Wednesday, April 06, 2016

How the Feds Plan to Federalize MOC

From the Commonwealth Fund's Washington Weekly Health Policy Week in Review:
March 31, 2016 -- Health professional societies and consumer groups have asked Medicare to tread carefully while overhauling its system for paying doctors, raising concerns about an agency suggestion to include guidelines from a campaign that seeks to curb the use of often unneeded procedures and treatments.

Medicare officials are awaiting White House clearance of a draft rule designed to tie payments for doctors to judgments about the quality of care they provide. The Office of Management and Budget has been reviewing this proposal since March 25. The Centers for Medicare and Medicaid Services (CMS) rule would carry out the changes mandated in last year's congressional overhaul of Medicare physician payments (PL 114-10).

CMS last year sought public comments on how to design a new payment. In a request for information, the agency raised myriad questions about how the so-called Merit-Based Incentive Payment System program for doctors could be designed.

CMS asked if there might be some benefit to weaving in new system measures from a 2012 initiative known as the Choosing Wisely program, which asked doctors to identify commonly used medical tests, treatments and procedures that may be unnecessary for many patients. (Emphasis mine) More than 70 medical specialty societies have since released recommendations as part of the campaign.
Practicing physicians and patients should understand how the ABIM and its corrupt Foundation planned to federalize Maintenance of Certification (MOC), an unproven quality metric, as a pay-to-play money stream using the soon-to-be-deployed CMS "Merit-Based Incentive Payment System." By stealing over $70 million of physician testing fees, they created the ABIM Foundation and secretly lobbied Congress to assure that participation in MOC would become tied to physician pay, incentivizing physicians to participate in MOC. It increasingly appears Richard Baron, MD was instrumental at forwarding this model when he served the "Seamless Care Models Group" at CMS.

Senior citizens should be very concerned that top-down measures created from the ABIM Foundation's Choosing Wisely® campaign are really in their best interest.

After all, Choosing Wisely®, the ABIM, ABMS, and the ABIM Foundation are all about the money for these unaccountable non-profit organizations.


 Image reference: The Heartland Blog


Ed Rico said...

Big Surprise /sarcasm off. If you can't convince physicians with science and facts (because you have none to support your position), then ABIM just cranks up the tap dancing and smoke show along with the lobbyists that they don't admit to employing, with the goal of mandating participation in their $55MM/year extortion ring. Coercion 1, voluntary participation zero.

Are you sure about the name of Dr. Baron's group at CMS? I would think the name "Shameless Care Models Group" is more appropriate in describing elite professional medical politicians who clearly are devoid of self-respect.

retired doc's thoughts said...

Some of leadership of the ABIMF have not been silent about what they want to happen.
Here is a quote from the Former CEO of ABIMF, Dr. John Benson. that was posted on the ABIMF blog.

"The time is well past exhortation. The issue has been recognized for decades. Hard choices and penalties must go beyond training the next generation. 2020 is closing in." ( He does not explain the ominous reference to the year 2020).

He continues

" CMS, which has the ultimate negotiating position in the form of reimbursement for Medicare services, could only accept negotiated bundled charges. It could also refuse payment for non-compliance with the Choosing Wisely recommendations." (note the current President of ABIM and ABIMF is Dr. Richard Baron who left a post at CMS through the revolving door to assume his duties at ABIM and ABIMF)

and it gets worse

" ABIM could require candidates to achieve a perfect score on questions related to costs and redundant care as a requirement for admission to secure exams for initial certification or MOC." (Maintenance of Certification)

The plan to federalize MOC and firmly place ABIM in control of many aspects of medical practice continues to unfold and make progress.

I hope that this time is not another example of "the dogs bark and the caravan moves on."

John R said...

"All I wanted was something to eat."

Thomas Nielsen said...

High Noon

I recently watched the classic Western High Noon (1952). Despite my love for movies and an extensive collection, this was the first time that I had seen this particular film. It is amazing, and sometimes creepy, how the same themes repeat themselves throughout history, and how well old stories relate to current events.

For anyone who does not know the story, in the movie we have our protagonist, Will Kane, portrayed by Gary Cooper, who is the retiring marshal in the small town of Hadleyville in the New Mexico territory. He has just married Amy (Grace Kelly) a pacifist Quaker and is on his way out of town with his new bride when he gets word that a criminal he worked hard to put away, Frank Miller, has been freed on a technicality and is on his way back to town. Kane knows that Miller will terrorize the town and will likely come after him, as he had previously threatened to do. Feeling the duty of his position despite just retiring, Kane returns to the town to face Miller.

