Saturday, April 29, 2017

Texas: The Latest Front of the Ugly Civil War in American Medicine

The Alamo, 1894 (from Wikipedia)

The ugly civil war in American medicine continues, this time in Texas.

This civil war is not a war between the left-right politics of healthcare, as many would hope it be depicted. Rather, it is a war between an emerging left-right alliance that's building to topple health care's increasingly corporate state.

On one side of the civil war is the staid old guard of American health care, represented by the Accreditation Council for Graduate Medical Education: the American Medical Association (AMA), the American Hospital Association (AHA), the American Board of Medical Specialties (ABMS), the Federation of State Licensing Boards (FSMB), the National Board of Medical Examiners (NBME), the Association of American Medical Colleges (AAMC), the American Osteopathic Association (AOA), and the American Association of Colleges of Osteopathic Medicine (AACOM). These organizations have operated for years without appropriate accountability and oversight of their own.

On the other side are a whole host of smaller, disparate grass-roots organizations that have emerged independently and are coalescing under several common themes: (1) exposing and ending corruption/corporate greed by these unaccountable non-governmental organizations, (2) removing unnecessary and unwarranted regulatory intrusions into the practice of medicine, and (3) preserving a physician's right to work as their patient's primary health care advocate.

The fight against the onerous and expensive ABMS Maintenance of Certification (MOC) "continuous re-certification" requirement that was born of an insatiable thirst for physician testing and educational fees in the name of health care "quality," was the catalyst that finally sparked the war between these opposing forces.

This past week, anti-MOC legislation in Texas (SB 1148) that prohibits hospitals and health insurance companies from discriminating against physicians based solely on their ABMS maintenance of certification (MOC) status, passed 31-0 and now moves on to the House. No doubt corporate healthcare lobbyists are already knocking on Texas legislators'  doors to insist they either kill the upcoming anti-MOC House bill or modify it to favor their interests. One can only imagine the money being spent to do so.

If Texas House legislators votes are swayed by the current healthcare establishment's influence over their vote, they should remember a bit of Texas history, because that vote will be against Texas patients' best interest, too.

Remember the Alamo, dear legislators.


Tuesday, April 18, 2017

Teirstein: An Urgent Call to Action

This important email has been widely circulated today from Paul Teirstein, MD, President of the National Board of Physicians and Surgeons (NBPAS) and is an urgent call to action for practicing physicians. I urge all physicians to take a brief moment and contact your representative as Dr. Teirstein suggests. He's made the process as easy as possible:

Dear Colleague,

Several states now have anti-MOC legislation pending. Recently the Georgia legislature passed HB 165, similar to Oklahoma's SB 1148 which prohibits Maintenance of Certification (MOC) as a condition of licensure or reimbursement from third parties. However, the ABMS and its member boards have been heavily lobbying state legislators to defeat the pending bills in other states (click here to view ABMS lobbying materials). Those of us opposed to MOC must educate legislators in these states regarding how MOC requirements are onerous, expensive, have no proven benefit, and are forced on physicians by conflicted, self-appointed private ABMS member boards.

Here is how you can make a huge difference:

  1. This is going to take you a few minutes. I spend hundreds of uncompensated hours per year on this issue. Please take 5 minutes of your time to help yourself and our profession.

  2. This is your action item:

  3. Click here to effortlessly send a letter by email to your district's state representatives. You will be asked to "register" by entering in your name, email and address.  That's it.  From your address the system will pull your specific state bill and a letter tailored for your specific state representatives you can edit (if desired) and click to send to all your district's legislators.  We have made it as easy as possible for you.

  4. There are currently many states with strong anti-MOC legislation pending. If your state currently has no anti-MOC legislation pending, your letter will encourage your representatives to create anti-MOC legislation.

  5. If you are curious and want to view all the sample letters we have written by state, click here.

  6. Please spread the word. We have 18,000 email addresses of physician supporters but we need many more. This will not work without your help getting this message out. Forward this email to your colleagues, your patients, your med staff office for hospital wide distribution, your specialty organizations, your FB, Twitter, Linked In and other social media friends. (You can also refer them to the NBPAS Advocacy Webpage).

  7. To join the National Board of Physicians and Surgeons ( and obtain continuous certification based primarily on AACME accredited CME, click here.
Thank you for your help and support.


Paul Teirstein M.D.
National Board of Physicians and Surgeons (NBPAS)

Monday, April 17, 2017

For Texas Legislators: MOC's Myriad Conflicts of Interest

The American Board of Medical Specialties' (ABMS) Maintenance of Certification (MOC) proprietary continuing education program has a myriad of conflicts of interest. I thought I would assemble a partial list of some of them below:

1) The American Board of Internal Medicine (ABIM), the largest ABMS member board responsible for credentialing one-quarter of all US physicians, is increasingly in debt thanks to high salaries and expenses. Its latest 2015 Form 990 shows a NEGATIVE asset and fund balance of balance of $50,642,980.

