A Case Study in the Wrong Way to Fix Clinician Burnout

Asking the system to fix the system in regards to physician and nursing burnout is like asking the fox to watch the henhouse.

They have no clue.

Case in point: the recent article published online before print in the Journal of the American Medical Association (JAMA) (where else?) preaching a "systems-based approach to clinician well-being and provide better patient care."

What "system" is recommending this "approach? None other than the Accreditation Council for Graduate Medical Education comprised of the American Medical Association (AMA), the American Hospital Association (AHA), and the American Board of Medical Specialties (ABMS), among others, with work performed by a committee comprised of friends from Blue Cross Blue Shield.

Most concerning, however, is this report was co-authored by one of the most conflicted authors in the health care business, Christine K. Cassel, MD. Recall that Dr. Cassel failed to disclose her board seats (and income) with Kaiser Hospitals and Health Systems and Premier (the largest health care Group Purchase Organization for the nation's hospitals) while serving as President and CEO of the American Board of Internal Medicine. 

Christine K. Cassel, MD was President and CEO of the ABIM from 2004-2014. During her tenure at the ABIM, Dr. Cassel received a highly influential political appointment on the President's Council of Advisors for Science and Technology under President Obama in April 2009, just before the Affordable Care Act was signed into law in 2010.

The same day she announced that political appointment, the ABIM contracted with Washington lobbying firm Jennings Policy Strategies, Inc. yet never publicly disclosed this relationship. Instead, ABIM tax forms from 2010 listed this firm as hired for "consulting services."  It appears to this lay physician that these "services" were in direct violation of IRS regulations concerning lobbying, especially given Dr. Cassel's substantial non-disclosed financial ties to Premier, Inc., one of the nation's largest Group Purchase Organizations for the nation's hospitals. At least one other lobbying firm was retained by ABIM (named Mehlman Castagnetti Rosen Bingel and Thomas, Inc.) until June 30, 2015, and this relationship was never publicly disclosed to ABIM's physician diplomates, the IRS, or the public either.

According to a Newsweek reporter, the ABIM used obfuscatory accounting techniques during and after Dr. Cassel's tenure: "I had an easier time figuring out the compensation of officials at Enron, WorldCom and Adelphia—all famous for lying on financial filings—than I did for those at the ABIM, where enormous effort seems to have been taken to make murky what should be crystal clear." The ABIM reportedly paid Dr. Cassel $1.7 million in her final year.

Some things never change: Dr. Cassel once again claimed "no conflicts" in the disclosures to this most recent JAMA article on physician burnout either.

Gaslighting physicians and nurses is not the way to fix burnout.

It would be far better for the members of the ACGME to hold a mirror before themselves to understand how their conflicts of interest have systematically done more to harm our profession over the years. Our current house of Medicine has gleefully created the world's most expensive typing pool with physicians and nurses as little more than data entry clerks clicking away whether home or at work. Our current non-transparent health care system has evolved this way thanks in large part to the AMA's behind-the-scenes business model dependent on licensing its ever-changing "Current Procedural Terminology" (CPT) codes for use by the electronic medical record companies and insurance companies to covertly ration care. At the same time, the ACGME supported and promoted the transition from lifetime ABMS board certification to an unproven and wasteful "continuous board certification" by insisting on lifetime testing and payments from physicians for themselves, the lucrative publishing and testing industries, and a vast network of physician specialty societies  without ever examining the harms this extortion has caused physicians and the patients they care for. It is telling there was no mention in the recent JAMA article of the "Maintenance of Certification" (MOC) controversy that has led to multiple ongoing federal class action antitrust and racketeering lawsuits, deprives physicians of personal and family time, and steals any semblance of self-educational autonomy from physicians for the benefit of the ACGME members and their collaborators.

To fix burnout we need doctors and nurses looking up at patients rather than looking down at computer screens. We don't need hand-holding wellness exercises, life coaches, and yoga classes. We especially dont need them right after witnessing the unfortunate death of a child or having a patient die beneath our hands despite our best efforts.

Doctors and nurses are not babies or widgets in an assembly line.We entered into this real-life drama of medicine with eyes wide open knowing full well that medicine and health care can be challenging.  Yet much of corporate medicine has taken on its role to push our limits to make the system more "productive" for the system at the expense of its caregivers.  Medicine is hard damn work that is both emotionally draining yet exhilarating all at the same time. We take the ultimate responsibility for our patients. The ACGME and their protected bureaucratic workshop do not. We risk falling prey to this exploitation if we fail to expose these many undisclosed conflicts of interest with the authors and "committee" wrote and published this paper in JAMA.

This is not to say I see a day where medicine will occur without the use of computers. But computers and secret sharing of data health care data can have its consequences if patients and physicians are kept in the dark. The depersonalization that computers bring to medicine has a nasty side effect on the care we provide: physicians and nurses need face-to-face, hand-to-hand, and heart-to-heart time with patients and their colleagues, not computers, procedure codes, and recommendations from people who foisted MOC upon us, stood to gain financially from it, but never participated in MOC themselves.

Distrust of our self-imposed corporate overlords is a large part of why we're where we are currently, particularly when they insult us with their self-serving "mission" to have physicians help themselves. What do these physician-bureaucrat posers know what's really happening on the front line of health care today?

Humility at admitting mistakes would go a lot further at curing physician burnout than beating the same corporate drum that wedges itself between what really matters: doctors and nurses caring for patients without the self-appointed, politically- and industry-funded National Academy of Medicine and their cronies telling us how to do our jobs.  It would be far better if they took off the chains they bind us with and let us do what we do best.

-Wes

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.

-Wes

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

Happy New Year, MOC!

As many of us head back to work to start a New Year, let's not forget that physicians have until January 15, 2019 to "comment" on the ABMS Vision Commission's (un-editable) Draft Report.

While Paul Teirstein, MD and his colleagues at the National Board of Physicians and Surgeons (NBPAS) did a nice job dissecting many of the problems with the Vision Commission's report and made it easy to "comment" to the Commission's Draft Report using SurveyMonkey, I would like to add a few important observations about the Vision Commission's report (and the response by NBPAS) that are not mentioned and remain stumbling blocks for me.

First of all, should physicians be bound by an adhesion contract (seen here) with Board Certification and MOC (or whatever "continuous certification" becomes called) that can change on the whim of the ABMS and their member boards "from time to time?" This gives unilateral control to ABMS and prevents appropriate checks and balances. How is this helpful to anyone except the ABMS member boards and their collaborating corporate entities - all of whom already enjoy a substantial position of power and monetary influence. Remember the history of MOC reviewed in the antitrust complaint (starting on Page 5) filed five days before the Vision Commission's "Draft Report" appeared.

Also, those corporate entities that collude with MOC are not mentioned and are extensive. A partial list includes ABMS Solutions, LLC, hospitals and the ABMS Multispecialty Portfolio Program, publishers like the Massachusetts Medical Society and Wolters Kluwer, Pearson LLC, CECity, Premier, Inc, PriceWaterhouseCooper, and subspecialty societies like the ACC and ACP - all who stand to benefit financially from MOC. Remember, a significant portion of the ABMS Vision Commission are not practicing clinical physicians and are deeply conflicted with corporate entities.

And let's not forget that the Commission's report leaves the harms already experienced by physicians and their families unmentioned (for obvious reasons) - again, see the recent antitrust Complaint filed. MOC was always about money and power for the ABMS and their member boards. The ABMS fully intends for MOC (soon to be rebranded as CertLink®) to shift from a desktop platform at a PearsonVue testing center to a mobile platform in the palm of our hands as "MOC pilots" become permanent in 2019! This translates to more distractive screen time for physicians away from patients and a lucrative life-long money stream to ABMS and their collaborators.

I would encourage physician to consider copying the content of this blog post and morph it into your own "comment" to the Vision Commission if you feel it would be worthwhile.

Also, consider donating to Practicing Physicians of America's legal fund. I believe you'll get more for your hard-earned money that protects your interests that way.

-Wes

On Trust

Elizabeth A. McGlynn, PhD, immediate past chair of the ABIM Foundation and Vice President for Kaiser Permanente Research and Executive Director of the Kaiser Permanente Center for Effectiveness and Safety Research (CESR) with Richard Baron, MD, President and CEO of the American Board of Internal Medicine,  at the 2018 ABIM Foundation Forum on "(Re-)Building Trust"

Recently, the ABIM Foundation hosted a webinar entitled "(Re-)Building Trust." Oh, the irony. The fact they need to have such a conference is telling of the dire straights the staid and outdated medical credentialing complex has become.

As physicians who funded the ABIM Foundation, why do we fund such nonsense?  The American Board of Internal Medicine has never sufficiently explained why this organization felt compelled to use over $78 million of physician testing fees to create the ABIM Foundation or how and why it uses that money. Is it really to fund such conferences?  Or might conferences like this really be a distraction for the real reason the ABIM Foundation was created: their retirement fund. By the way, whatever happened to those funds shipped off to the Cayman Islands? Why will we lose our privileges at hospitals or insurance payments if we don't pay into this scheme? And why is the ABIM Foundation colluding with Kaiser Permanente directors? What does Kaiser get for this relationship?

If physicians trusted the ABIM, we would not have to ask such questions and the ABIM Foundation would not have to hold conferences on "re-building" trust.

Three years ago, Richard Baron, MD issued the now infamous: "We got it wrong" mea culpa press release when the 2014 iterations of Maintenance of Certification (MOC) foisted on US physicians resulted in a powerful working physician backlash. Lots of soft-shoe, "listening," and MOC program changes have occurred since then. But in reality four years later, little has changed other than parsing our payments into annual aliquots rather than a single lump sum every-10-year payment. The growth of fees is back on schedule, climbing an incredible 276% in the past 18 years.  Even the ridiculous Part IV of MOC is back as before.

It is hard to trust any business, especially a nonprofit organization when they ignore the customer.

We should not lose sight that physicians are the customer of ABIM, not patients. We pay for their medical accolade and the paper certificate that ABIM issues when we successfully complete our initial Board certification and (now) subsequent MOC requirements.

There are many within the US medical board credentialing system who feel otherwise; for them, they are there to serve "the public." Yet this deflection is little more than a propaganda message created to justify their use of our money for their political and financial purposes.

When we see our funds continuing to be wasted at Las Vegas convention venues for American Board of Medical Specialties meetings with their "stakeholders" we realize that this old-school attitude of colleague disrespect and self-importance is endemic to the entire US medical board certification and medical credentialing industry. Hard to re-establish trust with overt demonstrations such as these.

-Wes

PS: Wonder what you can do to change things?  Donate here and get a free book at the same time! We're 78% of the way there!

Earning MOC™ Points: A Self-Paid Advertorial

As a follow-up of my earlier post on the American Board of Medical Specialties' (ABMS) Maintenance of Certification™(MOC™) program's tax on medical education, I was sent the "approved" responses of two different physicians that were required to answer questions to "earn" ABMS MOC™credits from the Heart Rhythm Society (HRS) Scientific Sessions after the meeting. These responses were "approved" by an HRS "reviewer" so the doctors could apply these points to remain "Board certified" and employed with their hospital systems. Each doctor had to write between 50 and 100 words (no more, no less) in response to questions posed by the ABIM. Despite their different responses, each received the exact same "feedback" that included links to various Heart Rhythm Society, American College of Cardiology, AMA, ABMS and non-governmental organizations' policies and web pages.

(See Physician 1's responses here and Physician 2's responses here.)

Given these canned responses to these physicians feedback, how is this time-consuming, costly, and meaningless "feedback" exercise for "earning" MOC™ points anything but a self-paid advertorial for the HRS, ACC, AMA, ABMS, and other non-governmental organizations?

It is a sad commentary that our own subspecialty societies legitimize this corrupt process despite all that we know about it today.

-Wes

We Want to Know

Dear Richard Baron,

As President and CEO of the 501(c)(3) non-profit organization, the American Board of Internal Medicine (ABIM) and its affiliated Foundation, the ABIM Foundation, you are responsible for public disclosure of IRS tax forms 990 to the public. Those tax forms were due at the IRS office 15 May 2017 for the ABIM's 2016 fiscal year (1 July 2015-30 June 2016).

Where are they?

We want to know.

We want to know because the finances of the ABIM and its Foundation are of paramount importance to us, your diplomates. We believe those finances are the reason we are required us to participate in the ABMS trademarked Maintenance of Certification (MOC) program. Because of clever regulatory capture through this unproven and monopolistic educational program, your organization is responsible for the ability of one quarter of ALL US physicians to work.

We want to know where our money that we pay for your unproven testing is going.

We want to know how much you paid yourself and your officers.

We want to know your legal expenses.

We want to know if you lobbied last year and how much you paid for it.

We want to know if you purchased another condominium for your organizations.

We want to know how much your paid PearsonVue.

We want to know who were your revolving-door officers that year and how much you paid them.

Right now, seventeen states have brought forth legislation to combat MOC. Doctors are leaving work to testify against the requirement for MOC that has been carefully incorporated to our new payment formula (MACRA) and HEDIS requirements made by the National Committee on Quality Assurance for the nation's hospitals, courtesy to Ms. Margaret O'Kane (who doesn't even hold a medical degree), and her board participation with the American Board of Medical Specialties, of which the ABIM is one of 24 specialty organizations.

We want to know the ABIM's finances because our jobs depend on that information. We want to bring that information before state legislatures so we may objectively and factually highlight your spending.

We will not rest any longer, Dr. Baron.

We want to know and we have the right, by law, to know.

Westby G. Fisher, MD
ABIM Diplomate #127308

Attention Tennessee Physicians and Physicians Everywhere

Attention Tennessee physicians and beyond:

As you may be aware, the (anti-)Maintenance of Certification legislation (see House Bill HB 413) and Senate Bill (SB 298) is on the calendar on Tuesday at 1:30 p.m. in Senate Commerce and at 3:00 p.m. in House Health Subcommittee. This legislation is highly contested and being opposed by both hospitals and insurance companies. TMA is working hard to get this legislation passed, but they need your help!

We need you to come to the hearings on Tuesday to show legislators that PRACTICING physicians are firmly AGAINST making the unproven, time-consuming, and distracting ABMS Maintenance of Certification program a requirement to practice medicine in Tennessee. Having physicians in the hearings may mean the difference in what happens with this bill in the committees on Tuesday. As the bill is highly contested, the outcome is unknown. It may be amended and passed out, or it may be put off until next year. Without physicians in the hearings, they will not go well. The legislators need to see physicians present supporting this bill and following it closely.

When: Tuesday - Senate Commerce at 1:30pm in LP 12
House Health Subcommittee at 3:00pm in LP 30

If you have any questions about this or if you are able to attend, please let me know, and if you haven't already, please contact your representative and senator and let them know you support this bill. https://www.votervoice.net/TNMA/campaigns/50846/respond

Thank you for your help,

Nikki

Nikki Ringenberg, MPA
Senior Director of Membership and Grants
Nashville Academy of Medicine
3301 West End Ave, Ste 100
Nashville, TN 37203
615-712-6236 office
615-712-6247 fax

nringenberg@nashvillemedicine.org
www.nashvillemedicine.org

It is time to turn your gaze away from that computer screen and rise up!

Practicing physicians' right to work is being compromised by the inclusion of the ABMS MOC requirement in state legislatures across the country.

Physicians need to alert their colleagues in Tennessee and elsewhere about this effort to restrict the practice of medicine by the American Board of Medical Specialties and Federation of State Licensing Boards. Practicing physicians are not against continuing education, but against the corruption that the ABMS Maintenance of Certification program represents and it's anti-trust implications it has to the practice of medicine.

It is time to save the practice of medicine and physicians' ability to act autonomously on behalf of our patients without the threat of unnecessary corporate intrusions into health care delivery.

There is not much time for us to mobilize. Please spread the word.

-Wes

Addendum: Thanks to Meg Edison, MD for her letter to circulate: http://us10.campaign-archive2.com/?u=5a9a08b64c48d493e89cb8192&id=5fb2b96d5c

Teirstein vs. Nora

Lois Margaret Nora, MD, JD of the American Board of Medical Specialties vs. Paul Teirstein, MD of the National Board of Medical Specialties debate at the California Medical Association meeting 16 October 2016:

Nora was given  20 minutes to speak.

Teirstein was given 10 minutes (but California Medical Association members booed until he got another 5 minutes).

Definitely worth a 14-minute viewing for it shows the revolving door of non-profit interests that maintain the MOC monopoly as only Paul Teirstein, MD can:


-Wes

Dr. Teirstein's slides can be downloaded here or a a pdf of his slides can be viewed here.

Pennsylvania Medical Society Spearheads Effort to End MOC Nationwide

Recently, the Pennsylvania Medical Society sent this letter to the executive vice presidents of all US state medical societies and many specialty societies regarding their vote of no confidence regarding the ABMS Maintenance of Certification® (MOC®) program and the current leadership at ABIM, stating specifically:

"... We believe that their current leadership is not capable of reforming the process in a timely, academically meaningful, and fiscally responsible way.

In keeping with the consensus of our members and physicians across the country, we call for the immediate replacement of the entire ABIM Board of Directors and leadership with new leadership, representative of physicians actively participating in the full-time practice of clinical medicine. The undersigned organizations would further offer to assist the ABIM and any of the ABIM subspecialties with the formation and transition to a new Board that is representative of and accountable to the physicians whom they will certify. ..."

For those interested in learning more or who's state is ready to sign on can email Dr. Scott Shapiro, President of the PA Medical Society at stat@pamedsoc.org‎ for more information.

Please forward a copy of this letter to all of your practicing physician colleagues (irrespective of specialty) and ask each of them to contact the leadership of their respective state medical societies and specialty societies to urge them to co-sign this letter and work with the PA Medical Society to end the corrupt ABMS MOC® re-certification requirement.

Only through aggressive, meaningful, nationwide collective action against this needless, unaccountable, expensive, and coercive ABMS re-certification program will practicing physicians restore sanity to our own life-long continuing medical education process.

Thank you-

-Wes

A copy of the letter to circulate to your colleagues can be downloaded here.

Video: The Gory Details of ABIM Maintenance of Certification

The Pennsylvania Medical Society posted the presentations made at the AMA House of Delegates Meeting at the Hyatt Regency Chicago on 13 Jun 2016 this morning (please see that link for all of the presentations made).

I post just two of those presentations here for your review.  First, the finances of the ABIM and ABIM Foundation that prompted the creation of Maintenance of Certification, as told by certified public accountant, Charles P. Kroll (27 min) (Slides here):



Next, my presentation on how Maintenance of Certification has affected practicing US physicians and their patients (22 min) (slides here):



Spend some time to review these videos and and inform yourself when you get a chance. Then work with your state medical societies and hospitals to end this onerous and corrupt physician program.

-Wes

AMA House of Delegates MOC Session Recap

It was a beautiful day in Chicago yesterday: sunny, not too humid. I left home early. The sun had risen some time ago and could be seen reflecting off the lake to the front of the downtown skyscrapers highlighting every detail of their construction. Lake Shore Drive is magnificent this time of day. I parked, as many must do each day, down in the basement of a nearby parking garage, making the "early bird special" parking fee of $16 when your arrive before 8 AM.

Nice.

(Click to enlarge)

I entered the Hyatt and saw a large meeting room across the foyer with a "Southeastern Delegate Meeting" sign outside the huge room. Lots of people with the representative state name on a card in front of them and a man in a bright kelly green jacket sitting next to the speaker stand who looked like a preppy leprechaun: the "Vice Chair." Heh.

I had to find registration at the Hyatt Regency Chicago: no easy task for someone who's never attended the AMA House of Delegates meeting, but approached what must have been a senior delegate adorned with his AMA badge with multi-colored tags draped some 14" beneath it highlighted by political stickers and little metal badges (I learned later you got some of these after contributing to various political action committees). He was cordial and helped direct me to the subterranean registration desk in the East Tower.

There were delightful ladies more than willing to help. "Are you a delegate?" they asked. "No, just a speaker." They gave me a registration card and I filled it out and was promptly handed a badge of my own with a lonely gray "speaker" badge dangling below.

"Don't listen to a thing he says, he's a doctor," someone said behind me. I turned around to find Charles Kroll, who has also just arrived, waiting to register.  I hadn't seen him for two years since we started to work together on the ABIM story. He grabbed his badge and we headed upstairs. I called David Winchester, MD, a delightful young cardiologist that I was introduced to via Twitter  (cardiologist and Florida delegate) and he joined me and Mr. Kroll for coffee.

AMA House of Delegates MOC Meeting
(Click to enlarge)

Next, I called Charles Cutler, MD from the Pennsylvania Medical Society who met us in the lobby of the East Tower. We headed to the meeting room and he introduced me to numerous people: Steven E. Weinberger, MD of the American College of Physicians (Executive VP and Chief Executive of the ACP), Stephen R. Permut, MD, JD, (Chair of the Board of Trustees of the AMA), and newly-elected Board Member of the American Board of Internal Medicine (ABIM), Yul Enjes, MD, among others. Only later did I realize Lois Margaret Nora, MD, President, and Chairman of the American Board of Medical Specialties (ABMS) was there, too, among many others (seated in the back, far right). Many stood in the back of the room despite available chairs in the front of the room (some things never change).

As luck would have it just before we began, the projector bulb blew shortly after it was turned on so another projector had to be retrieved. Meanwhile, the videographer had set up and was ready to go, but we had to remain seated as we spoke to use the available microphones. Once the new projector was secured, we were ready to begin.

