Sunday, August 06, 2017

ABMS Reacts to JAMA MOC Financial Study

It didn't take long for the American Board of Medical Specialties (ABMS) to issue a statement via MedPageToday on the ABMS member boards' fees and finances for physician certification and re-certification, claiming their fees are "reasonable." In my view, they would have been smarter to say nothing, especially since their entire non-profit status may come under scrutiny when all the facts and conflicts of interests inherent to the US physician Board certification system are carefully considered by the Internal Revenue Service.

Let's fact-check their public statement line by line:
"The research letter entitled 'Fees for Certification and Finances of Medical Specialty Boards' published in the Aug. 1, 2017 issue of JAMA offers an aggregate view of the fees charged by the 24 ABMS Member Boards for more than 860,000 physicians to obtain initial Board Certification and as well as continuing certification throughout a physician's career.
Note the ABMS rebuttal statement was careful not to use the term Maintenance of Certification® (MOC®), but rather used the term "continuing certification." That's because it would hint at the existence of their for-profit wholly-owned subsidiary, ABMS Solutions, LLC, domiciled in Atlanta, GA, that makes money selling physician MOC® certification status to third parties, generating revenues in excess of those disclosed in their rebuttal statement or in the original JAMA research letter.
"According to the letter, the 2013 Member Boards' revenue represents approximately $313 per ABMS Board Certified physician. This is a reasonable amount to support a nationally recognized credentialing program that is both respected and valued by physicians, healthcare providers, and institutions, and most importantly, patients and their families.
In fact, 81% of physicians feel MOC® is a burden and only 15% felt recertification was worth the effort. Independent studies have failed to identify a difference in time-limited versus lifetime-certified physicians, reinforcing the fact that MOC® is little more than a revenue generator for the ABMS. Also, the ABMS is careful not to mention the word "annually" in their statement when they describe the revenue generated per ABMS Board Certified physician. It is also strange that the ABMS would call their fees "reasonable" when those fees only apply to new, younger, often debt-burdened physicians and not to older physicians certified before 1990. Older physicians are not required to participate in MOC® to keep hospital privileges or insurance panel payments. Age discrimination - a hallmark of the ABMS MOC® program - is not "reasonable" to any ethical working physician or member of the public.
"In addition, the estimated annual cost for continuing certification of $257 per ABMS Board Certified physician is an acceptable cost for physicians to demonstrate that they have the current knowledge, judgment, and skills to provide the highest level and most up-to-date care to their patients.
Funny how this number that pays salaries that are over four times the average physician's salary are deemed "reasonable" for member boards of the ABMS. $257 stands in stark contrast to the competing certifying board, the National Board of Physicians and Surgeons ( whose fees are only $84.50 per year and is equally credible - if not more so - since their Boards' leadership are unpaid.
"IRS Form 990 provides information regarding revenues, expenditures, and assets. However, they do not outline the actual operation cost involved in creating, sustaining, and implementing a rigorous and comprehensive process of Board Certification and continuing certification for the nation's physicians. ABMS Member Boards rely on a highly trained and specialized work force including psychometricians, assessment professionals, and medical educators to develop, evaluate, and administer Board Certification programs.
Those fees also paid for a felonious strongman to overstep their authority to intimidate vulnerable physicians by secretly audiotaping a competing ACGME-accredited board review course. Using those audiotapes the ABIM obtained permission to raid the course director's home to seize his computers so the ABIM staff could track physician attendees' email addresses and accusing them of violating ABIM's "pledge of honesty." These activities are more akin to a protection racket rather than a physician continuing education/credentialing system.

