Thursday, August 15, 2019

MOC Issue Embroils EP Community

After I circulated my fund-raising video two weeks ago to the Electrophysiology Community via the Heart Rhythm Society (HRS) closed message board, a firestorm of challenges to the HRS leadership have erupted online. At their core, the HRS is now under increasing pressure to decide with whom they side: (1) their physician membership or (2) other corporate interests. The exchange has become so heated that the HRS has decided to issue a new "survey" to gage how their members feel about "continuous certification" and lifelong learning via the MOC paradigm. The re-issued survey closes 19 August 2019 and HRS members are encouraged to complete that survey just (re-)sent to them. (The first survey was shared publicly on social media and many physicians responded anonymously, making it difficult for HRS to determine their membership's responses, we are told).

Here are just a few of the comments being circulated, even as late as today, as HRS leadership try to defend their relationship with the American Board of Internal Mesicine (I have chosen to make comments anonymous out of respect to those who have made their feelings known publicly).
  • "Love it or leave love it. I am so looking forward to my body frisk looking for cheating materials at the Pearson View testing center in December - a $1200 massage will put me in the right frame of mind to take a day-long test, much of the content of which has no relevance to the things that matter towards helping my patients to live longer or live better. But no worries, I'm sure the HRS Board Review course (estimate >10K with room, board and lost wages, not to mention deduction from time for meaningful CME) will enlighten you as to the latest nitty gritty in IKwtf, so you'll be awesome at parties."

  • "As I’m sure you are fully aware, this money grab and power grab are far deeper reaching than most realize and your suggestion to deal with it locally cannot work. It’s extremely disingenuous of you to imply otherwise.

    A few years ago I decided to stand up for what I considered right and take a stand against the ABIM/ABMS. I refused to participate in MOC (though I go to HRS and a few other meetings every year and consider myself beyond competent). When my 10 years were up I chose not to take the recertification exam. I became board certified by the NBPAS. My local credentials committee didn’t know what to make of it, but when I met with them and explained my objection they went along. I told them if they didn’t I was leaving and I’m the only one who does a lot of the things I do in my institution. Then the insurers (BCBS) net with administration and their opinions changed. BCBS said they could no longer pay for anything I did unless I was pursuing recertification. The hospital administration said I needed to take the ABIM recertification exam or they could no longer employ me. I told them that’s fine, then I’ll quit and go into private practice and just see CMS patients (they don’t require ABIM certification). Administration told me if I did that then my privileges would be revoked. As I send this message I’m waiting for the first session to start at the board review course. I will never take this exam again. If this same bullshit exists in 10 years then I’ll retire at 56.

    Please don’t pretend that you are unaware that the NCQA which certifies insurance companies are in bed with the ABMS/ABIM who certify physicians. Don’t pretend that you are unaware that there are members who sit on both boards and profit tremendously off the backs of working physicians. I’ve met with the insurers who tell me they’d like to allow me an exception, but NCQA requires that all the physicians they contract with are ABMS (means ABIM in the EP world) board certified.

    So there you have it. ABIM requires MOC. If physicians refuse they revoke their certification. If they continue to object or seek alternative certification (NBPAS, IBHRE) then the rely on the NCQA to pressure payers (they threaten to revoke the insurers NCQA certification if they have physicians on their panel who are not “certified” by the one true board) to force physicians back in compliance by removing them from their panels. If physicians continue to refuse the payers threaten hospital administration and they threaten to revoke the physicians hospital privileges. If you don’t see a problem with this then I suspect you have a conflict of interest. Again please don’t attempt to deceive the HRS membership."
I have warned prior physician-presidents of HRS about this controversy, but it never dawned on me at the time that physicians no longer control the organization. That task, like so many in medicine today, was relegated to a non-physician non-profit executive long ago. It will be interesting to see how this will play out going forward, especially since the MOC monetary and conflict of interest genie is out of her bottle. The HRS leadership, be they physician or not, has a very serious fundamental decision to make: side with their physician membership, or side with their conflicted corporate partners who will stop at nothing to assure their profit margins.

