Wednesday, January 15, 2020

Who Is the ABIM Chief Medical Officer?

Drs. Richard G. Battaglia and Richard Baron
(Image from the ABIM Blog)
Who is Richard G. Battaglia, MD?

In 2015, the American Board of Internal Medicine (ABIM) announced Richard G. Battalgia, MD as their new Chief Medical Officer (CMO). This was the same year the American Board of Medical Specialties (ABMS) paid $922,479 to PriceWaterhouseCooper LLP (PwC) for "Management Consulting:"
What the ABIM website fails to mention with their announcement, is that Mr. Battaglia worked for PwC for 14 years, 3 months before being "hired" by the ABIM.

Is Dr. Battaglia, the ABIM CMO, concerned about medical education of physicians or merely a consultant purchased by the American Board of Medical Specialties to "clean up" the ABIM Maintenance of Certification (MOC) mess?

The ABIM website only says this about their CMO:
"Dr. Battaglia, a board certified internist, is Chief Medical Officer (CMO) of the American Board of Internal Medicine (ABIM). There, he leads ABIM's effort to incorporate feedback from practicing physicians and key stakeholders into clinical aspects of all of ABIM activities, including Certification and Maintenance of Certification (MOC).

Previously, Dr. Battaglia served as a primary care internist with Health Care Plan/Univera, a multi-specialty, staff model practice in Western New York before transitioning into leadership roles, including Medical Director of the Medical Centers Division and Senior Vice President, Medical Affairs/Corporate Medical Director. He also served as Medical Director/Chief Medical Officer of large multispecialty medical groups in Western New York. He has participated in national quality initiatives focused on physician group practice and health maintenance organizations. For more than 10 years, he devoted time to The National Committee for Quality Assurance, including a term as Chairman of the committee charged with accreditation decision-making. Most recently, he was a consultant (emphasis mine) for national and international organizations, including academic medical centers, health systems, community hospitals, medical groups, payers and national physician certification organizations.

Dr. Battaglia received a biochemistry degree from Canisius College, a Jesuit institution in Buffalo, NY. He obtained his medical degree from the University of Rochester School of Medicine and Dentistry. Dr. Battaglia completed his residency through the University of Rochester Primary Care Program in Internal Medicine and also served as Chief Resident."
Maybe PwC's "Unifying Thread" of using (physician) data is the real reason Dr. Battalia promotes "continuous certification" and MOC:
Data is the unifying thread across seven policy areas we highlight here. Privacy, antitrust, tax, regulation of artificial intelligence, and trade are converging around the collection, sharing and security of data.
Physicians subjected to lifelong payments to ABMS member boards for Maintenance of Certification (MOC) and Continuous Certification (CC) should know about Mr. Dr. Battaglia's PwC connection. Just like they should have known about Christine Cassel, MD's connections to Premier, Inc, Kaiser, and CECity, and Dr. Wachter's connections to the The Hospitalist Company and Teamhealth.

When considering patient safety and care quality, a corporate, non-clinical, damage-control medical consultant for a Fortune 500 accounting firm should not be Chief Medical Officer of the American Board of Internal Medicine.


Tuesday, January 14, 2020

Visible Cracks

it was a clinic day like all the rest
until it wasn't
she was there with her son and granddaughter
legs swollen "for a month"
afib, fast rate despite cardizem CD 300 mg daily, diabetic meds, norvasc.
BP 178/84, HR 124
meds to be started, but help?
EMR->no doctor
a nurse practitioner?
4:45 pm-> all gone
see you in two days
no appointments.

i wake too early
staring up
mind swirling
cases ahead
remembering her
and me


Monday, January 13, 2020

The Study We Weren't Supposed to See

Most US physicians are well-acquainted with the American Board if Internal Medicine's (ABIM) breathless claims of ABIM board certification and Maintenance of Certification's benefits. These have included:
  • The Public Expects It
  • Physicians Value It
  • Amount of clinical experience does not necessarily lead to better outcomes or improvement of skills
  • Certification is Associated with Better Care
But what about the harms of constant testing and its affects on physician burnout? Wouldn't it important for the ABIM to mention that their OWN study on 34 subjects, funded by US physician testing fees in the form of grants from the ABIM Foundation and authored (in part) by ABIM staff and consultants, has found that Certification and MOC:
  • "lead to higher measures of depersonalization and emotional exhaustion."
  • "may be an important source of medical errors related to clinical reasoning tasks in practice."
  • yet are considered the "Gold Standard of physician performance."

These are their words, not mine.

Where are these results published on the ABIM or ABIM Foundation website?

Shouldn't U.S. physicians who paid for such poorly conducted/self-promotional "research" be entitled to disclosure of (1) how much granbt money was paid to USUHS, (2) why the funding agency was allowed authorship of this "research," and (3) why the data contained in this work were not disclosed to ABIM diplomates on the ABIM website?


Please contribute to help support the legal effort to end Maintenance of Certification nationwide.

Monday, December 30, 2019

ABIM Antitrust/RICO Lawsuit Notice of Appeal Filed

Today, the official Notice of Appeal was filed in the United States Court of Appeals for the Third Circuit in Pennsylvania. It appears the ABIM's legal headaches regarding Maintenance of Certification (MOC) are far from over.

Working physicians can help the plaintiffs in their David-versus-Goliath effort to end the unproven American Board of Medical Specialties' MOC program by contributing to Practicing Physicians of America's GoFundMe page created on their behalf. We have almost reached our $400,000 goal. (Your contribution may be tax deductible before year's end - please consult your tax advisor.)


Thursday, December 12, 2019

Just In Time for Christmas: The MOC Legal Juggernaut Intensifies

With the recent back-to-back announcements that the class action antitrust and racketeering lawsuit against the American Board of Internal Medicine (ABIM) and the antitrust lawsuit against the American Board of Radiology were dismissed (e.g., the ABIM announcement and ABR announcement), doctors everywhere - both young and old - seemed resigned to the fact that they will have to be subjects to lifelong extortion of private American Board of Medical Specialties member boards and their affiliates if they wanted to practice medicine in the United States.

But fear not, dear colleagues. I bring you tidings of great joy. The first great Supplemental Opposition to the Motion to Dismiss the lawsuit against the American Board of Psychiatry and Neurology (ABPN) was filed yesterday that promises to renew the call for justice on the basis of proper legal procedural grounds:
Defendant American Board of Psychiatry and Neurology (“ABPN”) illegally ties its initial certification product, which it sells to new doctors to demonstrate completion of their medical education and assess the quality of their residency program, and its MOC product, which it requires some older doctors, but not all, to purchase throughout their careers to demonstrate lifetime learning or forfeit their initial certification. ABPN brings to the court’s attention Kenney v. American Board of Internal Medicine, No. 18-5260, 2019 U.S. Dist. LEXIS 164725 (E.D. Pa.Sept. 26, 2019) (“Kenney”), and Siva v. American Board of Radiology, No. 19 C 1407, 2019 U.S. Dist. LEXIS 200645 (N.D. Ill. Nov. 19, 2019) (“Siva”). Kenney came first, followed by Siva which “agree[d] with the reasoning in Kenney.” Id. at *11.1

Nothing in those opinions changes ABPN’s unlawful conduct. A critical reading of the opinions and application of the universally accepted rule that well-pleaded factual allegations and all reasonable inferences therefrom must be taken as true compels the conclusion that Kenney and Siva were, respectfully, wrongly decided.
1  The tying claims in Kenney were dismissed with prejudice without plaintiffs being allowed to amend, the court finding as a matter of law that separate products could never be alleged. Plaintiffs are appealing that ruling. The claims in Siva were dismissed without prejudice and plaintiff is filing an amended complaint on January 10, 2020.
The supplemental opposition to the ABPN motion to dismiss then outlines multiple legal reasons why the plaintiffs believe the decisions were wrongly decided. In essence, the attorneys are arguing that the facts in this case were not even allowed to be considered past the judges' chambers.

We can anticipate that the multitude of moneyed interests behind Maintenance of Certification will stop at nothing to assure this unlawful program continues unchecked.

Still, a bit of hope and cheer is always welcome for working physicians this time of year.

Merry Christmas!


P.S.: On a separate legal note:

Remember the Puerto Rican physician, Jaime Salas Rushford, MD, whom the ABIM revoked his board certification and dragged him through the court system since 2012 with a dismissed time-barred cheating claim while the President and CEO of the ABIM simultaneously failed to disclose her conflicts of interest with Kaiser and Premier Inc? Yesterday, the judge issued the following order to expedite the counterclaim suit filed against ABIM by Salas Rushford:
The American Board of Internal Medicine may file its motion for judgment on the pleadings no later than December 18, 2019. Dr. Salas-Rushford will respond no later than January 2, 2020. The Board may reply no later than January 9, 2020. The case schedule will be discussed at the scheduling conference to be held on January 31, 2020. Signed by Judge Francisco A. Besosa on 12/11/2019. (brc) (Entered: 12/11/2019)
It seems that case will soon be coming to a head, too.

Readers wishing to support the brave physician plaintiffs involved in these lawsuits trying to end the unlawful Maintenance of Certification program are encouraged to contribute to their GoFundMe campaign.