Mr. Kroll went first (slides at link, video here) and explained his background as a forensic accountant specializing in health care and non-profits to the audience. He began discussing his educational background, credentials, prior experience with other non-profit shenannigans in Minnesota (Alina/Medica scandal) and his experience working with the attorney general there. He then explained how he stumbled across the ABIM story (a former article by Linda Girgis, MD asking if ABIM was "extorting" physicians). He pulled the ABIM's financials and immediately found discrepancies and outlined many of his findings to the audience. You could see heads shaking with disbelief. He kept it simple and understandable.  It was devastating. He then told the story how he contacted a mainstream media outlet who requested the last twelve years of audited financials from the ABIM and how the ABIM refused to produce all but the last year, and only if they met in persons to review them together. Evidently, the reporter politely declined and then requested these financials from the PA Attorney's Office (who never responded).  Only after a request was made to the press secretary of the PA Governor's office were the last two years' of audited financials produced. Mr. Kroll, who had these full financials in his possession, then noted that when the ABIM published them, they failed to publish six key parts of those financials on its website. Only after he disclosed this fact in an article in MedCityNews, did the ABIM recant and post the full financials. Finally, we concluded with a description of the meeting he help with the Iowa Attorney General's office and the recommendations he made regarding actions the Iowa AG could impose on the ABIM and their Foundation.

I was next.

In my presentation (a rather large Powerpoint presentation can be downloaded here, video here), I discussed my background, the background of how Board certification, how the philosophy of lifetime certification morphed to time-limited based on the ABIM's assertion that older physicians lost their skills over time, but then pointed to the paradox of the "grandfathering" of physicians and the inherent age discrimination against our most vulnerable physicians with that policy change. I also explained patient's definition of the excellent physician vs the ABIM's definition, and reviewed the costs in terms of out-of pocket costs and time involved (detracting from patient care). I also touched on the creation of the ABIM Foundation and the transfer of funds from the ABIM to the Foundation for "research" and showed the webpage asking for physician data for more "research" without informed consent and disclosure to physicians who were serving as study subjects in violation of the Belmont Report. With the purchase of the ABIM condominium, perhaps they were performing investment research instead, I suggested. I then summarized much of what has transpired with the ABIM and asked the important question, "How did it get this way?" and why I thought it happened. Finally, I summarized the disturbing code of silence that has surrounded the ABIM controversy by using the "Little Red Hen" allegory. The only people who will fix this mess is practicing physicians, starting with a full investigation of the responsible parties.

Next up was Bonnie Weiner, MD, board member of the National Board of Physicians and Surgeons (NBPAS.org) who gave an update of their efforts to create a more credible board credential for assuring continuing medical education. She expressed concern that future modifications to MOC will result in making one wasteful test taken once every ten years into many worthless tests over the same time period. She summarized the philosophy and finances of the NBPAS.org and explained that she could no longer serve as an interventional cardiology program director because she refused to perform MOC for that credential. (So much for "voluntary" certification!) She noted over 30 hospitals now accept NBPAS as an alternative to NBPAS.org and emphasized the need to have competition in the credentialing market.

With the last presentation by Scott Shapiro, MD, President of the Pennsylvania Medical Society, a shot was fired across the bow of the ABIM. Dr. Shapiro announced that the PA Medical Society was publicly announcing  their "vote of no confidence" against the ABIM and approved funds to evaluate legal options against the ABIM:

Today, at the AMA Annual Meeting in Chicago, our Pennsylvania Medical Society Delegation convened a national discussion panel to present their research findings, insights, and recommendations regarding the failures of the American Board of Internal Medicine and the MOC process. The discussion regarding the actions, finances and possible historical motivations for the ABIM actions was eye-opening and alarming.

Notably, during the conference, we announced that our PAMED Board of Trustees—after reviewing the available data and recent ABIM actions—voted and are now issuing a statement of no confidence in the ABIM's Board and leadership.

We also announced that, earlier this year, our PAMED Board approved the necessary funding to move forward with obtaining a legal opinion into whether PAMED would have standing to file a lawsuit against the ABIM. We hired a firm and recently received their opinion that not only would we have standing but they found potential legal claims consistent with our concerns that could be filed in a lawsuit against the ABIM.

Physician leaders from many other states have inquired about how their state can join PAMED's efforts. We look forward to these and other strategic conversations in the near future.

Boom.

You could have heard a pin drop.

After his announcements (and I probably missed a few key words), the floor was open for question and answer. Lots of people asked questions respectfully. Many were in support. Some were disappointed that there was not a more broad perspective of the opposite arguments for MOC on the panel. One physician with lots of tags on his chest approach the microphone saying," I learned a lot today in this session. Most of all I learned that I'm really glad I never became an internist." (He was an anesthesiologist). The room burst into laughter. He then went on to express his like of anesthesia's "MOCA minute" initiative but never disclosed if he had conflicts with the program or how much it cost. (By now, Dr. Nora from the ABMS had joined the question and answer line.)

It had to be difficult for Dr. Nora to enter this room, but I respected the fact that she came to the microphone to point out her views.  Unfortunately, rather than mentioning anything about the corruption we had just uncovered, Dr. Nora seemed upset that I had been inaccurate with my portrayal of where the ABMS gets their money (I am paraphrasing here). She also commented that we have been given a privilege to self-regulate and that we should consider carefully what we are doing. I then asked her a question as she walked away. She turned to answer. My question was this: "Have you ever studied what happens the physicians that you fail and what happens to their patients in turn?"  She stated she didn't "understand" my question and then proceeded to redirect to another topic before turning to walk away. Perhaps there will be an audio feed soon of this interaction. It wasn't one of our chief regulator's best moments.

Other questions kept coming, with many shifting to "what's next?"  Unfortunately the session went 30 minutes over and another meeting needed the room.

Finally, it was over.

I would like to take this moment to thank Charles Cutler, MD of the Pennsylvania Medical Society for his invitation to speak in this important venue. I am glad I could meet the players in this saga firsthand. There's no excuse for delaying any longer. Everyone knows the problems. Illegal stuff has occurred.

I can only hope those responsible take meaningful and serious steps to resolve the financial malfeasance, corruption, cronyism, and lack of accountability that has been ongoing at the ABIM (and other affiliated member boards of the ABMS hierarchy) for so long.  Otherwise, it's going to get very ugly very quickly.

Practicing physicians across the US have had enough of the ABMS MOC requirement shenanigans.

-Wes

AHA House of Delegates MOC Session Speakers, June 13, 2016
(L to R: Scott Shapiro, MD, Bonnie Weiner, MD, Charles Cutler, MD,
Wes Fisher, MD, and Mr. Charles P. Kroll)

P.S.: I will post a link to the videos of the sessions as soon as they become available. (Update: links added where appropriate above)

Baron: "No Robust Evidence" for Maintenance of Certification

With the soft tinkling of gentle piano music playing in the background, Richard Baron, MD, President and CEO of the American Board of Internal Medicine (ABIM) and the ABIM Foundation, published a video on 20 May 2016 2014* attempting to justify the ABIM's high fees and requirement for "continuous" "Maintenance of Certification" (MOC) of physicians despite "no robust evidence" for the measure. Instead, he refers the viewer to the ABIM's "evidence summary" on their website and states "it's not randomized controlled trials but lots of what we do in healthcare is not randomized controlled trials. We do some things on a gut level of evidence, we do other things on a preponderance of evidence." (My detailed review of a portion of their "evidence" base can be found here.)

