Friday, April 08, 2016

Medical Societies to ABIM: What Gives?

In an unusual show of solidarity, twelve membership societies sent a carefully worded letter to Richard Baron, MD, President and CEO of the American Board of Internal Medicine (ABIM), asking him, basically, WTF?
For the past year, ABIM has actively solicited feedback from and encouraged the internal medicine community to engage in co-creating an MOC (Maintenance of Certification) program for the future. Despite these interactions—and even though our societies dedicate considerable resources to helping our members complete the MOC process—we are struggling to understand ABIM’s plan for re-engineering MOC to reflect the changing nature of medical practice.

However well intentioned, the overall vision, philosophy or strategy of ABIM’s changes to MOC are not clearly stated. Further, the lack of a shared vision makes it more difficult and costly for societies to adjust to changes made by ABIM that are implemented with little input from or notice to the societies.
While this letter might be "well-intentioned," it still buys into the notion that all MOC needs is to be properly “fixed.” These leaders completely ignore all of the financial improprieties that are part and parcel of the ABIM and MOC. They should be calling for its demise, or ensuring that MOC remains forever truly voluntary,by decrying any future linkage to licensure, reimbursement from payors, or hospital privileges, or they should join the mass noncompliance bandwagon.

Let's hope, however, that this letter represents the first crack in the ABIM's MOC "foundation." It is time membership societies stop beating around the bush and acknowledge how deeply corrupt and flawed the MOC program has become and understand that their membership is ready to jump ship if they don't.

They have a choice to make: ally with their practicing physician membership or ally with ABIM. Which will it be? I would suggest they start working on their next letter explaining to the ABIM what is actually happening.



Unknown said...

I for one will be sending a thank u letter to the president of the Infectious Disease Society of America. As tame and ACGME-professionalism-compliant the wording in this letter is, the seething anger underneath is pretty apparent. I bet you getting all those guys who signed this letter to agree on anything is monumentally difficult. The fact that they did so demonstrates how much anti-MOC sentiment is out there.

C Koo MD FACC said...

Stunningly, the ACC and the HRS have no equivalent response to this long list of conflicts (monetary and political) with the ABIM and the ABIMF. It's imperative that the ACC, HRS, SCAI and all cardiology societies view the ABIM MOC issues with circumspection and with the goal of preserving the interests and practices of its constituents.

1) all physicians who serve or participate in the ACC or HRS or SCAI and also serve the ABIM or ABIMF should fully disclose this potential conflict of interest and fully disclose any financial information including salary, stipends, perks, benefits etc.

2) the ABIM and the ABIMF should vow to invoke a policy of fiscal and financial modesty and transparency.

3) the ABIM and the ABIMF should vow never to overcharge the testing fees for graduating residents and fellows and vow to frugally use those funds for legitimate purposes.

4) the ABIM and the ABIMF should celebrate the accomplishments of its Diplomates and avoid hypercriticizing a cohort of hard working dedicated physicians.

5) the ABIM and the ABIMF governance is in desperate need of reformation and transformation. The leaders of the ABIM and the ABIMF should be elected into power by the Diplomates and not appointed into their position by a small cohort of ABIM administrators.

PC said...

There is not only rampant confusion about MOC, but there is misunderstanding about what the specialty boards are and their place in the "quality assessment" bureaucracy.

Physicians and even some of the authors of the above letter have the misconception that the medical boards are actually "regulatory bodies." This is not true. The ABMS is comprised of 24 private "evaluatory bodies". Participation is voluntary. This is clearly stated by the ABMS. Yet the ABMS does nothing to clarify this voluntary status to the employers, insurers and credentialing bodies.
This is the clincher. The voluntary nature of certification and the VAT tax (valueless added tax) called MOC--which was sprung on physicians totally against their will. My question is what will the ABIM and ABMS do about this intolerable and contradictory condition.

It is the ABMS' responsibility to correct all this with insurers, institutions, credentialing bodies, state policies, and especially the federal government regarding the voluntary nature of board certification. Any continuation of certification and MOC under such false pretenses is utter fraud on the part of the ABIM and ABMS.

It is fraud because it is a duplicitous act to communicate to physicians' faces and in written policy that certification (and MOC) are voluntary--when in fact the ABMS, its affiliates and associates have lobbied and pressed for lucrative revenue enhancing policies that have created the exact opposite conditions.

This is the unreasonable and untenable condition is which we find ourselves today where certification is tied to employment, compensation and credentialing. This hidden complicity and collusion of all medical societies in sustaining a mythological environment devoid of fact is absolutely irresponsible.

