Hillary Clinton's Physician Does Not Participate in MOC

In case anyone cares, Lisa R, Bardack, MD, reportedly Hillary Clinton's personal physician who issued a letter in 2015 concerning Ms. Clinton's fitness to run for President of the United States, does not participate in the American Board of Medical Specialties' Maintenance of Certification (MOC) program:

(Click to enlarge)

Classic.

-Wes

American College of Physicians Stands By ABIM MOC Program

Like the co-dependent spouse of a raging alcoholic, the American College of Physicians (ACP) continues to support the completely corrupt and untrustworthy American Board of Internal Medicine (ABIM) Maintenance of Certification (MOC) program.

In a carefully crafted e-mail to its members, Steven E. Weinberger, MD, Executive Vice President and Chief Executive Officer of the ACP recently stated:

"We're aware that serious concerns remain about issues related to MOC, expressed most recently in a statement of no confidence in ABIM by the Pennsylvania Medical Society, ACP, along with others, was asked to sign on to the statement. We chose not to because we believe the ACP should continue to press ABIM to improve the MOC process as quickly as possible to make it more relevant, efficient, valuable, and affordable to internal medicine specialists and subspecialists. Although we understand and respect the concerns of the PA Medical Society and others, ACP's priority is improving the process by which physicians demonstrate ongoing competence, and we believe we can have the greatest impact by taking a collaborative approach to making change rather than getting involved in other aspects about ABIM as an organization."

Despite the exposed corruption, illegal lobbying, financial malfeasance, strongman tactics, conflicts of interest, and illegal research performed on physicians for monetary gain, the ACP still choose to side with the Medical Industrial Complex rather than practicing physicians. Rather than siding with their own senior members who are Masters of the ACP, (i.e., Charles Culter, MD, MACP, who has been a outspoken critic and well-respected leader in exposing the ACP's own conflicted role in the physician education and credentialing cartel, among others), the ACP basically is telling their own membership they know what's best for them: MOC.

Then, like a frog leaping from the boiling bath of physician discontent regarding the corrupt and financially-conflicted ABIM MOC program, Dr. Weinberger (like Christine Cassel, MD, former President and CEO of the ABIM) decides to split and toss the MOC controversy hot potato to his successor, Dr. Darilyn Moyer:

"As many of you know, I am retiring from my position as ACP's Executive Vice President and CEO after Labor Day. At that time, I am delighted to turn over this responsibility to ACP's new EVP/CEO, Dr. Darilyn Moyer. As Dr. Moyer takes over her new position, I know she is as committed as I have been to seeing this process to a successful conclusion. Further updates will be coming from Dr. Moyer, but I will assist her as needed over the coming year as part of my interest and responsibility in assuring a smooth and seamless transition process."

Rest assured ACP members will remember Dr. Weinberger's "interest and responsibility" for supporting the MOC program. I encourage as many ACP physician members as possible to no longer renew your membership with the organization.

After all, it is now clear that the ACP is more about the ACP than its members' real concerns.

That's because their new "ACP Practice Advisor offers three new modules (author's note: for a price, of course) that (1) address key attributes and expectations of patient-centered medical homes, (2) are aligned with the Center for Medicare and Medicaid Innovation's Transforming Practice Initiative and the proposed MACRA rule, and (3) are eligible for CME credit and MOC points."

It's so sad to see that integrity, honesty, and financial transparency in our physician specialty societies are now officially being supplanted by little more than corporate greed as they abandon their responsibility to their members in favor of the virtually unlimited fees they can impose on their membership in the name of "health care reform."

-Wes

ABIM Foundation: "Co-creating" Healthcare?

Should the American Board of Internal Medicine (ABIM) Foundation be using our testing fees to "co-create" healthcare?

Here is what "cocreation" in action looks like:

As seen on Twitter

(Note the comfy chairs, uplit curtains, and microphones, all provided at ABIM diplomat expense). Real practicing physicians understand that words "co-create" are little more than corporate marketing-speak. Worse still, when the term "cocreation" is being used by members of the ABIM Foundation that has received a majority of funding from ABIM diplomat Board certification and re-certification fees, we see the breadth and depth of just how out of touch this organization is to the challenges practicing physicians face as they try to deliver real health care in America today.

Should front line practicing physicians be funding such waste? What the heck is the ABIM Foundation really for other than forwarding some perverted social agenda? Are they so flush with cash that they feel moved to hold expensive small group sessions with members of the insurance industry? Seriously? How is this helping patients? How is this helping our residents who can't afford the current testing fees at the ABIM?

Here is just a smapling of what just transpired at this year's ABIM Foundation 2016 Forum (just search hashtag #ABIMF2016 on Twitter to see what I mean):

• A plug for rethinkhealth.org, a website for "dynamic modeling and strategy" funded by the Fannie E. Rippel Foundation, a $35-million financial conglomerate that issues selective grants to "organizations or individuals with whom we have developed partnerships or who we have identified as advancing our core initiatives." In other words, people who share their "vision" for corporate health care, like the Robert Wood Johnson Foundation.
• A "Human Diagnosis Project" that promised "crowdsourcing will enable us to solve medical problems." (Seriously?)
• "Health raising" (whatever that is) with multi-colored uninterpretable charts (More gobbledegook)
• Don Berwick "discussing the complexity and imperative of co-creation in healthcare"
• And my favorite: "Clinicians/dieticians... try NG tube on themselves(!) as part of cocreation:"

"Co-creating" NG tube placement?

The ABIM Foundation is not about physician credentialing and patient safety and care quality. On the contrary, the ABIM Foundation is spending physicians' hard-earned fees on wooing idealistic health care fluff.

No wonder the real ABIM Maintenance of Certification program and its myriad of conflicts has never been shown to benefit patient care quality or physician outcomes.

They're too busy wasting our money on themselves.

-Wes

Class Action Lawsuit Filed Against the American Osteopathic Association

From the Philadelphia Business Journal:

A group of osteopathic doctors have filed a class-action lawsuit against the American Osteopathic Association (AOA) seeking to recover millions of dollars in annual membership fees that the doctors allege they have been forced to pay for years to the organization.