Kane seeks to put together a posse to stop Miller and his gang, but it quickly becomes apparent that this will not be easy. He apparently has been a tough marshal and has made as many enemies as friends in the town. His old deputy Pell (Lloyd Bridges) who Kane did not think was ready to be the new marshal tries to bribe Kane into giving him the marshal position, and when Kane refuses he quits in anger. The people in the saloon want nothing to do with him. The innkeeper is cheering against him. His previous allies are scared of Miller and fear for their lives. His friend Sam Fuller (Harry Morgan) pretends that he is not home and sends his wife to the door to lie to Kane, saying he is not there. The previous marshal says he is too old to fight and has arthritis. The people in the church think that if Kane will just leave town the problem may simmer down and somehow go away. The pastor claims piety and sets himself above the fray, saying he condemns all violence, although it is clear he knows that Kane is right.

All this time the clock is ticking towards noon. The train-whistle blows as Miller arrives and comes with his gang into town. Kane is left to fight by himself. He kills several gang members before being wounded himself. His new wife, who had been planning to leave on the train, runs back to find him and despite her pacifism, shoots another gang member. Miller takes her hostage, but she distracts him long enough for Kane to shoot him dead.

Finally the townspeople come out to find the gang and Miller dead. Kane throws his badge in the dirt and leaves with Amy as the credits roll.

So what does all of this have to do with our situation today? The parallels are obvious, if you choose to see them. Doctors are the townspeople. The ABIM/ABMS represent Frank Miller and the gang who have taken advantage of the townspeople. There are a few ‘Will Kanes’ out there like Wes Fisher who have taken a stand against the criminal wrong.

The question is who are you? Are you one of the people in the saloon who are siding with Miller’s gang? Are you a churchgoer who just wants Kane to go away and is hoping that Miller won’t continue to take advantage of the town? Are you the pastor who views himself above the fight and wants to pretend that he can go on doing his job while ignoring the wrong he sees? You can be Sam Fuller, Harvey Pell, or any of the others who run from the fight.

Or are you Gary Cooper, who despite all of the odds and the forces against him, knows right from wrong and is willing to face the bad guys?

Your choice.

Unknown said...

FYI, the American College of Occupational and Environmental Medicine (ACOEM) is also part of the Choosing Wisely campaign. Who is ACOEM? They are the occupational physicians' "nonprofit" trade association. For a few states such as California and New York, they write the guidelines that occ-med doctors must follow if they want to get paid for their services. It's written into state laws. Many injured workers are being denied the treatments they need based on work/comp insurers denying to pay the physicians for the treatments. It's a mess. Physicians are having to hire specialty claims adjusters to appeal the denials. The guidelines that ACOEM writes are not owned by the "nonprofit" medical association. They are actually owned by the Reed Group LLC. The Reed Group is a fully owned subsidiary of Guardian Life Insurance -- a major player in the work/comp game.

See "Guardian Life acquires Reed Group"

See Reed Group acquires ACOEM guidelines.

See ProPublica multi-part expose' "Insult to Injury -- the Demolition of Workers Compensation"

Shameless and Blameless said...

"How the Feds Plan to Federalize MOC"

We always were a federal program.

The supreme court determined long ago that the ABMS and all of its member boards are "state actors." The colors of the federal flag began to fly outside the ABIM and ABMS premises in 1965 with Thomas Brem stroke of the pen. The germ of federalism sprouted in 1975 with John Benson. Read his statement. (Benson is one of Cassel's neoconservative mentors.) Then ABIM began to peer at the sky and contemplate the monetary delights and coming power. The executives from its secret 'foundational investment account' planted in 1989. Physician taxation was added to the new federal plan. New money flooded in and was invested and used for federal and corporate sponsored programs, services and hidden political agendas.

In 1999 federalism merged with corporate cronyism when greed and political ambition said cash me in. Partisan politics under a banner of the democratic party fooled everyone into thinking that social equity was about to be propagated. Instead we got a secret society of hegemonic whackos taking control of the ABIM in order to support a corporate backed healthcare agenda.
In 2002, the "Charter on medical professionalism: putting the charter into practice"
was published. Medical propaganda and political deceit arose from out of the ABIM Foundation's dark green fodder.

In 2007 the ABIM and the ABMS requested that Ballard Spahr and the COO's office of ABIM's testing security form a joint operation to destroy testing/board study competition. They planted bogus information in the field to create a need to grow a secret police to weed out potential dissent from among the ranks of working physicians.

In 2009 they stung their prey nearly to death with illegal court action. But the facts survived and that dastly action of physician persecution created a reaction-- propagated the seeds of truth.

Today the entire ABMS is just a lying sack of self-appointment, greed and messy fertilizer. A board of elite "grandfathered" little sh***!

