Friday, May 20, 2016

ABIM Foundation Moves Assets Offshore

In a move that is more reminiscent of a sophisticated investment broker rather than a non-profit, tax-exempt 501(c)(3) corporation interested in promoting "medical professionalism," this year's tax records of the ABIM Foundation (which is affiliated with and shares the same address as the American Board of Internal Medicine (ABIM) in Philadelphia, PA) show the Foundation has total assets of $81,831,953 and moved some of its assets offshore to the Cayman Islands and Dublin, Ireland in the form of non-publicly traded investments.

Recall that the ABIM Foundation was created by secretly funneling $55 million in physician testing fees from the ABIM to their undisclosed "American Board of Internal Medicine Foundation" (later renamed the "ABIM Foundation" in 2009) from 1989 through 2008. Only after the name change with the IRS in 2009 was the ABIM Foundation revealed publicly.

According to this most Form 990, not only does the ABIM Foundation continue to hold their $2,356,267 Philadelphia condominium bought with practicing physician testing fees, we now find they have systematically transferred $6,516,936 of our fees offshore to ten different funds (nine in the Cayman Islands totaling $6,042, 336 and one in Dublin, Ireland totaling $474,600).

Meanwhile, younger physicians can't afford the fees for certification and re-certification mandated by the ABIM. We should also note that the President and CEO of the ABIM and ABIM Foundation,  Richard Baron, MD, pocketed a cool $812,006 last year without night call or having to subject himself to any of the tough discussions with patients.

The Internal Revenue Service (IRS) needs to immediately revoke the non-profit status of the ABIM and its Foundation.  Practicing physicians now realize these organizations are more about protecting and growing their assets than benefiting physicians, their patients, or the public.


Monday, May 16, 2016

Thuggery and Strongman Tactics Grow at the ABIM

There's a wonderful social media principle that might just stop Maintenance of Certification: the Streisand Effect.

The Streisand Effect is the phenomenon whereby an attempt to hide, remove, or censor a piece of information has the unintended consequence of publicizing the information more widely, usually facilitated by the Internet. And when the American Board of Internal Medicine (ABIM) resorts to thuggery and strongman tactics against a physician, this might just come back to bite them in the private parts.

Imagine, you are a physician and your regulatory agency strips you of your privileges to practice medicine without due process. Then imagine the same regulatory agency refuses to release information pertitent to your defense for months and months.

Then imagine, that same self-appointed regulatory agency decides to subpoena you for additional information for their case against you on the busiest travel weekend of the year with only 17 days notice (usual and customary time is 30 days notice). Then, after your attorney politely tries to plea for an adjustment of dates, that same regulatory agency that seems unable to provide information to you, basically says to your attorney: "Your client may choose to disregard it - and the sanctions such disregard will bring - at his own peril."

Welcome to the legal tactics of the ABIM that is feeling the heat of Dr. Salas Rushford's discovery requests and their upcoming meeting with the judge in the case on 3 June 2016.

In 2015, Dr. Salas Rushford had a  gross income $69,725 and a net loss of $1875 in 2015. Compare this amount to the $10.88 million Christine Cassel, MD earned from the ABIM and her cronies during her stint as President and CEO at ABIM from 2003-2013. According to their recently-released tax forms for fiscal year 2015, the ABIM recieved revenues of over $57,620,000 in its fiscal year ending Jun 30, 2015 and Richard Baron, MD (the current President and CEO) pocketed a cool $812,000.

One thing I know. The Internet doesn't like bullies that are trying to hide something from the public (just ask Barbara Streisand).

To me, this young man who has been accused of wrongdoing by the ABIM deserves a fair shake. Imagine what would happen if every US physician, internist, or medical student donated $1, $5 or $10 (or more) to his efforts - it would be a game-changer for the ABIM and for working physicians.

Consider donating to Dr. Salas Rushford's defense and countersuit of the ABIM here.

After all: bullies suck.


P.S.: Consider sharing this post with friends.

Tuesday, May 10, 2016

A Critical Review of ABIM's Recent MOC Changes

In its never ending push to preserve the lucrative Maintenance of Certification (MOC) revenue stream, the American Board of Internal Medicine (ABIM) once again announced a "new option" to complete their corrupt MOC program to beginning January, 2018 (corresponding press release here).

The real details of the new option were sketchy and only promised the following:
  • Take the form of shorter assessments that doctors can choose to take on their personal or office computer—with appropriate identity verification and security (emphasis mine)—more frequently than every 10 years but no more than annually;

  • Provide feedback on important knowledge gap areas so physicians can better plan their learning to stay current in knowledge and practice and;

  • Allow physicians who engage in and perform well on these shorter assessments to test out of the current assessment taken every 10 years.
What was not mentioned was the following:

  • What this "new pathway" will cost and

  • What "identify verification and security" tactics will be proposed to maintain control of the American Board of Medical Specialties' (ABMS) proprietary MOC program.
Let's break these two unmentioned issues down, since they are increasingly at the crux of the corruption at the ABIM and ABMS.