The money, according to their complaint, is paid as a condition of obtaining and maintaining physicians’ board certification in any advanced medical specialty. The lawsuit, filed in U.S. District Court in Camden, N.J., contends the requirement that they purchase memberships is illegal, has no reasonable connection to the advanced certification and violates the antitrust laws.

The AOA forces hefty annual membership fees to the paid to "maintain certification" and the American Board of Internal Medicine (ABIM) assures fee payments to themselves by changing lifetime "board certification" to a time-limited credential without proof of patient benefit - both are variations on the same monetary theme.

This new class action suit adds to the politically-connected Accreditation Council on Graduate Medical Education (ACGME)'s growing "Maintenance of Certification" headache. First, it was the American Board of Medical Specialties (ABMS) with their 24 member boards (including the ABIM) having an antitrust lawsuit filed against them. Now, its another member of the ACGME, the AOA, seeing similar legal action.

Who will be next?

When more details of this corrupt "Maintenance of Certification" program surface, I suspect there will be many more lawsuits. No wonder the ABIM Foundation moved $6.5 million of ABIM diplomat's assets offshore to the Cayman Islands: legal battles.

-Wes

When Patients Tweet Their Own Heart Attack

I was called at 04:30AM for a patient with tachycardia in the hospital and as I logged into my EMR from home, I saw this on Twitter:

Usually don't get excited about ECGs like this, but this one is mine...#NoJoke #LifeChanger pic.twitter.com/fSng2k5pxK

— rob rogers (@EM_Educator) July 30, 2016

In under two hours, there were 15 retweets, 44 "likes," and 19 comments that appeared on Twitter (so far), most wishing the patient the best, looking forward to pictures of the angiogram, etc.

This is the lovely world of social media, but it also demonstrates his very real limitations of the medium when potential life-and-death health care issues arise.

Not a single person on Twitter with its myriad of participants rushed to Dr. Rogers' aid, called an ambulance (tho' I suppose this depends on who's "following" Dr. Rogers on Twitter), started an IV, placed him on oxygen, gave him an aspirin, grabbed that EKG, prepped the cath lab, opened Dr. Rogers' coronary artery, spoke to his family, or held his hand. Social media reassurance, prayers, and good wishes can only go so far.

This is not too say there is not value in those prayers and good wishes. But we should remember that medicine and medical issues are real life, not digital.

And we should never forget the limitations of all of the digital technology in the world when it comes to delivering hands-on medical care to our fellow man, woman, or child. That requires those much-less-interesting real people, real workers, and real professionals (all on call 24/7/365) to help Mr. Rogers through his ordeal.

God speed, Dr. Rogers. I'm sure you're in the best of hands.

-Wes

Moving Forward With Ending MOC

Legislative action at the level of state medical societies to end requirements for participation in the unproven American Board of Medical Specialties (ABMS) /American Board of Internal Medicine (ABIM) Maintenance of Certification (MOC) program is moving ahead swiftly nationwide. Draft proposals for language for resolutions to end MOC at both state and federal levels can be found here (state - Word file - Enter your state name/medical society name at asterisks as appropriate) and here (federal - pdf file draft copy). BOTH are important.

I would encourage all working physicians to adapt these proposals presented by Ellen McKnight, MD of the Florida Medical Association and present them to your state medical society/association so they may be  adopted whole or in part.

Together, working physicians can end this unnecessary requirement imposed unilaterally by members of the ABMS, ABIM, and collaborators within the Accreditation Council of Graduate Medical Education (ACGME) and Accreditation Council of Continuing Medical Education (ACCME).

Wes Fisher, MD

The Untold Story of Three ABIM-Sanctioned Physicians

He was a bright medical resident in his third year of internal medicine residency - industrious, committed, a team player. He never thought of himself as special. He had studied hard and achieved much in his short 30 years. Not only was he nearing the end of his residency training in Philadelphia, he was married and had his first child about to be born July 19, 2007. Like most first-time wage earners, his $42,000-a-year resident salary didn't go too far as a result.

As a US medicine resident in his third year of training, he would soon be sitting for his Internal Medicine Board examination in the Fall, a requirement to assure his later employability. So he began the process of registration with the American Board of Internal Medicine (ABIM). He read the requirements and the ABIM "Agreement of Conditions" statement on the their website at the time:

Before electronically signing your application, you will be asked to read the following statement:

"By this application to the American Board of Internal Medicine (the "ABIM"), I agree to be bound by the terms, conditions, and rules set forth in the ABIM's Policies and Procedures for Certification and in this Web site, as they may be amended from time to time. I understand that by applying, I am entering into a contract with the American Board of Internal Medicine to provide certain health care operations services, including practice assessment and evaluations. The ABIM HIPAA Business Associate Agreement is a part of this contract.

I agree to indemnify, release, and hold harmless the ABIM, its employees, officers, directors, members, agents, and those furnishing information about me to the ABIM from any claims, liability, or damage by reason of any of their acts or omissions, done in good faith, in connection with this application, information furnished to the ABIM, the evaluation of my qualifications, and examinations. I agree that the ABIM may use my examination performance, training program evaluations, self-evaluations of knowledge and practice performance, and other information for research purposes, including collaboration with other research investigators and scientific publications. In such research, the Board will not identify specific individuals, hospitals, or practice associations. All practice performance data is HIPAA compliant.

I hereby declare under penalty of perjury that the information given in my application is true and correct to the best of my knowledge and beliefs.

I agree to be legally bound by the foregoing."

This statement represented the entirety of his "informed" consent for the ABIM's "research" - and from the looks of things, he was "legally bound" to comply. On the web page this  "Copyrighted Materials" clause was included as well:

Copyrighted Materials

The Board's examinations are confidential and copyrighted under the Federal Copyright Act. Candidates agree not to copy, reproduce, reconstruct by dictation or other means, or disclose examination content in any manner. Board Self-Evaluation Process (SEP) modules are also copyrighted works. Candidates agree not to copy, reproduce, or make any adaptations of the modules in any manner; or to assist someone else in the infringement of this or any Board-copyrighted work.

