a test-writer for the American Board of Internal Medicine and thinks overall they're a responsible group.  He knows how hard his fellow physicians work at constructing a meaningful continuing education process. As the  President of his local medical society, too, he knows money doesn't just grow on trees. And if people tried to disrupt the status quo, what's the endgame?

Frank on the other side of town serves as an editor to the preeminent hematology-oncology journals and has held multiple leadership positions in his subspecialty's medical society. He is widely respected by his peers, served as a director at the American Board of Internal Medicine (ABIM) and helps write test questions for the ABIM, too. He finds test-writing challenging and believes in the value of continuous testing to maintain a physicians fund of knowledge. He devotes countless hours to this endeavor to assure it is fair and impartial to those who must recertify. Sure there are some challenges, but given all the good people working on this, no one needs to question the integrity of the process.

* * *

The dilemma facing physicians today is that the majority of physicians who work with the ABMS member boards and our subspecialty societies are good, hard-working members of our profession. It is hard to fathom that a very tiny minority are corrupt and have been operating below the radar for years. I have no fantasy that your Frank or mine would approve of this corruption or even be able to believe it. And yet, here we are.

Our own inability to tolerate this complication threatens to paralyze us from cleaning up the corruption in our ranks.

There have always been good people in our professional societies and ABMS member boards. But these colleagues, who value contributing and community involvement, should be engaged in a far different framework. Doctors need community and support and collegial leadership. Returning medicine to a truly non-profit, voluntary, democratic representation of working physicians today rather than the self-selected, profit-churning, elitist employment service that it has become. Alternative structures are already emerging. It is time to be open to new possibilities or to take on the challenge of creating them.

What we face now is not new. There have always been top dogs who operate with impunity in contrast to all of the good causes that they publicly champion. In 2018, with the Harvey Weinstein, Matt Lauer, and Eric Schneiderman hypocrisies, surely we can understand this reality.

Today, physicians' ability to work, receive insurance payments, and willingness to stay in our profession, are threatened by the out-of-control, corrupt, ever-evolving Maintenance of Certification (MOC™) requirements supported by Organized Medicine. It's time to see it for what it is.

We all know a Frank, or several Franks and Francines. They cannot continue to be a shield for the exploitation of practicing physicians. Or a reason to look the other way. We all honor the hours of work it has taken our esteemed colleagues who have participated with the best of intentions over the years, but its time to clean up the corruption in the ABMS member boards and colluding medical subspecialty societies.

Cleaning up the corruption is the first step. Please contribute whatever you can to our effort to do so.

Thanks-

-Wes

Sunday, June 03, 2018

Before You Pay Your $155 to ABIM (or Any Other ABMS Member Board)

This past week, the American Board of Internal Medicine sent this reminder to all ABIM Board-certified diplomates participating in Maintenance of Certification (MOC™) (thanks @jtsaxon for sending this):



Before paying this fee, please take a moment and re-read this classic post from Robert Wachter, MD from 14 August 2012 that he placed on his former industry-sponsored blog, Wachter's World. The post is titled "On Becoming Chair and Why the Boards Matter More Than Ever."

Be sure to read the comments included, all 95 pages of them (or at least a good portion of them). (They have been saved to my server in case Dr. Wachter and his industry companions want to wipe the internet archive, too.)

On 1 August 2013, Robert Wachter, MD received 1355 shares of IPC Hospitalist Company stock. On 2 January 2015, Robert Wachter, MD received another 2186 shares of IPC The Hospitalist Company stock. Some of the fees he was paid were shared with his employer at the time, the University of California, San Francisco, too.

Wachter's World no longer exists because it was pulled from the internet in 2016 because Dr. Wachter's company, IPC Hospitalist Company, had to settle claims filed by a whistleblower and the DOJ for "up-billing" Medicare under the False Claims Act.

You decide.

Do I want to send my money to the ABIM to perpetuate the MOC ruse or send my money to the legal fund at Practicing Physicians of America that was created to end the consumer fraud perpetrated by the ABIM and its co-conspirators?

What "matters more than ever" is your decision.

-Wes




Saturday, June 02, 2018

US Board Certification Survey Results to Be Presented at the June AMA Meeting

The largest independent voluntary survey of US physicians on the topic of US Board Certification (and continuous certification) will be presented at the 2018 Annual Meeting of the AMA House of Delegates at the Hyatt Regency Chicago on June 11, 2018, at 9 AM. The social media-promoted national survey was conducted by Practicing Physicians of America and explores the topics of value, cost, burnout, research methods, physician awareness of conflicts of interest, and the negative consequences physicians have experienced from the process. Physicians from all 50 states and nearly all US territories and subspecialties responded.

