Saturday, October 05, 2019

You Know There's a Problem with MOC When...

... yet another antitrust lawsuit is filed against ANOTHER American Board of Medical Specialties' member board.  This time, the American Board of Orthopaedic Surgery joined the antitrust litigation fray on September 11, 2019.

Look for those Maintenance of Certification® (MOC®) fees to continue to skyrocket as the certification cartel extracts more fees from working stiffs doctors to help pay their mounting legal bills.


PS: Want to help with this David vs Goliath battle to help end MOC®? Click here.


Anonymous said...

A Federal case in a Southern California venue will help tremendously.
As this winds through the West Coast, the chances for a win are vastly better than Center City Philadelphia.
Next stop- SCOTUS.

ABMS MOC® Standard of Excellent Control said...

ABMS raised their fees to member boards by 3% for 2020.

"The ABMS Board of Directors recently approved the 2019 total dues, with a 3% increase, assessed to Member Boards. The 2019 dues also include the 2nd year adjustment of the 3-year transition using the new methodology adopted in 2017. The full effect of the new dues methodology will be reflected in the 2020 dues."

The member boards will blame the lawsuits, but the MB fees are the largest source of revenue for the ABMS as far as we know. Data may have passed it up.

Data programs ABMS Solutions, etc are their top performing assets. International income another high margin enterprise supporting the bulk of the top executive compensation. Multispecialty Portfolio program losing money. Research Foundation droopy. CertLink pilot program a loser.

Interesting that none of the associate members mind having a double standard abroad. In fact many of them are participating in the revenue generating international certification/accreditation/CME cartel by creating their own offshore businesses. ACGME-International, ABMS-International, ABMS-Singapore, the Joint Commission-International

How did it come to this that ABMS and their associates turn their backs on the US physicians forcing them to do MOC, but take the money and run in their offshore testing/accreditation markets? It is corrupt as hell...when you look at the growth in insurance companies global revenue increases and market share.

It is sickening when you see the PBMs gaining market share abroad and scratch your head at all the dots that have never been connected by public watchdogs and the DOJ.

The large "employers" are gobbling up competition in the international markets. UHG is eating up Brazil's hospitals and expanding there core business. In many international markets in the middle east and Asia, that the ABMS and its affiliates (and accreditation NGOs) operate there is little to no competition. It is one ruling family/party that is providing the lucrative handouts. ME Foundations that do not think twice about kickbacks.

Clearly MOC is a scam to generate revenues for the executive largess in the US and for the benefit of their internal and external stakeholders both domestically and offshore.

Offshore certification revenues are from lifetime certifications the rest from "consulting".

ABMS/ABIM MOC Double Talk Double Standards said...

The ABMS-International is administering an offshore testing programs in Singapore and they do not require MOC. Singapore transitioned from the British system in 2008-2010 and worked with the ACGME-International and the ABMS-International to develop a less onerous system the met the needs of the population. The ABMS and associate member ACGME have a duplicitous double standard in their offshore market in Singapore.

In the US MOC is required by the ABMS and medical specialty member boards and it is getting more onerous and more complicated/confusing/bizarre all the time. Loss of certification means loss of livelihood and reimbursement in the current environment. Not meeting MOC requirements means loss of certification. The proverbial catch 22.

The ABMS argues publicly that certification should be only one consideration in physician hiring and reimbursement, but they work with their internal stakeholders to lobby the government and push their external stakeholders to do just the opposite in fact. That is, the ABMS cartel pushes hard for their external stakeholders to require ABMS certification as a necessity for employment and reimbursement. Nowhere else in the world is it so bad for a physician than the US in this regard.

From an NIH publication in 2015

"The regulatory climate in Singapore currently does not require recertification through participation in an MOC programme or sitting for an examination – yet.(10) However, similar to the requirements of most state medical boards, documentation of participation in accredited continuing medical education sessions is required for renewal of practice certificates (licensure) by the Singapore Medical Council ( Unlike in the United States (US), medical boards and credentialing committees of Singapore-based hospitals and clinical institutions currently do not require staff physicians to undergo MOC programmes or pass recertification examinations."

It is significant to report that in Singapore the ACGME-International and partner ABMS-International turn their backs on physician assisted caning (a barbaric bloody skin peeling/flesh removing brutal punishment). They also allow the residency/fellowship call schedules to be so grueling that it leads to early burnout. Aging population and population increases have led to demand for more physicians, but the demand cannot be met. If the ABMS introduces MOC or any of the tortures found in the US, the Ministry of Health will be looking for an even greater proportion of foreign physicians -- docs they cannot hire so easily or keep for more than their three year contract. As the author of the NIH publication mentions if they introduce MOC physicians have greater incentive at that point to become bankers.

