ABIM To Diplomates: Merry Christmas! Participate in MOC or Else

This weekend, I received this orange notice from the American Board of Internal Medicine (ABIM) in the mail:

(Click to enlarge)

At first I was going to ignore this flier, since I am board certified until 2023 in Cardiology and 2024 in Cardiac Electrophysiology.

But then I read the reverse side of the flier, and noticed this threatening sentence:

"Your deadline is approaching, so we wanted to follow-up on the email reminders we've sent to you about earning 100 MOC points by 12/31/2018 to stay certified." (emphasis mine)

(Click image to enlarge)

It appears the ABIM will revoke the "time-limited" certification(s) I have paid for through 2023 in Cardiovascular Diseases and through 2024 in Cardiac Electrophysiology because I have refused to earn 100 Maintenance of Certification® (MOC®) points by 12/31/2018.

Must diplomates who have "pre-paid" for their certifications now ALSO have to participate in MOC just to maintain their pre-paid certificates?

I certainly hope not. If so, things could get ugly very quickly for everyone involved.

-Wes

Ending MOC Nationwide

Continuing education for physicians is important (and we've been doing it all our lives on our own), but when working physicians' right to care for their patients is threatened by unaccountable non-profit testing organizations that have serious undisclosed conflicts of interest, we will take action.

 -Wes



P.S.: Patients, doctors: want to help? You can still donate.

MOC as Physician Stick and Carrot

Remember when the American Board of Medical Specialties (ABMS) Maintenance of Certification (MOC®) was sold to physicians by our specialty societies and ABMS member boards as a "pathway to know that they are staying current in the medical knowledge they use to treat patients and make important care decisions daily?"

Congress was sold the same thing in 2013:

"ABMS MOC® is a system of specialty-specific assessment and professional development activities that require medical specialists to reflect on their practice performance, identify gaps, and adopt new practices to improve care."

It seems physicians and the public were purposefully mislead. MOC® was always a stick that is now being introduced as a carrot to direct physician behavior.

Yesterday, Blue Cross and Blue Shield of Michigan announced (via their friends at the Michigan State Medical Society), that lowly family practice physicians, internists, and pediatricians that are "designated" patient centered medical home physicians won't have to participate in MOC® after all:

"Effective Jan. 1, 2019, the board certification status of family medicine, internal medicine and pediatric practitioners will be reviewed annually. If their board certification status has lapsed and they are a designated patient centered medical home physician, Blue Cross will grant an exception and allow the practitioner to remain in their Blue Cross and BCN managed care networks. This exception does not apply to new practitioner enrollments. Blue Cross and BCN will continue to require all providers to have board certification upon initial enrollment for affiliation."

Meanwhile, the ABMS "Vision Commission" tap dances and distracts by seeking more public comment 2019 timeline magically appears, just as the transition to Medicare's next unproven "value-based" physician pay model is implemented.

Patient care value?

Now you see it, soon you won't.

-Wes

The Fallacy of dEthics

Meet dHealth (video).

dHealth is digital, algorithmic, group-based health care delivery using blockchain technology.

Who are the dHealth promotors and visionaries? The exact same ones who lead the ABIM and ABIM Foundation in 1999 when it set out to "define medical professionalism" for us. Their final product, the 2002 Physician Charter on Medical Professionalism still stands tall as the guiding light of dEthics for much of organized medicine.

dEthics demands that devotion to the best interests of each individual be replaced by an ethic of devotion to the best interests of the group for which the physician is personally responsible.

dEthics is now driving corporate medicine. Data control. Information control. Education control. More with less; profit before person.

