Wednesday, July 18, 2018

US Physician ABMS Board Certification: From Voluntary to Mandatory

The American Board of Medical Specialties (ABMS) is very careful to claim their version of "Board certification" is a "voluntary process," otherwise, this Chicago-based non-profit 501(c)(6) organization might be accused of anti-trust behavior.

"ABMS Maintenance of Certification" and "ABMS MOC" were registered by the ABMS in the US Patent and Trademark Office August 21, 2007 after filing the terms February 23, 2007.

MOC for ABMS has value.

We also know Ms. Margaret O'Kane, founder and President of the non-profit "National Committee on Quality Assurance" and that created and owns the Healthcare Effectiveness Data and Information Set (HEDIS). HEDIS is a tool used by more than 90 percent of America's health plans to measure performance on "important dimensions of care and service." We also find that Ms. O'Kane was a "public member" of the Board of Directors of the ABMS and advertised the importance of the ABMS MOC program "to patients and the pubic" by video and implies the ABMS board's actions assures improved "outcomes" for patients.

So it should come as no surprise that some of those payers who stand to benefit by limiting patients' access to care (in this case, Blue Cross Blue Shield of Michigan) have made initial ABMS Board certification mandatory for physicians on their panels:


(Click to enlarge)

While claiming MOC as a requirement for physicians to receive payments because it assures their  "quality," BCBS of Michigan does not demand the same of mid-level providers like physician assistants and nurse practitioners without similar subspecialty training. Additionally, physicians who received their "Board certification" before 1990 and are farthest away from their training are not required to perform ABMS Maintenance of Certification to remain on those same insurance panels, introducing a hypocritical and discriminatory double-standard that financially benefits insurers and hospital systems (more insurance claim denials and cheaper staffing requirements).

ABMS is the puppet of the insurance companies, just as they were the puppets of Big Tobacco in the 60's.

The IRS, FTC, and SEC need to get serious about investigating this ruse.

Why?

It's compromising patient care and our patients' access to care.

-Wes

P.S.: If you haven't contributed already, please consider donating to the legal fund sponsored by Practicing Physicians of America that hopes to bring an end the ABMS Board certification/MOC monopoly nationwide.






Thursday, June 28, 2018

A Critical Review of the ABIM Knowledge Check-In Program

This video is a first attempt at something new. I look forward to your thoughts. (Yes, as always, the comments are open).



As a professional physician who has devoted his whole life to helping others, the introduction of the American Board of Internal Medicine's (ABIM) latest iteration of Maintenance of Certification (MOC), called "Knowledge Check-in," is maddening. Knowledge Check-in continues the humiliating and embarrassing pre-test body search (now in the comfort of our own home or office), higher fees, and (as I review in the video above) places physicians at a very high risk of identity theft. Having doctors acquiesce to this nonsense every two years just so they can keep doing their job shows how low the independent non-profit ABIM (and all other American Board of Medical Specialty member boards that subscribe to this approach) will go to keep their cash flow going. They're not "listening" to physicians as they promised, they're using a classic strongman approach to market physicians as "cheaters" before caregivers, just as before.

If you feel as upset as I do that this is no way to perform physician education, please join our effort to end this costly and unproven re-certification program nationwide for all subspecialties by contributing to our GoFundMe page.

-Wes

Monday, June 25, 2018

Rent-Seeking: ABIM Shows Us How It's Done

The new ABIM fee schedule was published online for 2018, and physicians should pay attention. Like the classic shell game played by a New York street hustler, there are lots of hand motions and movements in the new cartoon video produced by the ABIM that explains the new fees that cleverly hides the MOC fee increase. And here's how those "fees" are coached on their website:


But what physicians should understand now is the "MOC Fee" does not include the "Assessment Fee."  Here's what that additional "Assessment Fee" gets you that's NOT included with the "MOC Fee" above:


When one tallies all this together, here are the real 10-year costs for MOC in 2018, according to the ABIM website:

While the ABIM seems happy that "MOC fees have not increased since 2014," let's look at what they've done since 2000:


We should all have this kind of year-to-year return on our investments! Here we are, paying all of these fees, just so we can keep our jobs and insurance payments coming.

