Saturday, June 15, 2019

"Nothing Else. Promise!"

From Sermo:
There is no evidence that recertification makes better doctors. All evidence points to a process that merely enriches the boards that impose their wills upon us.

I was one of the first classes to not be "grandfathered". Those who came before me said "Everyone needs to recertify, except us, we're special." But don't worry, they said, it'll just be an open-book, take-home exam every 10 years.

Except then then changed it to a proctored test that I have to drive 2 hours to, taking a full day off work, leaving the night before, and paying an exorbitant amount to be suspected of being a criminal as I show 2 forms of ID, and sign multiple documents stating I am who I say I am, and am video taped while taking the test, and can only use the bathroom during this time with permission.

But that s all! That said. Except it wasn't. We also need you to do a few CMEs. Just a few. Ok 100, alright 200. Better make that 300.

But that's it! Nothing else. Except for these self-assessment exams. You just need to do one. Ok 2. Alright fine, 4. But that's it!

Oh, except for this self-improvement project. Yeah, we need you, over several months, to do an experiment on your patients. No IRB oversight needed. Just pick something, make a change and tell us how much better your clinic is for doing this, ok?

But that's it! Nothing else!

Oh, except the money. Pay each year or we list you as "not current" on your MoC. Pay us, pay us again, and keep on paying us. Lots and lots of money to keep up. And we promise not to add anything else. PROMISE! (fingers crossed behind back).
Legal work takes money. That money is necessary to get past the numerous Motions to Dismiss attempting to throw out the numerous lawsuits recently filed against the ABMS member boards in order to proceed to discovery.

Have you done your part to help?

-Wes

Wednesday, June 12, 2019

More Legal Trouble for ABIM

Last Thursday, US District Judge Katherine Hayden ruled in favor of Jaime Salas Rushford, MD's motion to sever and transfer his counterclaims and third-party complaint against the American Board of Internal Medicine (ABIM) to the District of Puerto Rico.

For those unfamiliar with this case that began in 2014, a brief summary is included in the Opinion (references removed):
ABIM is an Iowa corporation that oversees the board certification process for internal medicine physicians, which includes administering a one-day, computer-based exam given annually on different days at testing centers nationwide and abroad. Salas Rushford resides and practices medicine in Puerto Rico, where he (was) registered to take the 2009 ABIM exam. In preparation, he enrolled in a preparatory course given in New York by Arora Inc., a New Jersey corporation that gives courses to physicians seeking board certification.

In December 2009, ABIM sued Arora (the “ABIM-Arora action”) in the Eastern District of Pennsylvania, alleging that the company “unlawfully obtained ABIM’s secure [e]xamination items by mobilizing course attendees to divulge the contents of the [e]xamination” in violation of federal copyright law. (Am. Bd. of Internal Med. v. Arora, No. 09-05707). That complaint also named John Doe defendants, “a presently unknown number of past and/or present candidates for Board Certification who have complied with [Arora’s] requests…to provide secure, copyrighted [e]xamination content to Arora for further dissemination.” The ABIM-Arora action settled and was dismissed in mid-2010. (June 11, 2010). Non-identical tests are offered through the month of August, which offers early test-takers the opportunity to alert later test-takers about content. To guard against this, ABIM requires that before they take the exam, all candidates must sign a “Pledge of Honesty” whereby they promise “not to disclose, copy, or reproduce any portion of the material contained in the Examination.”

It took ABIM until October 2014 to sue Salas Rushford in this district, alleging in a one count complaint that he was among those John Doe “past candidates” who unlawfully shared exam questions with Arora. Salas Rushford moved to dismiss for lack of personal jurisdiction. Early in 2015, while Salas Rushford’s motion to dismiss was pending in this district, ABIM sued him in the District of Puerto Rico in a parallel action, asserting a copyright infringement claim identical to the one it filed here. In both actions, Salas Rushford filed counterclaims against ABIM and a third-party complaint against the ABIM Individuals alleging malicious breach of contract, commercial disparagement under the Lanham Act, 15 U.S.C. § 1125(a), and tortuous conduct under Article 1802 of the Puerto Rico Civil Code. In these claims Salas Rushford challenged ABIM’s publication on its website that Salas Rushford’s board certification was “suspended” during a disciplinary investigation, as well as the manner in which that investigation and subsequent hearings were conducted. In addition to his motion to dismiss, Salas Rushford moved to stay the action in this district pending the result of the Puerto Rico litigation and for sanctions. In September 2015 this Court denied Salas Rushford’s motions and in the same month, the district court in Puerto Rico dismissed the parallel action without prejudice.

