Sunday, August 25, 2019

Assuring Longitudinal Physician Exploitation and Burnout

ABIM Email Notification
His day started at 07:15 AM with two planned atrial fibrillation ablation procedures and an implantable cardiac defibrillator (ICD) implantation scheduled. As the day progressed, another unscheduled ICD was added, then three emergent pacemakers had to be implanted. Squeezed between the cases were rounds, inpatient consults, phone calls, post-op checks, emails, EMR tasks, and echos in his inbox. He finally headed home at 10:45 PM; another dinner missed with his family.

One of his emails included a notification that the American Board of Internal Medicine (ABIM) is developing a Longitudinal Assessment Option because they were "hearing those voices" from an overseas professor that implied "many of our colleagues have said they would like to see the process of maintaining certification offer more flexibility and choice." The ABIM now adapts behavioral and cognitive psychology to teach this busy electrophysiologist the "important competencies" of "professionalism, working in a team, and collaboration" promised by this new ABIM Longitudinal Assessment Option for MOC.

The ABIM stands on the head of a pin as it sends mixed messages about competency, professionalism, teamwork, and trust, all while maximizing the medical industrial complex's profit stream. It sends its email or tweets as they shape our next generation of physicians to continue to comply in being exploited and to make peace with the new medical group-think. A thinking person might see the contradictions inherent in these conflicting goals - but then this is the new MOC reality despite the lawsuits underway to end this program.

Pity the poor doc who now must decide at 10:45 PM whether he sits on his zafu, engages in relational maintenance with whoever is still up at home, or completes the graduated teaching assignment kindly forwarded by ABIM.

What we must never ask is whether there will ever be a MOC module or a pranayama sufficient to make this lifestyle sustainable.

-Wes

Thursday, August 15, 2019

MOC Issue Embroils EP Community

After I circulated my fund-raising video two weeks ago to the Electrophysiology Community via the Heart Rhythm Society (HRS) closed message board, a firestorm of challenges to the HRS leadership have erupted online. At their core, the HRS is now under increasing pressure to decide with whom they side: (1) their physician membership or (2) other corporate interests. The exchange has become so heated that the HRS has decided to issue a new "survey" to gage how their members feel about "continuous certification" and lifelong learning via the MOC paradigm. The re-issued survey closes 19 August 2019 and HRS members are encouraged to complete that survey just (re-)sent to them. (The first survey was shared publicly on social media and many physicians responded anonymously, making it difficult for HRS to determine their membership's responses, we are told).

Here are just a few of the comments being circulated, even as late as today, as HRS leadership try to defend their relationship with the American Board of Internal Mesicine (I have chosen to make comments anonymous our of respect to those who have made their feelings known publicly).
  • "Love it or leave love it. I am so looking forward to my body frisk looking for cheating materials at the Pearson View testing center in December - a $1200 massage will put me in the right frame of mind to take a day-long test, much of the content of which has no relevance to the things that matter towards helping my patients to live longer or live better. But no worries, I'm sure the HRS Board Review course (estimate >10K with room, board and lost wages, not to mention deduction from time for meaningful CME) will enlighten you as to the latest nitty gritty in IKwtf, so you'll be awesome at parties."


  • "As I’m sure you are fully aware, this money grab and power grab are far deeper reaching than most realize and your suggestion to deal with it locally cannot work. It’s extremely disingenuous of you to imply otherwise.

    A few years ago I decided to stand up for what I considered right and take a stand against the ABIM/ABMS. I refused to participate in MOC (though I go to HRS and a few other meetings every year and consider myself beyond competent). When my 10 years were up I chose not to take the recertification exam. I became board certified by the NBPAS. My local credentials committee didn’t know what to make of it, but when I met with them and explained my objection they went along. I told them if they didn’t I was leaving and I’m the only one who does a lot of the things I do in my institution. Then the insurers (BCBS) net with administration and their opinions changed. BCBS said they could no longer pay for anything I did unless I was pursuing recertification. The hospital administration said I needed to take the ABIM recertification exam or they could no longer employ me. I told them that’s fine, then I’ll quit and go into private practice and just see CMS patients (they don’t require ABIM certification). Administration told me if I did that then my privileges would be revoked. As I send this message I’m waiting for the first session to start at the board review course. I will never take this exam again. If this same bullshit exists in 10 years then I’ll retire at 56.