No one saw this more clearly that Dr. Richard Fogoros on his now quiet Covert Rationing blog:

The intent of the 2002 Charter on medical professionalism was to repair the problem (i.e., to cure the “frustration”), not by confronting the forces of evil doing the coercion, but rather, by simply changing medical ethics to make bedside rationing OK. And that’s just what the document did, though only after careful re-editing to make this radical change to medical ethics sound as benign as possible.

dHealth is the next great hope. The vision for world health sees blockchain technology allowing nurses (video) to access to a "complete file" of a patient's health information and to "see into the future in health" to deliver scalable care worldwide remotely using corporate dEthics as their guide.

What could possibly go wrong?

-Wes

h/t: to james gaulte at the Retired Doc's Thoughts blog.

The MOC Fight

From Medical Economics:

“Physicians are pushing legislation on the state level because they don’t trust the ABMS [American Board of Medical Specialties] and its financial conflicts of interest,” says Paul Mathew, MD, a volunteer board member of the NBPAS in Cambridge, Mass. “Many feel the only way to declaw the tiger is legislative action due to insurance companies and academic institutions having no reason to change their pro-MOC policies.” The ABMS oversees MOC for its 24 boards.

-Wes

For Whom MOC Tolls

He saw me in the hall between cases and our eyes connected, however briefly. I probably looked a bit tired, hair askew, and rushed after a long ablation case as I scurried to grab a quick bite to eat before my next case started. He was one of our best fellows in cardiology - hard working, innovative, never one to skip a clinical detail or shirk a responsibility, who clearly wanted to chat. He approached respectfully, smiling timidly, and said quietly:

"Dr. Fisher, is it true that I have to pay ABIM $155 to maintain my certification even though I passed my boards? And do I have to do this for life? I went to the ABIM website and it really isn't clear what we have to do."

I explained the ABIM's current iteration of fees and testing as best I could in the brief time we crossed paths. The ever-shifting sands of the ABIM parsed fee and "point" structures, "discounts," programs, credits, and value of participating (or not) in Maintenance of Certification have lead, I believe intentionally, to the current chaotic state of US physician Board certification. I felt sorry for him but was not surprised he was confused, especially since explaining the board process was equally difficult. I sensed he knew that speaking candidly about his concerns with others in positions of leadership might compromise his reputation as a hard-working, reliable cardiology trainee and was grateful he felt he could approach me with his concerns.

This is what US physician board certification has become: little more than a shakedown of our best and brightest to fund a bloated bureaucratic credentialing system that adds little to no value to our trainees' learning experience. After our conversation, I grabbed a salad and returned to do my pre-operative checklist for my next patient. My phone received a text message:

""They also included a discount on multi-year payment."

"$155 is my annual savings during fellowship..."
-Wes

ABMS and ABU Spin on DOJ Letter

Board certification of US physicians continued on its path of deceptive and misleading propaganda following the Department of Justice's (DOJ) letter issued on behalf of a request by the National Board of Physicians and Surgeons (NBPAS) in its effort to thwart the monopoly practices of the American Board of Medical Specialties (ABMS) and its 24 member boards. Despite that letter, the ongoing collusion between the member boards and the ABMS was particularly evident in the email circulated two days ago by the Executive Secretary of the American Board of Urology (ABU), Gerald H. Jordan, MD. The ABU's email attempts to spin the ABMS position as the same as what is stated in the DOJ letter by conflating initial lifetime ABMS Board Certification with the self-created separate time-limited Board certification market product (called Maintenance of Certification®):

The ABMS position that legislative interference which limits the use of physician certification is inappropriate is consistent with the position set forth in the DOJ letter. The ABMS and the ABU have always supported a fair and competitive marketplace for physician specialty certification and continue to do so, encouraging accurate comparison of our programs with other certification programs available.

ABMS agrees with the DOJ’s support of the right of patients and health systems to determine which certification programs best meet their expectations for providing information about high quality specialty care. The ABMS and ABU promote communications practices that allow the public to easily identify and compare the program standards used to certify that a physician has demonstrated, through training and assessment, that he or she in fact has demonstrated the knowledge, skill and judgment to practice in a medical specialty or subspecialty.