Salas Rushford then moved for judgment on the pleadings on the basis that ABIM’s lawsuit for copyright infringement was barred by the three-year statute of limitations. In March 2017, this Court granted the motion, and dismissed ABIM’s complaint with prejudice. Following that decision, ABIM and the ABIM Individuals (Richard Baron, M.D., Christine K. Cassel, M.D., Lynn O. Langdon, Eric S. Holmboe, M.D., David L. Coleman, M.D., Joan M. Von Feldt, M.D., and Naomi P. O’Grady, M.D.) moved for judgment on the pleadings on Salas Rushford’s counterclaims and third-party complaint, and Salas Rushford moved to sever and transfer them to the District of Puerto Rico. (Magistrate) Judge Waldor granted Salas Rushford’s motion to sever and transfer in the Opinion and Order from which ABIM now appeals.
The 2010 Arora-ABIM case led to this article published the Wall Street Journal. That article claimed as many as "140 physicians" were involved, and mentioned five physicians that the ABIM had just sued. Dr. Christine Cassel, President and CEO of the ABIM at the time was quoted as saying:
"Any high-school kid knows that cheating is unfair," said Dr. Christine Cassel, president and chief executive of the ABIM, who called the sanctions "a message and a deterrent."
What Dr. Cassel had never mentioned were the tactics the ABIM used to bring those charges against the vulnerable Arora course attendees. Furthermore, none of the charges brought by ABIM were ever upheld in court.

No doubt US internists who have been subjected to the strongman tactics used by ABIM sense a bit of schadenfreude knowing the "ABIM Individuals" may be traveling to Puerto Rico to stand trial there, too.

Sadly, their travel and legal fees will be at our expense, too.

-Wes

Monday, June 10, 2019

Plaintiffs Respond to ABPN's Motion to Dismiss

The recently-filed plaintiffs' Opposition to the American Board of Psychiatry and Neurology's (ABPN) Motion to Dismiss concisely summarizes the legal issues with Maintenance of Certification (MOC):
ABPN sells initial certifications to new doctors to demonstrate satisfactory completion of their graduate medical education. ABPN has a 100 percent market share in the market for initial certifications, possessing monopoly (and market) power. ABPN also sells a maintenance of certification product to older psychiatrists and neurologists (“MOC”). According to ABPN, MOC tests something it calls “lifelong learning.” ABPN sold initial certifications for more than sixty years before it began selling MOC. ABPN forces doctors to buy MOC or have their initial certifications terminated, illegally tying its MOC product to its initial certification product in violation of Section 1 of the Sherman Act.

Psychiatrists and neurologists do not want to purchase MOC or would prefer to buy “lifelong learning” products from other providers, but cannot without ABPN terminating their initial certifications subjecting them to substantial economic consequences. In this way, ABPN holds each doctor’s initial certification hostage and controls the maintenance of certification market. Through these and other anticompetitive acts ABPN also has a nearly 100 percent market share in the separate maintenance of certification market. It obtained and continues to maintain its monopoly position in that market in violation of Section 2 of the Sherman Act.
Plain an simple.

Let's hope the truth will set us free.

-Wes

A True Story

From the front line of health care in South Carolina:
It had been a long week of consults and surgeries when he received the call.

"Doctor, why are you behind on MOC®?"

"Really, that's none of your business," he said.

They threatened to take his privileges.

He said, "No you can't because I'm relinquishing them now."

They said, "Wait!..."

He left.
Please help end the abuse.

-Wes

Sunday, June 09, 2019

MOC's End Game: Physician Data Sales

Provider Information Management (actually Physicians Information Management) is the new digital currency being compiled and sold.

