Thursday, May 23, 2019

The Bizarre Week of Pro-MOC Activities

"ABIM is disappointed to learn of a lawsuit filed on behalf of four diplomates. The organization will vigorously defend itself, recognizing that doing so will consume resources far better dedicated to continuous improvement of its programs."

- ABIM blog

What a bizarre week it has been by those who support Maintenance of Certification (MOC). Despite the growing uproar in the working physician community, it is becoming clear that the proponents of MOC are circling their wagons in an effort to go "all-in" on the program.

  1. First came the article by highly conflicted members of the ABMS Vision Commission that was published in JAMA by Christopher C. Colenda, MD, MPH, William J. Scanlon, PhD, Richard E. Hawkins, MD.

    The authors listed the following conflicts of interest:
    "Dr Colenda and Dr Scanlon served as co-chairs on the Continuing Board Certification: Vision for the Future Commission. Dr Colenda is president emeritus of West Virginia University Health System and founder and principal for Christopher C. Colenda, LLC, a firm that provides consulting services to academic health care institutions and organizations, reported receiving personal fees from the Association of American Medical Colleges (AAMC), The Ohio State University, Virginia Tech/Carilion School of Medicine, and Loyola University School of Medicine, and serves as the "of counsel" role with Witt/Kieffer Search, an executive recruiting firm. Dr Hawkins reported receiving personal fees and royalties from Elsevier."
    Of course the authors failed to mention their other significant conflicts. Dr. Colenda was a member of the Board of Directors of the Accreditation Council on Graduate Medical Education (ACGME), the National Board of Medical Examiners (NBME), the American Board of Psychiatry and Neurology (ABPN), the AAMC's Administrative Board of the Council of Deans, Health Systems Governing Council of the American Hospital Association (AHA), and the LCME, where he was chair from 2012-13. Dr. Scanlon served as a "Consultant" to the now-obsolete National Health Policy Forum, a group created to help the government determine how doctors should be paid that was funded (in part) by Blue Cross Blue Shield, the Robert Wood Johnson Foundation, and the Josiah Macy, Jr. Foundation. Both the Robert Wood Johnson Foundation and Josiah Macy Jr. Foundation have donated significant funds ("grants") to the ABIM Foundation to foster the "Choosing Wisely" campaign and "team based" health care delivery. Dr. Hawkins, currently serves as President and CEO of the American Board of Medical Specialties (the owners of the MOC® trademark) and ABMS Solutions, LLC that sells physicians ABMS certification status, updated daily, to third parties.

    God forbid they mention these facts or the editors of JAMA provide professional scrutiny over disclosures.

  2. Second came the plethora of new, costly MOC-preparation materials offered by the American College of Physicians and American Board of Internal Medicine. The business of re-certification is stronger than ever!

  3. Thirdly, the Heart Rhythm Society suddenly became "concerned" that HRS members are losing their ABIM certification. (Who knew?!?) In an announcement to their members after siding with the ABIM and the ACC to create the CMP pathway, they "woke" from their slumber and said:
    "There has been some confusion among members who are not participating in MOC that they should be listed as "Certified, Not Participating in MOC," This has been the case, however, for those last certified in 2014 or later, certification will be forfeited after 5 years of non-participation in MOC. To reiterate, if you certified after 2014 and you have not been participating in MOC, you will be listed by ABIM as "Not Certified" after 5 years. While this has been communicated by ABIM since 2014, we are now seeing the first of our members being negatively impacted by this requirement."
    It's a bit hard to believe that they were unaware of this little right-to-work "problem" with MOC. How did they turn a a blind eye to the many MOC problems as they forged ahead to create the EPSAP educational product for MOC re-certification and the ACC's CMP pathway? Where is their concern over the discrimination against younger physicians certified after the 1990 "grandfather" date? Is another layer of discrimination for those re-certified after 2014 and threatened with losing their certification any different? HRS members on that forum have spoken clearly to the HRS leadership: "Collaborating with corruption is to condone it."

  4. Perhaps the most entertaining thing that appeared this week, however, was an anonymous Twitter account created by an professor at a major academic medical center who serves in a senior leadership position at the American College of Physicians. (Remember, nothing is truly anonymous on the Internet). That account aggressively trolled/baited/harassed anti-MOC working physicians online. Here are a few of the best tweets:
    • "I'm not going to discuss GF (grandfathers). Get over it. What a false flag."

    • Or when responding to concerns about the purchase of a $2.3 million condominium purchased by the ABIM Foundation: "Ignorant comment. Knew you'd go there. That was not corrupt. They used it as a cheaper alternative to hotel stays. Once it went, they had to pay more of your money to house people. Nice job zealots!"

    On and on the tweets went in an unbridled, unprofessional and immature fashion until the account creator was exposed. Then the account went private. As Shakespeare's Hamlet famously said: "The lady doth protest too much, methinks."

