Saturday, November 09, 2019

MOC®: It's All About Physician Data

The Facebook–Cambridge Analytica data scandal was a major political scandal in early 2018 when it was revealed that Cambridge Analytica had harvested the personal data of millions of peoples' Facebook profiles without their consent and used it for political advertising purposes. The scandal, first exposed by The Guardian in 2015, revealed that Cambridge Analytica had managed to obtain data on millions of Facebook users in the UK, US, and beyond, made possible through "improper sharing" practices conducted between the "This Is Your Digital Life" Facebook app developer and the company. By giving this third-party app permission to acquire their data, back in 2015, this also gave the app access to information on the user's friends network; this resulted in the data of about 87 million users, the majority of whom had not explicitly given Cambridge Analytica permission to access their data, being collected.

Because patients do not give consent for the use of their data, who better to target for access to sensitive patient-related information than those entrusted with their care? As details come to light about the American Board of Medical Specialties' (ABMS) Maintenance of Certification (MOC) program that has plagued physicians since 1990, many similarities to the Cambridge Analytica data-sharing scandal are appearing. The adhesion contract that forms the basis for MOC and is increasingly tied to physician hospital privileges and insurance reimbursements, assures this data pipeline remains open:
I also understand that ABIM may use my examination performance, training program evaluations, self evaluations of knowledge and practice assessment, and other information for research purposes, including collaboration with other research investigators and scientific publications."
Unbeknownst to most physicians, the ABMS has been involved with the sale and sharing of physicians' demographic and sensitive MOC data with third parties for years. Each clinical physician in the United States may see 2000-3000 patient's each annually. Marrying physician data with their patient's data and targeting patient markets becomes possible with physician-specific MOC information. Procedural and pharmaceutical data allows medical suppliers, pharmaceutical companies, device companies, and others virtually unlimited opportunities to sell their products while optimizing most their bottom lines through increased sales and offering rebates to health care facilities (aka, kickbacks).

Group purchase organizations (GPOs) and Pharmacy Benefit Managers (PBMs) decide what equipment appears on a database for hospitals to purchase. Companies pay those GPOs and PBMs to be on the list. Doctors' equipment choices and pharmaceutical preferences influence that list. Companies want to know what doctors are using and who doctors are seeing. By knowing their patterns and knowing the procedures performed on patients, highly sensitive patient information can be deduced. Registries owned by procedurally-heavy specialty societies (like the American College of Cardiology) are a particularly ripe source of procedural data, particularly when it can be made doctor-specific (where MOC comes in). More data sales occur. Repeated MOC testing and demographic data entries required by physicians assures these physician-specific databases are kept current. Having the President and CEO of the American Board of Internal Medicine on the President's Council of Advisors for Science and Technology assured uninterrupted marketing access to physicians and their patients.

By using physician information and their patient care information for these corporate purposes, the ABMS/ABIM MOC® product looks more like Cambridge Analytica than a physician education tool and affects far more people's health care than the Cambride Analytica ever did.

So how how do all these organizations coordinate and connect their MOC data, registries, and corporate databases?

Through a virtually undisclosed tax-exempt AMA-funded private foundation shamelessly called the Physician Consortium for Performance Improvement (PCPI).

Reportedly formed in 2000 with the help of the AMA, the PCPI Foundation is located just blocks away from the AMA's corporate headquarters in downtown Chicago. The organization describes itself as follows:
The AMA-convened PCPI, in partnership with its members, has developed more than 350 measures, many of which are used in the Physician Quality Reporting System (PQRS) and Meaningful Use, as well as private health plan payment models. (emphasis mine)

In 2011, American Medical Association staff to the PCPI worked with a group of committed volunteer leaders to launch the NQRN®, a national, multi-stakeholder network of clinical registry stewards and others interested in registries. The NQRN has created tools and educational opportunities and increased the visibility and value of clinical registries as reporting and improvement systems. In 2016 NQRN was merged into the PCPI as a key program. In 2013, the AMA-convened PCPI launched the PCPI Quality Improvement Program to support its members improvement needs beyond measurement.

