Saturday, December 01, 2018

ABIM Fees Place Physician Bank Accounts on High Continuous Suction

The American Board of Internal Medicine's (ABIM) ongoing seemingly endless changes to their Maintenance of Certification® (MOC®) product is affecting physicians who re-certified a short five years ago - like myself.

Let's review precisely what has taken place since time-limited certification was implemented by the ABIM in 1990:
  • From 1936 to 1990, ABIM Board certification was a lifetime credential.

  • From 1990 to 2005, ABIM ended lifetime certification, and began issuing only time-limited certification to physicians for those certified after January 1, 1990, requiring re-testing (and renewed payments to them valued at more than a thousand dollars) every 10 years.

  • In 2006, "Maintenance of Certification," a product rebranded from "Continuous Professional Development" (note the similarities of these two linked webpages) was implemented. MOC was later trademarked by the American Board of Medical Specialties who stipulated programatic alignment from ALL physician subspecialty boards and required them to perform additional practice performance tasks and earn 100 "MOC points" AND re-take their board certification test every 10 years. Additional fees were often required to earn points from "MOC-eligible" courses.

  • In 2013, the ABIM imposed more burdensome changes to MOC, not only having to re-take their examination every 10 years, but a "MOC activity" had to be completed every 2 years with patient safety, patient "voice", and survey modules or "Practice Improvement Modules" performed every 5 years and they also had to accumulate 100 MOC points every 5 years.

  • Now the ABIM requires internists to pay not only an annual program fee to participate in MOC, but  an "Assessment Fee" for MOC examinations. Internists can sign up for Knowledge Check-in examination every two years, or still take the 10 year examination.

Through self-serving rule changes, the ABIM has become a tax-exempt for-profit money machine that has placed physician bank accounts on high continuous suction. They coerce physicians by  threatening them with the loss of their credentials or ability to receive insurance company payments to keep the money flowing.

We know why: thanks to their own hubris and avarice, they are failing financially. They have lost the trust of US physicians. And are a partisan organization beholden to the Medical Industrial Complex, not patients.

Given then above information, I believe the ABIM's tax-exempt status should be revoked. Their fees have skyrocketed from $795 to $2200 over 18 years (2000 to 2018) - or 276% - while providing the same product, "certification" of working internists since 1936, nothing more.



Keith S said...

The ABMS has become nothing but a rent extracting organization. My recent experience was attempting to apply to take the boards in addiction medicine. To do so, you are required to pony up 500 dollars so they can vet your credentials (Evan though I already was board certified in Internal medicine). Since I had not performed a fellowship, but have worked in the field for several years, they require a description of your professional activities and someone to verify that you are not making it up. After 2 months they asked for more information regarding my work in the field, but there on line website only allows 800 characters to provide this description. After some back and forth with phone calls (strangely, they only have an answering service that answers your call and then someone calls you back), they rejected the application for being incomplete! I was allowed to appeal, by writing a letter to the director of the American Board of Preventive Medicine who I mistakenly addressed as a doctor. Turns out he is a lawyer who use to work running a bunch of acquired Burger Kings in Indiana (I kid you not; this was his last job!) and his only medical experience was handling medical malpractice cases. He quickly reflected my appeal and I was told I would need to reapply and pay another 500 dollars for the privelgeg. Then maybe they would let me take their 2200 dollar exam! I think my time and money will be better spent elsewhere.

Money Check-out said...

In 2002 executive compensation expense totaled $1,260,155
By 2016 executive compensation jumped to $4,210,980

All other employee compensation totaled $5,856,220 in 2002.
In 2016 that number rockets to $18,207,797

In 2002 there were a total of 4 major contractors expense totaling $615,316
For printing, legal and computer consulting.
0 others contractors are list above $50,000.

In 2016 there were five listed major contractors at $4,467,572
For software services, legal, computer consulting and website design
There were a total of 13 other contractors over $100,000.
That bring the total to well over $5,767,572

Looking at these numbers it is mind boggling that their major contractors expense in 2002 was for printing of certificates.

And with a great deal of our money going toward investing in softare and who knows what,
you'd think that they could get their December 1st Knowledge Check in to work.

Anonymous said...

Can somebody give a report about the Knowledge Check in meltdown today? What caused it? Quite often when I call their computer systems are down.
Understaffed also. Won't transfer me to anybody who has authority. So much for transparency.

Anonymous said...

Keith- Glad you got to meet the Burger King CEO for GSO Blackrock Private Equity in charge Preventative Medicine. This is one of the biggest unreported scandal at the ABMS.


The ABIM needs to change its name to reflect its moneyed interests and partisan political orientation . . .
A new name, that spells out the scandalous/zealous nature of this members-only-club.
How 'bout
Society for Continuous Assessment and Monitoring S_C_A_M

Anonymous said...

I have taken my internal medicine boards and have subspecialty certificates and recertifications prior to 2018. I was told that I did not need any MOC points and would not be bothered until the next 10 years after each one. The ABIM is constantly moving the goal posts. As if I don't have enough uncompensated work to do for DOJ.CURES in California, MACRA and MIPS.

I know Charles Kroll has done extensive work on the ABIM's plunging finances. I have some questions and maybe someone could answer them.

What is the status of the lawsuits against the ABIM?
What was the Maryland medical board vote against MOC?
When will any state or federal Department of Justice evaluate the ABIM for racketeering?
When or if will the IRS evaluate and investigate the ABIM? If I was the IRS, I would nail them and collect a huge penalty against them. It's easy money.
Are there any state medical boards denouncing the ABIM?
Has the AMA done anything beyond lip service to follow up their statement concerning the ABIM and MOC?