    Please don’t pretend that you are unaware that the NCQA which certifies insurance companies are in bed with the ABMS/ABIM who certify physicians. Don’t pretend that you are unaware that there are members who sit on both boards and profit tremendously off the backs of working physicians. I’ve met with the insurers who tell me they’d like to allow me an exception, but NCQA requires that all the physicians they contract with are ABMS (means ABIM in the EP world) board certified.

    So there you have it. ABIM requires MOC. If physicians refuse they revoke their certification. If they continue to object or seek alternative certification (NBPAS, IBHRE) then the rely on the NCQA to pressure payers (they threaten to revoke the insurers NCQA certification if they have physicians on their panel who are not “certified” by the one true board) to force physicians back in compliance by removing them from their panels. If physicians continue to refuse the payers threaten hospital administration and they threaten to revoke the physicians hospital privileges. If you don’t see a problem with this then I suspect you have a conflict of interest. Again please don’t attempt to deceive the HRS membership."
I have warned prior physician-presidents of HRS about this controversy, but it never dawned on me at the time that physicians no longer control the organization. That task, like so many in medicine today, was relegated to a non-physician non-profit executive long ago. It will be interesting to see how this will play out going forward, especially since the MOC monetary and conflict of interest genie is out of her bottle. The HRS leadership, be they physician or not, has a very serious fundamental decision to make: side with their physician membership, or side with their conflicted corporate partners who will stop at nothing to assure their profit margins.

Working cardiac electrophysiologists know that HRS has advocated for many of their needs over the years, but on this issue and it potential to affect their right to work, the conflicts of interest inherent to MOC with insurers, group purchase organizations, and hospital systems present a formidable challenge to the entire HRS leadership going forward.

Trust take years to develop. Let's hope HRS doesn't lose what they've earned in a heartbeat.

-Wes

Thursday, August 01, 2019

AntiMOC Lawsuit Update

As the summer winds on, I have been approached by more and more people who would like an update on where the litigation filed against the many member boards of the American Board of Medical Specialties stand since the lawsuits were filed. I will do my best to briefly summarize the status of those lawsuits as I understand them. (For background on why these lawsuits have been filed against so many of the American Board of Medical Specialties specialty boards, please review this video).

The antitrust suit against the American Board of Internal Medicine (ABIM) was originally filed 6 Dec 2018 and amended 23 Jan 2019 to include RICO charges, the antitrust lawsuit against the American Board of Radiology was filed 26 Feb 2019, and the antitrust lawsuit against the American Board of Psychiatry and Neurology (ABPN) was filed 6 MAR 2019. These cases were filed by a law firm based in Chicago. A fourth lawsuit was filed by a separate law firm in Southern District Court of California on 19 Feb 2019 against the American Board of Medical Specialties (ABMS), the American Board of Emergency Medicine (ABEM), and the American Board of Anesthesiology (ABA).

Each of the member boards are represented by different law firms.

Three of the specialty boards (ABIM, ABR, and ABPN) have appeared and, as expected, filed motions to dismiss with mostly overlapping arguments. The motion in the ABIM case was fully briefed a couple of months ago (Motion to Dismiss here, Opposition for Motion Dismiss here), the ABPN motion was fully briefed last month (Brief in Support of Motion to Dismiss here, Opposition to Motion to Dismiss here), and the briefing in the ABR case should be finished mid-August.

In the interim, a motion to consolidate the above cases (brought by the law firm representing the plaintiffs in the ABMS/ABEM/ABA case) which the plaintiffs in the ABIM, ABR, and ABPN cases opposed out of the concern that it might delay the cases and add to their cost, was denied. So these three cases (ABR, ABPN, and ABIM) will each continue on their own in the federal courts in Philadelphia (ABIM) and Chicago (ABR and ABPN).

It would not be unusual for the courts to take several months to decide the motions to dismiss, especially given their complexity and importance. Discovery for these cases will begin once the motions to dismiss are decided, which is hoped will be no later than the end of the year. As I am sure many of my readers have already observed, the litigation seems to be having a modest impact, as many specialty boards and specialty societies claim to be re-thinking their Maintenance of Certification (MOC) requirements, at least around the edges.