In 2014, the AMA and AMA-convened PCPI leadership undertook an evaluation to determine the optimal governance structure to meet the growing demand for value-based health care. The result of this evaluation was the adoption of new By-Laws in June 2015, which set the course for the PCPI Foundation (PCPI), an independent organization with an expanded membership.
Not surprisingly, it's Board of Directors is lead by John S. McIntyre, MD of the American Psychiatric Association, who has never participated in MOC and is not required to do so:

The remainder of the Board of Directors include:
  • Thomas Granatir, MD, Senior Vice President for Policy and "External Relations" of the ABMS (formerly from Humana)
  • Lewis G. Sandy MD, FACP of the UnitedHealth Group
  • Non-physician Nancy E. Lundebjerg, MPA of the American Geriatric Society (Vice Chair)
  • Non-physician Laura J. Cranston, RPh of the Pharmacy Quality Alliance (Secretary)
  • Non-physician Dianne V. Jewell PT, DPT, PhD, FAPTA of the American Physical Therapy Association (Treasurer)
  • Larry A. Allen, MD, MHS of the American Heart Association
  • Bruce S. Auerbach MD, FAECP of the American College of Emergency Physicians
  • Arlene S. Bierman MD, MS of the Agency for Healthcare Research and Quality
  • Claire Bradley, MD, MPH who oversees "Quality Improvement"
  • Non-physician Carol A Cronin MA, MSW of the Informed Patient Institute
  • Non-physician Melissa Danforth of the Leapfrog Group
  • E. Scott Ferguson, MD - A radiologist on the AMA Board of Trustees and AMA representative to the National Quality Forum but does not appear to participate in MOC.
  • Deeraj Mahajan, MD FACP, CMD, CIC, CHCQM ("Certified Medical Doctor, Certified Infection Control, Certified Health Care Quality Measures") of the Medical Specialty
  • Lawyer Melanie G. Phelps JD of the North Carolina Medical Society who previously worked in the Government Affairs Department of Blue Cross Blue Shield
  • Non-physician Aisha T. Pittman MPH of Premier, Inc, the largest hospital Group Purchase Organization
  • Amir Qaseem MD, PhD, MHA, FACP of the American College of Physicians
  • Martha J. Radford, MD FACC, FAHA of the American College of Cardiology
  • David Shahian MD of the Society of Thoracic Surgeons
  • Computer Scientist Kurt Skifstad, PhD CEO of ArborMetrix, a data analytics company
  • Sandra Adamson Fryhofer, MD MACP from the Board of Trustees of the AMA
  • Richard D. Zorowitz MD, FAAPMR of the American Academy of Physician Medicine and Rehabilitation

Members get to "access the latest tools and insights on performance measurement, clinical registries, and quality improvement" as well as "influence through representation on the PCPI board, committees, advisory and other, as well as expert panels and task forces."

Members of this organization, according to the revolving banner on the PCPI website, include:
AvaMed, FigMD (MOC data collectors), AMA, ACP, ACC, ABMS, Informed Patient Institute, CMSS, Am Society of Clinical Oncology, The American Health Quality Association, Am College of Occupational Medicine, Primaris (A healthcare consulting and data abstraction company), American Academy Foot and Ankle Orthopedics Society, UnitedHealth Group (Market cap: $262B), The Society of Thoracic Surgeons, Pharmacy Quality Alliance, American Gastroenterology Association, Health Care Services Platform, American Optometric Association, Academy of Nutrition and Dietetics, American Heart Association, American College of Radiology, and on, and on...

It's handsomely paid CEO and Executive Director, Kevin Donnelly, is a non-physician, too. Here's their latest 2017 IRS filing that confirms a cool $2.78M contribution from the AMA to the PCPI and contains this explanation why the organization is not a true public "charity" after all:
The organization is filing this 990PF after the extended due date of November 15, 2018 (extension was for Form 990). Upon completion of schedule it was determined that the public support test had not been met for the second year. Research into IRS code and regulations was done to determine the next steps, which took the organization past the due date. The organization did not intentionally disregard the filing requirement, but rather, took time to ensure that that (sic) the appropriate filings were being made. Going forward, now that the requirements are understood, all 990PF filings will be timely. Additionally the organization properly extended the 2018 return as fling a Form 990PF.
I'm sensing some BS here, but I'll leave that to my readers (and the IRS) to decide.

Are UnitedHealth, Humana, Blue Cross Blue Shield, Premier, AvaMed (and all the medical device companies they represent), FigMD, and Primaris really about "quality" or their own bottom line?

Is there any wonder, then, that when a physician points out certain conflicts to medical editors of the Journal of the American Medical Association (JAMA) or the New England Journal of Medicine (owned by the Massachusetts Medical Society), he can't get a straight answer and is referred by the conflicted party to IRS tax filings?

One thing's for sure, to the best of my knowledge and belief, these multiple organizations are colluding with each other for their own best interests ("covert rationing" - a concept coined by the prescient Dr. Richard Fogoros) and using our physician MOC® data to drive their bottom lines while hiding behind non-profit tax law and the ruse of assuring the public it's all in the name of "quality."



MOC Block said...