Anonymous said...

Knowledge Check-In Fails the Test

"Looking for anyone else who has had issues with the proctored exam from their home setting. Just today I was 14 minutes short of finishing (with 10 questions, yes I am slow), when screen went white with large Failed error message across including the PearsonVue website. Still had proctored box up. Typed for help. Waited 6 minutes. (Watched time as wasn’t sure if I was going to get time back). Advice from Pearsonvue was to log out of PV proctor and exam and log back in. Explained I wasn’t comfortable with that. They replied they had this logged and would be able to refer back to that. Ended up not being able to get back into exam. PearsonVue said exam marked complete. ABIM “investigating.” Not sure if others have heard of difficulties with taking this at home."

Quoted from NEJM blog

Got IT Wrong said...

Here we go again, major problems with ABIM’s proctored testing system! They will have to do some damage control on this one. Click the link for an example of ABIM PR.

Are we too busy to think about Knowledge Check-ins to understand the pitfalls/dangers?

The KCI problem reported above was from if I recall 11/20/2018. On December 1st (here we go again) the ABIM reported what I understand were massive problems with their test delivery partner Pearson Vue

Every KCI test has now been a game of "Pearson roulette" ABIM's KCI beta-victims. Every one of the test takers scrambling under the ABMS MOC demands are anxious with the question, "what if Pearson's system freezes on me. What if ABIM’s contractual partner, Pearson, with its proctored revolving magazine loaded with real bullets, shoots the lead at them on their day off.

I.e. what if the system shuts down, freezes or goes blue screen/error on them. We don't know much about the technology involved and neither does Pearson or the ABIM as we can easily see.

Think about it. This ABIM/Pearson/KCI joint "bullet-proof" testing regimen/program has not only ruined the whole day (and months of useless study) for the "two-year KCI victims", but there is the likelihood that most physicians, or all, who opt to pay every year and do the two-year ABIM surveillance/data collection project, will at some point be a victim. So far the odds are that everyone will be affected and have to redo the test due to systemic failure.

It has happened every time so far. No exceptions. Baron is rolling out disaster-prone MOC products year after year and still the CEO keeps his job. We’d lose our jobs if we performed as badly as he has. Put someone in there who gets voted in by working physicians who will elect to end MOC.

I don't relish the thought of having to take yet another day off! To have a MOC make- up day. More nervous weeks fretting and studying to remember esoteric trivia that is outdated and forgotten as soon as the ABIM tests it in their beta-beta test. I don’t want to do the MOC dance with their $$$$$ bullets spraying at my feet.

END MOC and then we can all have a nice day!

O O P S said...

Apparently the ABIM is not "up to ABIM standards."

Count Down said...

Commentary on MOC madness

It becomes increasingly clear that ABIM executives can’t run the ABIM certification program with all the side shows they are engaged in.

Physicians are burdened/overwhelmed with MOC and all the onerous tasks associated with it. The Financial Frankenstein they invented called MOC has affected their own ability to keep up.

No longer are they able to perform their core mission, which has always been certifying physicians for life. But this is an attainable and manageable goal, but they are drowning in the complex quagmire they are blubbering in. They need to jettison the corporate talent and get some compassionate physicians back in those offices and make it a volunteer organiztion again. End the conflicts of interest once and for all. Or dissolve the American Board of Internal Medicine as it should have been years ago.

Politically, I am not bashful to say, they must be dumber than dumb - the political stupidity that Bob Wachter admitted to when they got caught red-handed with the purchase of a luxury condo (with that Mercedes sweet ride) they bought for ABIM's many "contractors." When it was all along intended for the entitlement of the 1%, and who knows what other mischievousness.

Blub blub is all they can say to all the unanswered questions about conflicts of interest, while they try to save the un-saveable heavy beast Mr. MOC. Blub blub, is all they can murmur as they keep trying to breathe life into Mr. MOC.

Miss Eng Money said...

Read my lips no MOC taxes

Is there a parallel between ABIM's avaricious financial activities and the Pentagon's massive appetite for dollars? So much of their money gets reshuffled or vanishes into thin air.

"The Pentagon’s Massive Accounting Fraud Exposed By Dave Lindorff
How US military spending keeps rising even as the Pentagon flunks its audit."

To the tune of 25%. Is that really possible?

Values In Conflict said...

UCSF GRAND ROUNDS Bioethics Expert Christine Cassel

The Choosing Wisely Chief says a root cause of physician burnout is over-treatment and the moral distress it causes.

Dr Cassel's geriatrician's pearls

Baby boomers

- "Bandaids, vaseline and a good old cast iron pan are all the medicine our aging population needs."

On self care

- "Never felt better, 10 million dollars and a golden parachute ago, when I dumped MOC and bought a cast iron frying pan."

Values in conflict

- "Ethical dissonance is what the old fashioned doctor prescribed."

Conflicts of interest

- "Professionalism in medicine today is teamwork; teaming up with corporate special interests and watching those gosh darn blues all fall away."

Being "Rich" said...

Episodes from ABIM's "It's an Easy Life"

MOC WAGE TODAY (999K per yr, DC/Cayman holidays and a 2MM golden parachute away)

Made_Of_Cain_ said...

M_O_C_® Company Script, Insurance Script

You sold your soul to the company store.