Professionally and financially unable to do otherwise, he completed his application and paid his $1,135 registration fee for the examination.

A short time later, he turned to his program director to inquire which board review course he should attend. He was recommended to attend the "Arora Board Review" course led by Dr. Rajender Arora MD. Others had gone there and given it good reviews. His Pennsylvania residency program thought highly enough of the Accreditation Council of Graduate Medical Education (ACGME) sanctioned course that they paid his $1000 registration fee. He decided to attend the board review course offered in June 2007 just before his scheduled board examination in August 2007.

The Board Review Course

Five hundred economically vulnerable residents were in attendance at the Arora Board Review course in June 2007.  The young doctor thought the course was taught well and helped him gain confidence for the exam questions he might encounter. Dr. Arora was a dynamic teacher and the examples and commentary he provided were helpful at teasing out the critical concepts for the examination. At the end of the course, it was mentioned that if he'd like, he could help "pay-it-forward" to his fellow colleagues by sending Dr. Arora information about the topics and questions he could recall that he encountered on his Board examination.

He studied hard for his examination for the next several months, rising early and staying up late and foregoing other social obligations. He reviewed his texts, journal articles, and board review materials. Then the day came for his examination.

He arrived at the test center, checked in, had his biometric palm scan recorded, deposited his wallet, car keys and mobile phone in a locker, was later searched, and finally admitted into the PearsonVue examination computer room. There beside him were others, pounding on their keyboards taking examinations for other trades. He sat and got comfortable. On his computer screen was a big ABIM logo with his name below and a set of instructions. Just before the timed test began, he read a document that threatened him if he shared content of the test. He had the choice: either click "I Decline" and be escorted out of the examination center and thereby waste his test preparation and potentially sacrifice his career as a physician or click the "I Accept" button to start his examination. He accepted and took his test, yet never received a copy of the agreement that he had just electronically "signed."

He thought he did well on his certifying examination. He remembered the general concepts of the questions and while he couldn't remember all of the questions and distractors, he was eager to share what he remembered of the test with the person who helped him prepare, Dr. Arora. After all, others likely did the same for him. He decided to communicate with Dr. Arora via e-mail to thank him for his help and share with him what he could recall as a way to "pay it forward" to others as requested.

Time passed. In late October, 2007 he received notification that he had passed his boards and felt relieved that he had at least secured himself the potential for gainful employment as a "Board certified"  internal medicine physician. He had no intention of repeating that ordeal, at least not in the immediate future. As life would have it, his medical passion had evolved to physical medicine and rehabilitation. His second child was born November 10, 2009 and because residency slots were tough to obtain, he moonlighted to bridge the gap before his second residency in his chosen field began.

On June 8, 2010, he received a sanction letter from the ABIM. In that letter the young doctor learned that the ABIM had suspended his certification for three years because they alleged that he had shared question content from memory with Dr. Arora in violation of the ABIM's "Pledge of Honesty." His board certification status was immediately revoked without due process.

His mind spun. "How in the world?... What happened?" His life, quite frankly, had gone from idyllic to uncertain in an instant. He couldn't sleep. He was humiliated and had to tell his wife. But one thing he was sure of: he didn't want to have to take the test again. Four years of medical school. Three years of residency. Night call. Sleepless nights. Finally, realizing the magnitude of what had happened to him and the possible lifelong ramifications, he retained a lawyer.

He spoke with his lawyer - someone he'd worked with earlier. She was sympathetic. So calls were made to the ABIM's lawyers. At first, ABIM lawyers were unyielding: it was a three-year sanction and then he had to retake the examination.

A short time later, his lawyer called him to tell him about this article that had appeared in the Wall Street Journal June 9, 2010. He was not the only one; there were 138 others. His penalty could have been worse, he was told. At least he wasn't formally sued but his privileges to practice medicine were temporarily suspended at one of his hospitals from 2010 through part of 2011 and compromised his ability to moonlight to pay for his children's daycare.

"I can't take that test again. I just started my residency!" he thought. After pleading with ABIM, the sanction was reduced from three years to one on July 28, 2010, but he appealed this decision since the financial and professional implications of even a one-year sanction were devastating.

Months later after more letters and were exchanged a plea "deal" was struck with the ABIM April 5, 2011 - the ABIM agreed to settle with the doctor for a $5000 fine along with 20 hours of community service in a medical-related charity and proof of completion of an ethics course.

What choice did he have but to agree to those terms?

Cancelled Check Paid to ABIM to Reinstate Board Certification*
(Click to enlarge)

Finally on 1 Sep 2011, the young physician's Board certification was reinstated but the scars linger. From now on, he must always explain that he was "sanctioned" by the ABIM when completing a hospital credentials' packet or being licensed by his state. Needless to say, he no longer practices in a hospital setting.

Commentary: In retrospect what this young doctor didn't realize at the time was that the Arora Board Review course was secretly recorded as part of an ABIM-sanctioned "investigation," apparently without law enforcement  oversight.  On the basis of that recording and evidence gathered by a undisclosed ABIM employee that secretly attended the review course, this "evidence" was presented before a federal judge by Christine Cassel, MD, Ms. Rebecca Baranowski, and A. Benjamin Mannes (the ABIM's currently employed "Director of Investigations" who carries two felony convictions (for impersonating a police officer and carrying an unregistered firearm) and has unfettered access to the ABIM diplomat's files and personal information). On the basis of that information, the ABIM was granted a writ to seize under seal after providing $10,000 in collateral so Federal Marshals could secretly invade Dr. Arora's residence with ABIM attorneys accompanying them. According to court documents, the ABIM obtained images of Dr. Arora's computers, hard drives, and 36 boxes of course materials. To the best of my knowledge and belief and on the basis of this ABIM "letter of concern," only after obtaining those computers did the ABIM discover the emails of who attended the Arora Board Review Course course and had communicated electronically with Dr. Arora.  The earlier communications with Dr. Arora were thought to be private and occurred without financial renumeration to either party of any kind. As such, it appears the raid was little more than a fishing expedition for physicians' emails and addresses who attended the board review course. It appears to me that because the young doctor's email to Dr. Arora was found on one of those computers, and he represented a vulnerable target, he was immediately sanctioned without due process. Dr. Arora, on the other hand, worked a separate settlement deal with the ABIM that has never been made public.

