Tuesday, July 28, 2015

An Independent Cost Analysis of the ABIM Maintenance of Certification Program

Today, the first independent cost analysis of the American Board of Internal Medicine (ABIM) Maintenance of Certification (MOC) program was published online before print in the Annals of Internal Medicine from the University of California San Francisco and the Veterans Affairs Palo Alto Health Care System.

The results of the Base-Case Analysis are remarkable: "Internists will incur an average of $23,607 (95% CI, $5,380 to $66,383) in MOC costs over 10 years, ranging from $16,725 for general internists to $40,495 for hematologists-oncologists. Time costs account for 90% of MOC costs. Cumulatively, 2015 MOC will cost $5.7 billion over 10 years, $1.2 billion more than 2013 MOC (emphasis mine). This includes $5.1 billion in time costs (resulting from 32.7 million physician-hours spent on MOC) and $561 million in testing costs."

How much does it cost by specialty over 10 years? Here's a copy of one of the tables from the article included for your review:

Cost to Participate in MOC by Subspecialty (Click to enlarge)

Here's a breakdown of MOC costs for individual physicians from the article based on the number of certificates they maintain with confidence intervals displayed:

MOC Costs for Individual Physicians - (Click to enlarge)

MOC is not an educational program based on evidence of improved patient outcomes or care quality.  Rather, it is an educational program that was created by fear - fear of loss of credentials and fear of loss of insurance panel participation and payments.  As such, it is inherently coercive.

If there ever was a time to stop the wasting of physicians resources and time that has yet to demonstrate any evidence that the program improves patient outcomes or care quality, the time is now.


Alexander T Sandhu ,  R. Adams Dudley, Dhruv S. Kazi. "Cost Analysis of the ABIM Maintenance of Certification Program" Ann Intern Med 28 July 2015,(), doi: 10:7326/M15-1011.

Addendum 29 Jul 2015 @ 12:41PM CST:
Dr. Richard Baron responds to this Cost Analysis on the ABIM blog as "The Cost of Keeping Up." No public comments are taken on the blog any longer, but the ABIM is accepting e-mails.  Baron's response fails to acknowledge that the authors projected ABIM will make more than half a billion dollars in ten years and that this cost estimate is ten times higher than Dr. Baron has mentioned on numerous occassions (see here and here), irrespective of the time required by physicians "to keep up."


Anonymous said...

The cost is without measure when we consider that MOC funded the ABIMf without physician knowledge and created choosing wisely, which is targeting veterans and seniors, whole states in a corporate-backed scam to defraud patients of their right to really think and choose competently. Nixon/Kaiser in 1973 now Cassell/Kaiser Permanente in 2015. Erlichman sold out and sold it to Nixon. Now Cassell is the new Nixon who liked the for-profit HMO model because it increased profits and gave the patient less. What's different today? No free press at all! Only blogging.

Anonymous said...

Is the ACP's publication of this analysis a strategic move to distance itself from the ABIM? The instinct for self-preservation carries the day, whether its the serengeti, Casablanca, or the murky world of the "nonprofit" academic medical industrial complex.

Jordan said...

Thanks for sharing this data. It's very disturbing looking at these graphs, but necessary!

drbob said...

Isn't it ironic that it cost $30 for a copy of the artcle.

Anonymous said...

ACP’s Two-faced Lame Attempt at Damage Control? What Does this Sterile Study Fail to Include or Mention? Is A More Robust Study to Follow?

Consider the following burdens and the economic, emotional and legal implications. Is it time to lawyer up?

Physician burnout up from 25% to 50%. How do you price that or MOC’s portion? Early retirement losses? Loss of family time? Increased psychological stress and creation/aggravation of mental illness issues in physicians and their families. Increased physical illness in a loved one or physician from stress; less time for family and self from "MOC-induced illnesses". (Not sure that's in the lexicon yet.)

More MOC related dollars spent on babysitters, nannies or caregivers for dependent children or elderly or disabled relatives. MOC/Certification, in its present and past form, often crushes physicians' self-confidence, personal and professional lives, and a family’s sense of security. Family crises arising from the MOC EFECT on everyone’s earning capacity. I will not attempt to make a complete list.

Speculative costs:

Legal fees, consulting time, discussing MOC and the ABIM’s self-serving intentions of continuing to create unnecessary testing and conflict in the medical profession.

The cost of bringing harassment and fraud charges filed against the ABIM should be considered and factored in for many physicians, at minimum the legal cost of any dealing with the ABIM. One should have a lawyer for any contact or to discuss dissolution of relationship. It might be a broken relationship with deceptive practices pushing the legal contract with them beyond repair. ABIM even admits they got it wrong. Now it is time to get them to admit to the 99% they don’t admit to.

Stressful impossible ABIM mandates concerning institutionally-imposed unscientific testing as part of workplace conditions. These are nationally mandated by all relevant stakeholders and pushed by the powerful DC lobby working for the ABIM, paid or unpaid. Harassment in the workplace by the ABIM and its secretive lobbying for its profit continuum has to be tested in court. What are the employers, insurers, and hospital boards’ responsibilities to provide work conditions that are free of harassment by the ABIM/ABMS and its stakeholders to protect the rights of physicians in the workplace.
How can one measure the total cost of all these things? What else do we find it hard to measure.

How about the way the ABIM squandered so much physician’s money on legal fees to protect their testing empire? How do you add in the millions tossed into the angry wind with ABIM's profligate hard-wired self-serving nature and adventurism to destroy competitors and or any 'agitants'.
Is the new CEO really one of those candidates ABIM did a thorough nation-wide search for? Why does ABIM downplay his past roles at the NQF, etc, and his prominent positions/activity at the ABIM in years past. Does the treasurer usually get handed the baton to rule. I'm sure I'm becoming much too suspicious of even uncompensated activities.

Is it true what ABIM's lawyers said about the current CEO being at least partly in charge of legal teams prosecuting various non-ACP test preparation businesses in an attempt to crush the competition. How about the physicians and their demonization and attempted ruination in court. Who did that? How is that calculated in the total cost of what MOC costs for everyone? Is this the kind of organization that fits one's busy lifestyle and ever-tighter budget. Certainly not family friendly as I can attest to.

Would the executives and the 58 other professionally excellent individuals making well in excess of those staggering and legendary six figure ABIM incomes consider taking a major voluntary pay decrease to help us all out with these additional emotional and economic burdens I outlined here?

Anonymous said...

Addendum: The Cost for Keeping UP
I thank the good doctor who manages this site for keeping us informed and especially for revealing the necessary truths that should make us uncomfortable enough to light a fire under us.

Dr. Baron did not in his response to the excellent cost analysis study make any apology for the costs at all, only a staunch defense. That defensive posture costs money. He did not write this article himself, most likely. That ABIM PR team has a cost and those hundreds of thousands of dollars in costs will be tacked on and passed along to every willing and unwilling consumer-client of the ABIM.

What is the cost for ABIM clients to keep informed of such an untrustworthy partner, who's executors and officers embezzle exorbitant salaries knowingly without remorse. The ABIM leaders defend their cushy positions as though they have unmitigated rights to create harmful and questionable programs. Everything else is window dressing and commentary. The hidden and unintended consequences of costs pertaining to all their activities is much more staggering than anyone is willing to calculate.

The time it takes to audit such a bad partner's finances and watch out for the publics' interest as the ABIM invents unhealthy initiatives for patients to consume as a new gospel is diabolical and beastly.

What is the cost of muzzling such an untethered beast from hurting the public with politically motivated medical propaganda. Or from chewing up their clients hard earned money and all the additional expensive years in school and training, which are still being paid for, and usually never calculated in. No one in residency or fellowship was prepared for an entanglement with such a strange/foreign entity as the one called ABIM and ABMS partners.

I am astonished each time, but never really surprised, with Dr. Baron and company's abnormal display of egregiously uncharitable behavior toward physicians and patients. Moreover, I ask, in response to Baron's fresh tripe, what is the cost of maintaining sanity in a world where such a well-established and highly connected 79-year-old goodwill society still persists, insisting on asserting itself in such an ornery and unabashed manner. How can you, Richard, and others there keep a straight face with such delusions and exclusions of what we usually call in life "sharing a common reality"?

Open up that blog. Tear down that wall, Dr. Baron. You and everyone else there at ABIM is really one of us, after all.

Anonymous said...

Do not underestimate the lobbying power of the AMA/ABIM/NQF kleptocracy. They are experienced at making lemonade from all the lemons that you throw at them. When the docs complained about the cost of EMR implementation, MU was borne with two purposes including forcing us to get on-line and serve as the data collectors while providing plenty of money to the computer industry think software companies (Microsoft, Oracle, Cerner) and hardware (Dell, Cisco, IBM). Billions of dollars funneled through our practices to Silicon Valley.

Fast forward to the present where our data is collected by entities like the ACC who charge our hospitals for the privilege and sell the data to CMS in a similar fashion as the AMA leasing CPT codes to the government.

Don't be surprised if the ABIM uses the complaints of cost as ammunition to start a new government program to fund MOC. In other words, docs would be a conduit for government dollars to flow to the ABIM who sells it legislators as a 'quality program'. This is a win-win. The docs don't complain about the cost and the ABIM gets access to a never ending flow of our tax money.

Anonymous said...

You're probably right - I'm going to puke right now.

Anonymous said...

The quick release of Baron's carefully prepared statement on the ABIM blog indicates the likelihood of ACP giving Baron/ABIM advance knowledge of the content and pre-release online. I suspect MOC is a minor issue that they feel in control of. Contrition just a head fake; not from the heart at all. ABIM's hands and cards must be watched at all times for dirty dealing. They own the press and ACP is complicit in the game that is afoot. Don't get lost in their fog machine.

Blog Administrator said...

'Methodology aside, the research raises an important question about whether keeping up and learning is a good use of physicians’ time. In our conversations with physicians, we are consistently hearing that “keeping up” is a core value that all of us share. The challenge for all of us is to avoid redundancy and busywork while recognizing, through MOC, high-value activities in which physicians engage to stay current in knowledge and practice.' - Rich Baron

This guy just won't let his/ABIM's/ABMS' MOC revenue stream go! Tell me - how is MOC evidence-based? And where was the funding for their study authors coming from? Apparently this guy only cares about COIs when his lucrative and exploitative revenue stream is at stake! Disgusting!

Anonymous said...

The challenge for all of us is to avoid redundancy and busywork while recognizing, through MOC, high-value activities in which physicians engage to stay current in knowledge and practice.' - Rich Baron

I love that..."Through MOC" ... No sir,.