It is important that physicians continue to help fund the GoFundMe page sponsored by Practicing Physicians of America. (Remember, short of processing fees, every penny of those contributions will to toward these continuing legal efforts.)

In summary, I believe the legal cases are progressing as well as can be expected and I remain convinced that, together, working physicians CAN end Maintenance of Certification's stranglehold on US physicians nationwide.

-Wes

Tuesday, July 30, 2019

Why the U.S. Specialty Boards Were Sued and Why Those Lawsuits Are Important

I hope every working U.S. physician takes 9 minutes to view this video on why the lawsuits against  the American Board of Medical Specialties (ABMS) member boards were filed and why those lawsuits are so important to our profession.

Please view and share with your colleagues.

An update on the status of those lawsuits will appear on this blog's pages soon.



-Wes

Friday, July 05, 2019

Subject of Major Lawsuit, ABIM Struggles to Fill Positions

Seventy-three positions are needed for the American Board of Internal Medicine (ABIM) to fulfill "a new governance structure," the ABIM announced on its blog July 2, 2019. True to form for this private organization: the need for a "new governance structure" and how that structure will impact working physicians is not disclosed. Will the ABIM have difficulty filling their positions?

It is lost on few in the medical community that the ABIM is struggling to survive. With its Maintenance of Certification program seen as little more than a revenue-generating scheme of little value to working internists coupled with a formidable class action anti-trust and racketeering lawsuit levied against the organization by four internists, the viability of this once-powerful physician certifying organization is being questioned.

And for good reason.

Trust in the integrity of the ABIM and other member boards of the American Board of Medical Specialties that "grandfathers" older physicians' initial certification while forcing younger, more vulnerable working internists to fund the organization by paying larger and larger fees to "maintain" theirs, no longer exists.

The real question now is this: will the other members of the Accreditation Council on Graduate Medical Education (ACGME) that depend on the lucrative certification data gravy train keep the organization afloat?  Will politically powerful specialty society "collaborations" that have developed with the ABIM suffer the same fate?

-Wes

PS: Physicians can keep the pressure on the ABIM but continuing to contribute the the GoFundMe page created in support of the many physicians harmed by Maintenance of Certification.


Monday, July 01, 2019

MOC's Incredible Price Growth


The chart above by Mark J. Perry, a scholar at the American Enterprise Institute and professor of economics and finance at the University of Michigan's Flint campus, was recently published demonstrating the rise in healthcare prices in government services affected by bureaucratic regulatory capture (red) and those that were not so affected (blue).

Physicians are directly feeling the brunt of this economic effect with American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC).

The American College of Cardiology and the Heart Rhythm Society have thrown their support behind the ABIM's MOC product by offering a new, even MORE expensive product, the Collaborative Maintenance Pathway (CMP), that will raise the cost for MOC over 462% from 2000-2020:


Think about that.

I would encourage all of my colleagues to support our GoFundMe effort the end the regulatory capture of the ABIM by contributing whatever you can to the anti-trust and racketeering lawsuit against them.

Thanks.

-Wes

Friday, June 28, 2019

The ABIM Tax Man Commeth... Again

Yesterday, lots of busy internists received email notices of another $140 check due to the American Board of Internal Medicine (ABIM). Physician's "Maintenance of Certification (MOC) fees are now an annual tax internists must pay to practice medicine. Physicians should ask themselves why they must pay for this unproven "educational promise" tied to their initial board certification that "tells the public" they keep up with their continuing medical education.

No doubt many will pay, simply because they have to do so - they signed an "adhesion contract" that binds them to this annual tax despite the fact that their payment will go to a private, unaccountable organization that has shown years of financial and political mismanagement.

I would advise physicians consider balancing the extortion with a contribution of any size to our GoFundMe page that supports the plaintiffs who sued the ABIM for alleged antitrust, racketeering, and unjust enrichment claims. Opposition to the ABIM's Motion to Dismiss has been filed, and the ABIM is on the ropes like never before. Now is our chance. It's now or never. There is simply no free lunch - legal fees are considerable for a legal case of this complexity.

Wouldn't it be nice to end this monetary and professional injustice once and for all?

-Wes