Same Course, Different Doctors, Different Sanctions

Another Arora Board Review sanctioned physician-attendee had a different penalty imposed.  Not only was this physician sanctioned for three years initially, this physician was later forced to sign an agreement with the ABIM that he had committed an ethical violation, had his upcoming subspecialty medical board examination cancelled, and was required to re-take his internal medicine certification examination. But this was not his most difficult problem.

After learning of the ABIM's sanction, his state licensure board also required the physician pass a "maintenance of certification" examination, take an ethics course with an "unconditional pass," do 50 hours of community service, pay a $1000 fine, and provide peer review references before state would re-issue this state license to practice medicine. His online credential verification still documents his sanction today. All of these actions did not include the legal expenses the physician incurred to defend himself with two separate state licensure boards (WA and TX) and the ABIM itself.

Ongoing Litigation

Some nine years after the June 2007 Arora Board Course, the ABIM has still not finished sanctioning physicians. Jaime Salas Rushford, MD, a Puerto Rican physician who attended the same Arora Board Review course, learned of his sanction by the ABIM on 8 May 2012. In his sanction letter, his certification was revoked indefinitely. Shortly thereafter, Salas Rushford also learned that he had been sued by the ABIM as well. What the ABIM had not anticipated was that Dr. Salas Rushford's parents are lawyers. They filed a counter-suit (begins on page 32). The case has been ongoing four years later and full details of the ABIM's operations and tactics are being systematically uncovered in documents on Dr. Salas Rushford's website, doctorsjustice.com. Millions of dollars in legal fees paid by physician diplomats continue to flow to the ABIM's legal team. Unfortunately for all US physicians, this story is far from over and will likely become, as described by the Pennsylvania Medical Society in their recent vote of no confidence (more here), "the most expensive medical mistake in the history of medical education."

Epilog

Given what we now know about the ABIM's long-standing tenuous financial condition, the "research" the ABIM performed and funded from these vulnerable diplomat's exam fees without true informed consent, the undisclosed lobbying that ABIM participated in as a non-profit outside of federal regulations, the years of fraudulent tax filings, the funneling of $55 million of ABIM diplomat fees to fund the ABIM Foundation that performed additional "research" and purchased a luxury condominiums for its use, it is hard to imagine the ABIM has physicians' or our patients' best interests in mind. Furthermore, the American Board of Medical Specialties' (ABMS) (who overseas all of the ABMS member boards, including the ABIM) earlier Senate testimony that claimed they are expanding "new kinds of (undisclosed) partnerships with public payers, private payers, and particular patients and consumer groups who represent them to get a deeper appreciation for the kinds of information they seek and their expectations for care..." with numerous undisclosed revenue streams, there is only one question to ask of these unaccountable cartel-like physician credentialing "non-profit" organizations now.

Did the ABIM act in the public's best interest by sanctioning the many vulnerable resident physicians who attended the Arora Board Review course or did they engage in extortion for the ABIM/ABMS's financial benefit as a result of the ABIM's financial largess using police-state tactics?

-Wes

“The arc of the moral universe is long, but it bends towards justice.”

― Martin Luther King Jr.
*The redacted canceled check and redacted documents above were all used with the ABIM diplomats' permission.

ABMS vs The Poor

The chilling reality of what is happening to patients when the ABMS changes the definition of what is required to be Board certified and ties it to Medicaid payments:

CMS officials disagree, saying in so many words that it's "unfortunate," but these Tennessee doctors skipped over the details on who, and what services, qualified for the additional pay.

First, CMS rules specified that Medicaid providers had to be board certified in internal medicine, family medicine or pediatrics. These doctors weren't, in part because in rural areas, hospitals often don't require board certification and, for older doctors, it wasn't a mandate after training.

Second, for doctors without board certification, their status as primary care providers could be documented if 60% of the codes they submitted in their claims were for a select set of primary care evaluation and management (E&M) or vaccination services, not specialty services.

So for those doubters out there that thought this "physician" Maintenance of Certification (MOC) discussion was a "physician issue" and did not pertain to patient care delivery, think again.

-Wes

Reference:

MedPageToday: Medicaid Boom Turns to Bust for Tennessee Docs - Lack of certification triggers payback requirement

Too Little Too Late: The ABIM Foundation Sells Its Condo

It was a story that broke on this blog nearly two years ago when the American Board of Internal Medicine (ABIM) Foundation was putting their luxury condominium, complete with a chauffeur-driven Mercedes S-Class town car that was purchased with physician certification and re-certification fees, up for sale.

Over 550 days later, we find the notorious ABIM Foundation condominium was finally sold on 6/21/2016 for $1,650,000 representing an up-front cash loss of $650,000.

But let's not forget the other associated fees required to sell a condo:

Real estate commission (6%): ($99,000)
Transfer Tax as buyer (2%) (2007): $46,000
Transfer Tax as seller (2%) (2016): $33,000
Title insurance: $10,000
Other fees: deed preparation, attorney fees, recording fees, etc. $10,000.
Furniture expense: $56,267


And then there's the annual condo fees, cable, phone, electric, cleaning, etc., that came to $41,000-$50,000 annually (approximately $450,000 over 9 years) (Source: Richard Baron, MD, President and CEO of the ABIM and ABIM Foundation)

All told, ABIM took $2,356,267 million of ABIM diplomat's cash and lost at least $1,265,267 on our behalf.

So much for "Choosing Wisely®."