Working cardiac electrophysiologists know that HRS has advocated for many of their needs over the years, but on this issue and it potential to affect their right to work, the conflicts of interest inherent to MOC with insurers, group purchase organizations, and hospital systems present a formidable challenge to the entire HRS leadership going forward.

Trust take years to develop. Let's hope HRS doesn't lose what they've earned in a heartbeat.



Anonymous said...

Moneyed interests.

Anonymous said...

Money rules the roost at the ABMS. ABIM has done nothing good for physicians only undermine.

Anonymous said...

Every physician should refuse to work in any capacity for the ABMS. We should also encourage any colleague who is working for the ABMS to resign until MOC is abolished. Remind these colleagues that the current ABMS is an evil institution whose greedy leaders are significantly contributing to physicians overall stress, burnout and decline in mental health. These leaders are collecting vast sums of money by extorting physicians with the threat to revoke hard earned board certification. This can lead to loss of hospital privileges, insurance contracts, and jobs. It is repulsive that these greedy leaders do not care if these losses deprive sick patients of medical care by competent and caring doctors. Remember that there is currently a physician shortage. When possible, physicians should try to obtain jobs that do not require continuing board certification through the ABMS or encourage their current employers to reject this requirement. Acceptance of non board certification or non ABMS certification by some health insurance panels will unfortunately be the next uphill battle. Hopefully, the Department of Justice will continue to examine and address this ongoing injustice and probable criminal activity. Keep fighting the good fight!

The Making of Corporate Medical Monopoly said...

The ABMS "advisory umbrella and medical specialty boards" no longer exist as originally conceived and intended. This is obvious with the invention of MOC to pad their revenues/executive payouts. What people may not know is history. A significant part of medical specialty board history is about its original mission. The "mission" of certification boards was quietly achieved in the 1970's and 1980's when the initial decades-long saturation of the professional markets was first achieved. A milestone that should have been clearly stated/announced, by these compromised trade associations. But for obviously conflicted reasons it was not announced and plans for more profit for executives were initiated. And more collusion involving financial and political control of the healthcare industry, physicians and healthcare agenda was planned and carried out. This includes the use of executives and surfeit monies for political lobbying and collusion with special interests such as we see in the most recent decades in the post MOC era.

From that point onward, the era of MOC, the ABMS/ABIM literally became a corpus of secret societies acting without transparency or in the interests of patient or physician. A coup was literally launched against self-regulation, the profession and the public. This all corresponded with the booming health industry revenues/profits in an increasingly technological/costly healthcare system. We see the stranglehold that large systems and payers and the control they began to wield. Before this, the ABMS/ABIM was certainly political clandestinely, but did not operated as a cash cow for conflicted or financially motivated executives/industry proxies at these once-upon-a-time non-pecuniary certification societies.

They lost their focus on mission (certification) and became financial and political juggernauts.

Incidentally, there were few certified physicians during the 1930's depression years and during WWII. Certification had its initial traction only in post-WWII America gaining slight momentum through the periods of US involvement in the Korean "war" (of the early 1950's) and seeing increased numbers of certified physicians during the Vietnam era. This was extended into the post Vietnam war era with strong certification market growth.

Of note, the introduction of social security act of 1964 brought secretive change in specialty board bylaws allowing for independent executive leadership without term limits. What were once non-pecuniary sleepy testing corporations became for-profits entities almost overnight with the stroke of an ABIM/ABMS pen, while the final drafts of the 1964 Social Security ACT were being prepared/honed for final passage in both houses of congress.

Most of the ABIM/ABMS revenue growth occurs after conflicted/industry colluding executives started leading the medical specialty testing corporations. Non-profit status should have been questioned by the IRS at that point as executive as compensation skyrocketed and revenues were flush with surfeits of revenues leading to hidden/hoarded profits. Executive compensation increased and the creation of corporate slush funds such as the controversial ABIM Foundation, which was created in 1989 with only one signatory - an independent executive in charge of finances and investments at the ABIM. In the case of the ABIM/ABMS we saw the march toward virtual monopoly status after the invention of "MOC" and related creation of the NCQA in 1989/1990. The collusion between the NCQA, large providers and insurers has a troubling aspect to it, when we examine the timeline and headlock that eveyone is held in by with the creation of the NCQA with funding from the insurers/fortune 500 advocacy via private foundation funding.

