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

Monday, June 24, 2019

Re-Defining Medical Professionalism

In 1999 we were told a new organization was created by the American Board of Internal Medicine (ABIM) to "improve healthcare through the advancement of medical professionalism." That organization then created a workgroup to create a white paper on "medical professionalism co-published simultaneously in the Annals of Internal Medicine and Lancet called "Medical Professionalism in the New Millennium - A Physician Charter."

The President and CEO of the ABIM Foundation has recently begun a speaking tour called "Rebuilding Patient Trust" that started with a Ted talk here in Chicago several weeks ago and now has spread West to the Aspen Ideas Festival. Given this, it is now abundantly clear that the ABIM Foundations' definition of "medical professionalism" needs rebuilding. As a past and future patient, the notion that the head of one of the most trust unworthy organizations in medicine is man-splaining to me how to "rebuild patient trust" is about as creepy as it gets. Visions of catholic priest pedophiles grooming their vulnerable victims comes to mind. Why is this?

Simply, the President and CEO of the ABIM and ABIM Foundation has not proven himself to be a trust-worthy individual. Trust-worthy individuals do not deceptively file tax forms. Trust-worthy individuals that run a 501(c)(3) non-profit organization do not purchase luxury condominiums for themselves. Trust-worthy individuals do not hire felons to serve as test security directors that raid people's homes. Trust-worthy-individuals to not lobby Congress as a 501(c)(3) organization and fail to claim this on tax forms. Trust-worthy individuals do not off-shore physician testing fees to the Cayman Islands. And trust-worthy individuals do not restrict their colleagues right to work because they refuse to succumb to tactics that leverage their false claims to hospitals and insurers to assure their products are purchased.

Patients know better.

Especially this one.

Honesty, transparency, and accountability are the foundations of medical professionalism.

Publicly gaslighting patients as a non-practicing physician in the name of re-establishing "trust" is true medical professionalism's antithesis.

-Wes

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