Pennsylvania Medical Society is hosting the event and I will be presenting. Given your busy schedules, I look forward to meeting all three of you who can make it.

-Wes

Friday, June 01, 2018

UCSF's Embarrassing Appointment

It seems some people can't help themselves. They have to tow the party line. You scratch my back, I scratch yours.

Imagine Christine Cassel, MD, self-proclaimed "bioethics" queen extraordinaire,  and former President and CEO of the American Board of Medicine (ABIM) and the ABIM Foundation when the Foundation purchased that $2.3 million condominium in December 2007 using ABIM diplomate testing fees, now the recipient of the UCSF Presidential Chair for 2018-2019.

And who recommended her?

Why none other than the "loving" Mr. Piano Man himself, Robert ("Elton John") Wachter, MD, the current Chief of Medicine at UCSF and former Chairman of the Board at ABIM.

While it's hard to make this story up, we should not be surprised. This is how interdependent the halls of academic medicine and the US physician credentialling system have become. Like opportunistic parasites, they feed on each other's narcissism to the embarrassment of their fellow working physicians who don't dare say a thing, lest they lose their job.

I'm not sure I've ever seen a more startling example of the sickening hypocrisy in academic medicine.

My alma mater should be ashamed of itself.

-Wes

PS: Please consider donating to our efforts to expose the deep-seated corruption in the halls of Organized Medicine.

Your Dollars At Work

American Society of Clinical Pathologists' (ASCP) Choosing Wisely® campaign needed nominations yesterday. Here were two of the top nominations made on Twitter:




Both are inspired choices.

Especially since the ABIM Foundation (the creators of the "Choosing Wisely® campaign) was secretly funded from US Physician certification fees.

-Wes

P.S.: Please donate to our GoFundMe campaign to end this corrupt redistribution of our certification fees and please share the following link with your colleagues: https://www.gofundme.com/practicing-physicians-of-america

Wednesday, May 23, 2018

Enough is Enough

It is 8:30PM CST on the 23rd of May, 2018.

The American Board of Internal Medicine (ABIM) has still not posted their financials from fiscal year 2017, due May 15th, 2018 after an extension is granted by the Internal Revenue Service, on their website. I wouldn't be surprised if they're insolvent, or close to it.

Maintenance of certification (MOC™) is expensive, costing physicians over $23,000 every 10 years in fees, travel, and time from work. Doctors are sick and tired of being manipulated and coerced into playing the continuous certification game created by the non-profit ABIM that has never been independently proven to improve patient safety, care quality, or patient outcomes after a doctor's initial board certification. Doctors are especially sick and tired of these unaccountable member boards of the American Board of Medical Specialties (ABMS) mandating busy work that, if not performed, would limit our ability to maintain our hospital credentials, receive insurance payments, or even obtain state licensure.

We are also sick and tired of being ethnographic research subjects and "HIPAA Business Associates" for the member boards of the ABMS so our data can be bought and sold while board members and officers of the ABMS member boards enjoy their multi-million dollar condominiums with chauffeur-driven BMW town cars, office buildings, first class and spousal air travel, Cayman Island retirement funds, and health club memberships all on our hard-earned nickel.

The conflicts of interest created by MOC spread far and wide: BCBS, CECity/Premier, PearsonVue, ABMS Solutions, LLC, IPC The Hospitalist Group, National Committee on Quality Assurance, American College of Physicians, Wolters Kluwer, Reed Elsevier, UCSF, Massachusetts Medical Society, the AMA, AHA, CMSS, among others.

The financial orgy within the bureaucratic halls of the ACGME has been going on for years at the expense of hard-working doctors. MOC fees alone have mushroomed 244% from 2000-2014 to fund these shenanigans. Numerous doctors are burning out, or quitting altogether, to avoid the ruse. It must come to an end. The integrity of our profession demands nothing less.

Please join me in this GoFundMe crowdfunding drive by Practicing Physicians of America to end MOC™ nationwide for all subspecialties. The specifics of the campaign's purpose are outlined in the campaign's "story" on the GoFundMe page. Please give generously.

It's time to stand up for what's right.

Enough is enough.