But let's face it, incurring a financial loss on an "investment" is not necessarily illegal. After all, any of us could have made a horrible investment decision.  Rest assured we'll soon hear the ABIM trying to justify their real estate loss because they would have lost this money anyway if they had to pay hotel costs for all of their out-of-town guests and programmers from India eager for a cheap place to stay.

But we should ask ourselves now with the sale of this condominium, what was illegal at the ABIM Foundation? Anything?

Tax Fraud

First, recall that Dr. Baron claimed in my communications with him that much of the condominium expenses they claimed on their tax forms as program service expenses was actually a depreciation expense they lumped into the "program services expenses" of the condominium. Yet the ABIM and their accountants never claimed depreciation under the separate line item on their federal IRS Form 990 for this expense.

Honest mistake?

Unlikely. After all, other tax filing discrepancies with the ABIM Foundation have occurred repeatedly and systematically over many years. Any credible accounting audit should have disclosed most of them.

For instance, surely someone at the ABIM knew the difference between the two states of Iowa and Pennsylvania, didn't they? So why was the ABIM Foundation domicile claimed as Iowa for years when, in fact, it was domiciled in Pennsylvania but never disclosed? And isn't it striking that the ABIM Foundation was claimed for years as being formed in 1999 until this blog disclosed that it was actually created in 1989, some ten years earlier? Only in its most recent tax filings has that little "oversight" miraculously been corrected without explanation to the Internal Revenue Service.

And why didn't the ABIM disclose that it was lobbying Congress on its tax forms when it had been doing so for years? Was this merely a mistake? Or was it because the ABIM and their Foundation would have opened themselves up to closer scrutiny and lost their tax-exempt status if they had?

Unethical Research Practices

Finally, we have to ask ourselves just what kind of research on physicians for the betterment of health care requires a $2.3 million condominium? After all, the ABIM Foundation has always heavily touted their research work and publications.

Some may argue there wasn't "research" being conducted at the ABIM Foundation but rather "quality assurance" or "Quality Improvement" exercises performed there. If so, then why did the ABIM Foundation promote it's pioneering research by using the term at least five times on a single web page in May of 2007?

Archived Screen May 2007 - ABIM Foundation
(Click image to enlarge)

We also find that the ABIM funded "various research projects" at its Foundation in the fiscal year 2008 with the transfer of $6,000,000 of ABIM diplomat fees:

Evidence of ABIM Funding "research projects" at the ABIM Foundation
for $6 million in Fiscal Year 2008
(Click image to enlarge)

There is no escaping the fact that this was a very serious effort at conducting "research" on physicians.

Or not.

Was the whole "research" story told by the ABIM and ABIM Foundation just a front for other activities? I wish to bring my reader's attention that the ABIM Foundation no longer has the word "research" appear anywhere on its website. Instead, there are only words like "Medical Professionalism Charter," "Initiatives," "Grants" and "Choosing Wisely®." The cover-up continues.

Credentialing of physicians involves human testing. As such, it appears the ABIM Foundation unilaterally decided to perform research on physicians without informed consent, without an impartial Investigational Review Board, and without a clear research hypothesis, method, or analysis of the harms they might cause.

"Research" conducted in such a manner is dangerous for many reasons and some of the most egregious examples of dangerous research have happened in government agencies or when the individual or collective social beliefs or dogma were imposed on others as justification for "research."

The Nuremberg Doctrine which rose from the World War II war crimes is very clear in its requirements for human subject research, especially as it pertains to proper consent. From my recently conducted bi-annual CITI Training:

"The voluntary consent of the human subject is absolutely essential.

This means that the person involved should have the legal capacity to give consent; should be so situated as to be able to exercise free power of choice, without the intervention of any element of force, fraud, deceit, duress, over-reaching, or other ulterior form of constraint or coercion; and should have sufficient knowledge and comprehension of the elements the subject matter involved, as to enable him to make an understanding and enlightened decision. This latter element requires that, before the acceptance of an affirmative decision by the experimental subject, there should be made known to him the nature, duration, and purpose of the experiment; the method and means it is to be conducted; all inconveniences and hazards reasonably to be expected; and the effects upon his health or person, which may possibly come from his participation in the experiment.

The duty and responsibility for ascertaining the quality of the consent rests upon each individual who initiates, directs, or engages in the experiment. It is a personal duty and responsibility which may not be delegated to another with impunity."

It goes without saying that human subject research that involves real estate investment strategies to fund research on practicing physicians is unethical (at least) and likely highly illegal. As we have seen, the MOC recertification program can cause significant harm to physicians, their patients, and their families, especially when this credential is tied to physician employment and remuneration. Worse still, the average failure rate of the unproven "Maintenance of Certification" re-certification metric has averaged 13.2% over the past 10 years with wide year-to-year volatility in pass rates using an inconsistent metric. Was the impact of funneling money from the ABIM to the ABIM Foundation for the ABIM Foundation's "research" really that harmful?

Absolutely.

But this story isn't about a condominium or its sale, is it? It's about the wholesale sell-out by some in Organized Medicine that have systematically and repeatedly turned their back on their fellow practicing physicians and the doctor-patient relationship for their own political and financial benefit. For this story is not just restricted to the ABIM or its Foundation. This story extends to all member organizations of the Accreditation Council for Graduate Medical Education (ACGME) that tie the ABMS Board certification credential to medical training program directors, lab certifications, and a host of other regulatory traps, too. So it should come as a surprise to no one that we find more recently that each of these organizations appears to have been complicit with the ABIM Foundation moving funds derived from practicing physicians' "research" fees offshore.

In the end, the entire American Board of Medical Specialties' Maintenance of Certification® story has alway been about making money for their coffers at the expense of practicing physicians, irrespective of the specialty.

Always has been and always will be.

It's NEVER been about "Choosing Wisely®."

-Wes

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.

An Upcoming ABIM "Community Exploration" Day in Chicago!

