Friday, May 10, 2019

Grandfathers, Lattes, and the ACC's CMP Pathway

Drs. Kovacs (L), Fisher (C), and Marine (R) discuss MOC and
the ACC/HRS Collaborative Maintenance Pathway (CMP)
at the Heart Rhythm Society's 40th Scientific Sessions
As I head back to Chicago today, I wanted to take a moment and reflect on my experience before, during, and after my opportunity to speak at the Heart Rhythm Society's (HRS) 40th Scientific Sessions in San Francisco yesterday.

Before I do so, I want to thank Tom Deering, MD, President of HRS, for reaching out to me and asking me to share the findings of a small survey I did on working cardiologists and electrophysiologists on the new "Collaborative Maintenance Pathway" (CMP) for "maintenance of certification (MOC)" that the Heart Rhythm Society and the American College of Cardiology have created.

It was clear this session was really an afterthought. It was organized about a month before the scientific meeting after I placed the survey I helped create to gather physician perspectives on the new CMP pathway on the HRS online discussion forum. Dr. Deering ask that I create the title for the talk while the HRS assembled the moderator and speakers.  Ken Ellenbogen, MD, longtime organizer of the HRS Board Review Course held each year in Chicago, was selected as moderator.  Bradley Knight, MD, member of the cardiology committee for the American Board of Internal Medicine (ABIM) was to participate (so I thought), as was Joseph Marine, MD, an EP from Johns Hopkins who helped create the ACC/HRS CMP pathway. It was held on the show room floor at one of those speaking "EPicenter labs" with a computer screen, pretty good sound system, and about 20-30 chairs before the speakers.

Despite the small venue, it was clear the talk was "important" to the ACC leadership. Both C. Michael Valentine, MD and Richard J. Kovacs, MD (out-going and incoming ACC Presidents) were there and warmly welcomed me. In our initial chat together, I learned they were both "grandfathers" to the MOC process but had worked hard to create another way physicians could comply with MOC using their cell phones. I had not met Dr. Marine before, but it was clear he really believed in the MOC process and the CMP program the ACC had created. Dr. Knight, I later came to realize, did not show, likely because of his work with the ABIM and the pending litigation against them.

Dr. Marine kicked off the session with a 15-minute talk describing the CMP program. To his credit, he included the costs circulated by HRS, regarding the program, and was quick to note that the costs really were acceptable, as he showed the relatively high salaries of cardiologists published recently and compared that cost a number of ways, including a comparison that it would only set back participants the equivalent of "2 or 3 lattes a week." It was like a line from the ABMS script.

Then I spoke. Gratefully, I was able to use slides (withheld from me in my discussion at the IL Medical Society) several weeks ago. As I looked around, there were plenty of people standing on the edges and reluctant to take a seat. As my talk progressed, I paused to have those in attendance answer one of the questions. It became clear they were reluctant to do so, but it was clear they sided with the sentiments of the first question - that the ACC should not leverage the sale of their CMP product to our certification. I did not press the audience to answer more questions since I did not want to put anyone on the spot. I continued on reporting the results, limitations, and my final thoughts on MOC in general.

Question and answer time arrived. Dr. Ellenbogen started off and again asked a version of the same hypothetical question Dr. Knight had tweeted earlier - if you had a loved one in another city that needed a cholecystectomy, who would you pick, a doctor who was board certified or someone who was not?" Of course, this question was a straw dog. We are not talking about initial board certification, we were talking about a re-certification product that, unless purchased, invalidates a physician's initial certification. Dr. Ellenbogen then urged one of the ACC Presidents to respond. I would see Dr. Valentine encouraging Dr. Kovacs to step forward, which he somewhat reluctantly did as he complained he really wasn't unprepared. But he sat down and shared the ACC's position: that CMP was a "different" pathway and that doctors have a commitment to show they "keep up."

Then several of the audience members stood up and gave emotion-packed questions of why only select sessions at this meeting are "approved" for CME while other, informative learning (like poster sessions) receive none? "We have to follow rule stipulated by the ACCME," was the (paraphrased) response. On and on it went, back and forth, but NOT participating in some form of MOC was never an option despite my seeming rational lines of logic ("Why grandfathers?", "Why no other country requires "maintenance of certification?", all falling on deaf ears.)

Afterward, I felt like I had just been through a few rounds in a boxing ring but had survived. Everyone left a bit worn, but unscathed.  Ethan J Weiss, MD tweeted from UCSF, "Who won?" I can honestly say that neither side "won." This really was not a debate. MOC continues and at least five antitrust lawsuits against the ABMS or its member boards are filed. But it was clear that working physicians and our little organization, Practicing Physicians of America, are having an impact.

I also came to realize that this battle's far from over.


PS: Please consider donating to our efforts to support those trying to end MOC for all subspecialties nationwide.


Anonymous said...

"We are listening." What a show!

Blind Studies With One Eye on MOC and the other one on the Money said...

MOC and MOC science are totally worthless.

Pro Racket said...

The Wolves of MOC Street

The "WOLVES OF MOC STREET" [in sheep's clothing] are herding their excellent sheep in the fields of medical sub-specialty. Keeping their "STAKEHOLDERS' FLOCK" in line with fear and intimidation. Controlling the numbers and value of everything. Keeping the highly trained sheep inside their STAKEHOLDERS' fences by telling them it is voluntary "SELF REGULASTION".

And they convinced the sheep to pay for it all with their fleece, flesh and hides.

Anonymous said...

CMP reveals how extensive the MOCeteering is. Look at the HRS and their top sponsors/stakeholders that they get money from. It's not a charity. Executive payouts are huge. It is a money-producing enterprise and serves the medical industry they represent. Technology is prominent. Medtronic, Boston Scientific, St. Jude Medical.
Look at the extensive data game with ACC registries and their comrades at HRS and thousands of medical systems/health related companies. The BHRS in the UK (even after several makeovers and name changes) is not much different in serving corporate stakeholders. Except in the UK they don't require MOC. MOC fuels graft. MOC by design encourages racketeering. British media/testing giants and other healthcare corporations make their MOC money from the US with their captive customers -- MOC mandated physicians -- and they are looking for expansion through thousands of pathways including the "specialty boards", medical companies and educational institutions in the EU, ME and Asia. MOC is bad for fair trade all the way around the globe, because it does not just limit competition, it stifles it and destroys innovation/free scientific thinking. MOC is antithetical to science and the profession of medicine. The moral foundations of our society are imperil because of racketeering systems like MOC. It needs to go, but those who get a big paycheck from MOC/CC, and from sitting on corporate boards/revolving door government positions don't want MOC to go. They want status quo with green bucks in their pockets and offshore investment accounts. Where is the integrity? Will ethical action ever make a comeback in the US and abroad.

[Playing] RUFF RUFF said...

Now this is a real straw dog.

The ABIM Foundation propaganda machine presenting Richard Baron/Dan Wolfson with a cunning disinformation campaign on "trust".

Think about what they are doing. It is sickening to see such PR stunts attempting to change the subject and make the aggressors appear like the victims. The situation with MOC at the ABMS medical specialty board turns my stomach.

Lying/making up distracting slogans/twitter nonsense about virtues they do not possess and could not buy in a million years with all the transferred assets/offshore money in the world.

What Richard and Dan are doing is so unbecoming and gives the word professionalism a bad name.

Where the Buck Stops said...

What is scary to me is that one of ABIM's top dogs on the medical specialty boards, Rich Baron, is looking more and more every day like the ABIM Director of their "Bureau of Investigations", Benjamin Mannes. Alias Ben Mendelson, Ariel B. Mannes, SME and many other names/roles/impersonations of bogus people with mock authority/fake public safety concerns.

In fact, Dr. Baron got sweaty armpits running the "office of Investigations" legal team liason bureau persecuting their "captive customers" and competition in the "medical review" markets beginning in 2008. The understudy to Chris Cassel presumably engaged in all this mayhem to qualify for that big payday/top honcho position at the ABIM.

Forgive me for speaking the truth in a time of big fibs and false image projection. If the ABIM was concerned about trust and gaining trust they would have announced the end of MOC years ago before they turned into those nasty people with dishonest smiles and professional airs.

Did the ABIM CEO/ABIM Foundation lead Wolfson mention a lack of trust in journalism today. One of the roles the ABIM's Director of Investigations played recently was impseronsating a journalist with the Buck County Courier. Yes, just look at the fake journalism the ABIM produces from the Offices of Investigations and the Communications VPs who hide in the shadows of the 17th floor hallways and never have press confernces with questions -- tough questions about their tax returns/financial dealings behind the scenes/secret lobbying/conflicts of interest up the whazoo.

I am tired of lies and facades at the ABMS. MOC has begun to destroy trust in the HRS and ACC. When is it going to end!?

Anonymous said...

You are managing this in the wrong way!!!!!!!!

I am a businessman and I work with doctors all the time. In the last couple of months, I have been interested and following this “physician movement” against the ABIM, David vs Goliath.
A couple of question immediately came to my mind:
1) Physicians study 4 year in accredited med schools. Those schools follow rules, regulation, and quality by the LCME.
2) After medical school physician performs residency and fellowship in Accredited training programs. Those programs are regulated in terms of requirement and quality by the ACGME, assuring the graduated possess the requirement needed to practice in the specialty trained for.