You have shoved that down our throats without any evidence based proof.

We are not going back.

Dr. Baron, you have lost all trust and you don't seem to realize this.

Anonymous said...

Evidence-based research has proven MOC to be a fraud. Any further investigation will create a "MOC-GATE" that ABIM and their mentorship are highly motivated to avoid. Choosing Wisely and all ABIM professionalism inititives are pilot programs which should be studied thoroughly and stopped immediately; or Choosing Wisely will be studying you. The confusion and possibly the design of this program(s) will create discriminatory practices in medicine affecting all Americans, but particularly targeting older veterans and senior cititizens. Endocrine societies have already made their statements and made a stance against Choosing Wisely. It is time for all societies to question and get to the bottom of who and what Choosing Wisely is/means really and what the consequences are, intended or unintended. Who are these vague committes that make recommendations without naming them or putting their faces up for us to see? What do these vague paragraphs mean they write without references to evidence-based sources of science. Are they just hoping we will fall for this new form of ABIM MOCK SCIENCE. Just read a few things they put out and put your wise finger to the wind. Your finger will burn and your stomach will turn.

The ABIM Foundation should be thoroughly investigated to determine its legality and what unvetted politically motivated medical bureaucrats control it and created it.
As a client of the ABIM I would insist on the former treasurer, Dr. Richard Baron, to put all their previous 990 tax forms and investment statements up on their website for easy review especially in light of revelations about the ABIM Foundation and its financial secrecy. There exists a need to disclose their history of negligent investment practices. In my mind evidence is available already to warrant a complete review by the DOJ or a special "Task Force" appointed by the Attorney General if facts receive a whitewash review. Is it that significant. Yes.
Especially because ABIM has created its own "Task Forces" to investigate medicine and its professionals. Some external authority needs to investigate them and determing if we truly need them at all. Obviously any high school student can tell you that the ABIM is a government out of control with no checks or balances.
As I would like to be honest here, I believe they do more harm than good. I may like the people who talk on the phone, but they can get a another low paying job.
Did anyone know ABIM has a history of discrimination against employees and test takers. Look up the court records. They settled out of court to avoid publicity. What is the total cost to clients in that discriminatory practice of iternal management. Legitimate discrimination with state action approving legal action against the ABIM.

Of particular interest for students of this scandal and any physician pondering future relationship with the ABIM, it would important to look at the 1986-2004 tax returns, the creation of the Foundation, the creation of ICE and merger of ICE back into the Foundation. ACP "grants" are normal course of business. Payouts tot he AARP. Interesting lists. This is necessary for all diplamates and candidates to study. Especially the generation of ABIM/AMBM candidates who have it in their power to never let fraud and conflict of intersts enter into the field of medicine ever again.

Anonymous said...

part 2

The current generation of medical politicians pretend "to not get it" as a self defense and justification. The financial dealings of the ABIM and its Foundation will put to rest any notion that we are dealing with sloppy admnistrative error. Any C-Span review of leaderships roles in influencing politics and furthering corporate interest is a lengthy but revealing study for young candidates in deciding their future. All studies regarding MOC have been funded by insiders or friends doing favors. Plenty of favors. What is the pricetag on favors. It is a form of barter and lobbying, pedaling of political influence that the IRS and the DOJ, OIG, state medical boards, insurance commisions, and state attorney generals should be made aware of.

Additionally, it would be entirely voluntary, but with any elected officials in government it is customary to reveal personal tax returns. Given the breach in trust at the ABIM and ABMS, it is high time our unelected officials do this also. Please list all conflicts of interests for board members and executives, not just a dressed-up abreviated list, and a statement from the board or executives what their political persuasions and beliefs are. Bob Wachter does this voluntarily on his site.

Ditto for the ABMS as well. All 24 stepping stones of the medical industrial complex must be turned.

Anonymous said...

Reminder to all:
The ACC contribution to the Choosing Wisely campaign included the 'excellent' recommendation to only revascularize the culprit vessel during an acute MI. A scant two years later and there is a randomized clinical trial that proves the exact OPPOSITE is the correct treatment. The same morons who are writing the MOC protocols came up with this patently false advice. HOW CAN ANYONE BE SO COMPLETELY CLUELESS? How have they obtained such high stature in our professional societies despite an obvious lack of comprehension of the practice of cardiology?

I challenge anyone reading this to closely examine the Choose Wisely campaign lists. Nearly everything is about LIMITING medical care. THESE GUIDELINES HAVE BEEN WRITTEN BY THE INSURANCE COMPANIES then published by ABIM. How much money does ABIM/ACC receive from the insurance companies via grants, direct compensation and other obfuscated methods of payment?

Anonymous said...

The ABIM has come a cropper!

Anonymous said...

What do the FMG's who statistically get higher board scores and better outcomes think of MOC and "Choosing Wisely"? The huge payouts to ABMS administrators? The mistated items in their tax filings? The potentially illegal formation of the ABIM Foundation?

Regarding FMG's, I have observed various forms of discrimination in residency and fellowship placement. There are obvious disparities in work and educational opportunities and conditions, which to my knowledge have never been properly discussed and addressed.

One observation of an incident involving the ABIM and FMG's was during the ABIM initiated lawsuits against so-called "cheaters". It seemed to me that most or all of these ABIM targets were vulnerable to attack. I suspect they targeted FMG's who have always had less recourse to defend themselves for obvious reasons.