The ABMS member boards also have numerous large, undisclosed financial conflicts of interest. For instance, in fiscal year 2013, the ABIM paid their non-physician Chief Operating Officer, Ms. Lynn Langdon, over $464,747 while Christine Cassel, MD (President and CEO of the ABIM and its Foundation) earned $838,603 from physicians while she simultaneously served on the Boards of Kaiser Foundation and Hospitals and Premier, Incorporated, the largest hospital purchasing agent that also does "performance improvement consulting" for over 2,900 US hospitals. True to form:  the ABMS never mentions these additional conflicts of interest in their statement.
"For this reason, the greatest expenditure is appropriately in the area of staff salary and compensation, as noted in their 990 reports. "The assets reported on the IRS Form 990 that the ABMS Member Boards currently maintain are crucial to sustain and evolve vibrant and innovative Board Certification and continuing certification programs. ABMS Member Boards are continually reinvesting in program improvements and enhancements to transform their certification and continuing certification programming, including the development of quality improvement and longitudinal assessment programs.
Those "vibrant and innovative enhancements" include a $2.3 million condominium complete with a chauffeur-driven town car, investments in the Cayman Islands, for-profit real estate ventures, and even a pond. The largest member board, which secretly channeled over $77 million of physician testing fees to create their ABIM Foundation from 1990 through 2007, now only has $13.6 million remaining in their latest consolidated financials thanks to high salaries and mounting legal fees. I'm not sure I can remember a time of so much innovation (and cover-up) in physician certification!
"These investments will ensure that ABMS Board Certification continues to be a relevant, valued, and important quality indicator for those who hold the credential as well as those who rely upon it for the highest standard of quality care."
Unfortunately, the ABMS member boards have enjoyed a sheltered workshop for years that the internet has thoroughly disrupted. Sadly, physicians no longer trust the ABMS and their member boards to act in their interest or in the interest of the public. Instead, the data are overwhelming now that the ABMS and their member boards are more concerned about themselves than the public. As such, their tax exempt status should be challenged.

The question now is, are there any investigators/prosecutors at the IRS that will investigate this potential fraud, or are they beholden to the highly political Medical Industrial Complex, too?


Image credit: Medscape.


Straight from the Horse's Mouth said...

It was a marvelous rebuttal by the ABMS on Aug. 1, 2017.

I can only say, what others have said. "The crimes that Nixon committed with Watergate are minor in comparison to the crimes that are committed today."

In my own words said...

What the ABMS/ABIM elites have to say about "what they knew and when they knew it" in their own words

"I, Richard J. Baron, CEO/President of the ABIM, solemnly swear that I, along with my close colleagues at the ABIM, possessed full knowledge of and fully participated in the 'Cassel-gate' break-in. And yes, I was next in line to be CEO, as long as I played my part. It was hard work running a seamless care model clinic, and delivering "suggestions" to the CMS, NQF, and NCQA--all while running a sting operation, raid, seizure and public exhibition at the ABIM.

Ok, we got it wrong, but in all modesty we cheated at the ABIM in order to control and monetize physicians in a reasonable way. After all we were trying to make the public safe. We did it because it was the right thing to do. And we became reasonably rich in the process charging reasonable fees. Sometimes when working with your professional teams you have to act outside the margins of the law to be successful. It is also important in order to win by taking personal risks for the team. But always be ready to plausibly deny it all and use language to your advantage such as calling reasonable all that you inwardly know to be outrageous and a scam. But this is Philly and you have to be able to live large and in the right neighborhoods. Otherwise you end up . . .

And hell yes, I took my own 10-year re-certification test myself; I just took it at the ABIM's safe secure environment where I had access to all the answers. I am a busy man. What did you expect! Get real. It's part of being an ABMS team and one of the free perks."

Interpreting ABMS newspeak said...

Would it be fair to say when the ABMS uses the word "reasonable" it is a code word for a well-thought-out and highly orchestrated Ponzi scheme?
What do they need all that money for besides executive cloud-nine earnings, fatted-calf retreats at the Four Seasons; business trips to luxury hotels in Venice and exotic destinations along the Silk Road? International investment accounts? Lying to the IRS about lobbying for monopolistic influence and unfair business favors? What about the luxury mansion for Chris, Bob and Dick and the rest of the politico/corporate gang? Who really used Cassel palace in the sky?
Why do they give themselves executive accounts for lunch and dinner at he most expensive clubs, and first class spousal coverage for the CEOs.
For the ABMS/ABIM non-profit is just a code word for living like the rich and famous an indulging in the excesses of the Wall Street elite.

Anonymous said...

If the ABMS were a federal agency the executives would be in jail or tossed out on street for all the improper perks and gift they have received while working abroad for "ABMS International." The executives of ABIM and other member boards have participated in ABMS expansion projects overseas and without much doubt been in receipt of personal gifts/benefits without having kept track of this partly because there is no properly incorporated international member board "businesses" to track expenses and receivables.

Nothing on ABIM tax forms about international moneys for persons/executives listed in schedule R. More obfuscation? Probably. The ABIM 990s reflect some income, but it looks suspect from the conformity of the moneys that have been funneled to them from the ABMS. There is nothing that defines this income.

You just can't make this stuff up what they are doing and getting away with. All without proper monitoring by the IRS or an assurance organization that watches the ABMS. I can hear their explanation already for the "sloppiness in accounting". "It is just how they do business in the Far East and Middle East. You just have to go along with the corruption or you can't play ball with them."

