Monday, November 23, 2015

ABIM Legal Fees: Pre-MOC vs Post-MOC

Pre-MOC Average: $146,073/year
Post-MOC Average: $1,090,184/year
This graph sums up another reason the American Board of Medical Specialties' Maintenance of Certification (MOC) program (implemented by the American Board of Internal Medicine in 2005) is such a mess.

(h/t @CharlesPKroll via Twitter)



Pro Bono Investment Advice said...

They say that you can read history in a graph.

This money trail above tells a story that the ABIM executives, board, new council and staff should be very ashamed of.

The kind generous staff, who are heart of the ABIM, should really inquire into the real story behind the scenes that has not yet been told about the ABIM--the hidden dark world of dereliction; the shirking of real work "to protect the public" in favor of lobbying, selfishness and greed.

ABIM staff should ask the executives this question:
"Are we/were we really investing MOC and testing fees into socially responsible people and programs?"

MOC pays/paid for many undesirable and unintended consequences. Who will own up to this shameful, negligent and irresponsible way of running this humanitarian non-profit goodwill organization. Who?

Who trammeled the public good? Who cheated hard working physicians? Who did it?

The voluntary nature of the original organization was decent at its core--completely different than today's hurtful people and their impetuous ways--hammering out policies that become legal mandates to oppress and reap for themselves.

The ABMS heaps ashes on the heads of physicians; gives cold stares at the patient population who are nothing more than numbers (with costs)that must be reduced--just like mowing grass.

Anonymous said...

The ABIM is dead. Look at it. Don't wait around for the resurrection.

No phoenix bird will rise out of the ABIM ashes--only an astonishingly high level of renewed greed and powerful coercive goads.

The COMPANY represents nothing, does nothing good; but always manages to breed big fat bank accounts for the politically motivated elite and rich.

Transfer it over from the piggy bank. Put it in your account to grow at a negative rate of conflicted interest. -0

What can be done? Probably nothing at this late date.

The ones that should have done something are lecturing for big bucks, retired in luxury, or scratching their heads about what went wrong with the health care reforms--the one's who took all the big money with them.

I recommend a divestiture of socially irresponsible people and programs.
MOC is dead. Evil and greed killed the ABIM--this child of the once proud ACP and AMA.

What does this death of the ABIM tell us about how good the parents are.

The worst stewards in the world are the dishonorable ones who watch death and never weep, never feel ashamed.

Ed Rico said...

Another great example of the circular reasoning at ABIM: Dr Baron and Dr. Wachter say the high salary for the ABIM CEO is appropriate because that's the market price for the head of any healthcare organization of similar size and scope, yet the only reason that ABIM became a $55MM a year operation is because the ABIM principals decided to make it one by setting their own fees in a monopoly and dialing up their own desired level of revenue. Once again, the MOC fees are necessary costs of "keeping up", yet the fees are also apparently necessary to provide a significant share of this revenue to funnel into aggressive and heavy-handed legal activity to fiercely protect their "intellectual property", which wouldn't be necessary without ABIM certification/MOC.

If ABIM/ABIMF terminated operations, cashiered the attorneys, lobbyists and "magic pencil" auditors, liquidated their assets and compensated the prior targets of their litigation while returning the rest to the diplomates, allowing Dr. Baron, et al to return to the private sector, I'd suspect that the vast majority of practicing physicians as well as the public would consider that they were better served than by continuation of the status quo. The problem is, as Ronald Reagan once described, "The first rule of bureaucracy is to protect bureaucracy". So don't count on any epiphany by the ABIM principals, any definitive action to correct the current problems will have to be imposed on ABIM from outside the organization.

Anonymous said...

Very concise evidence-based assessment, Mr Rico. We totally agree that we cannot count on any "definitive action to correct the current problems" [they] will have to be imposed on ABIM from outside the organization."

Regarding the former part of your statement, "don't count on any epiphany by the ABIM principals," I would venture to say that the principals might be having one hell of a "nervous epiphany" right now looking at their future prospects. I understand they are catching flack from their "oversight committee" whoever they may be.