How can a scientific body that acts unreasonably and creates untenable conditions to the point of illegality be called a scientific body. It may be that what we are witnessing at the ABMS and ABIM are executives making up the rules of science and corporate policy to suit themselves and not the public and clients who they have contracted with to serve as a safety net for healthcare. This is a dubious state of affairs that must be addressed immediately, today. Not tomorrow.

To witness the degeneration of our healthcare system because medical societies and the bodies of physicians who pay for exacting supportive benefits in terms of real representation in Washington and in communication with the medical boards is troubling. We have seen a perpetual downward spiral in ethics at the ABIM and ABMS. Their self-appointed officers have fallen from grace to such a degree that they have adopted and implemented business tactics and profit oriented practices that one would certainly not expect to find in ethical institutions such as the ABIM and ABMS--which traditionally prides itself on ethics, responsiveness and transparency.

"Of the profession for the public?"

The downward spiral and devolution of medical practice is inevitable when a top heavy bureaucracy thrusts itself upon society with unreasonable, unprincipled and unscientific demands.

When "voluntary" becomes "involuntary" and "science" is associated ad nauseum with an unscientific MOC, we can be sure we have a real problem that needs solving and a state of affairs that needs reversing. "Pseudo" can never be a "add-on" for valid science and the underlying principles, which we have struggled to develop over the recent centuries. MOC can be associated only with PSUEDO.

Have we become blind. Or have we just become lazy and greedy?

Anonymous said...

I agree there is an underlying anger and disappointment in medical society letter asking the ABIM to get it together, or we will be sending a stronger message next. The cat is out of the bag and beginning to bite the ABIM. The cruelty inflicted on physicians for profit and politics is becoming apparent even to the true believers who thought that these "grandfathers" could do no harm.
The truth when sifted out gives a compelling assessment of the ABIM/ABMS. They are pain factories. They have not even done much that one could see as "good."
It's a carrot and stick approach to satisfying profit and politico-corporate ambitions. The "grandmothers" forgot to instruct the "grandfathers" about carrots altogether. That is how vile and heinous the organizations have become.
Cassel, Langdon, Holmboe, Baron, and Wachter chomped down all the carrots themselves and did favors in exchange for those lucrative positions.

Anonymous said...

ABMS/ABIM and the Panama Papers

Who's not in the Panama Papers? Richard Baron and Lois Nora, Christine Cassel, Robert Wachter, Kevin Weiss, James Stockman III, Lynn Langdon, et al. Why is that? Were they redacted out of the fast and furious crowd to protect their identities and hide their hidden relationships and responsibilities to corporate America?

No, they already have their tax havens right here in the United States! They don't need no offshore accounts. Although, I'll bet they do have offshore investments through you know who--Mr offshore accounts himself who the ABIM Foundation gifted huge sums to more than once to support his dubious offshore causes.

Anonymous said...

This is how sick and twisted this is. Wes, is right. Just come out and address the real issues. Don't beat around the bush. These 12 medical societies are asking about 20/20 task force reports and what they are going to do with them when they should be asking the ABIM to show the proof that they can even "see" or are qualified to do anything other than grow profits and ruin physicians. WTF is right on the money!

W. Douglass II said...

I follow this post as patient. As Arbi aptly pointed out we don't really know what is in the minds and hearts of the dozen medical society leaders are except they are concerned. We have 12 different interpretations or levels of concern. This is a tremendous thing when this many societies have spoken out and addressed the ABIM and given a timeline for a response. That displays the serious nature of the twelve apostolic messengers. I will take it as good news, but it does not go far enough. The letter is a seed that must be put in a context of propriety and an ethical intercourse of medical minds faced with a great quandary--how do we proceed or act in concordance or singular purpose when there is confusion. The ABIM has done much to create a chaos out of medicine, our societies and boards by administering programs that received a small part of physician fees compared to profligate lifestyles of the Rich and Infamous.
The ABIM and ABMS in a concerted effort to shore up monopolies with greater revenue streams are the culpable parties who have done more than breach ethics, they have violated laws, imo. The societies must not stoop to the level of a syndicate of twelve, but have to proceed with steps dictated by policy and ethics. That is a good sign and more medical societies will join in as a result. As Arbi also said once, we want to win. We don't just want to be right. He will right to his board. We should do the same to encourage this big step of so many medical societies, including I might add, the Society of Hospital Medicine. That show some independence I hope to really explore what is right for medicine. The dissent will destroy them completely as quality assurance organizations, so the questions must be put in order. The societies must evaluate and to some degree regulate the boards. It is up to the DOJ and AG or IRS to evaluate any wrongdoing of the ABMS/ABIM which are one and the same in my experience. A cartel of franchises hell-bent on profit and influence and not safety. They have done more to confuse medical practice than perhaps any organizations that I can think of with the bandwagon efforts at the ABIMF's campaign to Choosing Confusingly ignoring the unintended consequences. Two endocrine societies can appreciate who confusing their patients have become when they prescribe and their patients come back saying that Choosing Wisely says that A1c of 9 is ok and they don't really need insulin. This is not just confusing, but deadly. I am not a physician, but I follow these things closely as a concerned patient with diabetes. Strips are no longer carried to monitor at many places. The list goes on and the heartbeat goes on, but for how long until we can all come together to find the right balance of cost controls with real wisdom, not sham science.
I will take my response offline. I have no time to edit, sorry. Thank you.

