Sunday, July 26, 2015

American College of Cardiology and the MOC Crisis

This week's issue of the Journal of the American College of Cardiology (JACC) contains an editorial from Robert Shor, MD, Chair of the American College of Cardiology (ACC) Board of Governors entitled "Addressing the Maintenance of Certification Crisis Calls for Working Together." The editorial touches on the relationship of the American Board of Medical Specialties (ABMS) and the American Board of Internal Medicine (ABIM) and that "ACC-sponsored polls have shown that the vast majority of cardiologists have concerns about the validity, relevance, utility and associated financial and opportunity costs of meeting these revised (MOC) requirements."

Importantly, the editorial also mentioned several other well-known facts: that new 2014 MOC rules established by the ABIM that "required newly graduated fellows who have successfully completed their initial certifying examination to also sign up for ABIM MOC or be listed as "not certified." 

Fortunately for our most vulnerable new cardiologists, the ACC is pressuring the ABIM to revise this policy that financially benefits the ABIM exclusively. It seems the ABIM will stop at nothing to monopolize the recertification market for themselves.

While the ACC Leadership under Dr. Shor 's direction seems sincere, his letter ignores the financial cover-up at the ABIM, specifically the fees that were funneled from the ABIM to the ABIM Foundation from 1989 to 1999, the lavish salaries of the officers and staff there, and the fact the ABIM remains has a balance sheet that is over $47 million in the red. Instead, the chooses to "be cautious because we realize the complexity of the situation." Dr. Shor continues with a half-truth, saying: "In the interim, all of us have alternatives. These include joining a new board, waiting to see the final ABIM proposal, and waiting to see if an alternative ACC board is feasible and/or needed."

Because of the regulatory capture created by the ABMS and their demand for "recertification," contrary to Dr. Shor's statement practicing physicians do NOT have a choice avoid ABIM recertification. Practicing physicians cannot "wait." Practicing physicians MUST continue on their ABIM recertification pathway lest they lose their hospital privileges or aren't allowed to participate  on insurance panels to receive payment for services.

We should note that after revealing ABIM lobbying efforts that were not disclosed the ABIM's tax forms on 31 May 2015, the ABIM terminated their relationship with their lobbying firm on 30 June 2015.

It is increasingly clear that the ABIM and the ABMS have constructed a lucrative money stream for themselves thanks to "recertification" at the expense of practicing physicians.  Recertification after initial certification still has no Level A evidence that it improves patient outcome or care. Instead, as clearly documented on this blog and elsewhere, recertification has been proven to be a corrupt and potentially illegal process that demands thorough investigation by the IRS, Iowa and/or Pennsylvania Attorney Generals, and the US Attorney General or the Inspector General of the Department of Health and Human Services.

This is where the ACC should insist on action. It is simply not in keeping with the highest standards of medical ethics and integrity to collude with organizations that have shown themselves to be working in their own interests over those of practicing physicians and their patients everywhere.



Paul Kempen said...

I concur completely! Well stated Dr Wes!

W. Bond said...

Well said, as always.

Anonymous said...

sayonara abim

Anonymous said...

A lie stands on one leg, truth on two.
- - - Benjamin Franklin

There are only two ways of telling the complete truth--anonymously and posthumously.
- - - Thomas Sowell

The simple step of a courageous individual is not to take part in the lie. One word of truth outweighs the world.
- - - Alexander Solzhenitsyn

Whoever is careless with the truth in small matters cannot be trusted with important matters.
- - - Albert Einstein

You can't cheat an honest man.
- - - W. C. Fields

Political deception, money, power; maintenance of political deception, money, power.
- - - ABIM manual, version 2.0

All the smart money has sold their shares and gotten out.

Anonymous said...

Concerning measurements, reports/files on medical students/interns (and the first ABIM test) let's go back to the Association of American Medical Colleges, 1936. The beginning of it all for the ABIM with 9 board members and only 27 certified internists that year. A humble beginning...let's time travel for a moment...

"With opinions descending like rain, it is essential to have the umbrella of facts."
The academician, Dr. Raymond Walters goes on the say, "Such studies if wisely planned and executed constitute just such an umbrella." -AAMC meeting, Atlanta Georgia, 1936. Ray Walters, president of the University of Cincinnati speaking in turn opining on the value of qualitative measurement of students, interns and residents.

This quote refers specifically to the novel and extraordinary study/practice (at the time) of collecting data/keeping files on university/college students and medical interns/residents by the Association of American Medical Colleges and the Council on Medical Education. The member colleges of the AAMC, which numbered 81 medical schools at the time, began this national educational experiment around 1929-30 to measure performance and aptitude scientifically. They were concerned with not wasting precious educational resources on unsuitable students who wished to enter medical school and eventually professional practice. They wanted to be able to identify unworthy candidates, i.e., to weed out those not suited for medicine. They mention some of the first aptitude tests as well. All the top academic minds were in agreement that collection of such scientific data was necessary.

The AAMC annual meeting commenced with the reading of a paper called, "The Oneness of Objectives of the Association of American Medical Colleges, of the Council on Medical Education and Hospitals of the American Medical Association, and the Federation of State Medical Boards."
Also on the meetings three day agenda was the announcement of continued or newly established probationary terms for a few medical schools and the admission/denial of a few others to the prestigious AAMC fold. The only thing of controversy was the issuing of an honorary medical degree to an unidentified individual, which was quickly rescinded as inappropriate.

Would that things could be so simple today as to just be questioning the validity of a newly proposed voluntary specialty test for life! Or arguing in a hand-written letter (to the AAMC and CME) that one refuses to have private educational data collected and brandied about without giving written consent first.

Aim: To have the real "umbrella of facts" about this umbrella of certification societies called ABMS; to have a truthful explanation of what these powerful corporate bodies have changed into. Truth is essential for physicians and patients, especially after all the years of being brandied about and kept in the dark. Some facts have emerged, but isn't it time for the ABIM to open itself up to a voluntary informal investigation by the IRS, DOJ or others to get this mess cleared up. Bite the bullet now so it doesn't explode.

Pay the lobbying tax, restate taxes, do whatever it takes to get some trust back, whatever it takes. Show the real umbrella of facts. Put it all out there. Whatever it is. That is what is needed today. Can that be done?
Bring in an objective measure that people can trust, if possible.

Anonymous said...

I went to the meetings with Dr. Shor. The cardiologists were beyond angry at the ABIM. It was the closest meeting to a brawl that I have ever seen. Yet the ACC elects Dr. Shor to compose this letter which supposedly represents the ACC members. The ACC is just as corrupt, misguided, and clueless as the ABIM. They are partners in crime. After all, it was the incompetent ACC leaders at the behest of the insurance companies who discouraged complete revascularization during AMI. This is directly responsible for killing numerous citizens of this country. Does everyone remember the ABIM choose wisely campaign?

The Board of Governors is just window dressing for the ACC. All the meetings are filled with an agenda driven by the hierarchy and their goals of reducing utilization. Does anyone remember when they were trying to get Jack Lewin elected for best Washington, DC CEO? He was fired about three months later. What a joke! They are all on the industry or insurance or CMS dole. Poor Dr. Shor just doesn't realize how he is being manipulated.