This continued deception of the ABMS and its member boards by conflating lifetime certification with time-limited "continuous" certification will not go unchallenged. I encourage all physicians adversely affect by their member boards complicit in this ruse to consider contributing to our ongoing legal challenge against the ABMS board certification monopoly.

-Wes

Resident Recall - "Cheating" or Part of Free Speech?

Read the opinion piece referenced below carefully. It discusses the widespread use of "resident recall" to study for the American Board of Radiology's board certification examinations by both residents AND faculty/senior physicians:

https://pubs.rsna.org/doi/full/10.1148/radiol.12120251

Then read the back story on how the American Board of Medicine threatened internists in 2010 on the basis of the threat to their training monopoly:

http://drwes.blogspot.com/2016/06/maintenance-of-certification-medicines.html

Then ask yourself: who has "cheated" whom?

It is clear that the American Board of Medical Specialties, who continues to promote its lavish ABMS Conferences with "stakeholders" in Las Vegas (full schedule here), has a serious problem on its hands. This problem is exacerbated when it claims to work collectively with "500 professionals from across the health care community who, working together, will accelerate the transformation of Board Certification and the delivery of quality patient care."

Where's the data a computer test and secret data collection scheme does anything except raise prices and stroke the egos/bank accounts of the boards' leadership?

What do these Las Vegas boondoggles do to reestablish trust in the ABMS board certification process?

The answer is quite simple:

Nothing.

-Wes

When the Walls Start Crumbling Down

From the Department of Justice via the NBPAS website:

'The DOJ explained that the ABMS Program on MOC may have the effect of “harming competition and increasing the cost of healthcare services to customers.” ABMS may do so “by imposing overly burdensome conditions on physicians who wish to maintain their certification.” The DOJ added, with respect to ABMS, “[the] vast majority of [its] board members are medical doctors”—i.e., “active market participants”—who may have incentives to limit competition through “industry self-regulation.” As a result, the DOJ warned, “there would be competition concerns, if dominant certifying bodies [like ABMS] set de facto participation requirements that did not sufficiently correspond to health, safety, or other procompetitive justifications.”'

While this letter is very helpful to the National Board of Physicians and Surgeons (NBPAS) and detrimental to the efforts of the American Board of Medical Specialties and their subsidiary boards to monopolize the physician continuous credentialing system in states' legislation accross the country, it might not be entirely advantageous to employed physicians because of this paragraph on page 14:

"At the same time, the Division discourages the legislature from interfering with unilateral business decisions—such as an individual hospital’s decision about what criteria to use for granting hospital privileges or an individual insurance carrier’s decision about what criteria to use for allowing participation in the insurer’s network, as restricted in the Workgroup’s Bill—unless a restriction is determined to be necessary and narrowly tailored to redress well- founded consumer harms or risks. ... The Division encourages the Maryland legislature to consider whether other tools, such as facilitating entry by competitive certifying bodies, can address concerns with certification without imposing restrictions on the unilateral business decisions of hospitals and carriers."

Still, this letter represents a significant blow to ABMS in their efforts to prevent NBPAS's entry into the physician maintenance of certification (or "continuous certification") market as 30 states have some form of anti-MOC legislation either pending or passed.

-Wes

Thank You, Colleagues

I would be remiss if I did not thank my friends and colleagues nationwide who contributed to our GoFundMe page to initiate our pre-litigation investigation of the American Board of Internal Medicine and the ABIM Foundation. While I was upgrading a DDDR pacemaker to a biventricular ICD today, I received a text from a colleague that we had reached our funding goal for this initial phase.

I cannot express my gratitude enough. Thank you all.

It is very reaffirming to know that others feel as I do about Maintenance of Certification and what it has done to physician autonomy, morale, and even our right to work. I know that the dollars contributed could have been used for so many other things. I hope you will soon see that it your money was well spent.