Anonymous said...

The MOC spectacle has been a story of greed and collusion. MOC needs to be investigated/exposed with correctional intervention by the courts/US Justice Department.

The ABMS/ABIM has failed the profession and the public. Unfortunately, the ABMS "advisory" and testing corporations (currently 24) have morphed into an egregiously conflicted and greedy body of membership trade associations that collude with the medical industrial complex. And we must add they insult the intelligence and do further harm to patients and physicians by engaging in duplicitous corporate and political propaganda under the heading "professionalism" to maintain its monopoly status and unbridled sway over physician work relationships/livelihoods. They preach ethics without practicing such ethics themselves.

Moreover the ABMS -- this twiny fascia of non-profit corporations-- actively engages in deceiving the public and betraying the profession they falsely claim to be "of". ABMS Executives ruse the healthcare industry and the public through the constant use of false/fake narratives/public relations campaigns. Self-regulation and voluntary certification/re-certification are both a large part of that false narrative -- along with hypocritical and conflicted propaganda relating to physician professionalism. You cannot make up stuff like this. Such absurdities involving compromised executives and board members/officers self-appointed leaders speaking, not for the profession or public with its safety in mind, but solely for the ABMS and their 24 medical specialty boards and affiliates.

Decades of self-appointed executives and their conflicted/passive medical specialty boards, plus co-opted highly conflicted medical specialty societies are the core roots of the present MOC debacle.

The US Dept. of Justice is supposed to protect the public and the rights of individuals working diligently to serve the healthcare needs of nearly 400 million people.
This is not a time for doctors or patients to remain passive thinking that their overburdened systems of justice will take care of them. It is a time to act and aggressively end the corruption of the ABMS and their associates/affiliates.

ABIM on Trust (MOCiavellian Propaganda)? said...

The ABIM Foundation's expensive propaganda campaign on the topic of "trust" in healthcare is one of the most sickening and hypocritical examples of an egregiously conflicted organization appearing not only frighteningly bogus, but lacking honesty/capacity for self-reflection. In the sense of trust and transparency the ABIM has changed only in how they project their image. They have done so at a cost. The ABIM has transformed their Public Relations department/external contractors into something dark and medieval. With their superficial window dressing, the ABIM has "transformed" themselves (in such a sickeningly false way) to the point and extent that they appear Machiavellian.

When Dr. Baron mentions the ABIM and being its "head" (CEO) in his recent TedTalk on TRUST in Chicago, he draws the greatest laughter. It appears working for the ABIM or the organization itself has become a joke.

MOC said...

Maintenance of Corporation?

Location " " said...

The regimentation of physicians (MOC plays a key role) is a result of greed and lust for control/power. A subjugated professional labor force serves the corporations and investors who want greater profits and dividends.

Anonymous said...
This comment has been removed by a blog administrator.
Anonymous said...

If every single physician simultaneously and en masse refused MOC and refused to be on staff at hospitals, we could shut this whole down immediately. When you've worn down your physicians to a nub, is this who you want implanting your pacemaker? This entire scheme of abuse, racketeering and graft is destroying thousands of doctors. The doctor shortage is here. NP's and PA's can only go so far...I wish these abused doctors would cross state lines or open free standing centers that do not play these games. Oklahoma is endorsing physician freedom but not everyone can pick up and move. I pray every night for the destruction of the medical-corporate complex from JCAHO/NCQA/ABMS et. al. down the line.

SRMColorado said...

I agree. The only way to fight them all is for every physician to refuse to participate. The hospital I work in has increased my documentation time by 1 1/2 hours daily “preparing for JCAHO visit”. None of this has anything to do with patient care. I am planning on leaving in the next few months due to the increasing demands without increasing payment.