JC said...

I am livid about being forced to pay ABIM their voluntary annual fee. Why pay them at all? There is scarce time to spare for doing MOC and even less for patients. There is no time left for family and one draws a negative lot for oneself.
Money and time! There is nothing left for anything. But is not that the ABMS' intention; to steal our money and time rendering us powerless. The more money one withholds from the ABIM, the more power, time and money goes back to physicians to fight. They will not give up their abusive power voluntarily.

Anonymous said...

Medical Societies Liability for Turning a Blind Eye and What they are Not Talking About but Should

If the DOJ starts knocking, and they will, because there is evidence of incredible wrongdoing, it will be a nightmare for those who are participating and colluding financially or blatantly turning a blind eye regarding their ABMS partners and partnerships. We are talking about alarming facts concerning the ABIM's financial and 'operational habits' which Wes and so many others have pointed out.

This includes the hidden facts revolving around the ABR sting operation. The fact of hiring known felons to harm or destroy competion to the ABIM and ABMS. They did so by conducting legally sullied and egregiously unethical investigations to create a highly irregular body of evidence that had conflicted financial and political motivations at its core of operation. In essence the ABIM conducted their sting operations and fishing expeditions against physicians in total disregard and violation of civil liberties--in particular their 4th amendment rights.

The ABIM and ABMS organized their sting operation utilizing a pseudo-police force entirely created by the ABIM and ABMS. This was secretly created internally within the ABIM's COO's office. This pseudo-police division was created to intimidate and strong-arm physicians. This was the clear intention and message sent. The ABMS was involved and had full knowledge of this pseudo-police force and shared this personnel throughout the member boards for testing security and any operations or persecution of physicians--either civilly or criminally.

The ABMS' Radiology physicians and many others were targeted and investigated by the same pseudo-police force employed by and operating out of the offices of the American Board of Internal Medicine in Philadelphia. This pseudo-police team was led by a known felon with a criminal felony assault record. He was indicted and convicted of crimes which included illegal possession of firearms and impersonation of a police officer while violently assaulting an individual with such brutality that the victim had to be transported to a local DC hospital for his external injuries and bleeding.

What are the implication for the ABIM and its activities? It reduces the legality of the ABIM and ABMS pseudo-investigations to zero and creates an indefinite amount of liability that no insurer would touch--especially if facts were known that felons were employed with egregious criminal records.

Anonymous said...

Money, politics and cronyism is the Powerball game at the ABMS and ABIM--not quality assurance or public safety.

And these are systemic problems throughout the ABMS. It is not just the largest and most powerful medical board, the ABIM, now under the leadership of Richard Baron. Baron's career is tainted. It is conflicted as much as Christine Cassel. Baron should step down and let someone who can be trusted come in who can clean it up and return the organization to a status where there are no questions of ethical and legal breeches.

Anyone with clear eyes can see the ethical and legal breaches. The media has been silent on the history of violations to the public (as patients and taxpayers) and to the clients as providers of healthcare, whose arms have been twisted by policies that have become law through backdoor influence--whether documented or not. If it is not documented we have a compounding of the legal and ethical violations against physicians inflicted by the Chicago and Philadelphia-based ABMS medical boards.

The courts who need to move forward on lawsuits against the ABIM are being hindered in discovery. Stonewalled. Why is that? I think we know. It is obvious. It is all related to the repeated obfuscation and covering up of the sickening truths which the ABIM hides from everyone.

The stonewalling regarding their clients questions, concerns, and direct opposition is disconcerting. The certified physicians who depend on reliable honest and transparent transactions and communications is being egregiously wronged by the ABIM and ABMS who should put itself under a system of accountability just like any other large and prosperous corporation involved in standards and measurement.

I am surprised that only twelve medical societies have requested answers demanding response by the end of April. Where are the others and why is the ABMS not holding the ABIM accountable for many of the critical points not addressed in the medical societies letter.