But as Winston Churchill famously said:

"Now this is not the end. It is not even the beginning of the end. But it is, perhaps, the end of the beginning."

Thanks again -

-Wes

Video: 7007 US Physicians Weigh In on US Board Certification

From January through March 2018, a voluntary Internet-based survey of US physicians and surgeons was conducted by Practicing Physicians of America concerning ABMS Board Certification. 7007 completed surveys were available for analysis. Here is a brief video summary of many of the survey's findings as promised:



-Wes

Reference: pdf file of PPA Physician survey questions that formed the basis of this report.

Two Surveys: US Physician and Surgeon Perspectives on ABMS Board Certification

At the beginning of this year, Practicing Physicians of America (PPA), a 501c6 physician membership organization (with whom I serve as an unpaid board member),  collected results of a voluntary survey via social media channels on ABMS physician and surgeon Board certification. The method of data collection using social media. The data collection is  novel compared to previous surveys conducted on this topic and for a while represented the largest reported survey on Board certification ever performed. We submitted the results to JAMA (and later to the Annals of Internal Medicine) in hopes they would be published. They were not. As is true with most surveys, bias was a prevailing concern.

Shortly after our survey was being circulated, the American Board of Medical Specialties introduced their own survey on Board certification to pre-chosen "stakeholders" on Board certification. In July 2018 they announced the results of their survey. They had received responses from "36,392 people, including 34,616 physicians, 1,373 non-physician providers and stakeholders involved in the delivery of health care, and 403 members of the general public." To the best of my knowledge, the text of their survey was not made available to the public.

Since we were waiting the reviews of PPA's survey for months, we were prohibited from publishing our results. After considering the reviewers' comments (which were very thoughtful), I think the odds of ever publishing such a survey of this type in a peer-reviewed scientific journal are low. Hence, the board of PPA has allowed me to announce the results of our survey publicly via this blog and (hopefully) Doximity so these results may be interpreted alongside the survey results reported by the American Board of Medical Specialties' Vision Commission. Admittedly, our survey asked different questions than that conducted by the ABMS, but the results are not only notable for their differences, but also for some similarities.

By way of background, here are the 32 questions we asked in the PPA survey.

Here is the full paper (with some minor edits) we submitted for peer review that was NOT accepted for publication. This pdf includes the background for the survey, the methods used, the results obtained, and a discussion of those results, as well as references, figures and tables.

Similarities of PPA survey to the ABMS Survey on Board Certification:

• Both ABMS and PPA surveys used SurveyMonkey to collect responses


• A large number of physicians responded to both surveys. Still, the PPA survey represented only 0.92% and the ABMS survey represented only 4.5% of the total US physician population in 2016. Neither survey mitigates potential under-coverage bias and non-response bias.
• In the PPA survey, 93% of physician respondents were board certified vs 96% in the ABMS survey.
• In PPA survey, 80% (4973/6004) participated in MOC; in the ABMS survey, 69 percent of respondents were currently enrolled in a primary specialty MOC program, and 33 percent are currently enrolled in a subspecialty MOC program
• Costs, burden, and the lack of true reflection of their abilities as clinicians were of significant concern to physicians in both surveys

Differences of PPA survey from the ABMS Survey on Board Certification:

• PPA survey used logic to limit responses from clinically-active physicians only
• PPA survey attempted to geolocate physicians by IP address and excluded non-US physicians
• PPA survey included MDs and DOs; it is unclear how many ABMS physicians were MDs or DOs.
• PPA survey was simply distributed to physicians via social media, not targeted groups like the ABMS survey. Heavy contributors to the PPA survey included members of the Pennsylvania Medical Society and Doximity.
• Discontinuation of "continuous certification" was not offered as an option in ABMS survey. Ending MOC and reverting to lifetime certification with CME was offered as an alternative in the PPA survey.
• PPA survey assessed physician perceptions of the negative consequences, contract obligations, and potential conflicts of interest of MOC; ABMS survey did not address these issues.
• PPA survey specified physician-respondents' specialties and state of origin. ABMS survey did not.