The ABIM's evil cart has tipped over, Mr. Rico. Their guts are spilling out all over the floor and in the car on the way home.

The other businesses at 510 Walnut Street are concerned how they will pay the rent when the ABIM is gone. The engineering firm is seeing a slowdown and the bagel kitchen is not selling as many lox with crème cheese. "Just coffee, please."

The landlord is on a timetable; has increased the rent. The heat is on for the superior ones who produced such terror.

Their trademark is terror and the ABIM's principals will end in the same terror, Mr. Rico.

Live by terror; die by terror. They cannot jump over their own knees.

Anonymous said...

Ed Rico,
Well said. But there is enough angst that once the IRS and other agencies get drawn into this, the ABIM will have more legal woes to worry about. The ABIM is in a hugely precarious position. They have no right to declare any physician as "De-certified" or "Un-qulaified" or "incompetent" or "unfit" to work. Their standards have been ripped to shreds and won't stand any legal scrutiny. Think about it. If the ABIM continues their plan of overstating their relevance, the number of people dying to sue the ABIM will cause so much litigation, their entire structure will collapse.

The ABIM MOC program is not and never will be an accepted, validated, and universal "Re-certification" program. That's why their verbiage is "Not PARTICIPATING IN MOC" via ABIM. One could easily prove that there are other ways to maintain your skills as a physician. Any attempt of ABIM to "de-certify" a physician and therefore unable to make a living put them in a precarious position.

If let's say 100 physicians are "de-certified" by the ABIM and therefore "Un-Boarded" and their State licenses are revoked because ABIM refuses to retract their mislabeling, what would happen? That's right- 100 lawsuits scattered across 52 States. Let's calculate average salary $200,000 x 100 x 3 years apiece for litigation to wind through. $60M. 200 lawsuits? $120M liability.

One should wonder if the ABIM has an insurance policy even close to covering this kind of liability.

I guess we can put a lien on the ABIM building or put a lien on Rich Baron's house.

Rich Babble from the country said...

The towering house of cards is already on the brink.
A rigid tower made of 24 cracking crumbling bricks.
"You can't touch us inside our elitist world," or so they think
With their rich protected hides seven miles thick.

Don't take my word for it, just shout to the wind and knock on wood.
Tell them anything true, they'll say what, I'm not following you
until you feel like a fool--just a stupid honest hick.
I must have been born in a different America--proud, decent and good,
'Cause what the 'folks' at the ABMS have done to dirty and cheapen our country
makes me sick.

Anonymous said...

MOC aside, the ABIM has violated every ethical standard and step out of bounds on the law. They fraternized with financial crooks who knew how to and did cook the books.

If anyone went in now to sue the ABIM or even some of their partners, they would have solid legal legs from many different angles for doing so.

If you knew to what lengths the ABIM went to preserve MOC, you would be horrified.
For them cheating, lying, bullying and coerced results are standard policy.

Ask the "Rich."

If you do sue it won't take long in your investigation to uncover their dirt.
That's what they're most afraid of. Their own unclean, negligent house.

They're stalling and stonewalling, buying time, hoping their cheating scandals and racketeering won't hurt the elections. They're money grubbing as well as political.

Everyone knows it.

Grapes of Wrath said...

Thank you for the above contributions and to Gary Levin on the previous posting. It was helpful and precise.

Every person sharing something of what they think and see is more knowledge and power to fight the corruption that has taken
root so aggressively surrounding the medical specialty boards and their corporate partners.

I think we need to understand that corruption is an elusive
opponent that grows and connects to many organizations progressing like a virulent vine.

We need to understand the root structure and how much unified strength is needed to pull it out combined with intelligent efforts. What will it take to put the vines back into a manageable state contributing to the garden, and not sucking and choking the life out of it.

Anonymous said...