The 2700 letters of reprimand sent out to residents and physicians attending Arora's board preparation courses seemed to target FMG's. A great percentage of the attendees were sent and financed by residency programs. The attendees were an average mix of US and foreign medical graduates. What are we to make of such disparity? Political and economic actions?

There was a huge financial cost for many to get these letters removed from their files. Ha anyone done an investigation into the discriminatory practices of the ABIM? I'd like to see one. Or is this organization beyond any oversight. ABIM disparaged so many very good clients and caring people. It breaks my heart when I think of it even now.

This act of discrimination and other practices against foreign medical graduates by the ABIM has not been address properly. What responsibility does ABIM have here?ABIM has never formally and publicly apologized for this "McCarthy era tactic" and the victimization of FMG's, if I am right about this. Why?

Can the ABIM address this and explain it truthfully? Did they over reach in their job descriptions? Was there an uncontrolled emotional temper in this unproffessional violation of human dignity and rights? The same rights which should be afforded to all?

Anonymous said...

An important MOC question for all.
Who were the masterminds behind MOC? When I called to inquire about this new latest round of money demands over MOC, a couple of payments ago, I was told I would have to call the ABMS.

What? Why should I have to do that?

Staff said ABIM had no control over MOC, because ABMS requires this payment structure and fulfillment of testing in order to meet maintenance of certification. ABMS requires MOC of all its member organizations.

Who is the ABMS I asked? But...No real answers.

So, I called ABMS in Chicago; but that call got me nowhere except wasting my time.

My gut and experience told me at the time that ABIM kind reps were lying to me. I suspected ABIM’s illustrious political leadership cunningly hatched the current MOC plot from funds granted by the ABIM Foundation when they were playing around with what the meaning of professionalism is.

Previously, I let all of my past ABIM frustration and anger go, and went to sleep, until I got an email from Richard Baron referencing a Newsweek article and Kurt Eichenwald. I don't read NW and never heard of Eichenwald. But Dr. Baron's skillful political dodge and tone motivated me to read his articles; since then I have done my own research to verify.

I can tell you that everything that Wes has written here I've verified for myself, also. It is meticulous writing with real pointed research searching for the truth--asking plainly and openly for the ABIM to tell the truth.

I agree that MOC should go. And because WES's tone in everything is completely professional and sincere and he is asking the right questions, I understand clearly the truth of what he is saying and the critical issues. I personally will never go back and fall asleep, accepting the status quo of the ABIM.

They blew their own high flying plane right out of the sky with their political manipulation and greed!

I have seen too much corruption in our medical bureaucracy. Even from these so-called ACP governors who are often given positions for placement of political power in key states in the anticipation of granting political favors. That's why I would be cautious even a good study like the one here on the cost of MOC. I question everything. The ABIM has taught me to be a better citizen by propelling me into the sky to see the secret missiles they launch at our civilian populations via political maneuvering. They launch the medical profession's equivalent of a missile at physicians. They know if they get called out they can simply deny it with whit-words or just blame it always on the other guy.

About ACP: I have direct insight into the ABIM regarding the collusion of ABIM's leadership of the past serving a political agenda that is not in keeping with IRS rulings concerning non-profit medical societies like the ABIM and ABMS. I've grown very wary of the ABIM and most of the medical bureaucracy complex with their billions of dollars taken, or, if you will, literally stolen from physicians.

So who done it, really? Who killed medicine by cunningly dishing out on physicians' heads the slippery stuff of MOC?

Anonymous said...


If ABIM's folks produced MOC, as I suspect, it was spit out like political foam from ABIMA's wise clever mind. (And her advisory of corporate priests.) Isn't MOC, after all, a further example of conspiratorial fraud, manipulative coercion, and deceptive practices in the pursuit of the restraint of trade?

I still have a mixed reaction of helplessness and boiling inside over these goon- thugs at the ABMS or ABIM who preside over everyone's fate. I don't like it one bit. I loathe those closed-door committees that have no name or accountability. Those who act like oracles, while at the same time slamming the door on truth.

What do the goon-thugs say through the kind mouthpieces they hire to work the phones? The nice faces who work the boards claiming they never questioned the tax forms as they are hired and required to do. Who is their audit committee. Where is their voice. To not speak out is immoral. We know that now. I want everyone to speak out as they should. Not just Wes Fisher!

Who done it, I ask again?

"You can email abim@info.org and we will make sure your question gets to the right person."

Yes, whose cunning head thought up the current iteration of MOC?

I'm still waiting for an answer! My gut knows who, but I want this and other answers spoken aloud directed to the patient and everyone in the medical profession who suffers in the silence.

Is Bob Wachter the only one with real guts to speak in depth and in detail? Where is Chris Cassel's voice? John Benson? Harry Kimball? We need to understand. Can we hear the whole truth. Speak out please. Don't let Richard Baron fall on his sword for everyone. He does not deserve that. Right?

Anonymous said...

Typo: Fri Jul 31, 02:38:00 PM CDT
RE ABIM Foundation grants: AARP is a typo. It should read AAPP, which is the American Academy of Private Physicians. The AARP is already "choosing wisely". Not sure what the AAPP "grant" was for. Maybe when the ABIM corrects their numerous errors they can answer that question as well.

Anonymous said...