Finally, here is a pdf of the Powerpoint presentation I presented in June 2018 at the AMA House of Delegates meeting in Chicago summarizing findings from the PPA survey.

Major Findings of the PPA Survey

7007 physicians responded (52% male, 48% female)

Demographics

• Every US state was represented, with the largest being PA (910), CA (506), TX (504), FL (406) being the largest physician participants
• Responses came from 24 different subspecialites, with the largest being family medicine and pediatrics
• 19% of physicians had at least one "grandfathered" certification.
• 65% of the respondents had 10 or more years of clinical experience
• Of the physicians with initial ABMS board certification, 80% participated in MOC.

Major Findings

• 90% of all respondents thought board certification should be a lifetime credential with CME used for ongoing education.
• 95% felt MOC increases burnout.
• 53% of respondents estimated costs (direct and indirect) were more than $4000.
• 94% were unaware their data were being sold.
• 80% felt IRB and informed consent should be required for research conducted by the boards.
• 86% perceived MOC could threaten their right to work.
• 8.4% failed a recertification examination.
• Of the 394 physician that failed recertification, harms experienced included psychologic harms (more than 56%), 10% lost of hospital privileges , 5% lost their job, 8% lost insurance panel participation, and 17% plan to retire rather than retaking the re-certification examination.

I hope these data are informative and provide a balanced perspective of a large cohort of US physicians' and surgeons' perspectives on ABMS Board initial and "continuous" certification.

Physicians and others are welcome to use these data under a Creative Commons license (see below), we just ask for appropriate attribution.

-Wes

P.S.: Physicians desiring state-specific data regarding the PPA survey results are welcome to contact me via Twitter or email.


Survey of US Physicians and Surgeons Perspectives on US Board Certification by Practicing Physicians of America is licensed under a Creative Commons Attribution 4.0 International License.
Based on a work at http://www.practicingphysician.org.

How Practicing Physicians Can Double Their Money

From now until we reach our contribution goal, an anonymous donor(s) has/have graciously stepped up to match, dollar-for-dollar, physicians' contributions to Practicing Physicians of America's GoFundMe page to fund the litigation factual and legal investigation and the drafting of proposed complaint against the American Board of Internal Medicine, the ABIM Foundation, their directors, executives, and perhaps others under federal antitrust laws and state consumer fraud and deceptive trade practices acts to bring an end to MOC™ nationwide.

After four years of bring this issue to my readers on this blog, the AMA, and state legislatures, too many questions and conflicts of interest remain about the financial and political shenanigans of these organizations. While the ABIM claims they have "listened," they still have failed to stop the ability of the proprietary ABMS MOC™program from potentially affecting a physicians ability to retain hospital credentials and insurance payments if they don't pay for the program; in other words, their right to work.

Hundred of physicians have been adversely affected by this program already. For every physician who drops out of medicine because of refusal to play along, approximately 2000 patients are affected in turn.

So please give generously. After all it's a "two-for-one" special going forward!

Thanks everyone (and thanks to our special donor(s))!

-Wes

P.S.: Again, here's that link to donate: https://www.gofundme.com/practicing-physicians-of-america

MOC's Greatest Lesson

Yesterday, I read with interest the American College of Obstetricians and Gynecologists widely circulated piece authored by Lucia DiVenere, MA entitled, "MOC: ACOG's role in developing a solution to the heated controversy" published in the August issue of OBG Management. By carefully listing the numerous physician concerns with MOC (costs, relevance to practice, lack of data to improve care, relationship to licensing, employment, privileging, and reimbursement), the article reinforced many of the issues on this blog while being simultaneously crafted to sound as if ACOG was really "listening" to physicians concerns about ABMS Maintenance of Certification (MOC).