2) The cost of for participating in the proprietary ABMS MOC program has grown far in excess of the rate of inflation (16.3 to 17.2% annually), without adding any appreciable change to the product delivered to physicians or the public.

3) The ABIM Foundation, which was reported as being created in 1999 on federal tax forms from 2008-2013, has a POSITIVE balance of $77,255,188 on its 2015 Form 990. Much of this balance was secretly transferred from the ABIM physician testing fees from 1990-1999, ten years before the organization was reportedly "created." Furthermore, the Foundation is domiciled in PA, not Iowa, as it was claimed from 1999-2013. With some of those funds, the ABIM purchased a $2.3 million condominium that came complete with a chauffeur-driven Mercedes S-class town car for itself in December 2007.

4) Christine Cassel, MD not only worked as President and CEO of the ABIM and its Foundation from 2004-2014, she also secretly served on the Board of Kaiser Foundation and Hospitals, earning $1,683,221. From 2008 through 2013, she also served on the Board of Directors at Premier, Inc, the largest US hospital procurement firm, earning 230,000 in case and stock in 2013. (Here's the breakdown of her take). None of these conflicts were ever disclosed until she was investigated by Propublica before becoming the President and CEO of the National Quality Forum. From 2010-2014, the ABIM paid a little-known company, CECity, Inc., over $5.5 million to process physician patient survey/practice improvement survey data. Shortly after Dr. Cassel left the ABIM, CECity, Inc was bought by Premier, Inc for $400 million in 2015.

5) Robert Wachter, MD served as a consultant and board member for IPC Hospitalist Company while working as Chairman of the Board of the ABIM/ABIM Foundation in 2014. IPC Hospitalist company was investigated for overbilling Medicare and Medicaid patients and paid $60 million to settle Medicare/Medicaid false claims act violations with the DOJ February 6, 2017.

6) The ABIM has been lobbying Congress for years, but such lobbying has never been disclosed to the public via Form 990 tax forms.

7) The adverse effects of MOC on physicians and patients have never been studied. Yet the ABIM has been conducting research on physicians (see here and here) without their consent or Institutional Review Board oversight, potentially in violation of Protection of Human Subject statutes of the Department of Health and Human Services.

8) The American Board of Medical Specialties (ABMS) and the American Hospital Association (AHA) are both member organizations of the Accreditation Council on Graduate Medical Education (ACGME). Maintenance of Certification (MOC) favors hospitals eager to limit competition.

9) Margaret E. O’Kane is founder and president of the National Committee for Quality Assurance (NCQA). Margaret E. O’Kane is founder and president of the National Committee for Quality Assurance (NCQA). The NCQA is responsible for credentialing insurance companies that must accept ABMS MOC as a condition if their credentialing under the Affordable Care Act. Ms. O'Kane is also a public board member of the American Board of Medical Specialties (ABMS) that actively promotes the ABMS MOC program that benefits the ABMS. In addition, Richard J. Baron, MD, the current President and CEO of the ABIM, served as member of the Standards Committee for the NCQA.

10) The ABMS sells credentialing information on physicians through its wholly-owned subsidiary, ABMS Solutions, LLC, a for-profit corporation based in Atlanta, Georgia.

11) The American Board of Family Medicine (ABFM), one of the ABMS member boards, holds ABFM Realty, LLC, a for-profit real estate company that manages commercial real estate and is funded almost entirely by physician testing fees.

12) The American Board of Pediatrics (ABP) has numerous real estate holdings surrounding its North Carolina address and contracted with its retired CEO, James A Stockman, III, MD to work 8 hours per week for $793,438 in 2014.

These are just a few of the conflicts inherent to the ABMS MOC product. Sadly, there have been many more throughout the years, including cozy relationships with major US academic institutions.


Friday, April 14, 2017

Dear Legislator

Physicians, consider providing the following letter (or a modified version) to every state legislator considering anti-MOC legislation.

Dear Legislator -

Across the country, bills are appearing in state House and Senate chambers regarding a trademarked  educational product owned by the American Board of Medical Specialties (ABMS) called Maintenance of Certification (MOC). No doubt a team of gray-suits representing the insurance companies and hospital systems in your area (aka, lobbyists) will be knocking on your door explaining why this program is so important to assuring the public that their physicians are of the highest quality and competency. They will insist that this proprietary physician continuing educational program is the only integrated system of physician education that assures quality educational content for doctors while also providing a multitude of practice improvement modules to assure the highest quality of care for patients.