After extensive consideration about the Choosing Wisely campaign and the connection between ACC and ABIM, it is obvious that most of the 'leaders' of the ACC have been from California and linked indelibly to Kaiser Permanente. It makes perfect sense that an insurance company would place its representatives at the top echelon of the 'professional' society determined to label procedures inappropriate.

Anonymous said...

Choosing Wisely. Just up the coast from California, which got heavy funding from ABIMF and Robert Wood Johnson... ABIMF/OMA in Oregon and ABIMF/WSMA in Washington State have been pushing the Choosing Wisely "awareness" into "action" with grants.

"Choosing Wisely" may have been scuttled in Oregon, laying low, as the initiative ran into scandal there with Christine Cassel's close associate, governor John Kizhaber, not choosing wisely enough in his personal and public life. In early 2015 Oregon's four-term governor, John Kizhaber, had to resign when he became the object of a criminal investigation involving corruption. "Cover Oregon", the Obamacare health portal had to be abandoned after wasting nearly $300 million in Federal funds; Oracle could not get it to work. And then there were highly conflicted state contracts handed out to Kitzhaber's fiancé. So to make a long story short, the governor resigned under extreme pressure while under state investigation. This potentially could be a black eye for Obama and his ACA team, so federal investigators shut down the state investigation and took over the criminal investigation themselves. Evidence and emails could prove damaging to many involved with the state.

So Oregon is supporting Choosing Wisely, but quite a bit "quieter" about Choosing Wisely and their OMA/ABIM pilot program. Oregon was to be the model healthcare state with millions of federal dollars in incentives poured in, but not now, it appears. https://en.wikipedia.org/wiki/Oregon_Health_Plan
(Intel, Nike, etc.,large supporters of health plan cost savings in Oregon.)

Moving further up the coast to Washington State we have ABIMF/Choosing Wisely handing out grants to push a watered down version of “CW” to ease cautiously into the state. The new model Choosing Wisely state? after Oregon muddied the waters with scandal.

In Washington, Choosing Wisely is backed by management of Group Health/Permanente, Virginia Mason, and Swedish/Providence, WSA and the WSMA. Of note: it is not mentioned, of course, by the ABIM Foundation, but all the providers mentioned are heavily married to Boeing’s cost cutting initiatives in health costs for employees; and BA has been outsourcing more and more nonunion labor outside Washington State to save money and pressure the state for concessions.

Boeing along with the its big bosses influenced Virginia Mason to adopt a Toyota factory-style approach to medicine to cut their corporate overhead. With Japanese words like "muda" (wasteful, bad) and "kaisen" (not wasteful, continuous improvement) as part of the Virginia Mason way Gary Kaplan and VM’s highly compensated pyramidal leadership introduced stop watches and flow stations for physicians. Strangely Boeing moved its corporate headquarters to Chicago a few years ago.

Microsoft, based in Redmond, WA is involved also as a major employer wedded to cost savings utilizing VM and Group Health, but it has been seemingly more fair and generous at least in historical image, but we’ll see what the bottom line dictates as far as muda goes. Right now it is layoffs. And the care available for employees has changed almost in the blink of an eye. Old images of institutions prevail for a time that they proved great care, when in fact, it is highly curtailed mechanized care where physicians work from the hallway flow station computer. Many long established physicians left VM in groves. Leap Frog #1 for a decade, but impossible to work there.



Anonymous said...

RE: ACC continues pressure on ABIM; takes credit for minor change in policy.

This is such a game of charades between Papa ACP and their 79 year-old brainchild the ABIM. The ABIM should just come out with it. Stop hiding in the closet and tell everyone they are sorry for deceiving physicians out of tens of millions of dollars.

End MOC requirements altogether; no maintenance should be required for a VOLUNTARY CERTIFICATE as it was intended to be in the beginning.

The nine founding medical fathers of the ABIM and their commonsense partners were wiser than we are today. They brought forth a voluntary offering of one certificate for life as a rite of passage. Anything else is a lie and exploitation for personal monetary gain and political agenda.

Furthermore, any ABIM voluntary certification should be decoupled from all institutional and insurance requirements. Evidence shows it does not have any more scientific weight than the paper it is written on.

The ACP is only 29 years late in coming around to addressing and hopefully correcting the 1986 conspiratorial blunder that has brought ruin to the house of ABIM and its parents the ACP and AMA!

Anything less than what I outlined will mean congressional investigation of all parties involved in the bureaucratic medical syndicate. If ACP and AMA did their jobs in the first place there would be no need to feign such negotiations with their unruly child.

It is the Aesop's fable of the crab and its mother. The mother crab turns around to see its youngster hobbling along getting nowhere in the same manner as the mother. The mother yells out impatiently. "Child, why are you hobbling so!"

Anonymous said...

Any physician who is directly or indirectly employed by an insurance company (read Kaiser Permanente) should be excluded from any leadership position in any/all medical societies. These turncoats cannot be trusted. They have an agenda inspired by their costing cutting, procedure denying, greedy employers.

Anonymous said...

Thank you ACC for efforts to nudge ABIM. But it is not enough to negotiate. One must actively pursue and even sue the ABIM for any meaningful change. It is quite likely there is a growing consensus within the ABIM acknowledging that they have violated many of their professional standards in creating MOC and the ABIM Foundation. There is a trail of evidence pointing to corruption from within their ranks.