  5. Finally, in a Medscape article, the former President of the American College of Cardiology, C. Michael Valentine, MD, suggested that the ACC is prepared to enter the physician certification business by issuing "certificates" for physicians participating in their new Collaborative Maintenance Pathway MOC product:
    "We feel that this gives our members the most options available," said Valentine. "If you decide that you don't want ABIM certification, you can opt out and just do ACCSAP or Cath SAP or EP SAP and we'll then give you a certificate from the College saying that you are engaged in online continuous learning through the College…but that may not be accepted by your hospital or your health system or your payment system. All it says is you're engaged in our SAP program and continuous learning."
    ACC Certification now? Really? For twice the price, too! Never mind that pesky little detail that hospitals and insurers don't currently recognize ACC's CMP without its tie to ABIM's MOC requirements.

It's a shame that the antiMOC battle has come to this, but its really not surprising.

A shift from the corrupt MOC status quo was (and continues to be) inevitable.



Anonymous said...

the ACP has got to be the most pathetic organization i have ever seen. it is so transparently about selling items to doctors: 700-900 dollars for an ABIM MOC review material! they do not represent physicians interests at all.

Anonymous said...

It's fair to say that the ABMS is scant on disclosure/discussion of real issues, especially involving MOC. But besides this, things like secretive lobbying or back-door financial brokering/political manipulation are beyond troubling. Tax filings have been demonstrably inaccurate and in fact rather rarified in accounting leaving one scratching one's head. Tax returns don't add up or tell enough story regarding for-profit activities.

I have a direct question here. Is the ABMS or any of its member boards along with the ACGME telling us the whole financial and political story? Do they receive any undisclosed money from corporations or government (for cash or non-cash services) that are of mutual or private benefit. We have evidence of this from investigations of ABMS CEOs involving the NQF for example. The ABIM/ABMS did not dislcose and did not feel an ethical/professional need to be honest with the public and clients.

I believe we all want facts and we deserve facts not propaganda and PR spin.

Anonymous said...

Discrimination in practice?

How can one run a specialty board if the elite insider executive politicians don't practice medicine? Or been out so long as to be out of touch.

If one does not practice/administer with real skin in the game, how do they know what it feels like to be a non-grandfathered physician? A physician facing discrimination with a full plate of onerous unnecessary burdens. MOC is one of the recurring entrees that tastes and feels like cardboard or a piece of brick.

Anonymous said...

Keeping up with medical practice licensure/CME/graduate medical education requirements at the -- AMA/ACGME/ABMS/ACCME/ACP

I see many ABMS/ACGME associated doctors don't participate in MOC or have a full and unrestricted license to practice medicine to even be certified in a medical specialty.

Does the AMA/ACGME/ABMS/ABIM/ACCME/AMA/ACP require medical specialty certification and full participation in MOC for its executives, associates and volunteers in order to be in good standing with the organizations for active employment and educational participation?

If not why not?

Do these organizations require a full and unrestricted medical license for medical specialty certification and participation in MOC to be considered a valid/high quality participant? If so, who pays for it and where are they tested? Can we see the Pearson Vue receipts with location and time?

Does retired (active) status satisfy ABMS professional requirements for having a full and unrestricted license? When the state does not allow retired status docs to practice at all. For example, according to Pennsylvania medical board, active retired does not qualify as a full and unrestricted license. CME is not required for retired active. (Except for a couple of opioid and child abuse credits.) After four years in retired status if one wants to reinstate to a full license it requires the examination/approval of the state medical board.

Another example ACGME review committees, "volunteers" who are typically chosen by the AMA

"The volunteers who serve on the ACGME’s residency review committees are
appointed by the AMA Council on Medical Education and the appropriate medical
boards and specialties. They are recognized as the leaders, experts and innovators
in their specialties, dedicated to excellence in medical education.
It is with their support that the ACGME is a leader in improving the quality of health
care in the United States by ensuring and improving the quality of graduate medical education.
It is with pride and gratitude that we acknowledge their contributions."

Many do not participate in MOC at all! Has anyone really taken a honed look at the organizational structure of all these partnerships? Why are conflicts of interest behind a paywall or hidden from view? The public does not get a fair chance to see what is going on behind the closed doors. Nor do most physicians who hold the biggest stake, or at least should.

ACGME-International LLC - for-profit or not-for-profit said...

Here's some interesting bit of information on the ACGME and their global interests

The IRS does not have any "not-for-profit" corporation listed as ACGME-International LLC

"In 2009, we created the Accreditation Council
for Graduate Medical Education International LLC
(ACGME-I). It is a non-governmental not-for-profit
organization responsible for the accreditation of
graduate medical education (GME) programs outside
the United States. Its accreditation processes and
standards are similar, but not identical to those
in the United States."

ACGME's IRS Tax Filing 2015
EIN 37-0269723 [ACGME-International LLC has its own EIN and is listed in Schedule R under "disregarded organizations"

"Globalism" in medicine after WWII

Talking Heads -- Who's Listening" said...

Ghosts from the Past

ACGME has a skeletal tax return with a lot of bones missing. Wonder what the "missing head" would say if someone found it and it started jabbering away.

Looks like more obfuscation on the globalist agenda calling ACGME-International LLC a "not-for-profit"!