For $812,000 a year and countless lost hours of patient care and financial mismanagement, you would think he could do better than that.

Instead, Dr. Baron justifies the ABIM's actions on the basis that the ABIM was "preserving and protecting self-regulation at a time of change... otherwise it will be people, not physicians, who drive what all the expectations are for physicians." He claims the ABIM helps physicians "communicate to the public ways in which they communicate to the public that they have skills and that they have knowledge that other people don't have." As if physician's degree and training and countless years of experience and nights on call aren't enough.

According to Baron's own words, it appears the ABIM is little more than an exceedingly expensive marketing team working on our behalf.

But the real evidence of whom the ABIM has been working for can be found in the financial, political, and strong-man tactics used by the ABIM over the past forty years since "continuous" certification was conceived.

Dr. Baron never mentions the ABIM's secret transfer and cover-up of $55 million dollars taken from working physicians' test fees from 1990 to 2008 to create the ABIM Foundation and how the Foundation has moved a portion of those funds offshore.

Dr. Baron never mentions that the ABIM spent hundreds of thousands of dollars lobbying Congress to assure a perpetual money flow to the organization and hid these actions from the IRS to avoid paying taxes.

Dr. Baron never mentions that within all of their propaganda research the ABIM or ABIM Foundation never (once) studied the negative psychosocial effects of failing even one of their unjustified MOC examinations, nor the potential negative effects of cost saving initiatives promoted by the Foundation's "Choosing Wisely" campaign for the individual patient. He never mentions that  13.2% of clinically experienced physicians tested by their unproven metric failed their examination on their first try to the financial benefit of the ABIM and their partner professional societies.

Dr. Baron never mentions the his predecessor, Christine Cassel, MD, earned $10.88 million (nearly $9 million of that amount from ABIM diplomats and an amount that included spousal travel fees) during her 11-year leadership at the ABIM and ABIM Foundation. Nor does Dr. Baron mention Dr. Cassel's long-standing conflicts of interest with Premier, Inc or Kaiser Foundation Healthcare and Hospital system. Nor does Dr. Baron mention Robert Wachter, MD's conflicts of interest with IPC Hospitalist company that is now under federal investigation for overbilling Medicare.

Dr. Baron also fails to mention how serious they are about protecting their monopoly - that they even use Federal Marshals to raid homes and seize assets, call physicians cheaters, then collect an amount estimated to be $3 to $4.5 million in hush money to justify their program that has "no robust evidence." He fails to mention have 139 physicians were sanctioned because the ABIM felt doctors were the one cheating. He also fails to mention that the ABIM continues to track down and hunt physicians from as far away as Puerto Rico some four years later after publishing their one-sided account of details of their raid in the Wall Street Journal for their benefit "as a message and a deterrent."

But not all of the blame for the acceptance of MOC as a facade for physician competency rests with just the ABIM.  The American Board of Medical Specialties (ABMS) and the Accreditation Council on Graduate Medical Education (ACGME) that has quietly insisted on this credential for hospital and graduate training programs just so they can assure they receive more money from Medicare deserves blame as well. Their lack of leadership to expose the egregious behavior of the ABIM is at least as concerning, if not more so, for our profession and society.

-Wes

* Note, it appears this ABIM video was published in 2014, not 2016 as I first published. I regret the error and have corrected the post. Thanks to the anonymous commenter to corrected the date. Hopefully that same commenter will address the other issues brought up in this blog post as well.

Medical Specialty Certification in the US - A False Idol?

For the first time, the history of the ABMS/ABIM board re-certification corruption scandal has reached a peer reviewed medical journal, the Journal of Interventional Cardiac Electrophysiology. I hope practicing physicians here (and others worldwide) take time to read the history and evolution of board certification in the US reviewed in the article and to review the associated references. 

I would like to thank my co-author, Edward J. Schloss, MD (Twitter: @EJSMD) for his contributions to this work and the many helpful editorial suggestions made by the JICE reviewers.

It is time we reconsider the ABMS "Maintenance of Certification" (MOC) program. It is also time to have an independent audit of the financials from 1989 to 2016 from the American Board of Internal Medicine and its Foundation, including full disclosure of the many financial conflicts of interest within the American Board of Internal Medicine (ABIM), the ABIM Foundation, and each of the 24-member boards that comprise the American Board of Medical Specialties. Finally, a full investigation of misleading tax filings and lobbying disclosures of the ABIM as a public tax-exempt 501(c)(3) corporation by the IRS and Department of Justice is long overdue in light of these revelations.

-Wes

Reference:
Fisher WG and Schloss EJ. Medical Specialty Certification in the United States - A False Idol? J Interventional Cardiac Electrophysiology doi: 10.1007/s10840-016-0119-4 Mar 8, 2016.

Holding the ABIM Accountable

I ask my readers to indulge me as I provide some background about the strongman tactics used by the American Board of Internal Medicine (ABIM) to protect their board certification monopoly.

It started with a press release sent by the ABIM dated 9 June 2010, resulting in a story by Katherine Hobson making national headlines in the Wall Street Journal entitled "Medical Board Says MDs Cheated." Ms. Hobson also cross-posted her story on the Wall Street Journal's Health Care blog which she helped moderate at the time.

With this article, the public learned that five physicians, Monica Mukherjee of Washington, D.C.; Anastassia Todor of Aurora, CO.; Pedam Salehi of Los Angeles, CA; Sarah Von Muller of Tulsa, OK and Frederick Oni of Warner Robins, GA were sued by the ABIM "for what it deemed were ethical breaches involving the disclosure of test questions—which aren't supposed to be repeated, copied or reproduced." Another 134 physicians were "sanctioned" by having their Board certification revoked for at least a year, and thousands more were sent "letters of reprimand." Labeled as an "unprecedented action," the sanctions were "immediate" and resulted in the revocation of these physicians' Board certification for at least a year or more without trial. Hiding behind the legalistic  "Pledge of Honesty" that physicians have no choice but to sign when they enroll in the ABIM certification program, Dr. Christine Cassel, president and chief executive of the ABIM at the time, called the sanctions "a message and a deterrent."

It's was also an unprecedented strongman tactic by a self-appointed and unaccountable non-profit corporation. Should the entire unaccountable American Board of Medical Specialties and their 24-member boards be allowed to  intimidate, threaten, and professionally destroy physicians to protect their financial stranglehold on their own version of professional certification?

To those in their isolated executive perches, it seems they feel they can. And so, the story does not end there.

Using undisclosed methods and personnel, it seems the ABIM traced emails from a computer seized from Arora Board Review to a physician in Puerto Rico four years later. In a letter dated May 8, 2012, from Ms. Lynn Landon, Chief Operating Officer of the ABIM, Jaime Antonio Salas-Rushford, MD, was accused of sharing board review questions with the Arora Board Review course. On the sidebar of that letter were other names: Chair Catherine R Lucey, MD, Chair-Elect Robert M Wachter, MD, Secretary-Treasurer Talmadge E King, MD, President and CEO Christine Cassel, MD, Chief Information Officer John K Davis II,  MBA, Senior Vice President and Chief Medical Officer Eric S. Holmboe, MD among others.  With only 10 days notice, the ABIM imposed its harshest penalty: to "indefinitely revoke" Dr. Salas Rushford's Board certification and "notify the Medical Board in every jurisdiction you are licensed." The ABIM then sued Dr. Salas-Rushford for alleged  Copyright infringement.