-Wes


Saturday, May 19, 2018

Earning MOC™ Points: A Self-Paid Advertorial

As a follow-up of my earlier post on the American Board of Medical Specialties' (ABMS) Maintenance of Certification™(MOC™) program's tax on medical education, I was sent the "approved" responses of two different physicians that were required to answer questions to "earn" ABMS MOC™credits from the Heart Rhythm Society (HRS) Scientific Sessions after the meeting. These responses were "approved" by an HRS "reviewer" so the doctors could apply these points to remain "Board certified" and employed with their hospital systems. Each doctor had to write between 50 and 100 words (no more, no less) in response to questions posed by the ABIM. Despite their different responses, each received the exact same "feedback" that included links to various Heart Rhythm Society, American College of Cardiology, AMA, ABMS and non-governmental organizations' policies and web pages.

(See Physician 1's responses here and Physician 2's responses here.)

Given these canned responses to these physicians feedback, how is this time-consuming, costly, and meaningless "feedback" exercise for "earning" MOC™ points anything but a self-paid advertorial for the HRS, ACC, AMA, ABMS, and other non-governmental organizations?

It is a sad commentary that our own subspecialty societies legitimize this corrupt process despite all that we know about it today.

-Wes


Saturday, May 12, 2018

Taxing Medical Education with MOC

I just received this in my email in-basket from an attendee at this year's Heart Rhythm Society (HRS) Scientific Sessions:
I just got back from our annual EP meeting (HRS) which was in Boston. As you can imagine, the entire CME process has been bastardized to monetize the ABIM (American Board of Internal Medicine). After dutifully checking off which sessions I attended and rating the speakers, I noted a few things.

Firstly, all attendees were electronically tracked with RFID tags. Our attendance at the sessions were electronically tracked and automatically noted. A pretty neat feature and designed, I think, to prevent fraudulent CME behavior.

We had to answer a separate ABIM Maintenance of Certification (MOC) section and actually provide prose with a minimum and maximum word count. There was a warning stating that the content of our replies would be reviewed before the ABIM would bless them for the MOC process.

Which begs the question. Under what circumstances does the ABIM have the authority to legitimize or delegitimize my reply to their nonsensical questions? The MOC portion of the CME conversion was more of a sampling of my opinion. Is this the new MOC paradigm: impose an educational tax on our meetings and then also charge a toll on their MOC highway?

This process is not only corrupt and inefficient; it is now surreal and insane.
Yes. It. Is.

MOC® is little more than taxation of physicians without representation.

(And we still don't have ABIM's financials from 2017 for the public's review.)

-Wes

Sunday, May 06, 2018

The Delicate Dance

There is a delicate dance between two partners every day in medicine: the dance between the benefits of innovation and the costs of that innovation. One can't survive without the other. Patients and doctors benefit from the innovation and corporations benefit by being able to sell more devices to benefit themselves and their stockholders. In a nutshell: this is capitalism.

But increasingly, doctors and patients are being asked to surrender more and more of their personal information non-transparently in a lopsided dance that benefits the corporations and their partners. A once mutual dance turns into an ultimatum.

When a physician's ability to practice medicine is tied to obtaining Maintenance of Certification® (MOC®) points, the benefit of trading that information for both the patient and physician are less clear. Doctors are threatened with losing their ability to work unless they accrue MOC® points and their patients shoulder more and more of the costs for their healthcare non-transparently to fund the ruse.

So it should come as no surprise that the "tag and release" of physicians at this year's Heart Rhythm Societies' 2018 Scientific Sessions in Boston continues unabated. Attendees are not only automatically "opted-in" to data sharing with corporations, but with accrediting agencies, too:


Here we see that a physicians'  personal information is automatically tied to a "Credit Cart" where personal "beacon" information flows to corporations in return for automatic documentation of their Continuing Medical Education (CME) /  Maintenance of Certification® (MOC®) credits. But to receive that credit, doctors must complete surveys for the various accrediting agencies that unilaterally decide what qualifies to earn CME/MOC® approval, and what does not. 

Want to steer physician thinking, give 'em a bone, or MOC® credit, to drive key opinion leaders (KOLs) to your talk, then watch your sales grow!

For doctors, here are the rules for HRS2018 that ties a doctor's information-sharing to their freedom to learn what they want and to practice medicine: 

(Click to enlarge)
Think about it every time you attend a session.

For ourselves and our patients, there's no such thing as a free lunch.

-Wes








Wednesday, April 25, 2018

ABIM Struggles to Keep MOC Relevant and Meaningful

Both MedPageToday and Medical Economics covered the latest American College of Physician (ACP) meeting and know how to drive traffic to their site - just mention Maintenance of Certification, Richard Baron, MD, and their pals at the American Board of Internal Medicine (ABIM).