While I do not know what the "new pathway" will cost, we should note that the changes promised by 2018 only provides another way doctors can provide funds to the ABIM. Their proposed "change" does not remove the requirement for the clinically unproven re-certification MOC metric or its secure examination. Importantly, the new proposal does not address prior fraudulent tax filings or secretive funding of their ABIM Foundation from physician testing fees. What we can be assured, however, is the ABIM is desperate for cash to fund its operations and protect its tests. Given what we now know about the ABIM financial burn rate, it is safe to estimate that the ABIM needs to extract at least $200 per year from each and every internist in the United States (and maybe $300/year from specialists) to maintain their current cash flow.

Look for cost of ABIM's MOC program to be $200-300 per year for physicians irrespective of the various "options" or "pathways" the ABIM constructs to fulfill its MOC re-certification requirement.


This is where things get interesting.

Test security is everything to the ABIM. Without it, anyone could replicate their process or "steal" their copyright-registered health information. Few details of how the ABIM plans to perform "identity verification and security" are forthcoming with their latest press release. But one thing we know, the ABIM will continue to have physicians entrap themselves in contract language promising secrecy and to observe obscure "pledges of honesty" before performing any MOC testing.

How might they protect their tests? Well, let's look at one of the test security options available to ABMS from a little-known test security firm, Kryterion. It seems Kryterion would monitor physicians who opt for the "at home" option using a webcam and microphones. According to Kryterion's Terms of Service, physicians will be asked to scan the room using their webcam before sitting before the computer with a live proctor on the other end of the line:
The Kryterion Certified Online Proctors (KCOPs) are trained to watch and listen for any unusual behaviors from the test taker. For example, unusual eye movements, removing oneself from the field of vision and making atypical noises are all noted and a behavior alert is sent to the test taker, depending on the business rules you set. The test taker is required to acknowledge the alert before continuing with the test and the KCOP resumes or stops the testing process, depending on the action you’d like us to take.
What legal action does the ABIM or Kryterion plan to invoke if they feel my eye movements are questionable? Yet this is the reality of "secure testing" that the ABIM might utilize. And as we've seen, it appears the ABIM is all to happy to deploy their lawyers on physicians at the slightest hint of a "testing irregularity" to extract even more revenue from physicians and to protect their monopoly.

Sorry. but I don't want Big Brother in my house. If this is how the ABIM plans to assure I'm compliant with my continuing medical education just so they can extract more revenue from me under the threat of litigation, they've got another thing coming.

ABIM has still not addressed its financial transgressions, multiple corporate conflicts of interest, high salary structure, and fraudulent tax filings. Unless and until these issues are addressed, look for the practicing physician community to avoid further interaction with the corrupt ABMS MOC program irrespective of any further changes to their MOC program the ABIM might propose.


Tuesday, April 26, 2016

Fearing Exodus: American Board of Medical Specialties Issues Statement on Oklahoma

Fearing a mass exodus of physicians from the lucrative ACGME-mandated Maintenance of Certification (MOC) program, two member organizations of the ACGME, the American Board of Medical Specialties (ABMS) and the American Osteopathic Association (AOA), recently issued statements of "disappointment" or "promising to innovate."

The ABMS stated they were "disappointed" on the passage of the Oklahoma law outlawing the use of the ABMS MOC program for board certification, physician hospital credentialing, or insurance company payments and were "committed to improving their programs for physician certification and assuring that participation in MOC provides physicians with meaningful improvement opportunities." No mention of how they might cut the cost of their "commitment" to physicians was made.

The AOA's statement, issued just after the National Board of Physicians and surgeons open its credentialing process to osteopaths, "promised to innovate" so they could reach their "Rooftop Goals." Too bad the AOA still doesn't seem to understand that their statement promotes just what physicians don't need: another bureaucratic building project.

Neither statement issued by the ACGME member organizations provide convincing arguments of sincerity to practicing physicians that have seen their hard-earned cash squandered by these organizations and have failed to truly prove the clinical relevance or need for re-certification of any kind. Further, no accountability for the financial mismanagementstrongman tactics used by ABMS member boards to assure physician payments into this unproven metric, and fraudulent tax filings by member boards of the ABMS has yet to take place.

This outdated ACGME physician MOC re-credentialing system built on political and corporate cronyism is being rendered obsolete by the presence of real competition to the status quo by the National Board of Physicians and Surgeons' credentialing process that is credible, more affordable, and financially transparent. There is simply no going back.

Good riddance MOC.  Trust me: you won't be missed.

Nor will those who've made a living for themselves promoting this very broken and highly conflicted ABMS MOC program.


Tuesday, April 19, 2016

NEJM Fails to Publish Comments Critical of ACCME Perspective Piece

Screen Shot was taken 4/19/2016 of NEJM web page showing undeclared conflict of interest
(Click to enlarge)
I find it interesting that my comment to the New England of Journal of Medicine pointing out the undisclosed conflict of interest highlighted above and mentioned two days ago on this blog has yet to be published in the comments section appended to the article. Authors must disclose their financial conflicts. Why don't the editors of the New England Journal of Medicine?