Unknown said...

The analogy is perfect but it's simpler to to consider them "Spiders and Pirates". There are not enough energized Kanes to make a difference..... until it's too late. Almost impossible to regain your birthright having sold it to the middleman

2 Little 2 Late said...

"There wouldn't be no trouble except for that king-shit cop! All I wanted was something to eat. But the man kept pushing, Sir!"

thomas morrow said...

Hate to make you guys jealous but I am hitting the big 65 in a few weeks and am not going through re-cert again... ever.

I do not care what the consequences are. The tests every 6 (now 10) years were ludicrous... about 20% involved delivering babies, something I stopped doing within a few years after residency and only kept it up because the government (I was in the USAF) required us to do so.

Many more involved things I long ago stopped treating and referred out.

SO... the ABFP just lost another "board certified" participant... ADIOS!

20/20 views said...

Richard Baron, ABIM, ABIM Foundation, ABMS, NQF, CMS and the Commonwealth Fund.

Richard Baron of the ABIM discloses most of his conflicts of interest. I see the conflicts of interest mentioned in Wes' blog for CMS. Also listed are past histories at the NQF and the Commonwealth Fund to name a few.

Commonwealth Fund, ABIM and Richard Baron.

Wes, what do we know about the Commonwealth Fund? Richard Baron, CEO of the ABIM, is a member/advisor for them according to the list of top influential medical politicians.
See link for the Commonwealth Fund's other advisors. Quite an impressive array of names and key influential positions.

Who's on the Board of Directors for the Commonwealth Fund?
It has some very influential players in healthcare, finance, and media.

Commonwealth Fund is led by the group president of Kaiser Foundation Health Plan and Hospitals in Southern California and Georgia.
Also on the board is the CEO of National Health Service, England, who previously served as executive vice president of UnitedHealth Group.
There is an Innovation Officer at Partners Healthcare System in Boston, who from 2009 to 2011, served as U.S. National Coordinator for Health Information Technology.
The list continues with a founder and chief executive officer of the health care investment firm Consonance Capital.
They retain a former executive dean at the Harvard Kennedy School of Government.
A former commissioner of the U.S. Food and Drug Administration who currently serves as foreign secretary for the National Academy of Medicine (formerly the Institute of Medicine).
They have an influential former commissioner of the U.S. Food and Drug Administration now CEO of JASA (Jewish Association Serving the Aging).
They entertain the former chairman of MFS Investment Management, who is a senior lecturer at Harvard Business School and a senior research fellow at the Brookings Institution.
They hold on the board a president of Franklin Templeton Investments and president of Fiduciary Trust, with overall responsibility for all investment management and research activities.
They retain the services of an influential healthcare journalist.
A president emerita of the Institute for Healthcare Improvement.

Full list of names and relationships to follow...

Anonymous said...

Are we the stupidest profession in the world or what? We get exactly what we allow! We have allowed a small percentage of our profession to dictate to the rest of us what should happen and how we are to act and function and then afterwards we complain and scream about how it wasn't fair or what we wanted. Instead if we simply abandoned the AMA, ABIM, and other similar alphabet soup "boys clubs" in favor of actual democratic voting based on every licensed provider we would get the results WE want. Why are decisions made by a few who aren't even voted in by the majority of us held with such regard? Why aren't rules made based on a simple mail out request for replies no different then how we vote for POTUS and Congress. We would register (already done by having a license) and then we would be placed into the loop to vote on decisions like MOC and whether funds should be spent on creating PACs and the like and even on the details of functional operation.
With the current advent of technology and the assumption that as healthcare providers we are required to be Internet and or similar savvy why not use technology to allow us to vote? Simple answer because like Washington Politics that would take grift money out of the pockets of the few who have figured out how to not have to treat patients and yet still earn a living off the rest of us who do.
Time we call them out and reset the shot clock here. Dr D

Anonymous said...

Ditto that on the voting for the integration of democratic principles as a prescription for the sickness we have allowed to chronically prevail. The sickness of the ABMS and AMA destroys patients and physicians--has for years. No to MOC and not to policies and mandates becoming LAW without representation and a fair impartial voting system. The internet they wanted, so throw it right back--a tool to do a reset toward democracy and sensible healthcare. Not the corrupt corporate cronyism we are being illegally and involuntarily forced to endure.

Rio Times said...

Garbage collectors in Brazil have more will and bargaining power than physicians.

Unknown said...

This Baron is a v capable scheister!

Ed Rico said...

My German isn't too good, but I think it would be more appropriate to refer to Dr. Baron as a Schei├čker, not a scheister.