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I just received the notice above in my inbox at work. It seems there's going to be an "ABIM Exploration Day" here in Chicago 26 August 2016. I requested an invitation but have a feeling I won't be sent one since I disclosed I was one of the ABIM's foremost critics of the ABIM MOC program. (That's right, you have to request an invitation at the link provided in this email blast)

Let's make this like open microphone night and feel free to leave your questions for the ABIM in the comments section on this blog. That way, no matter who goes to this hosted event, they'll have plenty of "exploration" questions to ask Yul Enjes, MD and Richard Baron, MD or their representatives. (Physicians are encouraged to identify themselves (and their ABIM diplomat number) so the ABIM knows you're real).

-Wes

The ABMS MOC Contagion Spreads

It seems the humiliation of physicians to collect revenues by member boards of the American Board of Medical Specialties (ABMS) Maintenance of Certification (MOC) program knows no bounds.

This time, we begin our focus on the American Board of Pediatrics (ABP).

First, take a moment to read what happened to a younger physician mother-of-three who tried to re-certify in pediatrics when her child was 9 months old and still breast feeding.  Horrible.

Pediatricians are one of the lowest paid medical specialties in medicine. Yet like all US physicians, the must pay thousands to "re-certify" with the American Board of Pediatrics every 10 years.

And why must they pay such high fees?

Perhaps there's no better example than James A. Stockman, III, MD.

Dr. Stockman worked for the ABP for 20 years, retiring 31 Dec 2012.

Dr. James A Stockman III, MD Retires from ABP 31 Dec 2012
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As part of that retirement, we see the ABP paid him over $2.4 million:

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But this, you see, wasn't enough. Despite often earning over a million dollars a year prior to his retirement while working for the ABP, and then making a $2.4 million golden parachute on his retirement, Dr. Stockman stayed on as a "consultant" for the ABP. His first year there, he earned a cool $861,820 working 45-50 hours a week.

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But the next year was even better. On their most recent 2014 Form 990, we see that Dr. Stockman earned $793,438 for working just eight hours a work-week:

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If we assume there are 48 work weeks in a year and Dr. Stockman works just eight hours a week for a total of 384 hours, then in 2014 Dr. Stockman earned a whopping $2066.24 per hour.

I think it's time pediatricians join internists and cry foul loud and clear.

The ABMS Maintenance of Certification extortion of US physicians has to go.

-Wes

One Small Step

Here's the official final wording of the AMA House of Delegates' Resolution 309, Continuing Medical Education Pathway for Recertification adopted June 15, 2016:

Resolution 309, Continuing Medical Education Pathway for Recertification, was adopted as amended. The final recommendations are as follows:

RESOLVED, That our American Medical Association call for the immediate end of any mandatory, secured recertifying examination by the American Board of Medical Specialties (ABMS) or other certifying organizations as part of the recertification process for all those specialties that still require a secure, high-stakes recertification examination; and be it further

RESOLVED, That our AMA support a recertification process based on high quality, appropriate Continuing Medical Education (CME) material directed by the AMA recognized specialty societies covering the physician’s practice area, in cooperation with other willing stakeholders, that would be completed on a regular basis as determined by the individual medical specialty, to ensure lifelong learning; and be it further

RESOLVED, That our AMA reaffirm Policies H-275.924 and D-275.954 (Author's note: use the AMA Policy Finder to review these policies); and be it further

RESOLVED, That our AMA continue to work with the American Board of Medical Specialties (ABMS) to encourage the development by and the sharing between specialty boards of alternative ways to assess medical knowledge other than by a secure exam; and be it further

RESOLVED, That our AMA continue to support the requirement of Continuing Medical Education (CME) and ongoing, quality assessments of physicians, where such CME is proven to be cost-effective and shown by evidence to improve quality of care for patients.

-Wes

ACGME Announces New Affiliation with ABMS

PRNewswire - (Chicago) July 1, 2016 - Today, the Accreditation Council of Graduate Medical Education (ACGME) announced a new affiliation with the American Board of Medical Stenographers (ABMS), promising new efficiencies and reduced medical transcription errors within the Electronic Medical Record (EMR). "Ever since the Institute of Medicine's (IOM) 1999 report entitled "To Err is Human" that claimed as many as 98,000 patient deaths as a result of medical errors, we've been looking for ways to reduce medical errors in today's hospitals and clinics," said Joseph Throckmorton, MD, President and CEO of the ACGME. "The public has been asking for a way to certify all US physician's typing skills to assure the highest standards of patient care quality and safety," he said.

As part of this program, the ABMS has instituted a Maintenance of Typical Skills® (MOTS®) program using a simple online typing test performed each month in the convenience of the physician's own home or via his or her mobile device. Test scores will be verified and uploaded to the ABMS CertificationMatters website for public review. The cost for physicians will be nominal - only $25 per month. Typing speed and error toleranance levels will be determined by the Board and subject to change. Physicians who fail the test can retake it twice before they must re-register to maintain their credential. A Pledge of Honesty is required of all participants.

"The importance of such a credential comes at a time when self-regulation of our profession is more important than ever," said Imso Boring, MD, JD, President and CEO of the ABMS. "We're proud we could play a part in the harmonization of this important patient care metric with other critical patient care quality and safety initiatives promoted by the ACGME."

Existing members of the ACGME include the American Board of Medical Specialties, the American Medical Association, the American Hospital Association, the Association of American Medical Colleges, the Council of Medical Specialty Socities, the American Osteopathic Association, and the American Association of Colleges of Osteopathic Medicine.

It is currently estimated that EMR typographical errors are the third leading cause of death in the United States.

* * *

 

Hope all my faithful readers have a happy and healthy 4th of July.

 

-Wes

On Brexit and Maintenance of Certification

The degree to which this was a vote that was directed against the British elite is vital to understand. Politicians, business leaders, and intellectuals were all seen as having lost their right to control the system. The elites had contempt for their values - for the nationalism and their interests. This is not a new phenomenon in Europe, but it is one that the EU had thought it had banished. This is not a British phenomenon by any means. This is something that is sweeping Europe and China. It is also present in the U.S., in the figure of Donald Trump, whose entire strategy is to attack the Democratic and Republican leadership and the elite who have contempt for the nationalism and moral principles of those beneath them. It is the general process the West is undergoing, and it came to London (Thursday).