ABMS Maintenance of Certification (MOC®), is the means to keep that physician database current.

Meet Phynd Technologies, Inc., a partnership of ABMS Solutions, LLC, Epic Systems Corporation, Amazon Web Services, Drupal, and the non-profit Healthwise, a network of databases used by healthcare organizations to control costs while providing "deeper" patient and consumer engagement with information that they claim, "saves lives."
"Inaccurate provider information puts care, revenue, and reputation at risk.

There is no single source of truth, until Phynd.

Phynd serves as the single source for high-quality provider information:

who they are
where they work
what they do
what qualifications they have."
And let's not forget:
"Referring providers are important.

They’re worth $1 million a year or more to your health system.

You have 10 times as many referring providers as credentialed. Or more.

Your referring provider population is growing much faster than your credentialed population."
MOC® is not about physicians' education, skill, expertise, or knowledge. MOC® is just physician data, credentialed or not, compiled, reformulated, and for sale to the highest bidder.

All done with the blessing and support of our equally-conflicted medical subspecialty societies.

-Wes

Tuesday, June 04, 2019

HRS Hears From Its Members on MOC

From the Heart Rhythm Society online forum by a cardiac electrophysiologist:
After exploring the web of corruption that supports the ABIM and NCQI
(editor's note: actually the NCQA, the National Committee for Quality Assurance), I decided I would take a stand against it and not participate in MOC or re-certify with ABIM. I certified with NBPAS and re-certified with them. I truly believe it’s a great organization. I thought perhaps I could influence the situation and force it closer to a breaking point because I practice in a geographically isolated location and if I’m not here treating patients there will be tremendous expense flying/transporting them to the next closest center hundreds of miles away.

I was able to get my hospital system to accept NBPAS as an alternative board certification...for a time. Until BCBS (who answers to the NCQI  told the hospital they would no longer pay for my services. I explained to the hospital how board members of ABIM sit on the NCQI board and vice versa. How they profit off physicians through their corruption, how the DOJ has taken a position against ABIM, the class action lawsuits and harm the ABIM is causing physicians and patients alike.

Once there was an economic cost to my opposition the hospital system caved. They said they could no longer employ me if I didn’t re-certify with ABIM. I told them fine, I’ll quit and work as an independent physician seeing only CMS patients (CMS does not require board certification). The hospital told me if I quit they’d revoke my privileges and I’d have to move (it’s the only hospital with an EP lab on the peninsula). So this year, for the first time in 15 years, I didn’t attend HRS. I stayed home and clicked meaningless buttons on my screen to collect the 100 hours of MOC points required to be able to take the ABIM recertification exam. I’ll use my CME time to go to the board review course and learn about what gene mutation is associated with LQT type 6 which I’ll never see in my lifetime rather than HRS which changes my practice for the better every year. This is a cost to patients, it’s not quantifiable, but a cost none the less.

I was happy to sacrifice tremendously for this cause because it’s the right thing to do, but in the end I have a family to support. If we stand alone they will shoot us down, if we stand together we may have a chance. It would be nice if HRS would stand with us. If not them then who and if not now then when.
- Name withheld

The time is now. Please contribute: https://www.gofundme.com/practicing-physicians-of-america

Wednesday, May 29, 2019

Medical Societies Side with ABIM at the Expense of Their Members

Yesterday in a coordinated blow, the American College of Cardiology (ACC), Heart Rhythm Society (HRS), Society for Cardiovascular Interventions (SCAI), the Heart Failure Society of America (HFSA), and the American Board of Internal Medicine (ABIM) turned to their marketing muscle, funded in large part by the medical device industry, to issue a joint letter to their respective physician memberships that they stand with the nations' consolidating hospital systems in requiring Maintenance of Certification (MOC) for working physicians:
Dear Member:

We are writing to provide information of interest regarding cardiologists' American Board of Internal Medicine (ABIM) certification status.

On Jan. 1, 2014, ABIM Maintenance of Certification (MOC) requirements changed. In addition to the 10-year assessment requirement, diplomates wanting to maintain their certification are required to complete 100 MOC points every five years. The end of the first five-year period for many diplomates was Dec. 31, 2018.