The answer is quite simple. The ABMS is a tangled mess of willful collusion producing harm to the public and clients. The liability goes beyond the coverage of their policies. The kinds of activities the ABMS has involved itself in and the civil and criminal harms done are not just negligence or malpractice. The ills of such a corrupt organization cannot be solved by twelve powerless societies. The liabilities we are speaking of are not covered in anyone's policy.

I am surprised more societies are not questioning more and getting at the real facts and heart of the problem. Why are not medical societies being transparent about their real concerns if they are not just planning to continue to turn a blind eye on the corruption at the ABIM and ABMS.

If I were the insurers (or re-insurer) of the medical societies I would be advising my clients that they should formally distance themselves to get as far away as possible from the almost limitless liability of the ABIM and ABIMS.

Blog Administrator said...

The solution is pretty straightforward:

1. Suspend MOC immediately and indefinitely.
2. A truly independent auditor (not chosen or financed by ABIM/ABMA) needs to thoroughly examine their accounting as disclose everything.
3. All current ABIM/ABMS/ABMF Exec need to resign effective immediately
4. And those officers need to be replaced by physicians ELECTED by their peers to move beyond and forward past this mess of Baron, Cassel, Landgon, Wachter, etc.

Nuff said!

Anonymous said...

Westby "Truth" Fisher

Ed Rico said...

Above points 1-4 seem incredibly obvious and sensible to everyone, except of course the elite professional medical politicians who created this debacle in the first place. They will not be expected to "go gentle into that good night", there will be some kicking and screaming involved on both sides.

Anonymous said...

So, almost half on April is over and I can see the responses now..

1. What is the overall vision or philosophy ABIM is looking to embrace regarding MOC?

"Well, our philosophy is to screw MDs so we can make a lot of money"

2. What additional changes to MOC is ABIM considering?

" Increasing the cost and adding 10 more hurdles for docs to deal with. Yeah, those docs can be really pushed around"

3. Will ABIM consult the internal medicine community prior to announcement—let alone implementation—of further changes? If so, when and how?

" Consult?? With You ?? Oh hell NO ! Our policy is to play you by telling you 'we're still listening' meanwhile we do whatever the hell we want.

4. What is ABIM’s timeline for implementing the co-created, re-engineered MOC? Could you share its current form and provide updates as adjustments occur? For example, part of the 2020 Task Force assessment was to reconsider the secure exam. For many diplomates, the 10-year exam is due soon. Should they wait to see if a different method of “exam”/assessment will be rolled out?

" No... they should take the test now so we have more time to fail them and still make even MORE money ! And notice whenever anyone asks us about the failure rate ( that went from 10% to 20%) , we always say 95% eventually pass after 3 or 4 exams."

5. What does ABIM view as the respective roles of the ABIM Board of Directors, ABIM Council, ABIM specialty boards and ABIM staff in this process?

"Role??? They have no ROLE !!Their ROLE as you put it is to go along with whatever we say and then STFU !!

For by For said...

Unlawful and Shameful

1. ABIM/ABMS unlawfully deceived their customers
2. Willfully engaged in unfair business practices
3. Unethical conduct by executives, officers and board--shameful
4. Price fixing--rigging certification and MOC prices with member boards
5. Undisclosed contingent arrangements for pay to play
6. Dubious enhancement of executive compensation by creating hidden foundations
7. Payment arrangements and relationships creating egregious conflicts of interest
8. Failure to acknowledge or satisfactorily confront corruption in the industry
9. Cheating corporate clients, institutions and individuals through rigging prices and collecting huge fees on certification verification "solutions"
10. Creation of an unlawful testing security "apparatus" that violates constitutional rights and civil liberties

For by For said...

Negligent and Reckless

11. Tampering with the judicial processes, illegal strong-arming tactics on clients and others
12. Negligent and reckless management
13. Unaddressed questionable money transfers and legality of ABIM Foundation
14. Undisclosed lobbying
15. Inappropriate use of funds for purchase of private condo with no believable accounting of its use and purpose (compared to the low cost and availability of leasing comparable space)
16. Employees paid jaw-dropping sums whose contracts states an hourly work week with wages not documented properly to reflect hours worked and what actual work was done as required by general accounting practices and non-profit rulings
17. Executive overreach and breach of trust
18. Board officers doing extra-curricular work not in keeping with policy, professional expectations or established labor practices
19. Board members does not properly audit financials
20. Board members have been remiss in monitoring activities of executives. Elite ABMS executives/directors repeatedly went beyond their job descriptions to the detriment of the ABMS and ABIM harming clients and consumers

for BY for said...