We now see how ABIM has been "listening" to practicing physicians: rather than addressing these exorbitant costs, the ABIM keeps adding to them by dividing them into pieces and making up new fees so the fleecing of US physicians can continue. 

It's time to end this charade. If you haven't already, please help.

This expensive rent-seeking behavior to fulfill political and personal agendas must end nationwide.

-Wes



Wednesday, June 13, 2018

More Changes Are Coming to MOC!

Today in Medscape, we learn that even more changes are coming to MOC.

The simple answer to the "will physicians get relief" is, of course, no.

Here's the comment I left, just in case it does not get published, that explains why they won't get relief from the changes proposed:
This entire charade - ALL of MOC - is NOT about physician's continuing education, but about using our Board certification and re-certification status/scores/demographics/SSN, etc - in other words, our DATA - as a pseudo-"quality" indicator for Big Business. Big Business includes Blue Cross/Blue Shield and Premier, Inc., the largest group purchase organization for the nation's hospitals. In not mentioning this, Medscape perpetuates the gaslighting of physicians that has occurred for years on a massive scale - (but then, they, too have their corporate conflicts). Physicians have tried to play nice and go with the flow at first, but now the situation is untenable, in large part because the member boards have wound their financial strings around the MOC bicycle spoke so far, they can't unravel it.

Nowhere is there mention of corruption and political activities that have occurred with the member boards, the $2.3 million condo purchased by the ABIM Foundation, the spousal travel, the $1.7 million Golden parachute Christine Cassel MD received from the ABIM when she left to join the National QUALITY Forum.

It's time to end the corruption. But myself and others can't do it alone. We need your help. Please visit our GoFundMe page and learn how you can contribute to pre-litigation investigation and the development of a legal complaint for fraud against the ABIM, the ABIM Foundation, and its leadership and others:

https://www.gofundme.com/practicing-physicians-of-america

Thanks-
Seriously, I can't do this alone.

-Wes

Tuesday, June 12, 2018

Churning Pseudoscience

Recently, two papers published by authors at the American Board of Internal Medicine (ABIM) appeared in the mainstream medical literature that purported to provide evidence to the value of their Maintenance of Certification program.

The first was "Associations Between American Board of Internal Medicine Maintenance of Certification Status on a Set of Healthcare Effectiveness Data and Information Set Process Measures" by Bradley Gray, PhD, Jonathan Vandergrift, MS, Bruce Landon, MD, MBA, James Reschovsky, PhD, and Rebecca Lipner, PhD in the Annals of Internal Medicine. The other was "The American Board of Internal Medicine Maintenance of Certification Examination and State Medical Board Disciplinary Actions: A Population Cohort Study" by Furman McDonald, MD, MPH, Lauren Duhiggt, MPH, Gerald Arnold PhD, MDH, Ruth Hafer, BA, and Rebecca Lipner, PhD published in the Journal of General Internal Medicine.

Both of these studies' senior author was Rebecca Lipner, PhD, a testing psychometrican who currently serves as the Senior Vice President for Assessment and Research at the ABIM earning $435,990 per year. Last year's tax records also disclose Dr. McDonald, ABIM's Senior Vice President "Academic and Medical" earns $419,497 annually for his services. The other author's salaries are not disclosed, but we can imagine their salaries are not zero.

The first study by Gray et al, is a cross-sectional design and used observational data. As such, its results only reflect associations and not definitive indicators of a causal relationship (acknowledged in the limitations section by the authors). The second study by McDonald, et al. is another observational study and cannot determine causality either.

So why are ABIM diplomats funding so many "association" studies? Given the cost of producing these studies, might the ABIM be churning pseudoscience to forward their own agenda rather than forwarding helpful public policy or medical science? Not disclosed in their "Conflict of Interest statements is the fact that ABIM sells our board results and "status" via the American Board of Medical Specialties (ABMS) to others via ABMS Solutions, LLC. As such, these publications serve the organization's undisclosed covert agenda and should be called what it is: very expensive propaganda.

With our current era of the proliferation of predatory journals, it is clear we also have an era of proliferation of predatory publication that supports the needs of our ABMS member boards that is not in their diplomates' best interest as well.

