Sunday, February 24, 2019

Examining the ABIM's Evidence for Maintenance of Certification®

In response to an recent article in MDEdge about the GoFundMe page supporting four plaintiffs who brought suit against the American Board of Internal Medicine (ABIM), Richard Baron, MD, President and CEO of the ABIM said:
“Valuable credentials with standards behind them gain market share because they are meaningful and say something important about the doctors who hold them,” Dr. Baron said in an interview. “There is evidence in peer-reviewed journals that doctors holding our credential are more likely to meet quality metrics throughout their careers [Ann Intern Med. 2018 Jul 17. doi: 10.7326/M16-2643], that they are more likely to order mammograms for women who need them [Womens Health Issues. 2018 Jan-Feb. doi: 10.1016/j.whi.2017.10.003], that they provide care of equivalent quality at lower total cost [JAMA. 2014 Dec 10. doi: 10.1001/jama.2014.12716], and that they actually earn higher salaries [Health Serv Res. 2013 Jun. doi: 10.1111/1475-6773.12011]. All doctors should be concerned if making evidence-based claims about our credential based on data published in peer-reviewed journals gives rise to litigation alleging fraud.”
Breaking Dr. Baron's comment down:

The first reference Dr. Baron cites is a retrospective report of an association (not causation) between Maintenance of Certification (MOC®) status and performing Healthcare Effectiveness Data and Information Set (HEDIS) measures for industry. The study's abstract states in its "Limitations:"
"Potential confounding by unobserved patient, physician, and practice characteristics; inability to determine clinical significance of observed differences."
The second reference cited by Baron is another retrospective review of two single-year cohorts of internists performing mammogram screening in a single year before and a single year after time-limited certification was implemented. This study is subject to innumerable biases (sampling, recall, and information). It is no wonder that the authors state in the study's limitations:
"Finally, more research is needed to fully understand the causal mechanism by which MOC® participation might impact mammography screening specifically and quality of care more generally. In addition, changes to the MOC® program have occurred since 2001, and future research is needed to determine whether associations with the MOC® requirement we report were sensitive to this."
From the limitations of the third retrospective study Baron cites above:
"...more research is needed to determine whether the negative associations we report between MOC® and growth in costs were due to improvements in care quality not captured by our quality measure, reductions in wasteful practices unrelated to patient outcomes, or negative consequences not captured by our outcome measures.
The last study Baron cites in his quote above pertains to initial board certification and only supports the supposition that doctors make more money if board certified - a finding that is not patient-centric at all, but physician-centric.

All of the studies cited by Dr. Baron were retrospective studies and therefore only hypothesis forming. None of the references he cites in his response to the interviewer were causal.

Finally, Baron said:
"All doctors should be concerned if making evidence-based claims about our credential based on data published in peer-reviewed journals gives rise to litigation alleging fraud."
I agree. All doctors should be concerned. What does this say about our journals that publish these studies? Why would a group of practicing physicians with full case loads create a wholly new non-profit (Practicing Physicians of America) to represent the interests of working physicians? Why would those same working physicians create a GoFundMe page to raise money to support litigation to end MOC®? Lastly, why would such an organization support four fellow physicians that dared to challenge those in positions of power by bringing unprecedented claims of antitrust, racketeering, unjust enrichment, wire fraud and mail fraud?

These are very important questions.

Especially when the President and CEO of the ABIM offers poor "evidence-based claims about (the ABIM certification) credential based on data published in peer-reviewed journals" that "gives rise to litigation alleging fraud" in response to questions posed of him.

-Wes

6 comments:

Take Your MOC OIL - Why? Because we say so! said...

The ABIM Has Come Full Circle

What Rich Baron said in the article (pulled from interviews) is very troubling. It makes one wonder about the integrity of any of their "studies". Particularly when ABIM's research already bears the hallmarks of a classic sales ploy ripe with seasoned (trademarked) propaganda. Telling their clients to buy and drink their MOC tonic liberally everyday because it is "good for your brain". I thought the ABIM was established to distinguish a man and woman of science from a street peddler of snake oil.

The basis of ABIM research is apparently to first find some malleable data and then see if anything can be done with it to suggest anything that will sell their product (MOC). Their work comes across unfortunately as a bunch of litanous ramblings, flimflam persuasions and embarrassing soft-shoe methods of passing off their bogus proprietary work as "scientific investigation".

The prescription is MOC oil forced down physicians' throats. The directions on the label says, "repeat, repeat and repeat" in hopes that there are some MOC parrots that will pick up the refrain. But the reality is that most are utterly fed up with MOC. Yet still they must give into the ABMS demands, because they are afraid of losing their jobs or reimbursement from the payers.

Quote of the decade from a snake charmer

"The primary reason for specialty boards was to identify the boundaries and the content areas that defined specific specialties. It was a time, shortly after the Flexner report, when American medicine was beginning to try to distinguish itself from the proprietary physicians trained by apprenticeship, many of whom had little science base and were often considered “snake oil salesmen.”
- Christine Cassel ex-CEO/President/Chair ABIM and ABIM Foundation

Unknown said...

You mean the Christine cassel who happily shoves MOC down our throats but does not participate in it herself?

Unknown said...

By the way the claim that MOCtors are providing care at a lower overall cost is so inflated from the finding as to make it a lie. The actual finding was an association of a 5 percent decrease in the RISE of healthcare costs. So if a good costs 1000.00 dollars and it's price rises 100 dollars then abim is bragging on 50 cents of savings.
­čśĺ. But the ABIM has a long inglorious history of crouching protectively over any spark of "evidence" like this and calling it a bonfire.

News From the Outhouse said...

Not to waste good paper

PubMed, you name it, is riddled with ABIM's smooth bald-faced lies, branded as "studies". Round up the usual suspects, and you guessed it, they all work for the ABIM or are on their payroll.

Click on any of their "literature reviews" and they all say/try to do the same thing. To sing praise of MOC or ding a DOC.

I love their "conclusive findings" on how knowledge makes a better doc. Look for the LRs by, Kimball, Lippner, Holmboe. They are classic farcical reads. The limitations on the studies and disclaimers, conflicts of interest always makes one scratch one's head and then laugh.

How can they get away with such extravagance - wasting so much of our finite money. And the lavish lifestyles they must live from the big piggy bank paychecks/perks/bennies they award themselves. It makes one nauseous or worse.

ABIM's scientific literature is good for wiping one's feet on

Heading into the lean days they are helping to create, I've got some of the ABIM Foundation's literary prizes on "professionalism" awaiting their mission in the outhouse.

Anonymous said...

I hope he has to make those quotes again on the stand. Then the DOJ will come after him and the other members, former and curren,t on the ABIM/ABMS boards. Don't forget the ABMS vision commission too and their statements. These guy are almost writing the questions, the attorneys will use against them.

Unknown said...

Well heck. 5 dollars in savings. But you get my drift.­čśČ