Their pieces suggest the ABIM is trying to keep their corrupt "Maintenance of Certification" program, born from a collaboration between the ABIM and ACP years ago, "meaningful and relevant."

And in a way, they are.

Nothing brings doctors together more than the topic of the mandated Maintenance of Certification® (MOC®) program and great quotes like:
"Grandfathering is a really vexing challenge," said Baron. "It's pretty difficult to defend ... I would not see those doctors as equivalent to doctors who rectify."
I'd like to thank the editors of both journals.

You are the bomb.

-Wes

Friday, April 13, 2018

What the ABIM, ACC, and Facebook Have in Common

Mr. Mark Zuckerberg, uncomfortably stuttering and stammering before Senator Cantwell about a little-known company named Palantir (aka "Stanford Analytica"), reminded me of a similar moment when Christine Cassel, MD from the American Board of Internal Medicine (ABIM) had to answer questions about her affiliations with Premier, Inc., and Kaiser Foundation Health Plans and Hospitals upon taking the helm at the National Quality Forum. Dr. Cassel brushed off those concerns as "distractions" by resigning from the boards of those corporations, in large part to avoid questions of why those relationships were an issue.

Nowhere did Ms. Cassel explain that her former non-profit corporation, the American Board of Internal Medicine, had changed its bylaws in 1997 to allow virtually unlimited conflicts of interests to benefit their organization. I remember the ABIM's website claiming their organization gets 97% of its money from its physician-diplomates. Now we see nothing could be farther from the truth. Funds are flowing back from the ABIM Foundation as a "Funding Initiative." And ABIM executives have always enjoyed a wonderfully lucrative relationship with CECity, the $400M data-gathering subsidiary of the hospital group purchase organization, Premier, Inc.:
Through Premier, client organizations are able to quickly and cost-effectively launch their own sophisticated online initiatives directly to their target audience (e.g. members, employees, associates, applicants/diplomates, etc.) by leveraging Premier’s multi-million dollar investment in world-class applications and enterprise-level infrastructure (SAS 70 Type II).

At its core, Premier’s products link performance management (data acquisition via web forms, IVR, external and internal registries, data feeds, etc), assessment, benchmarking, peer comparison, and identification of gaps (financial, knowledge and patient care) with interventions that drive performance improvement.

Our platforms align this cycle of performance management and improvement with various incentive programs to drive healthcare provider participation.

As a CMS-qualified registry for the Physician Quality Reporting System (MIPS, ePrescribing, MOC-MIPS) and as the service provider for many physician certifying boards (e.g. ABIM, ABO, AOA) Premier is uniquely positioned to align professional and financial incentives with CQI to deliver ‘game-changing’ quality initiatives that have proven and measurable results.
This CECity/Premier relationship is firmly embedded in the ABIM's HIPAA Business Associate Addendum agreement every practicing physician must agree to as a condition of enrolling in "Maintenance of Certification (MOC)" (also known as "continuous certification").  With the lack of disclosure of this relationship by the ABIM, is clear that patients and doctors alike aren't supposed to know their personal data are being sold.

The American College of Cardiology

The same data-gathering strategy appears to be true for the American College of Cardiology (ACC). The ACC has always had the ability to side-step the ABIM and re-certification but has chosen not to do so.  Physician and patient data are too important to them, too. I was naive to think that was because of the use of physician data for their NCDR "registries" used by the nation's hospitals. Instead, it seems there may much bigger play in mind, as reported by CNBC:
Facebook provided a quote from Cathleen Gates, the interim CEO of the American College of Cardiology, explaining the possible benefits of the plan:

"For the first time in history, people are sharing information about themselves online in ways that may help determine how to improve their health. As part of its mission to transform cardiovascular care and improve heart health, the American College of Cardiology has been engaged in discussions with Facebook around the use of anonymized Facebook data, coupled with anonymized ACC data, to further scientific research on the ways social media can aid in the prevention and treatment of heart disease—the #1 cause of death in the world. This partnership is in the very early phases as we work on both sides to ensure privacy, transparency and scientific rigor. No data has been shared between any parties."

Health systems are notoriously careful about sharing patient health information, in part because of state and federal patient privacy laws that are designed to ensure that people's sensitive medical information doesn't end up in the wrong hands.

To address these privacy laws and concerns, Facebook proposed to obscure personally identifiable information, such as names, in the data being shared by both sides.