-Wes





Monday, June 11, 2018

Recap: Dr. Wes Goes to 2018 AMA Annual Meeting

It was a rainy day in Chicago.  I elected to take the commuter train downtown to avoid the traffic well before my scheduled presentation for the PA Medical Society at 9AM. After leaving the Ogilvie Train Station, I walked to the cab station to hail a cab to the Hyatt Regency. It was then I saw this Facebook ad at the train station:


Such irony.  There I was, heading to the AMA House of Delegates to speak on this very issue and how it has adversely affected physicians.

"MOC is not about physician education, it's about our data."

-Wes

To view the entire presentation, you can view the live stream of the talk here. (Sorry about the quality, it was my cell phone that was only dropped once...)

Please consider giving generously to our GoFundMe page to begin the process of ending Maintenance of Certification™nationwide.

Tuesday, June 05, 2018

Everybody Knows a Frank

Frank is one of the smartest people in his cardiology division. He's bright, congenial, and capable of citing the latest clinical trial on the best imaging study to detect hibernating myocardium. He loves learning. Frank is the guy you used to confide in the doctors' lounge (that doesn't exist anymore). Others knew what a good guy Frank was too; Frank was nominated to write and edit questions for the nuclear medicine boards. Deep down inside Frank knows the boards are a problem. But he's afraid that if someone were to implicate his medical society as colluding with the boards, he'd see himself as being partially responsible for losing the one scientific meeting he attends each year where he can re-connect with colleagues and maybe learn something new.

At another center, Frank is the Chairman of the Department of Medicine responsible for the day to day workings of a large urban hospital system. He is a highly respected member of the Internal Medicine community, author of 14 books on the principles and practice of  Internal Medicine, and a beloved bedside instructor to generations of internal medicine residents. He also serves as a test-writer for the American Board of Internal Medicine and thinks overall they're a responsible group.  He knows how hard his fellow physicians work at constructing a meaningful continuing education process. As the  President of his local medical society, too, he knows money doesn't just grow on trees. And if people tried to disrupt the status quo, what's the endgame?

Frank on the other side of town serves as an editor to the preeminent hematology-oncology journals and has held multiple leadership positions in his subspecialty's medical society. He is widely respected by his peers, served as a director at the American Board of Internal Medicine (ABIM) and helps write test questions for the ABIM, too. He finds test-writing challenging and believes in the value of continuous testing to maintain a physicians fund of knowledge. He devotes countless hours to this endeavor to assure it is fair and impartial to those who must recertify. Sure there are some challenges, but given all the good people working on this, no one needs to question the integrity of the process.

* * *

The dilemma facing physicians today is that the majority of physicians who work with the ABMS member boards and our subspecialty societies are good, hard-working members of our profession. It is hard to fathom that a very tiny minority are corrupt and have been operating below the radar for years. I have no fantasy that your Frank or mine would approve of this corruption or even be able to believe it. And yet, here we are.

Our own inability to tolerate this complication threatens to paralyze us from cleaning up the corruption in our ranks.

There have always been good people in our professional societies and ABMS member boards. But these colleagues, who value contributing and community involvement, should be engaged in a far different framework. Doctors need community and support and collegial leadership. Returning medicine to a truly non-profit, voluntary, democratic representation of working physicians today rather than the self-selected, profit-churning, elitist employment service that it has become. Alternative structures are already emerging. It is time to be open to new possibilities or to take on the challenge of creating them.

What we face now is not new. There have always been top dogs who operate with impunity in contrast to all of the good causes that they publicly champion. In 2018, with the Harvey Weinstein, Matt Lauer, and Eric Schneiderman hypocrisies, surely we can understand this reality.

Today, physicians' ability to work, receive insurance payments, and willingness to stay in our profession, are threatened by the out-of-control, corrupt, ever-evolving Maintenance of Certification (MOC™) requirements supported by Organized Medicine. It's time to see it for what it is.

We all know a Frank, or several Franks and Francines. They cannot continue to be a shield for the exploitation of practicing physicians. Or a reason to look the other way. We all honor the hours of work it has taken our esteemed colleagues who have participated with the best of intentions over the years, but its time to clean up the corruption in the ABMS member boards and colluding medical subspecialty societies.

Cleaning up the corruption is the first step. Please contribute whatever you can to our effort to do so.

Thanks-

-Wes