Singapore is an offshore cash cow tax haven for the ABMS through their HOLDING COMPABNY ABIM SINGAPORE AND PARENT ABMS INTERNATIONAL. I don't think they will do anything to rock the boat there. Lawsuits in Singapore against ABMS-Singapore might sink the healthcare system in the Lion City. Along with the entire ABMS umbrella in Chicago.

The are playing with fire in the US. It is just a matter of time before the lower courts, court of appeals or Surpeme Court issues an injunction, if the DOJ does not step in first. If you ask me, the ABMS ACGME dirt is piled up higher than the Chicago skyline.

Anonymous said...

UAE ACGME-International

Abu Dhabi and Dubai Internal medicine programs both suffer from severe burnout, depression reported by Director of program. UAE citizens more severe apparently than enrollees from other countries. (Abu Dhabi program is ACGME-International accredited in 2012)

Internist for hire, position in UAE (Requirements International equivalent of MD/DO degree plus annual CME.)

"Bachelor of Medicine, Bachelor of Surgery, or in Latin: Medicinae Baccalaureus Baccalaureus Chirurgiae (abbreviated in many ways, e.g. MBBS, MB ChB, MB BCh, MB BChir (Cantab), BM BCh (Oxon), BMBS), are the two first professional degrees in medicine and surgery awarded upon graduation from medical school by universities in countries that follow the tradition of the United Kingdom (UK).

The nomenclature suggests that they are two separate undergraduate degrees; however, in practice, they are usually treated as one and conferred together, and may also be awarded at graduate-level medical schools. In countries that follow the system in the United States, the equivalent medical degree is awarded as Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO)."

Context and timeline
John Hopkins International JHI and UAE SEHA (Collaboration on Patient Safety 2012)

Cerner, JHI and UAE SEHA

ACGME-I and its Relevance to ABMS

Remembering Chuck Denham, NQF and Carefusion Kickbacks

2012 Carefusion with UAE collaboartive safety efforts and product sales (JCI)

Anonymous said...

Christine Cassel co-chairs National Academy of Medicine report on scientific evidence regarding causes of clinician burnout as well as consequences for clinicians and patients, and interventions to support to be released October 23.

Register to join the release event in person or via webcast:

Industrial Engineer PhD co-chairs with committee members:RN, PharmD, Blue Cross Blue Shield insurance MD CEO, Mayo academic MD, and Cassel representing UCSF/ABIM.

No private practice or employed MDs.

ABMS Hidden For-Profit Corporations said...


After more and more deceptive propaganda keeps pouring out of the ABIM/ABMS/ABFM and the rest of the medical boards it is very convincing that MOC and the data generated from MOC are programs that should be taxed by the IRS.

MOC is a separate product that was unproven from the start and mostly has been shown to cause harm to the profession and the public. If the ABMS and member boards wanted to sell MOC as a voluntary product each medical board should have a separate incorporation of their MOC revenues. They have committed fraud and tax evasion and the evidence is compelling.

It is as clear as a bell that MOC is a for-profit entrepreneurial income-generating enterprise. The ABIM has around 26 million a year in MOC income listed separately on their tax filings. The US taxpayer is being scammed by the ABMS and MBs. And there are 24 member boards. That is a staggering amount of non-taxed income.

The ABMS has three for-profit enterprises listed on their tax forms in Schedule R. MOC should have been incorporated in the same way. The incorporation of MOC by the MBs as a corporate for-profit subsidiary should have been undertaken by each member board 30 years ago. The percentage of that money going to the ABMS in increased MB fees should have also incorporated as a for-profit subsidiary.

MOC is income generating and the amount is hidden in the obscene compensation packages and golden parachutes for the executives. The board committees sign off on this scandalous form of payout. In return for what should be everyone's question! The ABMS as parent organization of the MOC franchise should be punished imo along with the MBs for their actions. ABMS has received its percentage of the MOC income as kickbacks to the tune of 7 to 8 million dollars worth of MOC enhanced membership fees per year.

The ABMS and member boards have gotten away with a tax doge for over thirty years. Think about the implications of this. ABMS MOC® is not only a scam and Ponzi scheme it is a tax evasion. Each MOC program and reported revenue is actually income for each of the member boards and they should have created a separate for-profit subsidiary for that income as the ABMS has done with its data income and offshore testing and consulting income.