George Friedman, Geopolitical Futures

Could what has happened in London parallel what is simultaneously happening to Organized Medicine in the United States? Cracks have formed in the foundation that American physicians have trusted for years: the Accreditation Council on Graduate Medical Education (ACGME), the American Board of Medical Specialties' (ABMS), American Board of Internal Medicine, the American Medial Association, and our many of our specialty societies. Practicing physicians are looking with a new lens at "politicians, business leaders and intellectuals" who were once trusted to protect the practice of medicine and the physician-patient relationship.

Can our current byzantine system of unelected, unaccountable, non-profit health care organizations "lose their right to control" our health care system - a roughly $3.0 trillion dollar sector or 17% segment of the entire US gross national product? Will they endure under this new level of scrutiny and demand for transparency from those on the front line of health care delivery? How will these structures pivot?

How much tax fraud must occur, how many laws must be broken, how many physician personal liberties must be tossed aside before practicing physicians and their patients demand change?

You can feel the ground shaking.

The silence is deafening.

-Wes

Heart Rhythm Society Waffles on MOC

On Thursday (yesterday), I received this notice from the Heart Rhythm Society (HRS) concerning their stance on the American Board of Medical Specialty's (ABMS) Maintenance of Certification (MOC) referendum at the recent AMA House of Delegates meeting held in Chicago:

"The American Medical Association (AMA) House of Delegates recently approved resolutions addressing concerns about the American Board of Medical Specialties' (ABMS) MOC program at its annual meeting.

The resolutions are consistent with the HRS concerns and commitment to advocate for changes to the Maintenance of Certification (MOC) program. HRS currently has a representative in the AMA House of Delegates. To ensure that HRS maintains its seat at the AMA House of Delegates, the Society must demonstrate that 20 percent of the Society’s U.S. physician members are also members of the AMA.

The AMA also approved the commissioning of a study that will evaluate the impact of MOC and Maintenance of Licensure requirements on physicians. This study addresses the heart of the debate and HRS looks forward to the results of this important study."

I found this notice puzzling.

While the Heart Rhythm Society states the resolutions "are consistent with the HRS concerns and commitment for changes to the MOC program," it appears they do not understand that the House of Delegates overwhemingly resolved to end Maintenence of Certification immediately:

"RESOLVED, That our American Medical Association call for the immediate end of any mandatory, secured recertifying examination by the American Board of Medical Specialties (ABMS) or other certifying organizations as part of the recertification process for all those specialties that still require a secure, high-stakes recertification examination."

This does not mean changing the ABMS MOC program, it means ending it.

This does not mean studying the ABMS MOC program, it means ending it.

And this certainly does not mean supporting the AMA with our dues when they fail to act in the practicing physicians' best interests either.

Look, it is now abundantly clear that the ABIM did many, many illegal and self-serving activities with our diplomat fees for (at least) the past 27 years. And when they were caught red-handed with their hand lodged in the practicing physician's personal liberty and financial cookie jar, they tried (and continue to try) to cover it up. What they've done is illegal in many fronts. This is not acceptable and none of us need to "change" MOC or perform "another study" on MOC (funded by our dues) to sweep these actions under the rug. MOC just needs to end immediately.

I worry that the HRS leadership doesn't understand how angry practicing physicians are about what has transpired behind our backs as we've struggled to do the yeoman's work of patient care.

Here's the deal:  if the HRS wants my dues for another year going forward, move to end MOC now. Put your actions where our money is. Otherwise, I'll save my hard-earned assets for other things besides supporting groups who don't support those of us on the front line of health care who obey the law and prefer to manage our profession ethically and transparently, rather than through political channels using threats and intimidation as their modus operandi.

-Wes

ABIM's Bedfellows

Right now, the Center for Medicare and Medicaid Services (CMS) has a comment period that extends through 27 Jun 2016 regarding MACRA, the new payment scheme created by the health care industry, to pay physicians on the front line of health care. I encourage every physicians to voice their  opinion about this plan,

Before you do, however, I'd like to remind you of the recent indifference by the AMA regarding the House of Delegates overwhelming vote to end Maintenance of Certification last Monday.  Needless to say, there's a reason why.

Remember those conflicts of interest with Christine Cassel, MD, former President and CEO of the American Board of Internal Medicine (ABIM) and, later, the National Quality Forum, the ABIM, and ABMS?  Remember the huge splash the announcement of those conflicts had when her conflicts were disclosed by Propublica, and Dr. Cassel quickly relinquished her ties to Premier and Kaiser Health Plan and Hospitals? Remember how Christine Cassel, MD pocketed a cool $230,000 ($100,000 of which was in Premier securities) just before Premier, Inc purchased CECity for $400 million?

Here's the image on the front page of the CECity website:

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Look at all of the friends of the ABIM who welcome CECity's services: Johns Hopkins Medicine, the American Osteopathic Association (AOA), Merck, the American Medical Association (AMA), Aetna, The American College of Physicians (ACP), Premier, the ABIM, NextGen, Athenahealth, and Optum. These are just a few of ABIM's corporate bedfellows. The AMA has no interest in what doctors really want or need.  The AMA has no interest in ethics or what's best for patients.

The AMA and the ABIM only have interest in what's best for the AMA and the ABIM.

This is why the ABIM wants physicians to do Maintenance of Certification and enter all their demographic and survey data into the ABIM's database. It has nothing to do with maintaining physician skills but has everything to do with medicine's new digital party.

This is why physicians must act collectively to stop the tax fraud, violations of research ethics, and abuse of our civil rights that has occurred at the ABIM and the ABMS. Because like it or not, you're paying to have your right to practice medicine independently corrupted by these organizations that stand to earn billions from your work while being simultaneously coerced into paying ABIM's fees.