American Board of Thoracic Surgery already initiated 10 year MOC secure exam at surgeon's home computer for $125. "The Board is transitioning to using SESATS as the mastery learning tool... The Board’s MOC Exam Committee has chosen approximately 100 questions from SESATS for you to complete. The Board anticipates the Diplomate will work through the questions, similar to previous experience with SESATS. This new tool replaces the multiple-choice MOC exam, used in previous years, when Diplomates were required to go to a Pearson Testing Center."
[See Self Education Self Assessment in Thoracic Surgery]
For those of you who have not assessed SESATS in the past, it works in a fairly straightforward manner. After reading the stem, pick the option that seems correct. Even if your answer is correct, you will then need to click on the critique button, where there will be an explanation for you to read. By reading the critique, you will know if you were correct or not. You will then need to click on the question button and answer the question correctly. This will then allow you to proceed to the next question."
ABMS must have approved this, and ABIM could have done something like this.

Interestingly, by form 990 ABTS in 2013 had TWO paid employees with total compensation for MD executive director $307,407, and for administrative director $158,888.

Anonymous said...

Rubio defunding ObamaCare

Anonymous said...

"$50,642,980 Deficit Buried on Page 19" consolidated return ABIM and ABIMF

Broke, yet flush with Clinton-era ride-em-to-the-sky stocks, cash and other investments; unfortunately it can't be repatriated without liquidation of the most important jewel in the ABMS crown--the ABIM Foundation.

The money belongs to physicians and general taxpayers who have been beaten down and cheated for over 50 years.

Another Sterling Stock Pick said...

ABMS Exchange: Shares of MOC are plummeting on bad news.
What bad news? The ABMS Exchange is being bought out by TEAM.
The 24 medical specialties are being reduced to 2.

Team Inc (NYSE: TISI)
November 24, 4:02 PM EST
▲ 0.33 (0.86%)

November 24, 4:00 PM EST
▼ 4.16 (-108%)

But the good news today is the "Hospitalist Company" IPC;
investors are cashing in big on the merger with TEAM.
$42.78 at the beginning of the year. Merger price $80.25 per share.
Congrats to all!

IPC Healthcare Inc (NASDAQ: IPCM)
November 20, 4:00 PM EST
0.00 (0.00%)

Anonymous said...

Let us never negotiate out of fear. But let us never fear to negotiate.
John F. Kennedy

What's Up and What's Down said...

ABIM's Consolidated Financial Madness Continues (details below)

Charles Kroll blessed us today with some smoked turkey and buttery mashed potatoes:
(A heavy meal to swallow from the ABIM in reverse order.)

"Pass the Gravy: ABIM Consolidated Legal Fees $1,017,158 for Year Ending June 30, 2015; $12 Million Since 1998."

"Gobbled Up: ABIM Consolidated Investment Income Tanks 98.6%, $9.2 Million Year Ending June 30, 2015."

"Turkey Shoot: Program Fee (SEP) Component of ABIM MOC Revenue Quadruples from $4.2 Million 2013 to $18.6 Million."

"Plymouth MOC: Bankrupt on paper, ABIM gives thanks to unearned 'Deferred Revenue' cash funding $50,642,980 deficit."

"Cassel cancels NYT #1 Best Selling book signing tour to try to explain imminent release of 2014 NQF compensation 'How I Ran ABIM into the Ground and Got Paid $8 million for it.' A Guide for Dummies and Reference for the Rest of Us by Christine K. Cassel [MD?]."

"ABIM reports $9,368 Printing, $160,000 Lobbying gets buried..." [$80k?]

"Death Rattle? ABIM ties up 48.4% of investments in non-publicly traded investments, up from 0.1% in 2012."

"Magical: ABIM throws another $14.5 million into non-publicly traded TIFF Keystone Fund and no longer classifies as high-risk "Level 3" MOC."

"ABIM Fun Fact Nov 23
ABIM+Foundation booked $10,011,614 in Program Service Losses FYE 06-30-15"

"ABIM Does Not Post 2015 Stand-Alone Report
▶ $50,642,980 Deficit Buried on Page 19."

Retweeted from Twitter with or without permission.

Catch 23 said...