However, the company proposed using a common cryptographic technique called hashing to match individuals who were in both data sets. That way, both parties would be able to tell when a specific set of Facebook data matched up with a specific set of patient data.
While I appreciate the flowery take of this breach by ACC's spokesperson, I'm afraid the ACC's hand is stuck firmly in the financial data mine cookie jar. After all, as we've seen with Facebook and our recent election, not all uses of data are always in our patients' best health care or financial interest.

It's amazing, isn't it? These databases once thought to be a product of ingenuity by for-profit and non-profit organizations, are looking more and more like a product born of little more than opportunity and necessity.

But others much smarter than I have known this long ago. To the ABIM, the ACC, and Facebook: it's all just about guns, germs, and steel.

-Wes

Monday, April 09, 2018

An Internet Quiz: ABIM's Website Moves the Goalposts Again

The Internet loves mystery...

and cover-up.

There are very bright minds out there, and nothing gets those juices flowing for the dedicated Internet sleuths than when someone is trying to hide a carefully crafted change that benefits the Big Guy and screws the Little Man.

Lately, I've been watching the myriad of changes to the ABIM website.

It's got a whole new look and feel, full of big flashy graphics, but little on content. They will argue, no doubt, that it's all made to improve the navigation on their website and to introduce the bold new ideas they have concocted to be sure the fine print is missed.

So here's the challenge.

Take a minute and go the the ABIM website. (Warning, you'll need more than just a minute for this contest, but if you've got the time, this might satisfy criteria for some MOC points/CME credit).

Click on the Maintenance of Certification banner.

Look over to the left and find the "Policies" button. Here's what the screen looks like today:

(Click to enlarge)

Scroll down to look at what you've missed below the fold, as shown here: 

(Click to enlarge)

Now, this is where things get fun. It will be like The Price Is Right, where Bob Barker asks the contestant to look behind Door Number 1, Door Number 2, or Door Number 3. Go ahead, and click on one of those drop-down arrows of your choosing. What you don't realize, it that behind every one of those arrows, is the hidden surprise that has changed - your MOC® contract with ABIM in all its (hidden) glory.

So here's the challenge...

... which part(s) has(have) changed in the last six months?

Good luck!

-Wes




Wednesday, April 04, 2018

Feldman: MOC is Good For You

It was helpful for me to read this take on maintenance of certification from Wake Forest dermatologist Steve R Feldman, MD, PhD in The-Dermatologist.com. There are so many straw dogs here it boggles the mind, but the piece exposes a level of naïveté by academic supporters that really don't seem to understand the myriad of problems with MOC. Take this quote, for instance:
The provision of medical care is highly regulated. Not all the regulations are to physicians’ liking. Along with our monopoly power, comes controls that are designed to assure the quality of the care we provide. Our education has been regulated, getting licensed has been regulated, and getting certified has been regulated. Now, maintaining that certification has been regulated, too.
Dr. Feldman justified MOC because, well, we need more regulation! He seems to imply we should just get over it folks: the unaccountable member boards of the ABMS can do as they please with your money. Buy a condo in the name of "Choosing Wisely?" Sure. Send some funds off-shore to the Cayman Islands for their retirement fund while you do the dirty work of seeing patients? Sure. Buy a nice pond or purchase a nice car collection with your colleagues testing fees? Heck yeah! And why not run a for-profit real estate management firm with certification funds, too? Why of course! Then you can perform research on your colleagues without informed consent! And best of all, you can make sure your pals on the Dermatology board force working physicians into becoming HIPAA Business Associates to CECity (A subsidiary of the $4 billion hospital Group Purchase Organization, Premier, Inc.) when they sign up for their recertification tests? Man, the digital data party never stops giving!

Poor guy. Maybe Dr. Feldman didn't know about all this. Or maybe he still needs to threaten working doctors to scratch his social justice itch. (Let's hope not.)

But if that was not enough, Dr. Feldman made this suggestion as an alternative to our current re-certification mess:
If the argument that MOC has not been shown to improve quality, claiming a CME requirement assures quality seems suspect at best. What would a serious solution look like? It would have quantitative, representative measures. Perhaps, it could include random independent evaluation of videotaped patient encounters, supplemented by review of treatment decisions made of lesions and rashes based on photographs or on “secret shoppers.” All the really serious means to document and assure quality would be far more heinous than anything being considered now.
Threats of physicians won't dispel the truth about MOC: it is corrupt to the core. It has harmed physicians. It threatens their right to work on the basis of metric that does nothing to improve the quality or safety of patient care.

Dr. Feldman asks for a viable alternative to MOC. Really, the answer is very simple.

End it.

Completely...

... just as the AMA House of Delegates voted to do so almost three years ago.

-Wes