Friday, October 28, 2016

The Canary in the American Board of Family Medicine's MOC Gold Mine

In an editorial in the Mayo Clinic Proceedings this month entitled "The Evolution of Physician Certification and the Canary in the Coal Mine," James C. Puffer, MD, President and CEO of the American Board of Family Medicine (ABFM), reviewed a recently published survey on Physician Attitudes About Maintenance of Certification (MOC) by Cook, et al. that appears in the same issue. To his credit,  he acknowledged the following:
"Physicians today are overburdened with the vagaries of their electronic health records, endless reporting requirements, and the demands of multiple payors. The amount of time that they are spending with patients continues to dwindle, and the last thing that they want to do is spend additional time, meeting yet another set of requirements that they find burdensome.
Unfortunately, Dr. Puffer couldn't bring himself to admit that the costs for MOC are excessive, both in fees paid and the time required to perform this unproven exercise, and he failed to call for an complete moratorium on the unnecessary MOC requirement for the many family medicine diplomates his organization certifies.  Instead, he glowingly reviews the survey's "methodological approach," "meticulous design" and "rigorous analysis of the data," despite the survey being designed by an American Board of Medical Specialties (ABMS) employee and reviewed by a mysterious "anonymous external reviewer" (see Acknowledgements). As a result of the survey findings, he calls on "modifications" to MOC because the results of the survey represent the "canary in the coal mine" of how physicians will accept the current iteration of the MOC physician re-certification "quality" metric going forward.

But by merely disclosing that he is an employee of the American Board of Family Medicine (ABFM) in the Mayo Clinic Proceedings editorial, Dr. Puffer carries his own canary into the hallowed financial walls of the ABFM's MOC gold mine. It should come as no surprise for readers of this blog that MOC has opened all sorts of wondrous financial opportunities for the ABFM (and all of the member boards of the ABMS) at practicing physicians' expense.

For instance, while the public only has access to the ABFM's tax forms to disclose the financial dealings of the organization, we quickly see that MOC continues to be a windfall for the ABFM. In fact, in 2014 MC-FM fees (the ABFM's MOC program equivalent) contributed 46.4% ($12,776,905) of their $27,525,430 annual haul from ABFM diplomates. These fees helped support Dr. Puffer's $803,687 annual compensation and the organizations' $3,521,629 "donations" made to their "ABFM Foundation" and "Pisacano Leadership Foundation."  (In 2012 and 2013 these "donations" were even larger: $6,147,376 and $7,878,535 respectively). MOC also helped fund the ABFM Executive's first class and companion air travel and their Directors' first class air travel and a  $1,449,525 retirement package with $435,000 in post-retirement medical benefits. No wonder MOC is such a great deal and needs to continue!

The ABFM is a tax-exempt 501(c)(6) tax-exempt organization that has accumulated a remarkable $130,082,516 in assets on the backs of working physicians that is offset by "liabilities" that fund the salaries of 75 people and other "projects" in the amount of $45,838,832 yeilding a net asset balance of $84,243,684 at the end of 2014. Rather than offset the fees that diplomates have to pay the ABFM for MOC, these fund transfers show the ABFM would rather continue to plow this money into itself (rather than defraying costs to its members) by growing its supporting "Foundations."

But careful review of the ABFM Foundation's tax forms shows it carries many similarities to the infamous ABIM Foundation that gained considerable notoriety after its condominium purchase (complete with a chaueffer-driven town car) was disclosed on these pages and elsewhere.

According to the ABFM Foundation's most recent IRS Form 990, it exists for the "Fostering of Education and Scholarly Analysis or Research in Family Medicine." Like the ABIM Foundation, it seems that "scholarly analysis and research in family medicine" actually involves (in part) managing potentially lucrative real estate investments for themselves.

The ABFM Foundation is the controlling entity of ABFM Realty LLC (created in 2010) and ABFM International LLC (created in 2013), both based at the ABFM's office in Lexington, KY and lead by Dr. Puffer.

According to tax records, ABFM Realty LLC purchased a 22,793 square-foot office building (pictured here and whose location relative to the ABFM corporate headquarters is pictured here) at 1500 Aristides Blvd in Lexington, KY for $4,245,074 on June 26, 2012 from the $6,147,376 (page 11, Line 24a) of  diplomate fees "donated" by the ABFM to its Foundation that year. It appears this transaction happened about the time a large law firm, Bingham McCutchen planned to move hundreds of its employees to Lexington, KY the same year. The deal was consumated by a promise of $6.5 million in tax breaks from the Kentucky governor and anticipated revenues of $22.5 million over 10 years in rent and building improvements. Unfortunately, it seems Bingham was struggling financially and was "absorbed" just two years later by Philadelphia's Morgan Lewis and Bockius LLP law firm. Google's street view still shows Bingham's Global Services Center sign outside the ABFM's building as late as December, 2015. What this loss meant to the ABFM (and its many diplomates) is unclear, in part because to the best of my knowledge and belief this transaction was never been disclosed to ABFM's practicing physicians. Roger Bean, the Chief operating officer for ABFM at the time, "couldn't be reached for comment" either.