It appears the cronyism displayed by the ACGME in support of the American Board of Medical Specialties Maintenance of Certification (MOC) product also extends to our "finest" medical publications.

Caveat emptor.


Addendum 07:50AM CST: 9 Comments (including mine) now appear on the NEJM website.

Sunday, April 17, 2016

Rethinking Our Medical Education and Publishing Bureaucracy

Medicine has an image problem.

On one hand, medicine is full of wonder: incredible technology, incredible innovation, and incredibly bright people.

On the other, medicine is full of avarice, full of greed, and full of waste, much of it by the very same folks who bring us all that medicine has to offer: the Accreditation Council for Graduate Medical Education (ACGME).

The ACGME is an incredibly rich and powerful organization in medicine. It is comprised of the American Medical Association, (AMA), the American Board of Medical Specialties (ABMS) and its 24 member boards (including my "favorite", the American Board of Internal Medicine (ABIM)),  the American Hospital Association (AHA), the Association of American Medical Colleges (AAMC), the Council of Medical Specialty Societies (CMSS), the American Osteopathic Association (AOA), and the American Association of Colleges of Osteopathic Medicine (AACOM). Collectively, member organizations of the ACGME represent an annual burn rate of almost $1 billion dollars for medicine (Latest annual income figures from AMA ($261,328,052), AHA ($126,339,392), ABMS and its 24 member boards (Approximately $300,000,000; $54,454,584 for the ABIM alone), CMSS ($967,541), AOA ($44,376,054), AACOM ($10,855,122)).

As part of the ACGME's "Vision" statement, they "imagine a world" where residents and fellows are "prepared to become Virtuous Physicians who will place the needs and well-being of patients first."

This is where the ACGME's "vision" clashes with reality.

Right now, the average "Virtuous Physician" has a median debt load of $180,000 before they graduate from medical school and patients are experiencing bankruptcies from health care as our Medical Education Establishment dines at the Four Seasons and takes a few more reps in the gym.

The ACGME and their kin are still living in the world where first class air travel, memberships at health clubs, and $2.3 million condominiums with chauffeur-driven Mercedes S-class town cars are the norm. The ACGME seems blind to the irony of serving Virtuous Physicians while having one of its core values the "Engagement of Stakeholders" like their "friends in accreditation" at the Accreditation Council for Continuing Medicine Education, the Joint Commission on Accreditation of Hospital Organizations, the National Board of Medical Examiners, and the Federation of State Medical Boards, who foist educational programs like their unproven and wasteful Maintenance of Certification (MOC) program to fund their largess.

So it should come as no surprise that even our most "prestigious" academic journals like the New England Journal of Medicine (NEJM) are joining in on the fun. This week they permitted a promotional "perspective" piece entitled "What Do I Need to Learn Today - the Evolution of CME" to be published by the head of the Accreditation Council for Continuing Medical Education (ACCME), Graham T. McMahon, MD. Like other accreditation organizations within the ACGME, Dr. McMahon enjoys paid first class airfare and health club membership while promoting the legitimacy and expense of the costly and unproven ABMS MOC program that finds itself in a whirl of ethical controversy already. Meanwhile, the NEJM is selling its expanded and remarkably expensive  "Knowledge +" MOC educational product without ever acknowledging this conflict to its readers in this week's issue.

Our tired and inefficient "non-profit" bureaucratic medical education system better wake up soon to the new reality in medicine: practicing physicians and their patients are feeling the adverse effects of all those health clubs and first-class airfares.

In this time of serious cuts to patient care budgets in medicine, it's time our Medical Education and Publishing Establishment starts "learning what it needs to do today" besides stumping for wasteful "CME" programs and harvesting its budget from those who are finding it harder and harder to believe that our expensive medical education bureaucracy has their best interests in mind.


Wednesday, April 13, 2016

Propaganda Machine: How ABIM Spins Its Survey Results

As it continues to spiral out of control, the American Board of Internal Medicine (ABIM) issued a press release telling practicing physicians what they've "learned" from "key findings from a representative sample" of internists.

Sadly, how their "representative sample" of internists' survey responses was collected and reported for this press release is telling.

Reviewing the methods used for the survey collection, we see ABIM's "ALL DIPLOMATE" survey was really created from less than 0.2% of all internists they polled. (360 respondents of 196,867 emails sent) and the results were "weighted" from a select subset of the internists whom they repeatedly queried to assure an acceptable response rate, introducing substantial selection bias).

What the ABIM continues to ignore is the overwhelming rebuke of the MOC process from over 23,000 physicians in 2014 and a similar survey result from the membership of the American College of Cardiology.

Propaganda masquerading as flawed survey results that are obtained by unaccountable organizations with large conflicts of interest with the physician testing/quality industry has no place in the practice of medicine. Press releases such as this one issued by the ABIM are both irresponsible and misleading. By issuing this press release, the ABIM demonstrates its blatant disregard for the best interests of physicians and patient care just so they can maintain their lucrative MOC program.