Ed Rico speaks ironically quoting one of the professional medical bureaucrats that apparently gives everyone a migraine...then Ed provides us with the real reason for this MOC madness and purpose of those "heavy breathers" talking over the phone giving the orders...

"MOC fees are necessary costs of "keeping up", yet the fees are also apparently necessary to provide a significant share of this revenue to funnel into aggressive and heavy-handed legal activity to fiercely protect their "intellectual property", which wouldn't be necessary without ABIM certification/MOC."

This is the conundrum: MOC is totally unnecessary and so are the executives and their henchman manipulating markets and physicians.

Be gone ABMS/MOC say physicians! Then why is it not so?

It is the same answer as in the best selling book "Catch 22."

Physicians are guided by unfit physicians who are forcing real physicians to go into war needlessly. In the book the real physicians will get to go home if they can just survive the ordeal. But in our scenario the truth is MOC is a boat lost at sea that will never let one reach port as long as the firm and its Mafioso clients remain in business or with power.

The business is bestowed on them by real physicians giving them hard earned money, "Or else!" The power comes from, "Who knows where!"

The fake physician bureaucrats ordered the destruction of medicine to gain power, money and ultimate control.

This is the conundrum, tragedy, and hallmark of the new millennium:
"Gone. In Reverse."

American Board of Thoracic Medicine said...

Board of Directors serve without remuneration.

No certification for misdemeanors or felony charges and having material relationship to the practice of medicine.
No omission intentional or unintentional.
Must be upstanding in community.
Board will not respond to certification requests until annual MOC fee is paid. Hefty fees for certification in several steps/parts. Oral, written and in Pearson Center,(Booklet below).
The computers in many online proctored exams today will take control of your computer by the company administering test in order to monitor you for cheating. Who is the company used for the ABTS 100 question test using SESATS online at home? Anybody know?
Even CME at some conferences require cellphones to track your attendance.
Quite a techno leap lately. Why? Lot of business deals going on behind closed doors on it appears. Discuss?

2013 990 low costs for this board in terms of overhead reading from the 990. Not very large of course, but certainly not like Pediatrics CEO getting 4 times the amount.

Anonymous said...

Reply to American Board of Thoracic Surgery post Nov27 above:
The booklet you referenced above is dated 2014, and they have since made changes according to thoracic surgeon on Sermo. Again, please see
"Instead of taking the MOC exam at a testing center, the Board wants you to be aware that you will be taking the exam on your personal or office computer.  You will need to have a web camera that will work in conjunction with the software for security purposes... Each time you log on to the site, you will be asked to hold your license (with your picture) to secure verification."
Instead of a "techno leap", it appears that they have decided to trust their colleagues.

Anonymous said...

Thank you "anonymous 5:59" for the 2015 ABTS reference! It saved me some time searching for something I was researching. Immensely helpful.

We do need to find more trust. Ultimate trust would be to be able to shop for your own relevant CME and to end the "Mocopoly" of the ABMS.

I believe in a "free market" economy--not the Wall Street variety--just real consumer choice. The ABMS restrains trade and corrupts free market principles with insider market manipulation. The innovation so vital for our economy is being squashed like a bug. In medicine the important "up to date relevant CME" is not being stimulated with healthy competition to produce the best service.

I believe in MOL (with relevant CME) not redundant MOC. ABMS is a money regimen only.

The states need more power and oversight, not the federal government. The ABMS is the physicians' equivalent of the federal government. But just like the distant "Fed" it does not really listen; and even if it says, "Man, I hear ya," or "I feel yur pain," or even, "We got it wrong," there is no real response; there is no customer service other than lip service from the ABMS.

There is not physician voice.

I have talked with the ABMS asking many relevant questions and tried to share some of the viewpoints of physicians. I even told the ABMS team member where they are putting their enterprise at risk. Do you want to know where my discussions got me?

I think you already know!

Anonymous said...

Who will be the next among the medical specialty boards to switch to online proctored testing. They take control of your computer remotely. They started introducing this technology around 2008 in the marketplace.