Here we are in late 2016 and the 2015 tax forms for the ABFM and the ABFM Foundation still have yet to be disclosed publicly.  Perhaps their recent real estate snafu explains why these forms aren't available and why the ABMS still feels compelled to continue the highly conflicted ABMS MOC program publicly in the Mayo Clinic Proceedings.

Or maybe Dr. Puffer is positioning himself as the heir apparent to the ABMS now that Lois Margaret Nora, MD JD has announced the end of her tenure at the organization.

One thing's for sure: with his editorial Dr. Puffer's own canary in the ABFM's MOC gold mine just died and many more US family physicians are now officially on notice.



Anonymous said...

What a bombshell you just dropped on the integrity of the ABMS and in particular the ABFM! Absolute corruption is the pattern we are seeing across the gamut of ABMS medical boards with their self-inuring executives, secret political agendas, goon thug enforcement squads, Cayman money havens, and even global real estate investment trusts.

I'd like to see the "executive minutes" where the ABMS leadership discussed all these expensive and burdensome schemes to defraud phycians and the American taxpayer.

Anonymous said...

And how about the patient with all those premiums going up. Look at the political lobbying the ABMS did to get Obama Care passed to entrap physicians and patients in a cobbled together doomed-to-fail system. If I were not civil in tongue!

Anonymous said...

A pattern of questionable financial activities is emerging.

Here is something on a previous posting of yours that may be relevant to the ABFM investment property, foundation and the for profit ABMS "Solutions" located in Atlanta right in the heart of financial district. This Chicago/Atlanta connection is troubling in light of the corporate revelations on the ABFM. Each organization and the umbrella appear to need ways of funneling that money into investments, especially since a bank/bonds give Americans negative interest on their principal. The ABMS charges $700,000 to be paid from every medical board. This puts pressure on the exorbitantly high executive compensation/overhead of each medical board. There is a shortage which I would call the greed gap. This greed-gap is catching up with these clever medical boards and their umbrella. The are self-enriching and branching out like a Wall Street enterprise.

The proximity to the Embassy Suites is convenient. Actually there are lots of nice spas and hotels in the area. AAPS Cold stream Labs (Pharmaceuticals) is there. University of Kentucky Research

"From Scam to Scam (Certification, MOC and then came ABMS Financial Solutions)

The next logical question is since the member boards refuse to rein in costs, and even suggest creating self-sustaining foundations that seek donations to supplement their untidy but lucrative enterprises, what is to stop the specialty boards from investing money into a financial services firm called ABMS solutions to enhance the bang for your buck even further on Buckhead Financial Services Center, a haven for big money in Atlanta, Georgia. Birds of a feather flock together at Buckhead Plaza.

I am asking for some disclosure on what ABMS "Solutions" is and what are their plans for growth and development in the future. ABMS, the non-profit, receives $700,000 in hard cash from each of the 24 ABMS member boards annually to be part of the franchise. That alone is almost $17 million dollars right there. With the MOC fees and certification fees it really is a half-billion dollar franchise in revenue terms alone. Given the tax exempt status could be valued greater than any private company when you calculate in the tax boon.

How would wall street value ABMS as a company when they get away with paying zero taxes!"

Anonymous said...

The ABMS umbrella and 24 medical boards is a "circle of enrichment."

Collier said...

You hit ABFM nail on the head Wes. This is the spark that should ignite a movement.

We're not talking about canaries are we? We are talking about patients and physicians. Bad things happen in life when elites place greed over common good deed.

Both of my grandfather's were colliers. One died of black lung disease and the other was crushed in an explosive mine collapse. Damn company did not even put up a plaque for them. Only pain of loss remains of their memories. Hard work rewarded with lives cut short.

This whole scandalous ABMS affair stinks. It's like methane filling up a chamber ready to blow. Who are the elites that created such horrible conditions; can we find the concerted strength to find a better way.

One spark will ignite the whole damn thing. Do we run or stay and try to fix it with more tinder? We are the tinder and beams of medicine and we are getting crushed by corruption and greed. Real physician ownership is the only way to fix the mine before medicine and our country explodes.

This is a real revolution. Have many physicians forgotten where they come from. Their hard working roots? No, they have not, the spirit only gets stronger to do something as work conditions get worse and worse. Patients getting less and less help and time.