Please don't be fooled. As your life-time certified ABMS Board certified doctor, I have seen the implementation of "continuous" MOC in 1990 and watched it grow into a cottage industry costing physicians nearly $1 billion and 32.7 million hours away from patients annually (over $23,000 per doctor every 10 years) without proven benefit to patient care. ABMS MOC product replicates Continuous Medical Education we already are required to do to maintain our license in each state and does not permit physicians the freedom to chose the education they need for their practice, but rather forces them to comply with an unnecessary, expensive, and repetitive mandated computer-testing exercise. Imagine having to retake your high school trigonometry final examination to continue to practice your trade today. This is the equivalent to what physicians must now endure every 10 years.

The ABMS MOC program grew from a financial need of the ABMS and their 24 member boards, especially the American Board of Internal Medicine (ABIM) which "certifies" one quarter of all US physicians. The  ABIM is currently $50.6 million dollars in debt (according to its most recently-available 2015 public tax returns) while their executives earn three- or four-times the salaries of the average working physician, enjoy complementary spousal air travel, and purchase luxury condominiums complete with chauffeur-driven town cars for themselves - all at working physicians' expense. They then sell our testing information for profit to ABMS Solutions, a for-profit corporation based in Georgia.

The ABMS and their lobbyists say that a computerized test or a continuous question-and-answer barrage fed to our cell phones or laptop computers is superior to direct patient care experience for maintaining our competency to practice. I would hope you can see through their propaganda.

Finally, the ABIM and the ABMS have been involved with highly irregular financial dealings, including falsifying tax forms and transferring many our our testing fees to the ABIM Foundation in the Cayman Islands. They also perform "research" on physicians and their practices without informed consent or Institutional Review Board oversight - potentially in violation of federal law.

For these reasons I would ask that you strongly reject the importance and value of the ABMS MOC program to practicing US physicians. We have carefully researched the financial and political dealings of this conglomerate of independent non-profit agencies that are pushing for MOC and would ask to have them investigated by the appropriate authorities, including the Federal Trade Commission and Internal Revenue Service before siding with their lobbyists' demands.

Such an action would be in the best interest of our patients and US healthcare, not the endless ABMS MOC testing of physicians who struggle to serve as patient advocates in our increasingly regulatory healthcare environment.

Your caring physician -

Wednesday, April 12, 2017

An American Sickness and the ABIM

Thanks to Elisabeth Rosenthal, MD for the mention of the ABIM/ABIM Foundation controversy in her new book, An American Sickness: How Healthcare Became Big Business and How You Can Take It Back.

Sadly, the financial troubles and numerous financial conflicts of interest at the ABIM persist for reasons Dr. Rosenthal articulates well: it's a "testing Ponzi scheme."


Monday, April 03, 2017

Attention Tennessee Physicians and Physicians Everywhere

Attention Tennessee physicians and beyond:
As you may be aware, the (anti-)Maintenance of Certification legislation (see House Bill HB 413) and Senate Bill (SB 298) is on the calendar on Tuesday at 1:30 p.m. in Senate Commerce and at 3:00 p.m. in House Health Subcommittee. This legislation is highly contested and being opposed by both hospitals and insurance companies. TMA is working hard to get this legislation passed, but they need your help!

We need you to come to the hearings on Tuesday to show legislators that PRACTICING physicians are firmly AGAINST making the unproven, time-consuming, and distracting ABMS Maintenance of Certification program a requirement to practice medicine in Tennessee. Having physicians in the hearings may mean the difference in what happens with this bill in the committees on Tuesday. As the bill is highly contested, the outcome is unknown. It may be amended and passed out, or it may be put off until next year. Without physicians in the hearings, they will not go well. The legislators need to see physicians present supporting this bill and following it closely.

When: Tuesday - Senate Commerce at 1:30pm in LP 12
House Health Subcommittee at 3:00pm in LP 30

If you have any questions about this or if you are able to attend, please let me know, and if you haven't already, please contact your representative and senator and let them know you support this bill.

Thank you for your help,


Nikki Ringenberg, MPA
Senior Director of Membership and Grants
Nashville Academy of Medicine
3301 West End Ave, Ste 100
Nashville, TN 37203
615-712-6236 office
615-712-6247 fax
It is time to turn your gaze away from that computer screen and rise up!

Practicing physicians' right to work is being compromised by the inclusion of the ABMS MOC requirement in state legislatures across the country.

Physicians need to alert their colleagues in Tennessee and elsewhere about this effort to restrict the practice of medicine by the American Board of Medical Specialties and Federation of State Licensing Boards. Practicing physicians are not against continuing education, but against the corruption that the ABMS Maintenance of Certification program represents and it's anti-trust implications it has to the practice of medicine.

It is time to save the practice of medicine and physicians' ability to act autonomously on behalf of our patients without the threat of unnecessary corporate intrusions into health care delivery.

There is not much time for us to mobilize. Please spread the word.


Addendum: Thanks to Meg Edison, MD for her letter to circulate: