Saturday, May 19, 2018

Earning MOC™ Points: A Self-Paid Advertorial

As a follow-up of my earlier post on the American Board of Medical Specialties' (ABMS) Maintenance of Certification™(MOC™) program's tax on medical education, I was sent the "approved" responses of two different physicians that were required to answer questions to "earn" ABMS MOC™credits from the Heart Rhythm Society (HRS) Scientific Sessions after the meeting. These responses were "approved" by an HRS "reviewer" so the doctors could apply these points to remain "Board certified" and employed with their hospital systems. Each doctor had to write between 50 and 100 words (no more, no less) in response to questions posed by the ABIM. Despite their different responses, each received the exact same "feedback" that included links to various Heart Rhythm Society, American College of Cardiology, AMA, ABMS and non-governmental organizations' policies and web pages.

(See Physician 1's responses here and Physician 2's responses here.)

Given these canned responses to these physicians feedback, how is this time-consuming, costly, and meaningless "feedback" exercise for "earning" MOC™ points anything but a self-paid advertorial for the HRS, ACC, AMA, ABMS, and other non-governmental organizations?

It is a sad commentary that our own subspecialty societies legitimize this corrupt process despite all that we know about it today.

-Wes


Saturday, May 12, 2018

Taxing Medical Education with MOC

I just received this in my email in-basket from an attendee at this year's Heart Rhythm Society (HRS) Scientific Sessions:
I just got back from our annual EP meeting (HRS) which was in Boston. As you can imagine, the entire CME process has been bastardized to monetize the ABIM (American Board of Internal Medicine). After dutifully checking off which sessions I attended and rating the speakers, I noted a few things.

Firstly, all attendees were electronically tracked with RFID tags. Our attendance at the sessions were electronically tracked and automatically noted. A pretty neat feature and designed, I think, to prevent fraudulent CME behavior.

We had to answer a separate ABIM Maintenance of Certification (MOC) section and actually provide prose with a minimum and maximum word count. There was a warning stating that the content of our replies would be reviewed before the ABIM would bless them for the MOC process.

Which begs the question. Under what circumstances does the ABIM have the authority to legitimize or delegitimize my reply to their nonsensical questions? The MOC portion of the CME conversion was more of a sampling of my opinion. Is this the new MOC paradigm: impose an educational tax on our meetings and then also charge a toll on their MOC highway?

This process is not only corrupt and inefficient; it is now surreal and insane.
Yes. It. Is.

MOC® is little more than taxation of physicians without representation.

(And we still don't have ABIM's financials from 2017 for the public's review.)

-Wes

Sunday, May 06, 2018

The Delicate Dance

There is a delicate dance between two partners every day in medicine: the dance between the benefits of innovation and the costs of that innovation. One can't survive without the other. Patients and doctors benefit from the innovation and corporations benefit by being able to sell more devices to benefit themselves and their stockholders. In a nutshell: this is capitalism.

But increasingly, doctors and patients are being asked to surrender more and more of their personal information non-transparently in a lopsided dance that benefits the corporations and their partners. A once mutual dance turns into an ultimatum.

When a physician's ability to practice medicine is tied to obtaining Maintenance of Certification® (MOC®) points, the benefit of trading that information for both the patient and physician are less clear. Doctors are threatened with losing their ability to work unless they accrue MOC® points and their patients shoulder more and more of the costs for their healthcare non-transparently to fund the ruse.

So it should come as no surprise that the "tag and release" of physicians at this year's Heart Rhythm Societies' 2018 Scientific Sessions in Boston continues unabated. Attendees are not only automatically "opted-in" to data sharing with corporations, but with accrediting agencies, too:


Here we see that a physicians'  personal information is automatically tied to a "Credit Cart" where personal "beacon" information flows to corporations in return for automatic documentation of their Continuing Medical Education (CME) /  Maintenance of Certification® (MOC®) credits. But to receive that credit, doctors must complete surveys for the various accrediting agencies that unilaterally decide what qualifies to earn CME/MOC® approval, and what does not. 

Want to steer physician thinking, give 'em a bone, or MOC® credit, to drive key opinion leaders (KOLs) to your talk, then watch your sales grow!

For doctors, here are the rules for HRS2018 that ties a doctor's information-sharing to their freedom to learn what they want and to practice medicine: 

(Click to enlarge)
Think about it every time you attend a session.

For ourselves and our patients, there's no such thing as a free lunch.

-Wes








Wednesday, April 25, 2018

ABIM Struggles to Keep MOC Relevant and Meaningful

Both MedPageToday and Medical Economics covered the latest American College of Physician (ACP) meeting and know how to drive traffic to their site - just mention Maintenance of Certification, Richard Baron, MD, and their pals at the American Board of Internal Medicine (ABIM).

Their pieces suggest the ABIM is trying to keep their corrupt "Maintenance of Certification" program, born from a collaboration between the ABIM and ACP years ago, "meaningful and relevant."

And in a way, they are.

Nothing brings doctors together more than the topic of the mandated Maintenance of Certification® (MOC®) program and great quotes like:
"Grandfathering is a really vexing challenge," said Baron. "It's pretty difficult to defend ... I would not see those doctors as equivalent to doctors who rectify."
I'd like to thank the editors of both journals.

You are the bomb.

-Wes

Friday, April 13, 2018

What the ABIM, ACC, and Facebook Have in Common

Mr. Mark Zuckerberg, uncomfortably stuttering and stammering before Senator Cantwell about a little-known company named Palantir (aka "Stanford Analytica"), reminded me of a similar moment when Christine Cassel, MD from the American Board of Internal Medicine (ABIM) had to answer questions about her affiliations with Premier, Inc., and Kaiser Foundation Health Plans and Hospitals upon taking the helm at the National Quality Forum. Dr. Cassel brushed off those concerns as "distractions" by resigning from the boards of those corporations, in large part to avoid questions of why those relationships were an issue.

Nowhere did Ms. Cassel explain that her former non-profit corporation, the American Board of Internal Medicine, had changed its bylaws in 1997 to allow virtually unlimited conflicts of interests to benefit their organization. I remember the ABIM's website claiming their organization gets 97% of its money from its physician-diplomates. Now we see nothing could be farther from the truth. Funds are flowing back from the ABIM Foundation as a "Funding Initiative." And ABIM executives have always enjoyed a wonderfully lucrative relationship with CECity, the $400M data-gathering subsidiary of the hospital group purchase organization, Premier, Inc.:
Through Premier, client organizations are able to quickly and cost-effectively launch their own sophisticated online initiatives directly to their target audience (e.g. members, employees, associates, applicants/diplomates, etc.) by leveraging Premier’s multi-million dollar investment in world-class applications and enterprise-level infrastructure (SAS 70 Type II).

At its core, Premier’s products link performance management (data acquisition via web forms, IVR, external and internal registries, data feeds, etc), assessment, benchmarking, peer comparison, and identification of gaps (financial, knowledge and patient care) with interventions that drive performance improvement.

Our platforms align this cycle of performance management and improvement with various incentive programs to drive healthcare provider participation.

As a CMS-qualified registry for the Physician Quality Reporting System (MIPS, ePrescribing, MOC-MIPS) and as the service provider for many physician certifying boards (e.g. ABIM, ABO, AOA) Premier is uniquely positioned to align professional and financial incentives with CQI to deliver ‘game-changing’ quality initiatives that have proven and measurable results.
This CECity/Premier relationship is firmly embedded in the ABIM's HIPAA Business Associate Addendum agreement every practicing physician must agree to as a condition of enrolling in "Maintenance of Certification (MOC)" (also known as "continuous certification").  With the lack of disclosure of this relationship by the ABIM, is clear that patients and doctors alike aren't supposed to know their personal data are being sold.

The American College of Cardiology

The same data-gathering strategy appears to be true for the American College of Cardiology (ACC). The ACC has always had the ability to side-step the ABIM and re-certification but has chosen not to do so.  Physician and patient data are too important to them, too. I was naive to think that was because of the use of physician data for their NCDR "registries" used by the nation's hospitals. Instead, it seems there may much bigger play in mind, as reported by CNBC:
Facebook provided a quote from Cathleen Gates, the interim CEO of the American College of Cardiology, explaining the possible benefits of the plan:

"For the first time in history, people are sharing information about themselves online in ways that may help determine how to improve their health. As part of its mission to transform cardiovascular care and improve heart health, the American College of Cardiology has been engaged in discussions with Facebook around the use of anonymized Facebook data, coupled with anonymized ACC data, to further scientific research on the ways social media can aid in the prevention and treatment of heart disease—the #1 cause of death in the world. This partnership is in the very early phases as we work on both sides to ensure privacy, transparency and scientific rigor. No data has been shared between any parties."

Health systems are notoriously careful about sharing patient health information, in part because of state and federal patient privacy laws that are designed to ensure that people's sensitive medical information doesn't end up in the wrong hands.

To address these privacy laws and concerns, Facebook proposed to obscure personally identifiable information, such as names, in the data being shared by both sides.