So, Why those physician trained in regulated and accredited “educational program/institutions” are mandated to certify them self by a Non educational corporation by private physicians and arbitrarily defining quality?
ABIM its a business: They have done such an amazing job making ABIM certification relevant that even people believe that if a physician is not board certified they can not practice the medicine. Non-federal or state authority has ever required an ABIM certification for a physician to be legally able to practice the medicine in the US. ABIM has involved insurances, hospitals, professional societies in the biggest effort I have ever seen to sell a “product” (as they define the certification) coming from a non-profit corporation. They run the perfect business: “created a need in order to sell the solution”. They have created this nonsense need to certify the quality of physician already trained in certified and regulated Educational programs. Even more, according to ABIM statistics, 90% pass in the first attempt, is this not already telling you the guys are coming out of training in a good fashion?

Does this botter the state and federal authorities?
Seem that holding an unrestricted license to practice the medicine is not that important as been board certified. When was the last time you were asked about your medical license? And when was the last time someone mentioned your board certification status?.
If I was a federal or state authority I would certainly be bothered by how relevant this “voluntary”, not legally required certification has become, undermining official regulation.

Why the physician allowed this to happen?
Sorry to say but I realize how megalomaniac and egocentric you guys are. You guys like to show how much you know, you guys like to be the “best in the field” and you have to be honest: you guys LOVE to be a “BOARD CERTIFIED PHYSICIAN”.
You guys are not going to win the war against ABIM. Because big battles ALWAYS require some sacrifice, and you dont want not to sacrifice anything.
In order to win, you should target the purpose of the ABIM itself, not the MOC. But you guys are not willing to sacrifice the Board certified physician label, even If you win the MOC battle, ABIM WILL come up with something else and so over and over, its never going to stop unless to make ABIM disappear.

ABIM should disappear and, if you still want to be labeled as board certify, a new institution should be created under the watch, and supervised by “EDUCATIONAL INSTITUTIONS”, a new board run by ACGME programs with board members representatives elected by the same ACGME programs and the certification should be mandatory for every ACGME graduate, if they do not pass, they do not graduate.

I am going to finally put this in words you will understand better: CURE THE DISEASE, DO NOT TREAT JUST THE SYMPTOMS.

Anonymous said...

The ACGME is a big part of the disease. LoL. The results are more toxic than a superfund site. And the underlying corruption that created the waste. That's the ACGME. Check out the farce called ACGME International. Completely made up standards for dictators/tryants in the Middle East and Asia. "You pay we will play"(or let you play) is their motto. In Singapore virtually unlimited work hours for residents, because it suits the regime and budget of the health ministry. The ACGME displaced the British system of medical education through some intrigue that nobody is willing to talk about or report on. Military hardware may have part of the package.

Inga Stockholm (cover mania said...

MOC is insane and those pushing it are scandalous. The ABMS/ACGME (along with ACC/HRS) executives have been ignoring facts about the harm MOC does. Trade associations under the guise of 'medical specialty boards' and "members-only GME accreditation clubs" have been playing political games with physicians and patients for decades in order to line the pockets of their corporate stakeholders on "Wall Street". The ABMS/ACGME bwanas on "Easy Street" have enriched themselves personally in the process of making lucrative markets for their real stakeholders. (Pearson Vue and Wolters Kluwer are examples.)

How can cardiologists with ACC and heart rhythm society members align themselves with the ABMS and ABIM? The track record/history of conflicts of interest and being "on the take" from toxic Wall Street corporations are rife with examples for anyone to discover. This is in direct conflict with their (ACC/HRS) philosophy of healthy heart, scientific advancement and charitable giving. The ACC and HRS imo are not good bed-fellows with the ABIM/ABMS. Or maybe they have changed? They have their moral compass and ethical wheels stuck in the ditch.

Need a few real world examples?

Thomas Brem as head of both the ABIM and ABMS (advisory board) during the 1960's onward took money from big tobacco slush funds to support their bogus science/lobbying efforts in congress. Why? In order to support tobaccos' poisonous industry and flimsy science. Brem, MD did so by obfuscating the known science that tobacco addiction leads to cardio-vascular disease and cancer. (1964 Surgeon General Report/Warning on tobacco addiction/use.)

Christine Cassel took money from corporations that could directly benefit from her positions as full time lobbyist/revolving door medical politician for the ABIM. Cassel engaged in partisan politics and corporate catering/profiteering at the expense of ABIM clients who were unwittingly paying the newly created MOC program fees, so the ABIM could advance their self-dealing political and monetary interests.

Richard Baron has been secretively working behind the scenes at ABIM from before 2001 helping create the MOC money nightmare, onerous menace and political machine it is today. He worked as a revolver for the government and sat on boards/committees at the NQF, and NCQA -- both corporate driven companies with massive power over healthcare systems' profits/products/services offered/recommendations and institutional/corporate profits.