Early in 2018, ABIM noted that a number of diplomates were at risk of missing the 100-point requirement. ABIM initiated an intense effort to communicate with these diplomates. This resulted in a high percentage of cardiologists across all specialties obtaining enough points to remain certified before ABIM updated its public reporting in February 2019. When looked at through the lens of specific certificates, 94 percent of cardiovascular medicine certificates, 88 percent of electrophysiology certificates, 84 percent of interventional certificates and 100 percent of heart failure certificates were held by diplomates who met the 100-point threshold. Additionally, physicians who had not met their points requirement saw their certification status change to "Not Certified."

The leadership of the four major cardiovascular specialty societies – the American College of Cardiology (ACC), Heart Rhythm Society (HRS), Society for Cardiovascular Angiography and Interventions (SCAI), and Heart Failure Society of America (HFSA) – realized that many cardiologists who had intended to remain certified were somehow unaware of the new process and missed the deadline. Therefore, they initiated a call with the ABIM leadership to discuss opportunities for those cardiologists to bring their certification into good standing.

If you are one of those whose certification status has changed – or if you'd like to confirm what you need to do next – please follow these steps...
This letter was issued despite physicians losing their ability to practice medicine solely because they did not complete "MOC points" before an arbitrary five-year deadline imposed by the ABIM. Physicians across the country are receiving letters from their hospital systems threatening them with "automatic retirement" for allowing their board certification to "expire." Worse still, some of those letters were issued in states where anti-MOC legislation exists, thanks to loopholes conveniently added by hospital lobbyists.

So what do our specialty societies recommend physicians do? Ask the monopoly ring-leader for a letter:
If your hospital, payer or employer credentialing committees have raised concerns, ABIM will work with you to provide a letter that can be shared with them outlining what you need to remedy any temporary loss of certification. To discuss such a letter with ABIM, please see the contact information below.
In other words, pay up, get your MOC points, or shut up and lose your job.

-Wes

Please donate to the GoFundMe page created by Practicing Physicians of America to end this discriminatory educational monopoly and racketeering. It is clear now that state legislation created to outlaw MOC in most states means nothing to our nation's consolidating hospital systems.

Addendum: 29 May 2019 @ 1:18 PM CST - Link to physician letter fixed.

Thursday, May 23, 2019

The Bizarre Week of Pro-MOC Activities

"ABIM is disappointed to learn of a lawsuit filed on behalf of four diplomates. The organization will vigorously defend itself, recognizing that doing so will consume resources far better dedicated to continuous improvement of its programs."

- ABIM blog

What a bizarre week it has been by those who support Maintenance of Certification (MOC). Despite the growing uproar in the working physician community, it is becoming clear that the proponents of MOC are circling their wagons in an effort to go "all-in" on the program.

  1. First came the article by highly conflicted members of the ABMS Vision Commission that was published in JAMA by Christopher C. Colenda, MD, MPH, William J. Scanlon, PhD, Richard E. Hawkins, MD.

    The authors listed the following conflicts of interest:
    "Dr Colenda and Dr Scanlon served as co-chairs on the Continuing Board Certification: Vision for the Future Commission. Dr Colenda is president emeritus of West Virginia University Health System and founder and principal for Christopher C. Colenda, LLC, a firm that provides consulting services to academic health care institutions and organizations, reported receiving personal fees from the Association of American Medical Colleges (AAMC), The Ohio State University, Virginia Tech/Carilion School of Medicine, and Loyola University School of Medicine, and serves as the "of counsel" role with Witt/Kieffer Search, an executive recruiting firm. Dr Hawkins reported receiving personal fees and royalties from Elsevier."
    Of course the authors failed to mention their other significant conflicts. Dr. Colenda was a member of the Board of Directors of the Accreditation Council on Graduate Medical Education (ACGME), the National Board of Medical Examiners (NBME), the American Board of Psychiatry and Neurology (ABPN), the AAMC's Administrative Board of the Council of Deans, Health Systems Governing Council of the American Hospital Association (AHA), and the LCME, where he was chair from 2012-13. Dr. Scanlon served as a "Consultant" to the now-obsolete National Health Policy Forum, a group created to help the government determine how doctors should be paid that was funded (in part) by Blue Cross Blue Shield, the Robert Wood Johnson Foundation, and the Josiah Macy, Jr. Foundation. Both the Robert Wood Johnson Foundation and Josiah Macy Jr. Foundation have donated significant funds ("grants") to the ABIM Foundation to foster the "Choosing Wisely" campaign and "team based" health care delivery. Dr. Hawkins, currently serves as President and CEO of the American Board of Medical Specialties (the owners of the MOC® trademark) and ABMS Solutions, LLC that sells physicians ABMS certification status, updated daily, to third parties.