I say they are going to get burned if they have not already been put to the fire, by any honest critical members within or those who quietly admonish them from outside. The parent and member organizations all work in tandem.

Don't expect the mother crab to do anything about the baby crab. They both have slanted gaits.

Lisa said...

Big Picture: When we were kids every day we heard about "evil communism" and "evil soviets" and all this other Cold War talk. Before we knew anything about Soviet Union we just knew they were evil, pure evil. I don't think I met anyone who could tell me WHY communists were evil and why USSR was simply the most evil thing ever, beyond words. Eventually they told us the Soviet Union fell, they went broke, now it's the Russian Federation, which was now not evil--except until recently when we re-evilized them.

When Obamacare was perpetrated against the former United States, I first began to have answers to the questions I sort of had but couldn't articulate as a little girl. No one asked the details back then, because that was like you were a communist sympathizer red menace infiltrator pinko and probably a few other really bad things.

All the crazy things going on in healthcare, ACA, MOC, ABMS, ABIM and so on basically boil down to OMFG they were right about Communism. The pure evil, the corruption, the wealth disparity, the abuses. Today, I am somewhat curious about Russia but they probably still hold onto hopes of restoring the power of the Soviet Union and only slightly left behind communism for an open market since capitalism sort of happened to them and they had to eat. We're having communism sort of happen to us, and if we're not careful no one will be able to eat. If you destroy the healthcare well enough, then the people can no longer make wages and we're stuck with communism...and ACA, MOC, ABMS, ABIM.

I pray daily for the orange man in the white house to repeal ACA and hopefully get this red menace gone from US soil. How did this happen to us? We got infiltrated. The differences between USA & the now Russian Federation are that they watered down their communism for now, and United States watered down capitalism for now. I am open to an exchange program where USA will take RF capitalists as long as they will take USA's socialists/ communists. I pray Jeff Sessions will get around to bringing these medical racketeers to justice, there is just so much cleanup to do, this could take years, if only cloning wasn't unethical.

Be American or please leave the country with your wicked ways. Some of the capitalists are being wicked and going to far, but we know how to deal with them and they are going to be really really sorry they messed with us.

Censorship and the NO-MOC Movement said...

The ABMS has suppressed free speech and created conditions where physicians cannot work if they say no to MOC

The issues addressed in an article by Paul Craig Roberts are not unrelated to the fight against mandatory MOC. The PCR article speaks about US relations with Russia and it addresses some real issues of identity politics, propaganda and censorship in the workplace and almost everywhere we look.

Is Google engaged in censorship not unlike what the ABMS is doing to physicians? Notice how most of the contributors to this blog feel they must write anonymously. That is not healthy, but it is a fact. They fear repraisal from the ABMS, their employer or any of the sundry organizations that literally create fear in physicians.

What about looking at Google to see a parallel universe in what the ABMS is doing to physicians and patients. Google is apparently using its massive powerful platform to push political agendas. The ABMS and member boards as non-profit orgaizations are not suppose to use the NGOs politically, but they do. And quite effectively as a weapon against physicians and against the best interests of patients. Is the dissemination of propaganda by the ABMS (or Google) no an utter abuse of what should be the public's right, the right to have accurate unbiased information. Does Google manipulate what we can know and understand about news events and so on? How about the ABMS? Kurt Eichenwald was perhaps a victim of suppression by the powerful media. Who controls the media as far as the ABMS is concerned? Ask Rich Baron. Ask Christine Cassel. Ask Lois Nora. It is like playing blackjack where the game is stacked in favor of the information casinos.
The common man or woman lost the battle from before the game began. It is a game of strict control.

Censorship is real. It touches our lives every day.

Here's an example close to home. Bob Wachter, the former ABIM Chair and political steward of the ABIM for roughly ten years was a board/committee member on Google regarding important healthcare issues. He was on the editing panel for the HHS' AHRQ at the same time. (He still holds that AHRQ position along with a participating role by UCSF where he is one of the department chairs.) How was it that the "safety chairman" or executives of IPC the Hosptialist Company were never personally charged with engaging in Medicare fraud? Because it was all kept out of the press very nicely. Unless we hear the news there can be no public outrage to pressure authorities to seek justice for wrongdoers.

What about Google and this rather inconspicuous blog? Is suppression possible?