Get a very good privacy policy and civil liberties attorney before you allow them to take control of your computer, Dr. Fisher! They will strip your information clean to the last disc if they get a chance. Trust me.

ABTS/Penn State's new proctored online sponsor "Software Secure" and their "educational support technologies." How long have they known each other?

Meta Ingenuity has been around maybe a year or two and has one employee.
Astute Technologies has around a staff of 10. Who are these people that work from home and take over your computers or supply the "educational support" streaming into your home or office computer.

There is another company like this "Software Secure" that is trying to muscle into the ABMS market. It's parent company already spies on your website, Wes.

Good luck with trusting these new ABTS/Penn State colleagues who will be using unproven third parties--visiting the guts and brains of your computers.

They will have you sign a pledge that will open you up to civil and criminal prosecution like the teachers in Atlanta. The most egregious offenders got up to seven years in prison for erasure irregularities--due to high stakes testing and the security spies' most "expert advice" and their dubious investigators.

Don't sign anything before you have an attorney amend it down to just "I am doing MOC and agree to nothing more."

Anonymous said...


Software Secure, Inc.
Select Your Organization

Software Secure website for customers.

Competitors to Software Secure come knocking at ABP, etc.

Btw, I meant "techno leap" to reference the many possible angles that the end of 10 year MOC may lead to more onerous engagement with the physician colleagues pilfering pockets, annual charges, and demanding 15 hours of everyone's time when there is no trust for the ABMS left. And there is even less collegiality extended toward their hard working doc. Docs got it right when they said end all ABMS MOC.

We may see increased conflicts of interest over the new technologies.

Ultimately, ABMS will use you! And if you don't make the grade; they'll cut you loose.

They will even take your soul if you let them. Don't let them.

Patents of two competitors fighting for MOC money.

Privacy Statement for Internet-Based Learning:

"Penn State Privacy Policy

Penn State is committed to on-line privacy and confidentiality. This website is managed by Astute Technology, MetaIngenuity, and/or the American Board of Thoracic Surgery (ABTS), and their printed privacy policy applies to this site. CME credit for "Self-Education Self-Assessment in Thoracic Surgery XI (SESATS XI)” is provided by Penn State College of Medicine.

If you register for CME credit for this educational activity, Astute Technology, MetaIngenuity and/or ABTS will forward relevant personally identifiable information to Penn State College of Medicine so that we can maintain records concerning credits we issue to you. We may share data concerning registrations, evaluations, and CME credit on request of our joint provider (American Board of Thoracic Surgery). Penn State College of Medicine may use the information you provide on this site to contact you about your CME credit or other examination feedback. For more information, contact"

And for God's sake don't print or read this before talking to your attorneys.

If you go for this entrapment, good luck! I'll bring you guys and gals a file inside a cake. That's the best I can do for you.

Jerry's Standup said...

ABIM Trivia.

Did you know that the former Chairman of the ABIM Board, Sir Bob Wachter does around 40 paid talking engagements per year.

He really enjoys public speaking. He's good at it. On a good day he claims he can even provide a laugh or two. I highly recommend him.

His agency charges 20-40K per engagement--flying from California. I assume the latter blurb means he gets some travel and per diem.

He is truly blessed.

We luv ya! (mean it!)

Don't forget us, Bob!

Suzanna said...

About trusting colleagues talked about above. I am glad that there is some degree of online dialogue where we think "they" are listening, but I am wary also. Very wary. Even Lisa warns that Wes (subtly) that he may be just playing into the hands of the ABMS without knowing it.

Wes is not naïve about the dark aspects of the ABMS, but they have 24 paid risk management teams and a core think tank in the top floor suite that does nothing but think of how to protect themselves--not the public. This ain't Yuma!

A West Point tactician told me if you want to win the battle you must go to the top of the hill (metaphorically speaking) and get a good lay of the land. Never wage war on impulse. Plan thoroughly and know their Achilles. Sometimes they know you know what it is and will lay it out for you as a dummy bait--in order for you to be prematurely foolish.

The tactician also said, never trust the enemy when they hold up a flag of cooperation, when for the last five decades they just stabbed you each time in the back.