What the ABIM had not anticipated is that Dr. Salas-Rushford's parents are lawyers and they countersued the ABIM.  Currently, the case has moved from Puerto Rico back to New Jersey and continues in its discovery phase. Lawyers from one of the largest law firms in Philadelphia, Ballard Spahr LLP, are representing the ABIM - all paid for by millions of dollars of practicing physician testing fees.

As you can imagine, the legal fees for Dr. Salas-Rushford's defense are significant. Last evening, a website (doctorsjustice.com) went live to help crowdsource Dr. Salas-Rushford's legal costs. The website contains more about Dr. Salas-Rushford and copies of documents important to his case (including the Langdon letter and the ABIM's final sanction determination). I encourage everyone to review his information carefully.

Given what we know about the ABIM's recent actions, the secret funneling of funds from the ABIM to the ABIM Foundation from 1989 to 1999 to define their version of "medical professionalism," the use of physician testing fees for luxury condominium purchases, the concerning undisclosed conflicts of interest within the leadership of the ABIM (see here and here),  the revolving-door collusion between CMS and the National Quality Forum, the undisclosed political lobbying of this tax-exempt 501(c)(3) organization, their strongman tactics, and their propensity to advertise their self-determined sanctions to mainstream media before due process, it is time practicing physicians demand justice and a full investigation into the ABIM's methods of securing their lucrative physician "quality cartel."

Dr. Salas-Rushford's suit against the ABIM promises to shine a very bright light on the practices of the ABIM whether his case is upheld or not. For that reason, I encourage all practicing physicians, irrespective of specialty, to donate in whatever way you can - $5 or $500 - to his legal fund. You can also help by sharing his website and encouraging others to do the same.

It's time for practicing physicians everywhere to hold the ABIM accountable.

-Wes

The ABIM Maintenance of Certification (MOC) Controversy a Year Later

It has been one year since the story of the ABIM Foundation, Choosing Wisely, and the $2.3 million Condominium appeared on this blog. It has been one year without answers to the many financial, conflicts of interest, and likely illegal tax dealings of the American Board of Internal Medicine discussed within this blog's pages.

But as this story has unfolded, it is clear that this story is much more than a story of the purchase of a luxury condominium by a little known non-profit organization. It has been the story of betrayal of the entire practicing physician community in the United States and their patients everywhere in the name of self-serving power and greed by a relatively select few.

The story is also an embarrassing demonstration of the inability of our professional medical societies to deal forthrightly and honestly with all that has transpired. The vast network of the interconnected medical Specialty Board System led by the American Board of Medical Specialties in the United States that earns hundreds of millions of dollars annually from physician testing fees is incredibly wasteful and counterproductive. Instead of honest examination and disclosure of the facts, the ongoing deception, double-speak, and cover-ups of this system continues.

To date this story has also been about the failure of our legal, government, and law enforcement agencies to investigate the secret financial and tax filing discrepancies of the American Board of Internal Medicine and the ABIM Foundation. This has created a colossal erosion of physicians' trust with our US medical regulatory agencies, especially when doctors can't trust these agencies to protect them from fraud and abuse.

Why the lack of governmental investigation into over $70 million of physician testing fees that were secretly funneled from working physicians (preoccupied with the real work of patient care) into a shadow "Foundation" hellbent on making shady investments and enriching its leadership? The wanton disregard of the basic tenets of law and a civil society displayed by the ABIM is an anathema to honest physicians. Most physicians would prefer to believe that we do not work in an environment that rewards deception, theft, and greed. Yet here we are.

Finally, with the notable exception of a veteran Newsweek reporter, Kurt Eichenwald (see here, here, here, and here) and the tireless efforts of a single forensic accountant, Mr. Charles P. Kroll with whom I have had the pleasure to meet, there has been precious little true investigative reporting into the financial and anti-trust activities of the ABMS and their member boards by major outlets of main stream media. "It's a doctor problem" or "it's too complicated," I've been told. Is that the reason?

We'll see.

One thing's for sure: there's a lot of money at stake in the testing and control of practicing physicians and it is increasingly clear that these organizations (and even some segments of government for which they now work) won't open up willingly or relinquish their lucrative MOC re-certification program without a fight. They know they simply can't afford to maintain their current ways without it.

Getting It Wrong Again

Because of this reality of cover-up and backed by remarkable hubris and ego, the ABIM leadership appears to have made a more recent critical error - another little thing it appears they got "wrong." The ABIM decided to track down and hunt a young physician attendee of the Arora Board Review course attended in 2009 using an email that was found on the server at the residence of Dr. Arora and sued him almost five years later. These guys are serious.  It seems maintaining monopoly control of the lucrative board re-certification process using threats and intimidation (aka, The Chicago Way) was just too important to the ABIM.  But what the ABIM didn't expect is that this young man had at least one parent who was a lawyer,  and he sued back. Time wil tell if this brave man dealt the ABIM (already in the midst of their own financial and ethical mess) a potentially mortal blow.

This case is about to get interesting. So interesting, in fact, that it appears the ABIM's legal team will stop at nothing to try confuse and deceive the judge or magistrate who will soon hear oral arguments in late January 2016 about the case.

Perhaps then the truth will come out: all of the facts of the business of testing physicians; all of the tactics used to bully physicians into compliance with the ABIM MOC program; everything laid bare.

For this story is similar to the disturbing story of a subcontracting security firm that works with Pearson (a company reviewed earlier on this blog) and paid by the state of New Jersey that has been spying on children to protect their monopoly interest in the content of the national Common Core test. For physicians, it is no coincidence that a different division of Pearson, PearsonVue, is the professional testing division of Pearson that the ABIM uses to secure its examinations and cherished test questions.

When the facts come to light about the spying, the tracking, the hunting of physicians by an organization profiting handsomely from intimidation and thuggery, it will be hard for the ABIM and its Foundation to survive. So, too, the basic construct of the ABMS and our entire professional specialty board system.

It is increasingly clear that the ABMS MOC program is about threats and intimidation so people can enrich themselves selling unproven quality data to unwitting customers, and little more.  Physician education, if it happens, is really secondary. Is this what the physicians need from these sheltered and unaccountable non-profit organizations? How much time, energy, and money have we already wasted and turned from the delivery of health care with this program?  How many physicians' lives has the current system in its perverted construct ruined?

When all of the facts of the MOC program become known, maybe, just maybe, the ongoing fleecing of US physicians by the corrupt and misguided ABMS MOC progam and the irresponsible Code of Silence held by their subordinate member boards will end and our profession can get back to doing what its meant to do: treat patients.

One can only hope.

-Wes

PS: By the way, today in history on December 16, 1773, the Boston Tea Party took place.
Seems apropos, doesn't it?

Edging Toward the Tipping Point

We've seen the "We got it wrong" messages."

We've seen the "We're listening to our members" messages.

We've seen the "changes" to board certification: from the change from permanent certification to time-limited in 1986, from dropping the requirement for dual board certification for subspecialists to the requirement for just one subspecialty certification, and from board certification being about a more "continuous" requirement for education.

And we keep hearing the excuses by all 24 ABMS member boards that they really want to change the MOC program after all of the corruption of the system has been exposed over the past two years.