Unfair and Abusive

21. Executives and ABMS paid associates and themselves for lobbying during normal business hours in Washington DC and elsewhere—these were clearly political activities
22. Unfair discriminatory practices against employees of color
23. Documented abuses of employed women who were discriminated against based on pregnancy status or childcare issues
24. Discrimination and harassment of clients with disabilities who need special accommodation in test taking
25. Abuse of power and influence
26. Using the media for political purposes to demonize clients rather than simple impartial press releases to inform the public
27. Dissemination of unhealthy and confusing medical and political propaganda through the ABIM Foundation and other sources within the ABMS
28. Absence of vetting for conflicts of interest at the executive and board levels
29. Lack of due diligence in the human resource department to investigate conflicts of interest
30. Illegal ludicrous "take it or leave it" contracts in the form of instantaneous "online pledges"

4 buy 4 said...

Compromised and Fraudulent

31. Failure to terminate unscientific and harmful practices. ABIM and ABMS are involved in pay to play practices of recertification even though the vast majority of clients see the ABMS mandated MOC is a useless revenue-producing farce.
32. Secret political and financial collusion/transactions with compromised legislators and their staff
33. Undisclosed financial and investigatory relationships with non-ABMS employees resulting in privacy violations of clients by third-party testing security companies
34. Paying speaking fees to third-party company representatives with hidden mutual agendas or current undisclosed financial relationships with ABMS personnel
35. Inability to produce anything valuable for the public
36. Failure to meet the legal requirements to qualify as a non-profit humanitarian organization, while outlandishly professing to serve the public and its professional clients
37. Refusing to pay a fair share of tax burdens to the local community
38. Not paying a fair share of the tax burdens to the state government
39. Ignoring their obligation to share in the common tax burden to the federal government and ease the national debt
40. Preaching equity and professionalism while practicing neither

Anonymous said...

Just walk away from these fraudsters and manipulators.

Unknown said...

Dr. Wes,

FYI, below is a link to a letter I just sent to Tom Frieden, Director of CDC & ATSDR and others. The gist of the letter as it pertains to you and your colleagues is this:

"In these times of attempting to standardize medical practices in the U.S. for the sake of efficient and effective public health measures, it is difficult enough for honest U.S. physicians to navigate and treat patients based on ever-changing current accepted practices. They do not need DHHS & EPA continuing to fund bogus science interjected into the complicated equation by a long-term conflicted NGO partner"

I gave a presentation at a conference last Nov. The video of it may be viewed below. In it I briefly discuss how Choosing Wisely is not in the public's best interest in its current form.

All three of the "nonprofit" medical associations I discuss as being compromised and promoting garbage science (that is adverse to the public's best interest over a specific issue) are Choosing Wisely members. American College of Occupational and Environmental Medicine (ACOEM), American Academy of Allergy Asthma and Immunology (AAAAI), American College of Medical Toxicology (ACMT).

I mentioned ABIM in my presentation. Mistakenly called it "American Board of Industrial Medicine". Must have been a Freudian Slip. For good cause, I view them and the Choosing Wisely campaign as industries' means to gaining control of medical doctors via gaining control of conflict-laden "nonprofit" board members.

The reason I keep reaching out to you is that Choosing Wisely does not just impact the doctors. It impacts all of us. I am HIGHLY of the opinion that if ABIM is going to be a premiere NGO in health care -- then U.S. Senate hearings re: their conflicts of interest and bullying are well warranted and prudent for the sake of the future of public health. Senate HELP needs to remove compromised federally funded NGOs from the game -- or at least get better control of what they and DHHS are doing with the use of federal funds.

This is the link to the letter (in pdf form) I just sent to CDC:

This is the link where one may view my video presentation re: three Choosing Wisely members and the shear Hell their unbridled conflicts of interest have caused out here in the real world. (I think it's about 25 minutes in where I discuss Choosing Wisely.)

I am not a scientist or a physician. My background is marketing. What I study is how concepts are marketed to cause decision. You are literally "Right on the Money" with the concerns you raise. In its current form, Choosing Wisely appears to be a massive marketing scam purposed to suck money out of the health care system -- not to make it better and more efficient.

Anonymous said...

From Sharon Kramer..."Senate HELP needs to remove compromised federally funded NGOs from the game."

I am glad that so many people are waking up and taking notice that medical NGOs pose a grave danger to our populations--especially the vulnerable aging populations who served our country in uniform or who worked all their lives as civilians putting into the pool of funds their hard-earned social security and Medicare dues--only to find the promised financial/medical security in old age severely reduced and restricted.

These vulnerable populations are too big and important for us to fail.