Change can come quickly if it favors the ABIM. As you have seen any change that favors the bank accounts of executives and enslaves physicians to endless busywork can come with a quick brisk press release saying it's time to pay; annually or upfront for ten or you will lose your ability to work.
But when it comes to making changes that benefit physicians, ABIM offers nothing but a little different configuration of the same old entrapment.

It shows who is the zookeeper and who are the monkeys.

You know the story of the zookeeper and the monkeys?
A zookeeper saw how rowdy his monkeys became when he decided to give them their usual diet of seven bananas in reverse order.

He used to give 4 in the morning and 3 in the evening. Now he gave them 3 in the morning and 4 in the evening. When the monkeys began shaking their cages so vehemently at the change, the zookeeper was confused at first, but very quickly knew what happened and what he to do. Monkeys the zookeeper, thought to himself have a very short memory. But the rowdiness became a habit.

So he gave his furry captives 4 in the morning and three in the afternoon; and surprisingly they calmed down, thinking that they had a much better deal now.

I saw that a large province in Canada just declared animals to be sentient creatures creating severe penalties for cruelty. I'd tell you the province, but I fear then there would be not a single physician left here in the States to rattle the cage with if I told you of such a humane place. We need some real results. A real reversal of fortune and not just a different accounting of the same old ABMS bananas.

Anonymous said...

What a great guy....He seems to really care .(cough,cough)

Hey Rich.... MOC IS DEAD !!

ABIM Eases One MOC Rule

The American Board of Internal Medicine (ABIM) is easing one part of its controversial maintenance of certification (MOC) rules -- but only as it relates to paying for certification.

ABIM president and CEO Richard Baron, MD, noted in a blog post Tuesday that "a number of physicians have let us know that there is one particular issue that they felt should be addressed as quickly as possible: the link between certifications status and enrollment in MOC."

Baron explained that when the ABIM revised its MOC program in January 2014 -- a revision that engendered a storm of criticism from internists -- "ABIM made changes to simplify the fee structure by adding an annual payment option as an alternative to the 10-year fee."

However, he continued, "An unintended consequence of these changes was that physicians who did not enroll in and pay for the program in years in which they did not have to complete any requirements became 'Not Certified.'"

"This policy had a particularly adverse effect on those who just completed training or were engaged in fellowship. That did not seem right to me, to our Board or to many other members of the internal medicine community."

ABIM has now changed its policy so that physicians who have met the other program requirements won't lose their certification if they don't enroll in the MOC program during a particular year. "Diplomates who lost certification solely on the basis of failure to enroll in MOC or to pay MOC fees have now had their certification status updated to 'Certified,'" Baron noted, adding, "There is no further action they need to take."

If physicians want to be listed as participating in the MOC program, they will still need to be current with payments and meet ongoing program requirements, according to the blog post. And internists "must still meet 5- and 10-year program milestones to maintain their certification."

There was one further caveat: internists "who earned initial certification since 2013 or renewed certification since 2014 who no longer wish to be enrolled in MOC this year as a result of this policy change may be eligible for a refund of their 2015 MOC enrollment fees," Baron wrote.

"Please note that if ABIM provides a refund, MOC enrollment will be canceled, the physician's status will be reported on abim.org and to the American Board of Medical Specialties (ABMS) as 'Certified, Not Participating in MOC', and the physician will no longer have access to ABIM activities or their MOC Status Report, which gives them their specific requirements and deadlines."

The American College of Cardiology (ACC) said it was pleased with the change. "By tying together board certification and enrollment in Maintenance of Certification, the American Board of Internal Medicine appeared to devalue the secure examination passed by recently certified physicians, by setting different standards for them compared to those certified in previous years," ACC president Kim Williams Sr., MD, said in a statement.

"The ABIM should be commended for recognizing the negative impact of this policy on current and future employment opportunities, particularly for those in the early stages of their careers, and taking the steps necessary to reverse it."


Anonymous said...

"ABIM clearly got it wrong"... and they still are.

Great , keep ignoring 22,870 internists.

Your gravy train is coming to a flying stop.

Unknown said...

You don't even have to go that far. Just look at the ABIM board of directors. It is not ethnically representative at all of practicing physicians. I asked dr. Baron why there were no Asians, Central Asians nor Middle Easterners on the board. There was no response.

Anonymous said...

Toward a Scientific Definition of MOC (an objectifying quality measurement)

If it's ever-changing rules and requirements are impossible to comprehend,
it is MOC.

If it's quality measures are impossible to design and implement'
it is MOC.

If it's an onerous measurement schema that dulls the mind and heart,
it is MOC.

If it's an unnecessary, unscientific money-making scam,
it is MOC.

If it's something that stresses medical practices everywhere,
it is the ubiquitous MOC.

If it's a fraudulent bureaucratic invention, founded on well-documented lies,
it is MOC.

If it does harm; an activity involving medical middlemen and women who know squat,
it is MOC.

If it inures the "personal piggy bank" of the medical bureaucracy,
it is MOC.

If it involves "quality measures" and "flim-flam medical politicians" who have to get out of town,
it is most definitely MOC.

If it has the word "Foundation" associated with it,
it is the "high stakes" game of investing in MOC,
and your "Wise MOC Dollars" working for you.

Do you live in a country where medical politicians deceive,
often getting called out for their crimes, but still go free?
that is MOC too.

Does it seem you're made to live and work for an incompetent elite?
Are the egalitarian laws and professional boundaries often confused and blurred.
Is it all MOC?

Is medicine moving too quickly while click/template demands and bureaucratic red tape slow everything down; all the requirements changing faster than anyone can keep up with; fewer patients, denials, delays, not covered, and so on...
Less time for the patient, practice, and relevant CME?
Don't worry about it; welcome to plastic land of MOC!
Just pull out your credit card.

Anonymous said...

Mr. Kroll (anybody): Why was ABIM domiciled in Iowa? Loose laws and little enforcement pertaining to nonprofits?
Why was the ABIM listed as a foreign corporation in Pennsylvania in 1965? How did they create the ABIM Foundation so quietly (secretly?) registering it in Pennsylvania transferring all the profit/assets without dissolving the ABIM as the Iowa/Pennsylvania articles and bylaws required. The corporation was in fact under Iowa law governing nonprofits, even though they only had a registered agent to receive mail. No office or operation ever in Iowa.
I believe, based on what I see now, the funding of the ABIM was in fact an illicit step process that fraudulently transferred almost all ABIM assets to the Foundation. And they continued with this asset transfer through 2007. Mr. Kroll, have you studied this issue? Consulted nonprofit attorneys?
I would like to know about the legality? of the ABIM Foundation and possible corruption and fraud at the ABIM regarding this transfer without dissolution. (See articles of incorporation 1936, 1965, 1975, etc.) Please help clarify this for us.
I tried calling attorney general Ms. Kathleen Kane, but she and the Pennsylvania Attorney General's Office are not taking calls right now.
They seem to be busy with their own legacy of corruption issues. Where do we go for answers!?

Anonymous said...

ABIM Executive Pay Keeps Rising Every Year! I just looked at the ABIM tax reporting forms, myself. Why the increases for a worsening service? “We got it wrong!” The testing service and pass rates seems to be getting worse. Should not the pay be linked with performance at the ABIM? Performance is horrendous. “We got it wrong!”

I am generally a very positive person, but when I think of the ABIM I sometimes go into a rage. Why because I want this disingenuous organization out of my life forever. I am tired of serving them and paying their salaries. That is how I feel, based on deepening insight over the years and looking plainly at what I would term a failed testing company.

Anonymous said...

Who is Lorie Slass, Senior VP of Communications, and why does the ABIM need a former political media analyst to communicate with physicians? I have asked to talk with her a few times over critical issues, but she was never available to communicate. So, I will ask a few questions here due to frustration.

In the past a communications person or officer would communicate with people. I am talking about in a free democratic society. I have only quietly asking for the truth when I called. I am perplexed because of ABIM’s silence; also I realized I don't even know what Ms. Slass' face looks like, or why there has never been anything written about her or much spoken about her. Shouldn’t she be the face of the ABIM? You know like a press secretary--a Jen Psaki or Marie Harpf. At least these lovely women put themselves out there on the line for us at the state department. They informed and they kept the state secrets.

Does the ABIM hold state secrets too? I get the strong feeling that the ABIM has a great deal to hide because there is no face and no communication as there should be. How about a press conference every day for physicians and the media? Does Lorie Slass have anything to hide from us about herself and her past actions at the ABIM? Any embarrassed about past events?

How can hanging low justify your position, Lorie? Christine Cassel does not talk either from her compromised position at the NQF after Senator Grassley reprimanded the agency. The DOJ was knocking on the door again for the NQF. “We just want to cooperate with the DOJ.” Cassel got scared and has hid away ever since. Why? People want to know why? I read it over and over here. Do you know Lorie why silence is the rule? Even John Benson, the modern era father of the ABIM, does not give interviews anymore.

Why does ABIM need a Senior Vice President of Communications at 300K+ per year when we never hear from her? She never puts her name to the press releases, so I assume she does not write the announcements for the ABIM and the CEO. What does she do? I only have a couple of sentences of background on the ABIM website. Does that title VP and few blurbs about her mean that a wisp of a personal presence can justify such a high salary?

If you detect anger, yes I am angry. Slass apparently knows a lot about the politicized media and political spending, but what about medicine. She knows very little and cares for physicians even less. I learned that much about her. She does not have the right background for this job. Her political past would be in keeping with the political adventures of the ABIM, especially working with the "number two politician in America"; working with Cassel during the years of take no prisoners.

I am asking, what did Slass have to do with Cassel’s demoralization of thousands of physicians over the years and never addressing the need to analyze or study compassionately what happens to physicians after testing, pass or fail! You know I have seen many cry or go nuts just from the stress. For what? Do you people care at the ABIM? I want to hear from you, Lori!

Anonymous said...

And what about Lorie Slass, Lynn Langdon, Chris Cassel and the "steam roller" press releases, crushing, demonizing physicians as cheaters. What child would want to hurt so many so quickly, except an immature hurtful child. Or were you all under orders from above to seek and destroy so many, as people here, point out for political purposes. Or was it just to keep the monopoly going. Slass, are a political animal as a communicator. The lack of communication is political in style. Why does the ABIM need so many political animals?

Big question about ABIM discrimination: Did Lorie Slass stand up for the African American women at the ABIM who were under tremendous pressure from discriminatory practices directed by the top person? I mean those ladies who were working in one of the ABIM's vital departments for years; they saw a lot. Did legal gag them? And did Slass try her best to keep it quiet, so Cassel would not be implicated in a discrimination cases against people of color? I want to expose this. Don't you also want to get a lot off your chest, Lorie?

Nothing new for someone like Cassel to crush or abandon people, so involved in her own politics and using the organizations to further that political agenda. What's a few lives minced and tossed out who served there for years with a great professional record; did it matter to anyone to speak out and communicate injustice. Is that the democratic way? I believe in civil rights. And I am mad about this and all the actions and failure to communicate the truth that I mentioned over time involving the ABIM. I want to speak out about it now. There is so much people don't know about the ABIM. We need to get it out.

In honor of all employees at the ABIM past and present. How about a performance improvement module for you, Lorie, and Chris Cassel and Rich Baron? Lynn Langdon? And the rest of the violators of human value and rights. In honor of all the good people of Philadelphia I speak out here.

Anonymous said...

When you run political campaigns from a non-profit organization you have to run a tight ship. Right Lorie? I am sorry to pick on you; you see, you are supposed to be the voice of 'truth', but you do everything you can to suppress it. That loyalty to your fellow workers means nothing? The price you pay for your lack of honesty has gotten the ABIM in trouble. I believe simple direct speech is usually the best policy.

Would it be fair to say that the ABIM has not been a fair and equal employer, except for the big money making executives there?

Why don't you at least council Rich Baron to not shake his head sideways continuously when he is trying to convince of us of something that is not true. He does not believe himself either, it appears. A lie is a lie. A misstated financial document is a misstated financial document.

Lorie has been at the ABIM since 2007? Was she communicating well with the New York Times and others over the years? I am thinking back when she helped demonize physicians for political purposes.

And now what is going on? Strategically trying to soften the recent controversy and revolution over the MOC failure and its fallout. I'd like to have an expose from Slass on what she does and how she justifies that huge payout of hers.

Do we sound resentful toward her and the ABIM?

Yes, I am, because I am tired of lies and the ABIM typical way of "no-speak", which is more indicative of a political money machine than a humanitarian test company. Yes, I am testy about the testing and have rigorously put the certification process and the maintenance of that silly certification under the magnifying glass. It is fraud and they never keeps up with fast-paced medicine anyway. It's like being on the wrong train. You realize it and the conductor tells you the train does not stop in Philadelphia and never will.

If the ABIM constituency only lived up a little to the great democratic traditions in the city of brotherly love, we would go a long way toward resolving the MOC crisis and the political and financial corruption at the core of the institution.

As somebody said here on this blog Liberty Square is just a block away.

ABIM don't tread on me!

Anonymous said...

I am completely opposed to the program as it is being implemented in the US and internationally. There is nothing wrong with the words as a reminder that there is wisdom and choice, but the content and methods of ruse and concealment of financial conflicts is not alright. It is immoral; unethical by any normal standard.

If we hold those physician politicians at a higher level of ethical standard, who are behind Choosing Wisely, I believe they should be questioned by a higher authority for conspiracy to defraud patients and physicians.

Physicians don't understand that this program has "provider aids" (corporate trained assistants) who will be counseling patients during their visit with you! Good luck choosing wisely when you are not involved at all. This is a "pilot program plot" involving corporate greed (motive) as is evident by the usual perps pushing it at the ABIM Foundation, Robert Wood Johnson (and Johnson) Foundation, and the ACP. Then look at the corporate and government lineup behind them.

All recommendations of "medical things to avoid" are worthy of the same level of trust as ABIM Foundation's purported financial misstatements and hiding of negligent stock investments. At the root of the evil is the ABIM historical leaderships' professionally unethical primal lie. Politics as usual. Greedy to the root.

You know how much these negligent crooks at the ABIM lost in one year on risky stock purchases when they were supposed to be focused on test materials. On one investment alone, they lost a cool million dollars of physicians' money and hid it. That kind of thing is why you can never trust this organization. What was the stock that lost a million? TYCO. Remember? Look at the other financial blunders they made with physicians' money. Telecoms and tech lost big. Even their bonds, go figure. If you look closely at the tax forms and the high flying greed for cash among its executives, you will think twice about the ABIM being endowed with any or any good whatsoever. Totally reckless in terms of judgment with money and with health issues. Sold out for money and political empire.

"Get that money over to the secret piggy bank quick before anybody notices it is missing." (And how much we squandered gambling on bad stocks like LSI Logic, etc.)

Eichenwald should get an interview with Chris Cassel, and former CFO Henri Strozeski over the financial and political shenanigans during the Kimball-Cassel era. I still suspect that "fox Cassel" is guiding many orgs from the DC chicken coop.

Anonymous said...

How could this great country ever produce such a monstrous lie as the ABIM-ABMS and the political cleptocracy pulling the strings behind them?

Anonymous said...

Since Senator Grassley is looking into the NQF, perhaps someone ought to ask him to expand his investigation to include the ABIM, which also influences the flow of health dollars?

Unknown said...

Dr. Wes,

How do I reach you by Email. I have the ABIM Foundation 1023 filing. This is different than the 990. It includes their articles of incorporation, which they seem to be violating. Let me know and I will send over the PDF. I am also trying to get the ABIM, not the foundation, 1023 as well. They are probably violating their own charter in many ways.


DrWes said...


My email is wes - at - medtees dot com (written this way to limit e-mail spam)

Thanks -


Anonymous said...

Associating with an organization like the ABIM will sully your good name and besmirch your family.

Anonymous said...

Regarding MOC and Choosing Wisely: Is it time to revisit Tuskegee?