The subsidiaries should have been registered with their respective states Let me repeat this one more time: each medical board should have been taxed on their outrageous income generated for the past 30 years or more from their MOC income.

The tax-dodge-heaven the ABMS and MBs have created for themselves (and their associates) places a lot of burden on the US taxpayer. That burden should be eliminated. The overall harm the ABMS does in the process of generating income and providing favors and enhanced profits for its internal stakeholders and the mega-rich elite external stakeholders should be investigated. The DOJ and IRS need to step up to the plate and go to bat for the people.

The public outcry about this should be relentless until the patient, taxpayer and profession get some relief that they desperately need. MOC should have been eliminated when the AMA House of Delegates voted to do just that. said...

ABMS Vission Commission Contradicts the ABIM

"A national stakeholder survey designed by the Vision Initiative Planning Committee was
conducted at the beginning of this process. In total, 36,392 people participated in the
survey, including 34,616 physicians with responses representing all 24 ABMS Boards and
all 50 states. When physicians were asked if they valued MOC, approximately one in 10
physicians (12%) said they valued the program, nearly half (46%) said they had mixed
feelings about it, while 41% said they did not value the program. The results of this
survey were previously shared and are available in Appendix 4."

Nearly 90% of respondents did not really value the MOC program. Only 1 in 10 found value. page 64

The ABIM PR team, produces another tragic comedy and calls it "research"

Press Release ABIM - 80 culled primary care physicians "curb-sided" in a new ABIM "research" project (questionnaire) - possibly contacted from the 1 in 10 ABMS Vision group survey list mentioned above. It is theater that the ABIM is conducting, not science.


Anonymous said...

I hope I'm not the only one who sees the irony as to Christine Cassell, the person more responsible for clinician burnout than any one other person cochairing a NAM session on burnout. You really can't make this stuff up...

Anonymous said...

Christine Karen Cassel
Oct 11, 2019


Internal Medicine: Certified
Participating in Maintenance of Certification: No

Internal Medicine: 1979
Geriatric Medicine: 1998

Burnout? IT To The Rescue said...

Health Crisis that Demands Immediate Attention - Forbes

"Experts predict that if left unaddressed, burnout will further erode the mental health of doctors and radically undermine patient care."

NAM Committee on Physician Burnout

Christine Cassel puts down that she is from UCSF on the NAM committee header. How misleading as well as the masked intentions of NAM. Cassel is in the Bay area working the private equity circuits for Silicon Valley and her Quality Assurance buds. The study proves it.

"Systems Approaches to Improve Patient Care by Supporting Clinician Well-Being
A Consensus Study from the National Academy of Medicine

Activity Description
On behalf of the National Academy of Medicine, an ad hoc committee under the auspices of the National Academies of Sciences, Engineering, and Medicine will examine the scientific evidence regarding the causes of clinician burnout as well as the consequences for both clinicians and patients, and interventions to support clinician well-being and resilience. The committee will examine components of the clinical training and work environment that can contribute to clinician burnout in a variety of care settings, as well as potential systems interventions to mitigate those outcomes. The committee will identify promising tools and approaches to support clinician well-being, identify gaps in the evidence base, and propose a research agenda to address areas of uncertainty. In developing its report, the committee will consider key components of the health care system, including:

factors that influence clinical workflow, workload, and human-systems interactions;
the training, composition, and function of interdisciplinary care teams;
the ongoing movement toward outcomes-based payment and quality improvement programs;
current and potential use and impact of technologies and tools such as electronic health records (EHRs) and other informatics applications; and
regulations, guidance, policies, and accreditation standards that define clinical documentation and coding requirements, as well as institutional expectations and interpretations of those requirements.

The committee may develop a conceptual framework that encapsulates their findings and will issue a report with recommendations for system changes to streamline processes and manage complexity, minimize the burden of documentation requirements, and enhance workflow and teamwork to support the well-being of all clinicians and trainees on the care team, prevent clinician burnout, and facilitate high-quality patient care. More information"

Muda, Mura, and Muri said...

Lots of luck with that 'systems approach' for improving patient care through physician well-being. Turning hospitals and clinics into Boeing factories. These guys are nuts with their stop-watches, flow stations, and continuous kaizen. It is MUDA. That's why all the best physicians fled the 'system'.