But what you won't hear about from anyone involved with the Accreditation Council of Graduate Medical Education (ACGME) is anything about the money involved.

Practicing physicians are funding a profiteering racket.

This is what time-limited board certification is about, nothing more.

Proof of this can be found quite plainly at this website run by the American Board of Medical Specialties that promotes "ABMS Solutions." (video here).

ABMS "Solutions"sells "CertiFACTS Online®," "ABMS Certification Profile Service®," and "Direct Connect Select™" through Cactus, CredentialSmart, MD-Staff, and Vistar software systems.

We can see how the ABMS colludes with the Federation of State Medical Boards' (FSMB) newly-launched DocInfo service that "provides professional information on physicians and physician assistants licensed in the United States including information on disciplinary sanctions, education, medical specialty, licensure history and locations."

And now we see clearly how all of these privately-held non-profits of the 24 ABMS member boards are colluding together to prop up the very broken ABMS Specialty Board System financially:

Only CertiFACTS’ products connect professionals with board certification information that is updated daily with data provided by the 24 certifying ABMS Member Boards.

Physician ABMS board certification status, updated daily, and shot to a certification database near you. All for the low, low price of hundreds of millions of dollars a year and funded (in part) by every US physician.

It doesn't matter what new changes each of the member boards of the ABMS propose to change Maintenance of Certification (MOC).  The whole time-limited ABMS board certification is all about the money.

Always has been.

This is just one example of how the money pipeline overrides the welfare of the physician and their patients.

Between surveys, productivity ratios, data entry requirements, and now the board certification monopoly created by the ABMS,  I wonder how far the System thinks it can go before our new nation of employee-physicians unionize.

-Wes

ABIM Legal Fees: Pre-MOC vs Post-MOC

Pre-MOC Average: $146,073/year
Post-MOC Average: $1,090,184/year

This graph sums up another reason the American Board of Medical Specialties' Maintenance of Certification (MOC) program (implemented by the American Board of Internal Medicine in 2005) is such a mess.

(h/t @CharlesPKroll via Twitter)

-Wes

Labels

Two days ago after a typical day performing procedures in the EP lab, doing inpatient consults, fielding patient messages, attending administrative and research meetings, reading EKGs, Holter monitor recordings, and co-signing device clinic charts, I opened my email and saw this:

ABIM Email to Diplomats 11/20/2015

I was appalled. MOC is not longer about "keeping up" for physicians. It is a major distraction. This program is of unproven benefit to my patients and me. Thanks to haphazard and self-serving rule changes by the ABIM and their member boards over the past 25 years, the US Specialty Board system has become increasingly coercive. In fact, MOC program now threatens my ability to practice the work that I love because I could lose my facility privileges and ability to receive payments from insurers on December 31, 2015. That is my reality. This is the reality of every physician subspecialist who participates in the ABMS MOC program in US medicine today.

Remarkably, I just re-certified in Cardiovascular Diseases and Cardiac Electrophysiology in 2013 for the third time.  I have never failed. I have over thirty years of experience treating patients and standing in the cross hairs of what it means to be truly accountable to those I treat. I have had over thirty years of nights when I lie awake at night worrying about by patients, about if I did enough, about why a patient had to die. My family, too, has endured years of being woken in the middle of the night or seeing their father have to leave a school play, holiday concert, or friend's dinner party to place an emergency pacemaker.

I am not unique. I am a practicing physician everyman. I stand in unison with hundreds of thousands of others here in the United States just like me who get up every day, kiss their loved ones, and head off to do their favorite job in the world - a vocation so completely immersive and rewarding that we gladly give up a part of ourselves to earn the trust and faith of our patients and fellow physicians.

And because I've been practicing medicine so long, I know I do not need a private, unaccountable, and irresponsible organization to tell me how to behave. I am better than that. After experiencing the busywork of the evolving MOC program and its lack of value for the time spent, I looked into the corporations who promote this exercise. I had the help of accountants and fellow physicians who were similarly upset and uncovered a vast array of hidden financial activities of the ABIM and their collaborators. There is so much financial corruption it is mind-boggling. The conflicts of interest that are never acknowledged and corrected make my stomach churn. The practice of medicine is better than this. Practicing physicians are better than this. We do not need some dystopic corporate Big Brother watching over us to assure we log into a computer every so often to enter data that can be used against us. We do not need webcams, video monitors, body inspections, keyboard tracking, and palm scans to prove we are honest and ethical and won't cheat on examinations. But this is what the ABIM has become: some new form of quasi-police state for monitoring physicians.

Working in fear is not what I want for medicine. It certainly is not how I want my youngest colleagues to grow up learning and practicing medicine. But the ABIM and their parent organization, the American Board of Medical Specialties (ABMS), seem to love fear, humiliation, and intimidation to get doctors to participate in their lucrative MOC program. It is sickening. It is also the height of hypocrisy for these organizations to claim to run an organization that attempts to "Choose Wisely" when that same organization funnels tens of millions of dollars for itself from hard working physicians so they can choose an investment portfolio with multi-million dollar condos, meet at swank meeting venues, pay for spousal travel fees and first class airfares as they preen themselves in front of media lights. The ABIM Foundation "created to define medical professionalism" for the public? Give it a break.

Rest assured I am not naive. I know how important this MOC program is to certain investors. As I peel back layer after layer of the interconnected workings of these ABMS member boards and the ACGME, I know how high this MOC program goes and how dark this MOC program and its tactics have become. I completely understand that these specialty board organizations have managed to wedge themselves into our new health care law that calls itself "Affordable," wedged there by undisclosed lobbying efforts funded by the very doctors whose blinded trust was violated beyond comprehension. Just because these corporations want to make a buck.

So let me take the stick a moment.  Let me be perfectly clear and I don't say this lightly. I'm sure I say this on behalf of tens of thousands of other hard-working, honest, and ethical physicians. We have had enough of the ABIM and the ABMS MOC program. It is time to end it - completely.  No more "modifications" to make this broken program "easier." No more "listening" to our concerns but continuing this failed experiment. No more "MOCA Minutes" that we have to turn our gaze from our patients toward the computer screen or iPhone even longer. Continuing the ABMS MOC that has proven itself to be morally and financially corrupt, and exceedingly expensive to physicians, patients, and our health care system is ill-advised for our profession. The conflicts of interests alone are worth hundreds of millions of dollars to the corporations that stand to make millions from physician assessment, yet we never hear a word about this from them ABMS or the ABIM on this reality.

I am better than how the ABIM and ABMS threaten to label me. I served this great country for twenty-six years as a physician with the United States Naval Reserves and I continue to work every day to make sure I do the best I can for my patients in this increasingly difficult health care delivery environment. I worked then and work now beside hard-working corpsman, nurses, administrators and technicians who don't want to rock the boat and just want to do what's needed to finish our job every day. These people and the patients I care for are why I go to work every day.

So I ask the leadership of the ABIM: "Why does the ABIM insist on placing a "scarlet A" on my reputation by labeling me a "Not Participating in MOC?"  Such labels are offensive. I participate in ACGME-accredited CME as required by my license to practice medicine in the State of Illinois. I am not a slacker. I teach residents and fellows, for goodness sakes. I am certainly not one who doesn't mind working hard. I am a proud practicing physician with more years of clinical experience and direct patient care than any of you.