Google controls to a large degree the flow of knowledge/propaganda we receive, and the blogger of this site uses Google blogger. What happens to the dissemination of truth/facts about the ABMS and their powerful kindred organizations if Wes Fisher gets put on a fake news list? Have the powers to be even discussed it? We don't know, but almost certainly there has been some discussion of suppressing the flow of anti-MOC ideas.

It may be already the Google search engines show fewer direct hits to Dr. Wes' site/content than one year ago, even though his Twitter share has increased and so have the numbers of folks who read his healthcae/anti-Moc movement blog. The number of public responses has increased also.

If somehow the search engine makes Wes Fisher's thoughts and research harder to find. What then?

What has changed in a year? Wes Fisher has become more of a political and financial threat to the ABMS MOC program and the status quo. Anti-MOC legislation in most states has become a cogent and palpable threat.

PCR: Facts supplanted with propaganda wherever we look. Google engineer shares a sensitive view on equal pay for men and women.

Anonymous said...

This is chilling. Eric Schmidt, PCAST advisor sitting next to Christine Cassel PCAST advisor.

Anonymous said...

"We should not be surprised that google is opposed to free expression. According to reports, Google works hand in hand with the NSA and CIA to expand unconstitutional spying on everyone everywhere and to suppress independent and dissenting thought and expression.

For example, on July 31, the World Socialist Web Site reported that “Between April and June, Google completed a major revision of its search engine that sharply curtails public access to Internet web sites that operate independently of the corporate and state-controlled media. Since the implementation of the changes, many left wing, anti-war and progressive web sites have experienced a sharp fall in traffic generated by Google searches. The World Socialist Web Site has seen, within just one month, a 70 percent drop in traffic from Google.”

Anonymous said...

Look at your graph under stats. ???

Anonymous said...

They do not track you like google search !!!!

The dangers of unbridled power: the unleashing of fire and fury said...

72 years ago on August 6th, 1945 the United States of America dropped an atomic bomb on "a military base" called "Hiroshima". This is what the American people were told.

On August 9, 1945 President Harry S. Truman spoke to the American people in a long radio address. He closed by mentioning Hiroshima and the dropping of a atomic bomb. The bulk of his report focused on Germany and the Potsdam Conference.

The US decided to drop the atomic bomb on Hiroshima August 6, 1945 at the height of peace negotiations in Berlin. A second atomic bomb was dropped on Nagasaki August 9, 1945 upon Truman’s return to Washington.

Here is the excerpt of Truman’s Postdam radio address with a report about the atomic bomb:

"The world will note that the first atomic bomb was dropped on Hiroshima, a military base. That was because we wished in this first attack to avoid, insofar as possible, the killing of civilians. But that attack is only a warning of things to come. If Japan does not surrender, bombs will have to be dropped on her war industries and, unfortunately, thousands of civilian lives will be lost. I urge Japanese civilians to leave industrial cities immediately, and save themselves from destruction.

I realize the tragic significance of the atomic bomb.

Its production and its use were not lightly undertaken by this Government. But we knew that our enemies were on the search for it. We know now how close they were to finding it. And we knew the disaster which would come to this Nation, and to all peace-loving nations, to all civilization, if they had found it first.

That is why we felt compelled to undertake the long and uncertain and costly labor of discovery and production.

We won the race of discovery against the Germans.

Having found the bomb we have used it. We have used it against those who attacked us without warning at Pearl Harbor, against those who have starved and beaten and executed American prisoners of war, against those who have abandoned all pretense of obeying international laws of warfare. We have used it in order to shorten the agony of war, in order to save the lives of thousands and thousands of young Americans.

We shall continue to use it until we completely destroy Japan’s power to make war. Only a Japanese surrender will stop us.

The atomic bomb is too dangerous to be loose in a lawless world. That is why Great Britain, Canada, and the United States, who have the secret of its production, do not intend to reveal that secret until means have been found to control the bomb so as to protect ourselves and the rest of the world from the danger of total destruction.

As far back as last May, Secretary of War Stimson, at my suggestion, appointed a committee upon which Secretary of State Byrnes served as my personal representative, to prepare plans for the future control of this bomb. I shall ask the Congress to cooperate to the end that its production and use be controlled, and that its power be made an overwhelming influence towards world peace.

We must constitute ourselves trustees of this new force–to prevent its misuse, and to turn it into the channels of service to mankind. It is an awful responsibility which has come to us. We thank God that it has come to us, instead of to our enemies; and we pray that He may guide us to use it in His ways and for His purposes."

Anonymous said...

ABMS is ruthless and remorseless. It has still not been held accountable for dropping the MOC bomb on patient populations thirty years ago. And the wanton destruction of healthcare under their reign continues.