Look at the EU. Some members want to have their own policy, but the heads quickly pull out some trick and bring them back in line. Wes says any MOC is wrong and a waste of time.


ABMS Regulatory Capture--for Those Who Didn't Know said...

ABMS Solutions. (A credential verification platform--paid subscription service for ABMS stakeholders/clients.)

Here's another "nifty" idea and "super duper" money maker from the ABMS HOME OFFICE.

ABMS solutions is raking in the dollars from that precarious precondition for physicians that their ABMS certificate is linked to employment, i.e., being able to work or not. If any reader did not know, the once upon a time voluntary certification with an ABMS specialty board is GONE.

Certification is now tied to employment. The certification must be verified by the states, hospitals and insurers in order for physicians to work.

Presently out of deep compassion for patients, the ABMS has reached out to phycians to offer even more service to them (for a hefty fee). The ABMS invented MOC maintenance of certification, as revenues declined/reached a peak in 1975-1986. Certification and MOC are now required to work (in most clinically-orientated physician jobs).

Almost all the private physicians have been decapitated (not just emasculated)through bureaucratic requirements and low reimbursement rates forcing them to become employed by large institution like Kaiser Permanente or UHC.

Physicians (all sexes) now must remove and hang their "balls" up in the locker room before addressing or serving the administrators and patients; but most importantly the daily tasks engaging the computer/keyboard/EMR from the hallway flow station require low T output to get through the strenuous but humiliating day.

Any testosterone surges form any of the "worker units" will just not be tolerated and undermines the clerical nature of medicine.

A blogger on the previous posting said we need to "sue these bastards."

ABMS SOLUTIONS has the credential verification program that is just right for you!
States, hospitals and insurers pay for unlimited usage through subscriptions. If that is not the right package for you then we offer limited use packaged solutions for your credentialing and verification needs.

Miffed about ABIM's Tiff said...

ABIM Investment in TIFF Rather Steep Expenses at 1.71%
Fees, Expenses, and Annualized Expense Ratio (%)

MAF (1st column) STF (2nd column)

TIFF Management Fee 0.20 0.03

TIFF Administrative Fee 0.02 0.01

Subtotal (TIFF Fees) 0.22 0.04

Separate Account Manager Fees 0.47 -

Acquired Fund Fees and Expenses [a] 0.35 -

Subtotal (External Manager Fees) 0.82 0.00

Operational Expenses [b] 0.16 0.20

Subtotal Fees and Expenses 1.20 0.24

Interest Expense, Dividends on Short Sales [c] 0.51 -

[Total] Annualized Expense Ratio 1.71 0.24

Source: TIP Prospectus dated April 30, 2015.


For Comparison here's a much lower Vanguard Institutional Index I Fund's
Expense Ratio is .04%!

VINIX: Vanguard Institutional Index I
November 26, 7:00 PM EST

▲ 0.16 (0.084%)


Net Assets 105.43 B
YTD Return 3.47%

Exp. Ratio 0.04%
Category Large Blend

After very risky stocks with 1838 Investment Advisors (defunct 2005)
ABIM invested in Vanguard funds with expense fees as close to zero as you can get.
Index funds in many cases have outperformed multimanager funds like TIFF through annual savings on the expense ratio. The cumulative cost of TIFF's 1.71% could easily tip the TIFF into negative territory in flat years and decrease NAV in positive or negative years. Many institutional investors including University programs utilize low cost Vanguard products opting out of Fidelity's higher expense ratio for and may offer TIFF as a riskier option or not at all.

I looked at Tiff's MAF portfolio which is fairly extensive and I scratch my head at the added expenses stemming from utilizing hedge fund managers and incurring unnecessary interest expenses on short sales and other margined investments.

Anybody have similar thoughts about ABIM's choice of TIFF versus a low cost successful family of funds like Vanguard? It was founded decades ago by a pioneer in the lower cost index funds. And there has been ETF index funds that have merit as well with low expense ratios. You essentially have the same portfolio without the managerial fees and margin interest.