I have not forgotten the hard work and pain of those who came before me; that is why I speak out. And others must also. Is this why family practice is shrinking? The front lines of medicine retreating leading to a collapse in the battle against disease? What is the cost involved in that loss?

We are talking about corruption and elitism at the highest levels; we can't ignore the canary that stopped singing lying still on the floor of its cage.

Anonymous said...

They reap the benefit of accumulating the gold and we have to work in the mines.

melissawaltonshirley said...

All of this information aside, it wasn't the cost of the exam , the two days out of my practice, but the year it stole from the lives of my children and other family members. I don't think there was one single hour of it that I didn't begrudge. My kids can never get that year back and that's the real shame of it all.

Ted K. said...

Well said.

Anonymous said...

Has anybody complained about this cartel to the FTC? Don't bother, unless you know someone on the inside. Or maybe until we have a more responsive White House that serves the people. Of, for, and by!

I am looking forward to the repealing of Obama care and getting back to less burdensome models for providing care. ABMS fits the textbook definition of monopoly.

The ABFM fits the classic legal description of racketeering. What this current administration has done to destroy healthcare has been imo an impeachable offense and heinous crime against the American people.

Fewer hands taking more of our money.

"It appears that yet again, once more, Obama-appointee FTC Antitrust Chairwoman Edith Ramirez is asleep at her desk."

Anonymous said...

Physicians are sheep, and we family physicians are the sheepiest of the sheep.

This won't go anywhere.

A Dummy's Guide to the Presidential Elections said...

A Crime Family Syndicate and their Cheating Bosses Exposed to the Bone!
--Note: Hillary Clinton was caught cheating in the debates. The questions were fed to her in advance. Everyone knows that cheating is unethical and detrimental to the advancement of honesty and fair play in society.

BREAKING in case you did not know: the ABIM/ABIMF/NQF/RWJF/ and so on, are a small part of Hillary and Bill Clinton's affiliated medical franchises. The NQF was founded by Bill and Hillary and her cronies. The ABIM Foundation even created the means with which to ration healthcare and rein in costs as a complimentary strategy to the Unaffordable Care Act.

ABMS is a racist syndicate; it discriminates against IMG's (FMG's), pregnant women, physicians with disabilities, and people of color. For example, they attacked and defamed Dr. Arora, a Hindu, and several others of various races and creeds just for attending a well-vetted ACCME approved board prep course. Then they sanctioned and sued them! They put young vulnerable physicians in front of a horrid panel, but only AFTER they were sanctioned/sued.

For the past five years the ABIM/ABMS has been defaming and trying to ruin/destroy a Puerto Rican physician who is completely innocent, imo. The case is time-barred, yet the ABIM/ABMS insisted on using this young man--a first responder to the Haiti earthquake crisis as a part of US medical aid. It is obvious this physician has been used as political fodder. They spy on their clients and keep files on them. The classic textbook intimidation and strong-arming just like we have seen in many similar boutique racketeering cartels.

Who would do such a thing?

The Democratic Party's jewel of the ABMS--the ABIM--for being in violation of copyright infringement they allege. All the way back to 2009, all the way but the ABIM stonewalls and won't provide the documents required to prove it. It is a well-known strategy of bleeding your opponent to death.

The former "queen of the ABIM", Christine Cassel, was caught cheating in 2014 while at the ABIM(F). Casell was hired to do a job, but instead she and many others just got rich and advanced their partisan political agendas. The ABIM even lobbied when they say they did not on their tax returns. In fact folks say they did an awful lot of lobbying in Philly, the Windy City and DC. The ABIM recently sold their luxury condo when that on mark them enrich herself and her cronies by serving on multiple conflicting corporate boards. This was her modus operandi while at the ACP, OHSU, ABIM, ABIMF and NQF.

The "Secretary of Healthcare", Hillary Clinton has been Cassel's boss for nearly 25 years. In case you don't know Hillary Clinton was caught cheating in the presidential debates. They say Donna Brazil

This kind of "brain dumping" where Hillary Clinton was given the questions by DNC interim Chairperson/CNN commentator and answers in advance should not be tolerated. This form of cheating is very unethical; And it should not go unpunished. The best way to punish the cheating of the Clinton crime family and their archipelago of non-profit NGO's, like the ABIM/ABIMF is: Do not vote for Hillary; instead vote for a government of, for, and by the people. Its a movement now and not a personality cult. The Clintons utilized two trademark tools cheat and demonize your opponent. Trump speaks about the issues, but when attacked he exposes his opponent down to the bone.

Anonymous said...

What can we and should we do to stop this travesty!