Please don't be libelous and cast aspersions my way with your on-line labels. I've got much more important things to deal with. Stop pretending that you speak for "the public" and know what's best for them in health care when you don't even crack the door of an examination room or know what I do. Proceeding to take away my hard-earned reputation and ability to practice medicine because of your little label is both threatening and hugely upsetting.

Think about these words. Think about them carefully.

I beg of you and your affiliated private organizations to stop the labels.

The profession of medicine is better than this.

Your everyman,

Wes

Concerning Conflicts of Interest at the ABIM, ABMS and NQF

By now various medical societies are telling the American Board of Internal Medicine (ABIM) their ship has sailed. The ABIM's worn mantra that the "public" demands their program is simply not supported by evidence. The tales of misguided incentives and corruption within the organization grow daily. The blatant avoidance of the egregious financial dealings and conflicts of interest outlined in this blog's pages and elsewhere simply cannot be ignored by the ABIM - yet they continue to do so.

Why?

Because there are millions upon millions of dollars at stake in areas of physician assessment and measurement.

When Christine Cassel, MD left the ABIM and began her work at the National Quality Forum (NQF), physicians learned of some of her conflicts of interest with other organizations, namely Premier, Inc and the Kaiser Foundation Health Plans and Hospitals. Dr. Cassel labeled these conflicts as "distractions" as she resigned her board seats with those organizations. What we do not know (and this is important) is did Dr. Cassel receive any stock or stock options from the organizations she was so cozy with as part of her compensation package? Given the usual and customary way of compensating corporate board members, I would not be surprised if she did. (Update 19:15 PM: h/t to Mr. Charles P Kroll for confirming that Dr. Cassel owns 3,704 shares of  Premier, Inc stock)

Recently, a Premier, Inc press release announced its plans to purchase a company called CECity, Inc. I suspect most practicing physicians did not notice this announcement. After all, why would practicing physicians be interested in a press release touting a new business opportunity for Premier as it expands its "performance improvement capabilities across the healthcare continuum?"

But practicing physicians need to be VERY wary if our fellow physician-bureaucrats (especially those from the ABIM) when they consider their prior conflicts of interest as "distractions." That word is a flag that everyone should look deeper at these conflicts first reported by ProPublica.

When we do, we find more concerning revelations about the ABIM and the American Board of Medical Specialties (ABMS)'s motives.

According to the press release, CECity, Inc is worth about $400 million (or more) to Premier, Inc. and who do we find has been using CECity as its consultant?

Yep. You got it: the ABIM.

In fact, the relationship with the ABIM has been nearly continuous since 2010. According to CECity, they are a CMS qualified registry that provides physician "quality reporting data" to CMS:

As a CMS qualified registry for the Physician Quality Reporting System (PQRS, ePrescribing, MOC-PQRS) and as the service provider for many physician certifying boards (e.g. ABIM, ABO, AOA) CECity is uniquely positioned to align professional and financial incentives with CQI to deliver ‘game-changing’ quality initiatives that have proven and measureable results.

According to the ABIM's Form 990's, they have already paid CECity the following: $600,000 in fiscal year (FY) 2010, $1,217,800 in FY 2011, $1,112,600 in FY 2012, $1,378,138 in FY 2013, and $1,260,000 in FY 2014 (an example of these payments can be found on page 8 of the ABIM's most recent published Form 990 - provided they do not change their Form 990 after this report).

That's right: $5,568,538 of physician testing fees to CECity from practicing US physicians over five years - all of it (so far) on Dr. Cassel's watch.

If Dr. Cassel holds stock in Premier, Inc. from her prior board position there, I wonder how much money she stands to make when this cozy deal with Premier, Inc. closes? Should the U.S. Securities and Exchange Commission investigate this transaction? We don't know, but even the apparent conflict of interest with Dr. Cassel, the president and CEO of an organization responsible for "quality" programs in our nation's hospitals, is very disturbing, indeed.

This is not a minor revelation as physicians continue their difficult task of managing patients in such an overbearing regulatory environment while our specialty societies continue to support the financially conflicted ABMS MOC program. I believe allowing independent and unaccountable third-party organizations (like the ABMS and ABIM) to collect and distribute physician and de-identified patient-related data without written consent of those who could have their ability to practice medicine or collect payment from insurance companies revoked if they don't participate in MOC is a clear violation of Department of Health and Human Services Protection of Human Subject statutes. It also remains to be determined if this violates the Sherman (antitrust) Act.

After all, it is now clear the MOC program is not a "quality assurance" exercise performed for "public's" benefit.

This is profiteering and financially conflicted research on physician subjects in its most fundamental form.

-Wes

Heart Rhythm Society and ABMS: Friends for Life

Patients are dropping like flies in Electrophysiology Laboratories across the country. Death and destruction everywhere. Poor quality. Unsafe standards. Pitiful results.

What, you haven't heard? 

Clearly this MUST BE THE CASE! That's why it's SO important that the Heart Rhythm Society and the Intersocietal Accreditation Commision (IAC) INSIST (seriously) that EVERY electrophysiology laboratory in the United states have a MEDICAL DIRECTOR certified by the American Board of Medical Specialties.  Otherwise, your electrophysiology laboratory will be labeled as "NOT UP TO STANDARDS." And we wouldn't want that now, would we?

I just received this disappointing e-mail from David Haines, MD, president of the "IAC Cardiac Electrophysiology Accreditation" on behalf of the Heart Rhythm Society (who is clearly colluding with the American Board of Medical Specialties to assure regulatory capture of every electrophysiology laboratory in the United States) under the guise of EP laboratory standardization:

Last week, I sent an email discussing the recent partnership between the Heart Rhythm Society, the Intersocietal Accreditation Commission (IAC), and other key stakeholders to develop and operate an EP Lab Accreditation Program. Developed by the IAC Cardiac Electrophysiology Board of Directors, the draft IAC Standards and Guidelines for Cardiac Electrophysiology Accreditation are now available for public comment and I am requesting your assistance on this important initiative. Please review the draft standards and provide feedback to ensure that they meet the expectations and the field’s needs.

Listed below are the instructions to provide comments. The IAC Comment Form must be completed and submitted electronically by December 1, 2015.


To submit a comment on the proposed IAC Standards:

• Visit the IAC website.
• Click on the proposed Standard you wish to review and/or comment from the menu.
• A window will expand with the description of the Standard and a PDF to view the section of the Standards available for comment.
• Click on the PDF to open it in a separate window for review.
• On the right, fill in your name and provide your comments about the proposed Standards in the boxes provided.
• Push submit.

At the close of the comment period, the IAC Cardiac Electrophysiology Board of Directors will review all submitted comments, consider modifications, and vote on the Standards final approval. The new Standards will be posted to the IAC Cardiac Electrophysiology website and available for download in late 2015.

Don't you get it?  The new "Standards" are coming whether you like it or not.

I would suggest every electrophysiologist comment on this decision by the Heart Rhythm Society to insist that EP laboratories must meet certain "standards" regulated by yet another unaccountable body to the physician and patient (who the heck is the "Intersocietal Accreditation Commission?") After all, this is ALL about regulatory capture and the money generated for the ABMS and their member boards.

Where's the proof that patient care will be improved as a result of such standardization?

Instead, everything (including our "re-certification" expenses) will cost us more and more as the regulatory capture of medicine by the ABMS and the IAC/ and their pals continues unabated.

-Wes