It didn't take long for me to realize the article was really about the tired trope that the "ACOG asserts the importance of maintaining self-regulation." The leadership within the ACOG and Ms. DiVenere herself can hardly be described as "self" as far as working physicians are concerned. Ms. DiVenere is Officer, Government and Political Affairs, at the ACOG and OBG Management contributing editor. And while she "reports no financial relationships relevant to this article," her very job may have depended on writing it.

Which leads me to MOC's Greatest Lesson that it consistently teaches working physicians, both young and old: In medicine, it is okay to lie, cheat, and steal.

I do not say those words lightly. Everything MOC touches is corrupt. For a once simple medical accolade to be allowed to secretly morph into a one-billion-dollar-a-year enterprise and physician cudgel to fund the bloated bureaucratic and political aspirations of the Accreditation Council for Graduate Medical Education is beyond me. Yet this is precisely where working physicians find themselves. Are these the ethics to which we want our young doctors of tomorrow to aspire? Should they model turning a cheek the other way to ignore the implications of these actions on our patients just so specialty societies can maintain handsome salaries, political power, and "self-regulation?"

Despite all that has been uncovered by following the money, I still can't believe it's taken one simple GoFundMe page three months to raise $150,000 from working physicians to fight this corruption.

It seems MOC's Greatest Lesson has been taken to heart.

-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!

Moving Mountains By Example: Doctor Inspires Others to Fund Anti-MOC Legal Effort

In a reaffirming gesture of solidarity, San Francisco cardiologist Michel Accad, MD has offered to supply an electronic copy of his book "Moving Mountains: A Socratic Challenge to the Theory and Practice of Population Medicine" (seen on Amazon) free of charge to anyone donating $50 or more in the next two weeks to our legal effort to end the onerous and unproven ABMS Maintenance of Certification (MOC™) program nationwide.

 Dr. Accad's affable and insightful personal blog (Alert and Oriented) and podcast (Accad and Koka Report) co-produced with Philadelphia cardiologist Anish Koka, MD, have garnered wide physician followings by respectfully and thoughtfully discussing timely issues that matter to doctors. (My recent 46-min podcast discussing this funding drive with them can be heard here).

While the sponsor of the legal effort, Practicing Physicians of America (on whose board I serve), has already reached over 75% of the $150,000 funding goal, I hope Michel's generosity will inspire many other physicians to join this funding drive in hopes working physicians of all ages can help end - once and for all - the expensive, onerous, and corrupt ABMS MOC™ program that has the potential to unjustly limit a physician's right to work.

-Wes

Federation of State Medical Boards Attempts to Legislate Away Liability

In a press release, the Federation of State Medical Boards (FSMB) announced their support of the “Occupational Licensing Board Antitrust Damages Relief and Reform Act of 2018 (H.R. 6515),” introduced by Rep. Mike Conaway (R-TX) and co-sponsored by Rep. Lamar Smith (R-TX). According to the press release:

H.R. 6515 eliminates fiscal antitrust damage liability for state licensing boards-including state medical boards- their members, and staff who are acting within their statutory mandate to protect the public. Currently, board members and staff are exposed to personal liability and treble damages for actions taken as part of their service on a board. The lack of protection has had a chilling effect on the willingness of some individuals to serve on boards, causing some board members to resign for fear of personal financial liability.

It is interesting that this new bill attempts to circumvent the 2015 Supreme Court decision that held professional boards could not make decisions that potentially violated antitrust laws and quashed competition. The justices, in an opinion by Justice Anthony Kennedy, agreed with the government’s claim that although state entities are usually exempt from federal antitrust laws, the exemption did not apply because the board was not actively supervised by the state and because it was made up of self-interested private businesses.

The FSMB President and CEO, Humayun Chaudhry, DO, MACP has quite a history of working with similar self-interested private businesses.