    God forbid they mention these facts or the editors of JAMA provide professional scrutiny over disclosures.

  2. Second came the plethora of new, costly MOC-preparation materials offered by the American College of Physicians and American Board of Internal Medicine. The business of re-certification is stronger than ever!

  3. Thirdly, the Heart Rhythm Society suddenly became "concerned" that HRS members are losing their ABIM certification. (Who knew?!?) In an announcement to their members after siding with the ABIM and the ACC to create the CMP pathway, they "woke" from their slumber and said:
    "There has been some confusion among members who are not participating in MOC that they should be listed as "Certified, Not Participating in MOC," This has been the case, however, for those last certified in 2014 or later, certification will be forfeited after 5 years of non-participation in MOC. To reiterate, if you certified after 2014 and you have not been participating in MOC, you will be listed by ABIM as "Not Certified" after 5 years. While this has been communicated by ABIM since 2014, we are now seeing the first of our members being negatively impacted by this requirement."
    It's a bit hard to believe that they were unaware of this little right-to-work "problem" with MOC. How did they turn a a blind eye to the many MOC problems as they forged ahead to create the EPSAP educational product for MOC re-certification and the ACC's CMP pathway? Where is their concern over the discrimination against younger physicians certified after the 1990 "grandfather" date? Is another layer of discrimination for those re-certified after 2014 and threatened with losing their certification any different? HRS members on that forum have spoken clearly to the HRS leadership: "Collaborating with corruption is to condone it."

  4. Perhaps the most entertaining thing that appeared this week, however, was an anonymous Twitter account created by an professor at a major academic medical center who serves in a senior leadership position at the American College of Physicians. (Remember, nothing is truly anonymous on the Internet). That account aggressively trolled/baited/harassed anti-MOC working physicians online. Here are a few of the best tweets:
    • "I'm not going to discuss GF (grandfathers). Get over it. What a false flag."

    • Or when responding to concerns about the purchase of a $2.3 million condominium purchased by the ABIM Foundation: "Ignorant comment. Knew you'd go there. That was not corrupt. They used it as a cheaper alternative to hotel stays. Once it went, they had to pay more of your money to house people. Nice job zealots!"

    On and on the tweets went in an unbridled, unprofessional and immature fashion until the account creator was exposed. Then the account went private. As Shakespeare's Hamlet famously said: "The lady doth protest too much, methinks."

  5. Finally, in a Medscape article, the former President of the American College of Cardiology, C. Michael Valentine, MD, suggested that the ACC is prepared to enter the physician certification business by issuing "certificates" for physicians participating in their new Collaborative Maintenance Pathway MOC product:
    "We feel that this gives our members the most options available," said Valentine. "If you decide that you don't want ABIM certification, you can opt out and just do ACCSAP or Cath SAP or EP SAP and we'll then give you a certificate from the College saying that you are engaged in online continuous learning through the College…but that may not be accepted by your hospital or your health system or your payment system. All it says is you're engaged in our SAP program and continuous learning."
    ACC Certification now? Really? For twice the price, too! Never mind that pesky little detail that hospitals and insurers don't currently recognize ACC's CMP without its tie to ABIM's MOC requirements.

It's a shame that the antiMOC battle has come to this, but its really not surprising.

A shift from the corrupt MOC status quo was (and continues to be) inevitable.

-Wes