Wednesday, December 04, 2019

ABIM's Dark Side Needs More Light

From the recently filed "Objections to Deadlines due to Completion of Discovery" by Plaintiff Jaimie Salas Rushford, MD in Puerto Rico Federal Court comes public evidence of mafia-like tactics used against physicians by the American Board of Internal Medicine (ABIM) to protect their certification testing monopoly:

(Click image to enlarge)

So to summarize some of what has transpired at the ABIM to maintain their physician testing monopoly:

  1. The ABIM secretly created the ABIM Foundation in 1989 for the purpose of laundering over $70 million of physician testing fees from 1990-2007 for various personal and political agendas, including the purchase of a 2-bedroom luxury condominium, art collection, and offshoring of Cayman Island retirement funds.
  2. They published a white paper in 2002 in two major medical journals, the Annals of Internal Medicine and the Lancet, entitled "Medical Professionalism in the New Millennium: A Physician Charter" (which, given these revelations, should both be retracted in my opinion).
  3. They used a strongman convicted of impersonating a police officer and carrying an unregistered firearm as their Director of Test Security with access to physicians' most sensitive personal information.
  4. They forced a physician who admitted to wrongdoing to pay $15,000 to remain board certified on the condition that physician also serve as an informant.
  5. They continue to drag a vulnerable physician through the court system for what will be at least eight years to maintain their monopoly and hide the truth.
The American Board of Internal Medicine needs to be held accountable to working US physicians and the public for their actions. I believe their irresponsible and undisclosed financial and political dealings, paired with these mafia-like tactics, deserve full transparency and appropriate judicial scrutiny. 

Physicians deserve better. The public deserves better.

It's past time we shine a bright light on this racket.


Saturday, November 30, 2019

Watching Our Healthcare Hindenburg Burn

Just before Thanksgiving, 15 physicians were notified they will be replaced by less-experienced and cheaper nurse practitioners at the nearly $1 billion Edwards-Elmhurst healthcare system here in Chicago. Doctors, the article says, were "broadsided," perhaps because they were naive to events that occurred in Springfield, IL earlier this year. Thanks to aggressive lobbying, recent legislation was unanimously passed in both the House and Senate Illinois legislature allowing nurse practitioners to practice independently of physicians in any capacity except surgery. Working doctors likely missed this since they don't populate legislative halls - they populate clinics and hospitals caring for patients - or at least most did.

This trend of using more and more nurse practitioners in lieu of physicians appears to be accelerating nationwide as large hospital systems or consolidated primary care clinics with bloated numbers of midlevel administrators look to cut costs. Nurse practitioners are everywhere now: staffing ICUs, Emergency Rooms, and yes, primary care clinics. Some nurse practitioners are used to preferentially fill lucrative surgical pipelines armed with little other knowledge than what a routine case for surgery requires. And while advanced practice nurse practitioners do treat common ailments like earaches and sore throats, often quite well, how many can recognize the warning signs of a case of epiglottitis? What happens to patients then?

Is compromising years of physician training and care experience for cost efficiency really about patient care or cost savings or a facility's bottom line? Is the inevitable pitting of nurses against doctors in the patient's best interest or the institution's? Who sees the costs supposedly saved by hiring cheaper advanced practice nurses?  Will Edward-Elmhurst Healthsystem suddenly stop spending millions on collection agents who served as second-largest contractor for Edward-Elmhurst Healthsystem in Fiscal Year 2018?

Working physicians aren't without some blame either. Where were the physicians on the Medical Executive Committee of Edward-Elmhurst Healthsystem with this announcement? Did they approve  replacing 15 physician-colleagues for lesser-trained nurse practitioners or fearful of losing their jobs if they didn't "align" themselves with this administrative move? Who is advocating for patients at Edward-Elmhurst Healthsystem (or any other large non-physician run hospital system) now? Anyone?

Can Dr. Google and inexperienced physician posers safely replace the highly trained, experienced physician? No one really knows. This latest move is little more than a grand experiment promoted by healthcare consultants with patients' lives on the line.  Which leads us to ask: is touting a shortage of US physicians really a concern of the Association of American Medical Colleges or just a ploy by other member organizations of Accreditation Council for Graduate Medical Education (like the American Hospital Association) to justify these physician firings so hospitals can pad their bottom line?

Our Healthcare Hindenburg is burning: a bubble of excessive prices, high middleman salaries, a rapidly accelerating physician shortage, competition of healthsystems and patients increasingly unable to pay even basic co-pays for healthcare, medications, and procedures, as they are left to take the financial hit to maintain the health care industrial complex's status quo.

In healthcare, it's "Winner Takes All" with the likes of PriceWaterHouseCooper, McKinsey, and the Advisory Board at the helm.  The competition is fierce.

Patients (and their better-trained frontline physicians) be damned.