A former ABIM chief of staff/human resource director/ethics chief, Suzanne Biemiller, who had no medical background whatsoever worked as a political activist/makeover PR expert without disclosing the fact that her husband was executive at Glaxo-Smith-Kline. As a former deputy chief of staff for Mayor Nutter of Philly, GSK gave the mayor's office millions of dollars with "no strings attached". GSK was given preferred status in the advancement of property/real estate boons when the pharma giant moved their corporate offices to a new location at the prestigious Navy Yard.

A double felon (dirty cop) was hired to police physicians without disclosure or acknowledgement of his existence . . . even to this day they have never acknowledged or answered any questions about this tragic chapter in ABIM/ABMS history. Richard Baron and Crhis Cassel played a large role in the hiring of their thug investigative unit and cover-up of a great deal of other wrong doing. Constitutional violations. Privacy rights ignored.

And on and on . . . you name the conflict of interest . . . ABMS/ABIM did not disclose it . . .

Is the public in denial about the ABIM/ABMS or just physicians? Everyone needs to wake up along with executives at the ACC and HRS who are plenty awake but too "financially involved" apparently to speak about anything real in this bad relationship with the medical specialty boards and their accomplices. It is all getting worse by the minute.

AD HOC DEM COM Press said...

We have ostriches carrying their own sandboxes around the country. What are they doing?

Reports are coming in that ABIM/ABIMF executives are gallivanting around Senimnars/Conferences/Town Halls (wherever the expensive PR firms can book them) talking about TRUST!

The politically active head of the ABIM on the campaign trail saying, "I am not a crook?"

How can "white collar thugs" talk about trust, when the corporations they head/in charge of are in the federal courts accused of unfair trade practices/monopoly pay-top-lay antics -- all of it involving racketeering and unjust enrichment?

As many have already pointed out. Why do we have to get the truth from blogs and almost nothing from our trustworthy news journalists?

Do we have a media blackout on MOC and ABMS corruption, because the "ABIM Communications Veterans" and their corporate sponsored proxies have most of the major journalists/media conglomerates in their pockets?

We saw in the past how the ABIM/ABMS could manipulate the press -- Wall Street Journal, CBS, NY Times, Philly Inquirer . . .

It is a pity that the First Amendment and Press Freedom/Speech are being swept under the carpet by "the cleaners".

ABIM Professionalism As Policy Lever said...

"Richard Baron @RichardBaron17
Professionalism is an underutilized policy lever. Great to see these authors making the case so clearly"

How "professional" is it to propagate a scam (MOC) with policy levers to shake down the medical profession for money with dire consequences. The ABIM/ABMS is creating an atmosphere of oppression, fatigue and depression in the family. We are talking about a family of highly trained, skilled, continuously educated physicians, who do not need a bad cop stalking/distracting them, telling their captive clients how to treat patients through politically and financially conflicted mandates. One of the scam levers is time-limited certification with the introduction of a new "product" called MOC, through which the ABMS is deciding who works, how and where. (Taking away certifications if you do not pay/play while forcing their political agenda on everyone at the same time.)

ABIM Cares? (One day out of a hypocritical year!) said...

Does the ABIM care about their diplomates and candidates at all? Obviously they don't. With them it's contrived science and ludicrous political show. "'Smokes' and mirrors." I wouldn't be surprised if most of the execs at the ABIM/ABMS are depressed and bored with their harmful invented roles. The unreasonable role of distracting, torturing and harassing physicians who are trying their to work and live to the best of their ability in spite of the ABMS medical boards.

Giving a few dollars to 15$ mom and pop charities (that may or may not exist) just for media show is hypocrisy. Why? At the same time ABIM/ABMS thugs/corporate hit men led by a double felon and "government revolvers" Cassel and Baron spent millions of $ suing/intimidating their stakeholders' captured labor force during the same "charitable year". Such obvious fake charity does not set a precedent for "caring" or set an example for "professionalism" when they (ABIM) simultaneously throw their colleagues under the bus wheels. Recently they've done the same thing wearing a fake camera smile/propaganda sweatshirts with patently false slogans making subway sandwiches for the folks of Philly who do not make 450K to 1000K a year. While spending 5 years prosecuting many additional physicians with intimidation/sanctions and career threatening lawsuits.

("ABIM CARES."® 2017 PR makeover. "Transforming from an [autocratic] authoritarian organisation to an inclusive one.")

Slick ABIM PR. Check out their disinformation campaign on MOC Myths called "MOC myth busters". It is almost as hard to follow as the ever-changing complex testing requirements/onerous additional busywork and continuous and increasing cash demands.

MOC S. BOOMING said...

ACP and ABIM offer separate "educational" products in the same lucrative US markets.