-Wes

Pennsylvania Medical Society Explains Their Vote of No Confidence Against the ABIM

The Pennsylvania Medical Society just sent this letter to all Pennsylvania physicians explaining their rationale for issuing a "vote of no confidence" against the American Board of Internal Medicine (ABIM):

The Pennsylvania Medical Society (PAMED) believes that continual professional development, lifelong learning, and providing quality patient care based on the best science and evidence to guide medical decision-making is the fundamental cornerstone of what it means to be a physician.

For two years, PAMED leadership has had numerous meetings with senior management at the American Board of Internal Medicine (ABIM) with the purpose of representing our members' high levels of dissatisfaction with the ABIM Maintenance of Certification (MOC) program. Early in this process, we concluded that the reason ABIM leadership was so out of touch with practicing physicians was because nearly every member of the ABIM's board is not involved in the full-time practice of seeing patients. We attempted to work collaboratively with ABIM's leadership to help them better understand that their punitive process is needlessly time-consuming and takes physicians away from their patients. We demonstrated to them that their process is exorbitantly and unnecessarily expensive compared to other continuing medical education activities through which medical knowledge and excellence in patient care can be maintained and demonstrated. Most importantly, we clearly expressed to the ABIM that the content and available medical resources of their secure, high-stakes computer exams bear little to no relevance to the care we render to our patients in our offices and hospitals.

Through their marketing efforts, the ABIM has worked hard to give the impression that their recertification exam demonstrates competency. However, despite numerous calls to substantiate this assertion, the ABIM has been unable to provide reliable independent evidence that a secure, high-stakes exam—taken every 10 years by some and for which others are "grandfathered" and therefore exempt—leads to better patient care. This is because while the overwhelming majority of practicing physicians pass the ABIM recertification secure, high-stakes computer exams, this test and the MOC process have no correlation to how well a doctor can take care of a patient. Shockingly, countless medical leaders, numerous national mainstream publications, and several forensic accounting reviews have published information which suggests that the ABIM's motivation for their recertification process was primarily driven by little more than financial mismanagement.

If true, what makes these actions so deplorable to physicians is that it was perpetuated on all of us by our colleagues whom we mistakenly believed were part of our medical family. In response to the overwhelming pressure being placed on their leadership, the ABIM has begun a public relations campaign with a barrage of emails and blog posts to create an illusion that they have the ability and the desire to correct this problem. As our PAMED Board reviews these emails, we believe that the ABIM's motivation and ultimate program will continue to have as their cornerstone the creation of as financially lucrative a position as possible for their Board and their misguided foundation.

It is for all of these reasons that I announced at the American Medical Association's (AMA) Annual Meeting last week in Chicago that the Board of the Pennsylvania Medical Society has voted a position of NO CONFIDENCE in the leadership of the Board of the American Board of Internal Medicine. We believe that their current leadership is not capable of reforming the process in an academically meaningful and fiscally responsible way. ABIM leadership has issued an apology for instituting their January 2014 MOC program. The ABIM has admitted that all three aspects of the program were improperly designed and deeply flawed. Millions of dollars were spent by the ABIM in preparation for this program. It can be argued that the January 2014 MOC program was the most expensive mistake in the history of medical education.

In keeping with the consensus of PAMED members and physicians across the country who are embittered with the practices of ABIM, we call for the immediate replacement of the entire ABIM Board and leadership with new leadership, representative of physicians actively participating in the full-time practice of clinical medicine. In the absence of this happening in a timely manner, we plan on calling on ALL specialty boards and societies to listen to their members and to work to remove the MOC process from ABIM oversight. Our PAMED Board is committed to aggressively advocating for all physicians on this important issue. We hope to see more meaningful progress in the coming weeks. We will explore every avenue to bring about meaningful MOC reform and will plan on keeping all PAMED members informed on any progress made in our efforts. Most sincerely,

Scott Shapiro, MD, FACC, FCPP
PAMED President

I hope other state medical societies across the country issue similar statements in the weeks ahead.

-Wes

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

It's Time to End the MOC® Brand

After Monday's resounding AMA resolution calling for an end to Maintenance of Certification®, it is time to end, once and for all, the MOC® brand held by the American Board of Medical Specialties (ABMS).

Maintenance of Certification® remains as a failed social justice experiment foisted on unsuspecting and vulnerable practicing US physicians by the American Board of Internal Medicine (ABIM) and the ABMS solely for the dual purposes of financial and political gain. Multiple studies have demonstrated MOC's inability to improve patient care or quality while wasting valuable time and physicians resources to fund this illegal experimentation.  After secretly lifting at least $55 million in diplomate fees to form the ABIM Foundation, MOC® has become the poster child for financial malfeasance, corporate cronyism, conflicts of interest, and fraud.  In all my years of practicing medicine, I have never seen such an egregious violation of medical ethics levied on practicing physicians by some of our own.

Yet MOC lives on in the hearts and minds of the AMA and affiliates of the Accreditation Council for Graduate Medical Education (ACGME). From the AMA press release after Monday's passage of the anti-MOC® resolution, it seems the AMA still thinks MOC® is a good idea:

Asking the American Board of Medical Specialties to encourage its member boards to review their MOC policies regarding the requirements for maintaining underlying primary or initial specialty board certification in addition to subspecialty board certification to allow physicians the option to focus on MOC activities most relevant to their practices

At the same time in an apparent attempt to render MOC® life support, the Accreditation Council for Continuing Medical Education (ACCME) has recently begun co-branding CME with MOC®.  They've even produced a new logo (they call it a "badge" - seen above) for sympathetic training organizations and medical schools to download. It all amounts to brainwashing our youngest and most vulnerable physician professionals that the behavior demonstrated by the ABIM and the ABMS should not only be condoned but promoted.

Practicing physicians have spoken loud and clear about their feelings about the ABMS/ABIM MOC® program.  It's time to end it, all of it, and expunge this horror story from the practice of medicine.

-Wes