A profound revelation about the real purpose of ABMS MOC®! The new longitudinal assessment proposals reek as an enhancement of the continuous deception and corporate profiteering that the ABMS and medical boards are involved in.
Longitudinal assessment represents and enhancement of data collections and fits the MO of MOC's illicit and unethical data collection agendas.

Anonymous said...

It's a game changer, when you put all the pieces of the MOC puzzle together.

PCPI 2019 Sponsors said...

"Be sure to visit #PCPI2019 Annual Conference sponsors ArborMetrix, IQVIA, ARMUS Corporation and Premier Inc. #PCPI is grateful to our sponsors for the PCPI Annual Conference November 10-12, 2019!"

Anonymous said...

Superb investigative reporting, but there needs to be further investigation. It all smells bad to me. There's a lack of clarity about who the conflicted parties, sponsors and members are at the PCPI are and what they really represent!

How long have they been involved with the NQF. The National Quality Forum is an old fish full of conflicts and alleged kickbacks and the measures PCPI wrote for the NQF needs to be examined fully. Who are these people.

ABMS/AMA/PCPI Analytica said...

Interestingly, you said the PCPI is just blocks away from the AMA, but you did not mention WHO the PCPI (data collection corporation) shares offices with - leaving it to the readers (or IRS) to explore.

The PCPI website shows that PCPI currently shares the same address and exact same suite and number as the ABMS at 353 N Wabash, Suite 1400, Chicago, Il.

I'll repeat it so it sinks in. The PCPI and ABMS share the same address. The collusive nature of the organizations is self-evident, but this is surreal to be operating out of the same offices. Must make it easier to have ABMS Solutions involved in the data party also. This is egregiously conflicted with former Humana health policy advisor Tom Granatir showing up as a PCPI director on all the available tax forms. Granatir has been hired employed as a senior executive of health policy and corporate relations director at ABMS.

PCPI's "previous address" was the same as the American Medical Association at 330 N Wabash, Suite 39300, Chicago, Il.

In 2015 the address on the tax returns shows "in care of the Keller Co." a for profit corporation which manages trade associations. In other words the AMA hired a management company to try to create a false show of independence, which is not the case at all. More deception. Schedules O make it clear that the AMA is primary contributor and controlling entity in business relations and any appointments of executives.

Compare the addresses of the ABMS and PCPI below as of today's date.

This links the two corporations (not-for-proit?); I agree, the IRS should take a closer look at the ABMS and their 24 medical specialty boards. (The IRS might be interested to look at their tax forms. MOC (under revenues) is not coded as education, nor as a support for education but something "other" on virtually all the AMBS franchees tax filings! Other obviously refers to this unethical and probably illicit form of data collection via captured customers. Physicians are the captured servants of the ABMS and their monopoly empire. The case of corporate characters is growing all the time the more we learn.

"ABMS welcomes your inquiry and makes every attempt to answer all inquiries in a timely manner. If you have a specific question, please call us or use our convenient form below.

American Board of Medical Specialties
353 North Clark Street
Suite 1400
Chicago, IL 60654
(312) 436-2600"

PCPI website address:

353 N. Clark St. Suite 1400-a, Chicago, IL 60654 | Phone: 312-757-PCPI | General Email:

It's safe to say that the PCPI still has offices at the AMA and ABMS as they always have from their inception in 2000. (Or earlier.)

PCPI Tax Forms 2015, 2016 and 2017 said...

I have some questions

What is the Kellen Company and why did PCPI pay them $499,620 for management in 2016.

Who is Dr. Frank G. Opelka, who appears as recipient of $100,000 by the PCPI in 2016 and was paide $44,000 by the PCPI in 2015. Why isn't the PCPI mentioned in Opelka's sudden distinguished service award in 2016, as reported by the American College of Surgeons. Who did that 499,620 go to. Who did the Kellen Company write checks to for managing the PCPI. Was it someone at the AMA? ABMS? I think we need some disclosure. Management companies are notorious for giving a front for organization who want the leadership payments hidden.

Section B. Independent Contractors 1Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.
Name and business address (B)
Description of services (C)


2Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet1
Form 990 (2016)

If the AMA/ABMS already hired a management company why did Dr. Opelka get 100,000 for ten hours of work.

(1) FRANK OPELKA MD......................................................................
X X 100,000 0 0 [Form 2016]

Anonymous said...

MOC as a corporate wedge/tool of the ABMS and AMA - in cahoots with the healthcare industrial complex.

This all needs serious investigation.

I believe this report today needs to expanded using earlier publications for larger distribution and picked up by main stream media and alternative news sources.

(PCQI should be corrected to PCPI in the later part of your report.)

Financial Gastronomy said...