In fact, Dr. Chaudry has long supported the notion of Maintenance of Licensure (MOL) that required Maintenance of (board) Certification (MOC®) and "lifelong learning." Chaudhry chaired a CEO Advisory Council (comprised of a slew of non-governmental U.S. medicine regulatory organizations) that advised the FSMB's Board of Directors and worked with an FSMB MOL Implementation Group (with Richard Hawkins, MD, the current President and CEO of the American Board of Medical Specialties (ABMS), in 2009). That group recommended that physicians actively engaged in the Maintenance of Certification (MOC) program of the American Board of Medical Specialties, or the Osteopathic Continuous Certification (OCC) program of the American Osteopathic Association, should be recognized as "substantially in compliance" with any MOL program that is adopted by a state. Because of this tie between MOL and MOC, the activities of the FSMB in the state of Ohio were met with formal opposition from the Ohio State Medical Association in 2012.

No wonder the board members from various state medical boards have resigned from their positions out of liability concerns. They understood there is credibility to the Federal Trade Commission's concerns that were upheld by the U.S. Supreme Court.

Legislators (especially Rep. Mike Conaway and Rep. Lamar Smith) would be wise to realize that the multi-million dollar FSMB has financial conflicts of interest that may cause more harm than good to our patients.

-Wes

P.S.: Like the FSMB, ABMS collusion with state medical societies regarding MOC® is also evident in this recent ABMS press release.

The ABIM Has Lost Their Marbles

From the institution that secretly funded itself with ABIM diplomate fees to the tune of over $78 million that culminated in the purchase of a $2.3 luxury condominium for itself complete with a Mercedes S class town car, and offshored funds to the Cayman Islands,  comes this news release:

The 2018 ABIM Foundation Forum will consider the importance of trust in health care – and how to build and maintain it – against a backdrop of political and social turmoil and all-time lows in Americans’ trust in institutions across society.

Make no mistake: this is our physician Board re-certification money they are playing with.

At the very least, the optics of such a conference are horrible given the ABIM Foundation's past.

I hope everyone will make good use of the hashtag #abimf2018 on Twitter and then contribute to our legal fund to permanently end this shameless gaslighting of US physicians and our patients.

-Wes

Board Certification: From Marketing Accolade to False Idol

I'm Board certified.

So is Carmen A. Puliafito, MD.

So is Farid Fata, MD.

So are plenty of other Medscape "Best and Worst" physicians from 2012-2016.

So what is "Board certification?"

Truth be known, it is little more than a marketing accolade.

And for a while, it worked.  Doctors took board certification examinations to market themselves as competent in their field. They would take a written or oral examination created by their peers to demonstrate to others they knew their stuff. And while it remained a lifetime designation, it had some legitimacy. In reality, however, it was up to the residency training programs to train the physicians and verify they knew their stuff.  Hospitals used to verify credentials by calling residency programs and verifying doctors participated. They had large credentialing departments that kept everything on file.

But competition between hospitals vying for patients soon grew fierce and hospital marketing departments jumped on the credentialing bandwagon. Soon billboards would appear: "Come to see our board-certified specialists!" and the race was on.

Lawyers joined the fray, too. "My expert witness is better than your expert witness - see how many board certificates he has?"

Truth is, we love this crap. Just look at how many nurse practitioners are "board certified" now!

In the 1960's to 1970's, the American Board of Internal Medicine recognized how lucrative this craze could be, but they had one big problem if they were going to make certifying doctors a full-time business: the number of doctors out there was finite. (It was about that time the board members started paying themselves). They also saw how much money the American Board of Family Medicine, founded in 1969, was generating using 7-year time-limited certifications.

But the ABIM knew internists would be on to them changing the rules for board certification from a lifetime to time-limited credential. So they first tried making a voluntary "super accolade" for internists, called the "Advanced Achievement in Internal Medicine." Needless to say, after four attempts that garnered progressively declining enrollment, the AAIM concept flopped. It was Lynn O. Langdon, MA (a non-physician and Chief Operating Officer of the ABIM) who declared the "End to Voluntary Recertification" and time-limited certification was born with the threat of "uncertain circumstances" if doctors did not participate.

Needless to say, with the help of conflicted members of the ACP who stood to make handsome returns from the Medical Knowledge Self-Assessment Program (MKSAP), they were off to the financial races. And what a race it has proven to be: a nearly $1 billion dollar-a-year enterprise for the entire ACGME.

Unfortunately, no one has ever stopped to study what happens to skilled, competent, board-certified doctors that fail their computerized "re-certification" examination or fail to garner enough "MOC points" to sit for their examination. No one asks about the damage this time-limited credential is having on our physician numbers and access to care. The money is too important to the system.

Not long ago, the chairman of our cardiology division had to relinquish his role as a teacher to medical students because he refused to re-certify in cardiology while also being "certified" in interventional cardiology. (He could keep performing catheterizations and stent placements and remain credentialed thanks to the change in double jeopardy rules that changed just in the nick of time). How many medical students lost out on his experience as a result? Are we happier that medical students are now being taught by younger (time-limited) Board-certified physician instructors rather than life-time certified physicians with decades of experience in the field?

Doctors and nurses know the truth. That's why when seeking out a "quality" physician for their own care, they NEVER ask if a colleague is board-certified since board certification is now a false idol - a hoop to complete whether they're competent, ethical, or not.

We know that it's now far better to ask a trusted colleague or health professional when seeking care because there's much more to being a "quality" physician than holding a computer-generated "certificate."

-Wes

Reference: Fisher WG, Schloss EJ. Medical specialty certification in the United States - a false idol? J Card Electrophys October 2016; 47(1): 37-43.

US Physician ABMS Board Certification: From Voluntary to Mandatory

The American Board of Medical Specialties (ABMS) is very careful to claim their version of "Board certification" is a "voluntary process," otherwise, this Chicago-based non-profit 501(c)(6) organization might be accused of anti-trust behavior.

"ABMS Maintenance of Certification" and "ABMS MOC" were registered by the ABMS in the US Patent and Trademark Office August 21, 2007 after filing the terms February 23, 2007.

MOC for ABMS has value.

We also know Ms. Margaret O'Kane, founder and President of the non-profit "National Committee on Quality Assurance" and that created and owns the Healthcare Effectiveness Data and Information Set (HEDIS). HEDIS is a tool used by more than 90 percent of America's health plans to measure performance on "important dimensions of care and service." We also find that Ms. O'Kane was a "public member" of the Board of Directors of the ABMS and advertised the importance of the ABMS MOC program "to patients and the pubic" by video and implies the ABMS board's actions assures improved "outcomes" for patients.

So it should come as no surprise that some of those payers who stand to benefit by limiting patients' access to care (in this case, Blue Cross Blue Shield of Michigan) have made initial ABMS Board certification mandatory for physicians on their panels:



(Click to enlarge)

While claiming MOC as a requirement for physicians to receive payments because it assures their  "quality," BCBS of Michigan does not demand the same of mid-level providers like physician assistants and nurse practitioners without similar subspecialty training. Additionally, physicians who received their "Board certification" before 1990 and are farthest away from their training are not required to perform ABMS Maintenance of Certification to remain on those same insurance panels, introducing a hypocritical and discriminatory double-standard that financially benefits insurers and hospital systems (more insurance claim denials and cheaper staffing requirements).

ABMS is the puppet of the insurance companies, just as they were the puppets of Big Tobacco in the 60's.

The IRS, FTC, and SEC need to get serious about investigating this ruse.

Why?

It's compromising patient care and our patients' access to care.

-Wes

P.S.: If you haven't contributed already, please consider donating to the legal fund sponsored by Practicing Physicians of America that hopes to bring an end the ABMS Board certification/MOC monopoly nationwide.