However, the company proposed using a common cryptographic technique called hashing to match individuals who were in both data sets. That way, both parties would be able to tell when a specific set of Facebook data matched up with a specific set of patient data.
While I appreciate the flowery take of this breach by ACC's spokesperson, I'm afraid the ACC's hand is stuck firmly in the financial data mine cookie jar. After all, as we've seen with Facebook and our recent election, not all uses of data are always in our patients' best health care or financial interest.

It's amazing, isn't it? These databases once thought to be a product of ingenuity by for-profit and non-profit organizations, are looking more and more like a product born of little more than opportunity and necessity.

But others much smarter than I have known this long ago. To the ABIM, the ACC, and Facebook: it's all just about guns, germs, and steel.

-Wes

Monday, April 09, 2018

An Internet Quiz: ABIM's Website Moves the Goalposts Again

The Internet loves mystery...

and cover-up.

There are very bright minds out there, and nothing gets those juices flowing for the dedicated Internet sleuths than when someone is trying to hide a carefully crafted change that benefits the Big Guy and screws the Little Man.

Lately, I've been watching the myriad of changes to the ABIM website.

It's got a whole new look and feel, full of big flashy graphics, but little on content. They will argue, no doubt, that it's all made to improve the navigation on their website and to introduce the bold new ideas they have concocted to be sure the fine print is missed.

So here's the challenge.

Take a minute and go the the ABIM website. (Warning, you'll need more than just a minute for this contest, but if you've got the time, this might satisfy criteria for some MOC points/CME credit).

Click on the Maintenance of Certification banner.

Look over to the left and find the "Policies" button. Here's what the screen looks like today:

(Click to enlarge)

Scroll down to look at what you've missed below the fold, as shown here: 

(Click to enlarge)

Now, this is where things get fun. It will be like The Price Is Right, where Bob Barker asks the contestant to look behind Door Number 1, Door Number 2, or Door Number 3. Go ahead, and click on one of those drop-down arrows of your choosing. What you don't realize, it that behind every one of those arrows, is the hidden surprise that has changed - your MOC® contract with ABIM in all its (hidden) glory.

So here's the challenge...

... which part(s) has(have) changed in the last six months?

Good luck!

-Wes




Wednesday, April 04, 2018

Feldman: MOC is Good For You

It was helpful for me to read this take on maintenance of certification from Wake Forest dermatologist Steve R Feldman, MD, PhD in The-Dermatologist.com. There are so many straw dogs here it boggles the mind, but the piece exposes a level of naïveté by academic supporters that really don't seem to understand the myriad of problems with MOC. Take this quote, for instance:
The provision of medical care is highly regulated. Not all the regulations are to physicians’ liking. Along with our monopoly power, comes controls that are designed to assure the quality of the care we provide. Our education has been regulated, getting licensed has been regulated, and getting certified has been regulated. Now, maintaining that certification has been regulated, too.
Dr. Feldman justified MOC because, well, we need more regulation! He seems to imply we should just get over it folks: the unaccountable member boards of the ABMS can do as they please with your money. Buy a condo in the name of "Choosing Wisely?" Sure. Send some funds off-shore to the Cayman Islands for their retirement fund while you do the dirty work of seeing patients? Sure. Buy a nice pond or purchase a nice car collection with your colleagues testing fees? Heck yeah! And why not run a for-profit real estate management firm with certification funds, too? Why of course! Then you can perform research on your colleagues without informed consent! And best of all, you can make sure your pals on the Dermatology board force working physicians into becoming HIPAA Business Associates to CECity (A subsidiary of the $4 billion hospital Group Purchase Organization, Premier, Inc.) when they sign up for their recertification tests? Man, the digital data party never stops giving!

Poor guy. Maybe Dr. Feldman didn't know about all this. Or maybe he still needs to threaten working doctors to scratch his social justice itch. (Let's hope not.)

But if that was not enough, Dr. Feldman made this suggestion as an alternative to our current re-certification mess:
If the argument that MOC has not been shown to improve quality, claiming a CME requirement assures quality seems suspect at best. What would a serious solution look like? It would have quantitative, representative measures. Perhaps, it could include random independent evaluation of videotaped patient encounters, supplemented by review of treatment decisions made of lesions and rashes based on photographs or on “secret shoppers.” All the really serious means to document and assure quality would be far more heinous than anything being considered now.
Threats of physicians won't dispel the truth about MOC: it is corrupt to the core. It has harmed physicians. It threatens their right to work on the basis of metric that does nothing to improve the quality or safety of patient care.

Dr. Feldman asks for a viable alternative to MOC. Really, the answer is very simple.

End it.

Completely...

... just as the AMA House of Delegates voted to do so almost three years ago.

-Wes