Who's finessing the books for the PCPI? The AMA financial team or the ABMSs? Jennifer J. Fronek was hired in 2015. The ABMS is a very complex organization with at least six corporate parts. Some of them for-profits both domestic and foreign. I think it is time to have a real independent audit of the ABMS Fincancials Suite 1400.

Anonymous said...

It is fair to say that some resignations should be coming soon. There is a lot more here than you reported, Wes. I don't use the word fraud lightly, but that is what we are looking at when you look at the whole picture. The fight against MOC is not just a civil case, but a criminal one. Every physician should take a hard look at the entire ABMS and their business practices/partners/history.

Anonymous said...

Interesting discussion here from 2007 on your blog.

How Compromised Is The ABMS said...

How many ABMS for-profit businesses do they operate at 353 N Wabash Street, Suite 1400, Chicago, IL?

ABMS International is another ABMS for-profit. ABMS-I is a holding company that collects offshore money in exchange for issuing foreign certifications - certificates that do not require MOC. No MOC required in their flagship operations in Singapore.

So, looking at the Illinois Secretary of State data on businesses, ABMS International, and ABMS Singapore are two other ABMS companies that operates out of Suite 1400 along side the PCPI apparently.

ABMS Masters of Hypocrisy

This further confirms what you are saying about MOC, Wes. MOC is not about education, it's about coerced payments and data collection for the profit derived from it. In Singapore MOC is not required. Physicians get a free pass as the Singapore's Ministry of Health (MOH) does not believe MOC is necessary and the ABMS agrees to ABMS Singapore's 'certification- for-life plan".

Illinois Business Directory

ABMS International, LLC

File Number03466388

Entity Information
Principal Office 353 N CLARK ST STE 1400, CHICAGO, IL 60654
Entity Type LLC
Type of LLC Domestic
Organization/Admission Date Wednesday, 8 December 2010
Jurisdiction IL

Agent Information
Address 353 NORTH CLARK STREET #1400
CHICAGO , IL 60654

Change Date Thursday, 13 December 2018
Annual Report
For Year 2019
Filing Date 00/00/0000


ABMS Singapore, LLC

File Number 03466779
Entity Information
Principal Office 353 NORTH CLARK ST STE 1400
CHICAGO, IL 606540000
Entity Type LLC
Type of LLC Domestic
Organization/Admission Date
Wednesday, 8 December 2010
Jurisdiction IL

Agent Information
Address353 NORTH CLARK STREET #1400
CHICAGO , IL 60654

Change DateThursday, 13 December 2018
Annual Report
For Year2019
Filing Date00/00/0000

Anonymous said...

MOC has nothing to do with "quality".

AMA Rescinds ABIM Audit said...

One hand gives the other takes it away (ICYMI)

"The following directives will be rescinded in full, as the requested activity has been completed, with reports presented to the House of Delegates when required.

• D-620.988, “Analysis of American Board of Internal Medicine (ABIM) Finances” (to be rescinded)
1. Our AMA, prior to the end of December 2016, will formally, directly and openly ask the American Board of
Internal Medicine (ABIM) if they would allow an independent outside organization, representing ABIM
physician stakeholders, to independently conduct an open audit of the finances of both the American Board of
Internal Medicine (ABIM), a 501(c)(3) tax-exempt, non-profit organization, and its Foundation.
2. In its request, our AMA will seek a formal and rapid reply from the ABIM so that issues of concern that
currently exist between the ABIM and its Foundation and many members of the AMA and the physician
community at large can be addressed in a timely, effective and efficient fashion.
3. Our AMA will share the response to this request, as well as the results of any subsequent analysis, with our
AMA House of Delegates and our membership at large as soon as it is available.
4. Our AMA will call on the American Board of Medical Specialties and its component specialty boards to
provide the physicians of America with financial transparency, independent financial audits and enhanced
mechanisms for communication with and feedback from their diplomate physicians.
This directive was acted on in December 2016, immediately after the policy was adopted at the 2016 Interim
Meeting. The American Board of Internal Medicine’s verbatim responses to the questions were shared with the
House in an email from your Speakers on January 23, 2017."


AMA 2019 Annual Meeting said...

American Medical Association - Reports of the Board of Trustees 2019

Policies dealing with the AMA-convened Physician Consortium for Performance Improvement® (AMA-PCPI®) [pages 196 - 197]

Several policies deal with the AMA-PCPI which was initially established as a program of the AMA. The AMA-PCPI ceased all activities upon activation of an independent 501(c)(3) organization, the PCPI Foundation® (PCPI®).
Consequently, some policies should be rescinded and others amended to clarify these changes and our AMA’s role in the successor organization. Policies D-450.983 and D-478.974 should be rescinded as they no longer accurately reflect our AMA’s roles and responsibilities. The latter policy also references activity that was concluded years ago.