Do they misspeak when they say they "do it all for the patient?" To be without a physician, or one that is overly burdened is what the public wants? I don't think so.

And for all the harm it does, the ABMS is still allowed to terrorize practicing physicians and their patients with MOC in most states to this day! This must change.

Ohio MOC Protection Plans said...

Ohio House Bill 273 Summary/Documents/Status/Votes
General Assembly: 132

Short Title: Prohibit requiring physician to have maintenance of certification

Long Title: To amend sections 3702.30, 3727.05, 4731.14, 4731.281, 4731.29, 4731.56, and 4731.57 and to enact sections 3727.061, 3901.89, and 5164.302 of the Revised Code to prohibit a physician from being required to secure a maintenance of certification as a condition of obtaining licensure, reimbursement, or employment or obtaining admitting privileges or surgical privileges at a hospital or health care facility.
Primary Sponsor: Representative Gavarone
Version: As Introduced
Legislation Text : View Current Version

Co-Sponsors Rep. Johnson
Subjects Commerce : Insurance, Employment, Health and Human Services : Health Care, Health and Human Services : Medicaid, Occupational Licensing and Regulation
Committees House Health
Effective Date

Anonymous said...

ABMS: Corporation of Hypocrisy and Harm

MOC has a harmful effect on human populations. There is no benefit other than bestowing money and power to the undeserving executives at the ABIM and other member boards. And that wonderful umbrella that is supposed to protect the public from menaces such as MOC and rogue member boards that commit tacit sins against physicians and the public, it just gets richer and rewards their executives with what is essentially a big bribe for "going along with the MOC program". Is it all just to serve special interests as many say? Certainly the history supports this and that history just got richer with their "non-response" to the Carmen Puliafito USC Keck Medical School drug use/distribution/prostitution scandal.

And just look at all those bonuses paid out for losing money at the ABIM and spending lavishly on themselves like there is no tomorrow. Just like Puliafito living large like there is no tomorrow in total disregard for his colleagues and family.

And the malicious and defensive legal expenses that would be entirely unnecessary if the ABIM and other member boards just could get their heads out of the sand and end the game of MOC and MONOPOLY. How much are they spending getting right now at the ABMS or ABO in legal fees trying to minimize the effects of one of their star ophthalmologists Carmen Puliafito, the disgraced, admonishes, fired and banned USC/Keck dean and practicing physician.

Maybe someone should diagram in plain images and terms for them, so that the Rich Barons of the ABMS and affiliates can understand the harms they are doing via "MOC and MONOPOLY". And all the various engagements they have with conscious cover-up.

Or even a cartoon, showing the harmful effects of MOC and Monopoly and the outrageous hypocrisy.

Now look at this and think about the hypocrisy of it. Carmen Puliafito had close ties with the ABMS, ABO, ACGME, AAMC, ACCME, TJC and this list is long. Now consider his extremely young prostitute, the drugs, the binge parties with illicit drugs at USC and at expensive hotels just off campus? Why hasn't the ABO and the ABMS come out with a statement of admonishment and announcement of investigation or sanction. There has been nothing said. This is typical of protecting their own elites from getting shot in the crossfire. They know who they are and they are hoping that it all just blows over and goes away.

At least USC banned Puliafito from campus and fired the man for his immoral and illicit behavior. This is real and there can be little doubt about its veracity from the lengthy and thorough reporting by investigative reporters putting their reputations and paper on the line.

But what about the response to this scandal by the ABMS? The American Board of Ophtalmology? Where is it? We have not heard a thing about any sanctions or revoking Puliafito's lifetime credential. He was even "voluntarily participating in MOC". Why is that? The ABMS is just doing more harm and creating a great deal of confusion, by saying nothing. Or did I miss the New York Times full page add they took out condemning such behavior among their elite ranks.

Remember how in 2010 the ABIM quickly found guilty thousands of physicians for attending a competing board review course. They sent out letters and sanctioned them. Put marks on their file. Christine Cassel and company revoked certifications and sued several physicians and sanctioned over 150 others for what offense? Tried them mercilessly in the media. Violated due process and spit on the bill of rights. They used an underworld thug with two felonies etched into his wild pistol. Allegedly communicating via email with the teacher of an ACGME/ACCME approved and accredited course and its sole proprietor teacher/owner.

Can we just step back and take note of the ludicrous irony and hypocrisy of the ABMS and their partners who are running our "educational assurance industry". Or should I say "protection racket" programs.