Sunday, December 16, 2018

Primum Non Nocere

Primum non nocere - latin for "first, to do no harm" - is a philosophy working physicians aspire to throughout their careers when caring for patients. It defines a bioethical baseline for physicians and should be their guiding light in clinical decision making throughout their careers. Unfortunately, as is too often the case when politics and power enter the picture, it is easy for physicians to fall prey to avarice and greed, placing their financial and political interests before their patients and physician  colleagues.

Such is the case, in my opinion, with the bureaucratic ranks within the academic House of Medicine. Today, it is "pay to play" for hundreds of thousands of US physicians thanks to the American Board of Medical Specialties (ABMS)/American Board of Internal Medicine(ABIM)'s Maintenance of Certification (MOC) program.

As I mentioned in an earlier blog post, I received a notice in late November of this year by US mail that I had to earn 100 Maintenance of Certification (MOC) points, or I could see a "change in my certification status." The ABIM webpage displays that notice prominently as well.

Recall that I certified in both Cardiac Electrophysiology and Cardiology with the 2013 testing cycle. At that time, according to the ABIM's website and this archived webpage from January 18th, 2013, MOC required that I perform 100 MOC points every 10 years. When I purchased MOC and registered to take my recertification test in October 2013, this is what I thought I was purchasing.

Now I find the ABIM has changed the rules. Now we must perform 100 MOC points every 5 years.

Needless to say, I had only 10 MOC points when I received that notice from the ABIM after the Thanksgiving holiday. I had vowed not the earn another point until it might be needed 10 years from the data I enrolled for my MOC exam and have been working to end MOC through conventional channels since that time. I have talks at the AMA House of Delegates, Ohio Health committee, and help with the Texas anti-MOC legislation as proof of that effort. One guy doesn't stand a chance, I learned.

Still, I became worried about the implications of now needing another 100 MOC points and the time, focus, and commitment required so I could keep seeing patients. I searched for ways I could fulfill my requirements without paying the ABIM another dime.

This is where things got interesting.

It seems I pre-paid for "30 MOC points" - one for a 2017-2019 Hospitalist Update, a 2017-2019 Internal Medicine Update, and a "Care for the Underserved" module that offered 10 MOC points. (The other offerings that might have been there before had "expired.") These thirty points wouldn't be enough to get me where I needed to be by 21/31/2018. Furthermore, learning about these non-applicable topics to my specialty seemed to be a waste of time. Still, I needed points, so I did what I could and even performed the Hospitalist update. I was surprised to find that the ABIM's own Robert Wachter, MD, "Mr. Hospitalist" himself, helped author this module.  Because it was outside my wheelhouse, that module took way too long to successfully complete, but I finally did it to earn my "points."

Nothing to see here folks...

I was getting concerned. I checked the Heart Rhythm Society's webpage hoping they would have a module closer to my specialty that I could complete quickly and was surprised to find that they could only offer me 6.75 MOC points if I purchased a $650 Medical Knowledge update in Electrophysiology - a cost of $96.30 per MOC point! That was an astronomical price per MOC point and one that wouldn't get me anywhere near my goal of 100 total points.

I moved on.

The ABIM site suggested I look at the various offerings provided by the ACCME at - a horribly rudimentary website that had poor filtering capabilities for the offerings I might need. They sent me to this hospital system and that hospital system with ways to game the system, but nothing would work for me or each offering gave me 0.5 to 1 MOC point each. Everyone, it seemed, were more than happy to offer a point here or a point there, but every point required a post-MOC survey of how I liked it, it the exercise was free from commercial bias, etc. - all very time-consuming - so I kept looking.

I turned to the American College of Cardiology's website since I am a Fellow of the American College of Cardiology and looked at their MOC offerings. I still needed a LOT of points if I was to make 100 by 12/31/2018. That's when it struck me: this was the plan! Whether you're an ACC member or not, you've got to pay the Man.

There, on the ACC's MOC webpage was this offering: ACC Self Assessment Program 9 (ACCSAP9) for $1600 in return for 155 potential MOC points good through mid-2019, a bargain-basement price of $10.32 per MOC point!

Left with few options this late in the do-or-die MOC extortion game to keep my hospital privileges and insurance payments coming, I purchased ACCSAP-9.

Before I could get started, I had to agree to a "Credit Agreement." In that agreement I had to agree to "read all text, watch all presentations and answer all questions within the topic for which you claim credit. You must obtain 70% or better on the questions, but you may answer the questions as many times as necessary to achieve that score."


Then there was the indemnify and hold harmless "Disclaimer" clause of the Credit Agreement: "The American College of Cardiology is not responsible for the results obtained from the use of the information contained in this publication... The American College of Cardiology does not warrant the information contained herein is in every way accurate or complete, and disclaim all responsibility."

Ahem, isn't this WHY we're being forced into this expensive exercise? If I can't rely on them to assure patient and "the public's" safety, what good are these "Knowledge Assessments" for patients?

Having no choice but to "agree" to their terms, lest I lose my hospital privileges and insurance payments to my hospital on 1 Jan 2019, I reluctantly clicked "I agree" and started the arrhythmia section of the testing the week before Christmas.

My wife and kids were not pleased.

"Dad, be here now. It's Christmas! Here you are, 35 years of experience, doing these mindless exercises and getting all stressed out. Haven't you done this long enough?"

"Honey, it's always me doing everything for Christmas while you get all stressed out and have to sit at that damn computer, doing quizzes. Will it ever end? How many years has it been?"

I realize that they are right. Years of being Mr. Good Guy while they lost out on their father. Experience means nothing to the ABMS. Money is everything with MOC. It is clear to me now that the "lifelong" educational system for physicians is horribly broken - a once reasonable voluntary system of continuing medical education required for state licensure, has morphed to an do-or-die extortion scheme for doctors' money. It's not about the patients or the doctor. These organizations  indemnify themselves of this responsibility. It's just about the money.

And for hospitals and insurers, it's about control of the doctors to keep their profits high.

The ACC - our cardiovascular specialty society that looks more and more like the AMA, has found a way to get rich - very rich - using the threat of my loss of privileges to fund their organization via the ABIM's MOC program. No wonder they collaborate.

The American College of Physicians (ACP) has their Medical Knowledge Self-Assessment Program (MKSAP) likely does the same thing. So does the American Board of Pediatrics. Whether the ABMS member board is a "continuous certification" or MOC participant, the ABMS mothership keeps the money flowing to all of these entities who claim to educate using computer products while hiding behind "Disclaimers" that relinquish their responsibility.

Buying a product in 2013 thinking one thing, only to find it's another, is fraud as far as I'm concerned. Doctors like me don't like being swindled and forced to play games that have no meaning so they can keep providing patient care. There simply are not enough hours in the day for any of us to put up with these shenanigans required by the members of the Accreditation Council for Graduate Medical Education (like the ABMS) for their financial benefit. They are not only hurting doctors, but hurting their families at Christmas time, too. The ACGME members and ABMS Vision Commission should each carefully read how the ABMS MOC program has harmed doctors in this latest serious anti-trust Complaint filed in federal court against the American Board of Internal Medicine.

The "ABMS Vision Commission's" Draft Report fails to disclose these potential harms caused to physicians by MOC and its numerous conflicts of interest. Do they really think their assets will  indemnify them of their responsibility to the well-being of working US physicians, and in turn, their patients?

I think not.

Primum non nocere.



Anonymous said...

I hope you, Dr. Tierstein and Mr. Krowl will be speaking on behalf of the physicians who have filled the lawsuit against the ABIM.

2019 Vision Price Rigging In The New Year said...

Did you try ABIM customer care to explain the situation and to ask for a waiver or to be compensated for putting you through these heinous holiday hoops? After all it was falsely advertised and you fulfilled your contract in full. Get this on file with the ABIM staff, and entered in their expensive systems, so it too can be the source of a class action lawsuit. Complaint for deceptive business practices and price rigging to name a few obvious ones.

New Year Wishes said...

I'm dreaming of a MOC free Christmas just like the ones we used to know

The Ghosts and Dr. B said...

Bah Humbug, A_B_I_M Scrooge!

May the ghosts of MOC PAST, MOC Present and the MOCless world TO BE haunt you into becoming a kinder, gentler business.

This is Your vote/your voice to end MOC said...

Wes is being boarded to death at Christmas while he fights for us. What can we do for Wes and the movement to end MOC?

Secrets of the ABIM for 25 MOC Points said...

What the ABIM Does Not Want You To Know About the Appointment of the Self-Anointed Ones

"ABIM examinations are confidential, in addition to being protected by federal copyright and trade secret laws."

What BS. Did you know that the ABIM is paranoid, worried about people discovering the truth about the history of their testing hocus pocus.

So nervous, in fact, they keep the original (and facsimile) of the first test ever given (1936) under lock and key in their archives.

Speaking of ghosts from the past, guess who was the first test taker? Test number 1.
And how many took the test?

How many questions did the test have? What were the answers.

How many took the test and passed?

How many failed?

How much did it cost?

The ABIM is not proud of the answers, because they were founded by the ACP and AMA.

Why was it founded? It was formed based on politics and control of the flow of money. And certainly not public safety.

Think about it. An 83-year-old mystery waiting to be solved. Ask the ABIM to release the test, questions and lists online. They won't release it because release of the documents would unmask the original testing deception.

Was the ABIM formation the seed of a conspiracy?

Look at what is happening now and then answer. Physicians are subdued.

What't the important truth about the first test and its relevancy today?
The original nine founders all self-appointed themselves, took the test and graded themselves. Of course they all passed themselves.

The original ABIM was as esoteric self-annointing society in 1936, and it remains to be so today.

There was nothing considered so confidential in the beginning. The medical science was most important. Who can own that or want to keep it confidential. It was the answers that were in important and not so much the questions. Now its the questions that have been coveted and not the answers.

What year did the ABIM start copyrighting? Does anybody at the ABIM even know? The answer is clear by the way they behave. So out of touch.

Why is there no real peer review of the questions and answers allowed.

And how about that financial accounting?

Finally is the ABMS/ABIM comprised of tricksters and cheaters stealing our money. Or are they primarily social engineers blowing their hot air everywhere?

ABIM Founder, co Founder of the FSMB

Anonymous said...


The "Russians" are Coming said...

Sorry, false alarm, it's only a globalist publishing/testing/consulting cartel

The latest ABIM/ABMS MOC scam uncovered and revealed.

ABIM partner Wolters Kluwer (an Anglo-Dutch [Rothschild investments] conglomerate) now offers MOC points and not just CME for searching/using their product UPTODATE.

It's reassuring (ugh!) that its only the Rothschild family banking/private equity/wealth management cartel making a move on us and not the "Russians" invading us buying their way into our educational markets and influencing our politics, healthcare, and society. Does that also include lobbying and elections using our media and the currently available gamut of private and public commercial infrastructure? Do we need a physical patch for this potential security breach?

The Russians with their massive extractive industries (oil, gas, mining) are also under the thumb of the same powerful top tier banking cartel and their proxy the IMF. Russia was forced into austerity measures, recently just like EU countries (Greece, Portugal and others) to lower government pension payouts. The "enemy" [perhaps] used as a convenient distraction gets blamed for everything while our allies and bankster friends rob us blind, and silently gain control of "our" media, political sphere, and educational infrastructure.
We understand all to well that Pearson, LLC and its American subsidiary PearsonVue are partnered with the same globalist alliance.

A perfect magicians trick. They are getting away with almost everything, while the media draws our attention in the opposite direction.

The DOJ and State Department can't keep up. Is it because, they also too busy looking elsewhere?

An investigation into MOC may hold the key? Is it a conspiracy? It's always a conspiracy when you are forced en mass to sign your rights away so that others can rob you blind.



Myth: MOC is all about the money.

Fact Check:

Fact Check:

***ABIM's costly Web Design was unprofessionally created for pre-schoolers not busy doctors.


Next time on MYTHBUSTERS:

MYTH: MOC is a scam.

MOCkey Mouse Tax Club and the ABIM Piggy Bank said...

Bucks for the Dutch from the MOC TAX (UPTODATE MOC SCAM BUCKS FOR POINTS)**

"Westby Fisher, MD‏@ doctorwes
Thx to a colleague who taught me this work-around for MOC pts. Proof of the MOC scam: all you have to do is search, click, and click again to get CME and MOC pts. This is learning? Fulfill ABIM MOC Requirements with UpToDate"

*CME credits and MOC points from Individual Subscription Only (Or Institutional UPTODATE with CME/MOC surcharge)

Certification Verification Tax @ABMS Solutions

WoltersKluwer/ABMS Morass of Corporate Shells said...

ZHS Holdings: WoltersKluwer's Incorporation Obfuscation Scheme

Delaware: An Onshore Tax Haven

"When thinking of tax havens, one generally pictures notorious zero-tax Caribbean islands like the Cayman Islands and Bermuda. However, we can also find a tax haven a lot closer to home in the state of Delaware – a choice location for U.S. business formation. A loophole in Delaware’s tax code is responsible for the loss of billions of dollars in revenue in other U.S. states, and its lack of incorporation transparency makes it a magnet for people looking to create anonymous shell companies, which individuals and corporations can use to evade an inestimable amount in federal and foreign taxes. The Internal Revenue Service estimated a total tax gap of about $450 billion with $376 billion of it due to filers under reporting income in 2006 (the most recent tax year for which this data is available).[i] While it is impossible to know how much under reported income is hidden in Delaware shell companies, the First State’s ability to attract the formation of anonymous companies suggests that it could rival the amount of income hidden in more well-known offshore tax havens."

Corporation Trust Center said...

Tax Evasion 101

Ask the ABMS how they deserve their tax exempt status after you see all the connections and connect the dots.

CT Corporation said...

Do you know who stores your legal data? said...

Wolters Kluwer stores your legal data on the global cloud. Think about it.

Might want to go to paper on any lawsuit against the ABMS or any of the thousands of companies that Wolters Kluwer/CT corporation have tax leveraging relationships with.

It's all secret what they do. Name one member of Congress or the Senate/or EU Parliament that do not hold stock in any of the companies that get to take advantage of WK's tax dodge.

Seamless_Global Tax Services On the Cloud or On Premise Since 1986 said...

WoltersKluwer Knowledge Check-In

It's safe, it's secure, it's on the cloud.

It's Wolters Kluwer's Tax Solution Tagetik®

"Founded in 1986, Tagetik is a market leader in corporate performance management solutions, supporting the workflow of the Office of the CFO, including financial and operational budgeting and planning, consolidation and close process, financial modeling, analytics and reporting. Relied upon by nearly 1,000 corporate customers and 75,000 users in over 35 countries, Tagetik’s highly configurable, modular software suite seamlessly integrates with most ERP systems, including SAP, Oracle, and Microsoft. The solution can be deployed on-premise, in the cloud, or in a hybrid manner.?

Structured Payments for Rent? said...

Winding Down and Moving On (Campaign finance improprieties and WoltersKluwer?)

Where does your certification and MOC money go?

Where does the venture capital investment profit go?

May be many smoking guns on and off shore.

sum thots said...

Many suspect Christine Cassel bought a condo with ABIMF money for her own convenience, so she would not have to buy a house and live in Philadelphia as one would expect. Was it improper or illegal? That should be investigated. The condo was sold not so much because it was revealed, but that it was no longer needed for the lifestyle that Cassel desired at the expense of the Foundation. It was like funneling non-profit money for personal and partisan political use. Cassel was head of both the ABIM and ABIMF, so it could easily be arranged. Other executives and board members liked the idea and made use of it. The ABIM and Foundation work for their stakeholders in the medical industrial complex, primarily the insurance companies like United Health Group and large hospital corporations like Kaiser P. and UHS. This has been true since the early 1930's when the US government contracted Kaiser to build ships for the navy and provided health coverage to the workers. Not huge health coverage, but a few doctors hired by the company. Wage deduction paid for it. Things are much more complex today, but the scheme is the same. The regimentation of physicians into a system for control of the labor force and to cut costs for the corporations and government.

The condo was in essence dark money used for political and personal purposes. Cassel is a politician. Consider the condo a lobbying expense, one of convenience for Cassel or Wachter or Baron to be hold private meetings. The ABIM is more of a Political Action Committee than it is testing company, which is primarily accomplised with volunteers, as it has always been since the beginning. Non pecuniary. But the for profit side wheels and deals in politics to enhance the insurance companies hold over physicians. MOC is a key element of that control of the money flow and control.

MOC RAGE How to defend yourself from MOC! said...

"There are no "extenuating circumstances" that will result in an exception to these policies."

"Fee Policies

There are no refunds for the MOC annual program fee.
If you cancel a traditional 10-year MOC exam: Your MOC assessment fee will be credited to your account if you cancel your MOC exam in accordance with the MOC Exam Cancellation Policy."

"Refund Policies [exam]

70% of the exam fee will be refunded if cancellation is received 48 hours prior to exam date. (Example: For exams scheduled Thursday, October 11, 2018, the cancellation deadline would be 11:59 p.m. ET on Tuesday, October 9, 2018.)
55% of the exam fee will be refunded when cancellation is received less than 48 hours prior to exam date.
85% of the exam fee will be refunded if your application is disapproved.
Active military personnel may be eligible for additional exam refunds. E-mail for more information.
Cancel your application in your Physician Portal. You will receive immediate confirmation of the transaction. ABIM will not accept cancellations by phone. Cancellations cannot be processed by Pearson VUE.

Once your cancellation is confirmed, you are no longer eligible for admission to the exam.

There are no "extenuating circumstances" that will result in an exception to these policies."

Hillel's Sweet Polity said...

For the Love of Man

"Physicians do not deserve to have any exceptions, under any circumstances, to our every-changing policies." -- Lord Baron, ABIM's liaison to Ballard Spahr copyright enforcement division, 2001 - present. Stakeholder-advisor and policy maker for CMS. NQF's lone board member resigning in protest over mistreatment and ostracism of their Safety Committe Co-chair.
First male ABIM CEO to forget nearly all medical training and experience with his first day on the job. Future underwriter and credentialing agent for NCQA Global Hospitals and Insurance plans.

Anonymous said...

I don't think that the 860,000 plus physicians who are board certified can fathom the full extent of the betrayal by the ABMS, its member boards, and affiliates. If doctors knew every physician would be filing lawsuits and taking back control of their lives and professions.

If only the defrauded taxpayer and patient really knew. If only the dedicated public servants and their respective agencies charged with protecting the public really knew.