Two ER Physicians Lend Their Opinion on Reopening the Economy

Addendum: YouTube brought down the videos included in this blog post because they claimed it violated their terms of use. I found that very disturbing that non-anonymous US physicians were silenced during these unprecedented times. I believe we should promote (and not silence) legitimate, respectful, critical debate. Whether right or wrong (and certainly many of the facts delivered have been thoroughly debunked by others) their viewpoint opened peoples' eyes.

Because nothing is erased on the internet, readers will find links to the videos on a different platform below the YouTube video placeholders.

"Typically you quarantine the sick. When someone has measles you quarantine them. We’ve never seen where we quarantine the healthy."

"We’ve tested over 4 million… which gives us a 19.6% positive out of those who are tested for COVID-19. So if this is a typical extrapolation 328 million people times 19.6 is 64 million. That’s a significant amount of people with COVID; it’s similar to the flu. If you study the numbers in 2017 and 2018 we had 50 to 60 million with the flu. And we had a similar death rate in the deaths the United States were 43,545—similar to the flu of 2017-2018. We always have between 37,000 and 60,000 deaths in the United States, every single year. No pandemic talk. No shelter-in-place. No shutting down businesses…"

Dr. Daniel W. Erickson of Bakersfield, California, is a former emergency-room physician who co-owns, with his partner Dr. Artin Massih, Accelerated Urgent Care in Bakersfield, CA north of Los Angeles. They conducted a press conference regarding their opinions about reopening the economy and withstood many challenging questions by a hostile press. I encourage my interested readers to watch the entire hour-long press conference:

Addendum: Links to the above videos can be found here:

Part 1: https://vimeo.com/412698864

Part 2: https://vimeo.com/412699764

In a follow-up ABC news piece it is also interesting to note, "Dr. Erickson also claimed that state health department officials also agreed with his statements about reopening. 23ABC News reached out to the state to see if officials agree with Dr. Erickson about reopening and they have no(t) responded back."

We should acknowledge these physicians test patients and have a vested interest in doing so. Whether testing will ever really clear the way toward reopening the economy is debatable in my opinion, given that every test has false negative and false positive results. Yet testing is the popular narrative now.

As we sit in our living rooms staring at Netflix as the economy begins to creak forward, perhaps we should ask ourselves when we're told our salvation will occur after we test billions of people worldwide (which will never happen, in my opinion), who stands to benefit? Likewise, who benefits by promoting more fear and the isolation/distancing narrative?

-Wes

Rethinking the COVID-19 "Pandemic"

The front page headline of the Wall Street Journal this morning read: "Stocks Rally in Face of Downturn."

Why?

Perhaps they know something we don't? Or have we been too manipulated by fear to look critically at what has just happened thanks to a little-known RNA virus?

I realize that most of the blog posts here lately have been critical of the American Board of Medical Specialties and their 24 subsidiary medical specialty boards, in large part because they rely on rote memorization of trivial facts as a means of gauging physician "quality" and "professionalism" (as they have deemed to "redefine" the term in their 2002 widely-published self-written white paper). Clinical experience gained only after years of complicated and uncertain patient interactions has always been immaterial to these rent-seeking data-collecting medical specialty member boards. But what I'm focusing on now is something much more important for the practicing physician that can't be measured by a standardized test: the ability to think critically in the face of the unknown. After all, most new patient encounters require the ability to assimilate vast amounts of information and distill it clinically for the benefits of an individual patient that has an infinite number of possible clinical co-founders.

We have to remember that 27-year old journalists and younger brilliant physician sycophants of the computerized test, as much as they may mean well, can be easily manipulated by political, economic, and social agendas that have been engrained in our society for years. As clinical physicians, is our job to listen to politicians and economists and those young physicians, or to think critically about an incredibly complicated non-linear (and non-exponential) biologic event that has just swept the world and resulted in the shuttering of so many economies and left over 22 million unemployed in the United States alone?

In the beginning of this evolving WHO-defined pandemic, the world were enamored with mathematical models from economists and pundits based in complicated assumptions - most of which were (quite frankly) guesses and never truly gauged to existing well-known viral illnesses like seasonal influenza. The World Health Organization (WHO) proclaimed early on that this new coronavirus had an incredibly high 3.4% mortality rate. New phrases were quickly introduced into our daily vernacular by the mainstream and social media like"flattening the curve," and "social distancing" as images of refrigerator trucks to house the dead were pushed to our cell phones. But that mortality statistic, we're now finding, was markedly overblown.

Perhaps more important is the way this virus has managed to seek out and impact the most medically vulnerable of our populations: those in close living environments or the socially disadvantaged with serious preexisting medical conditions like obesity, diabetes, lung disease, heart disease, cancers, and blood dycrasias. The elderly in particular, have been remarkably vulnerable to succumbing to COVID-19, in large part because they carry these preconditions far more frequently than younger patients. Health care workers, too, see a skewed population that can seem overwhelming at such a time since we are subjected to an unknown pathogen with an uncertain transmission, prevalence, and unknown lethality. We see the people dying and our bias is reinforced: this must be something BIG.

So how do we gain perspective and reliable data? Do we turn to mainstream media, or print scientific journals that are slow to react and limited in their scope, or do we turn to each other knowing each of us is struggling with the same unknowns? Or maybe that, too, is complicated.

Fortunately, thanks in large part to the internet, the world is quite literally, our oyster. It is time as one British pathologist John Lee has appropriately suggested, that we begin to examine the evidence with "skepticism and vigorous debate." The COVID-19 death toll, and how it relates to our more typical seasonal flu that often impacts hospitals, is far from clear. There is nuance involved in proclaiming a death rate when those dying from a virus are intermingled with those dying with a virus.

Clinical physicians should begin to critically question our national narrative, given these recently updated facts regarding the COVID-19 pandemic from a Swiss physician, each of which are carefully referenced. Look them over. Carefully. Perhaps putting the current situation in perspective from other parts of the world will be more helpful to our patients and their economic and psychologic strife than  taking remarkably expensive and unproven computerized tests created by unaccountable bureaucrats that mean absolutely nothing.

-Wes

Image above from: Lee, J. "How to understand - and report - figures from "COVID Deaths."

COVID-19: A Way Forward

Since the beginning of the coronavirus pandemic and the ongoing Personal Protective Equipment (PPE) shortages I have quietly wondered, "Where is the American Medical Association (AMA)?" Why weren't health care workers and their patients the FIRST consideration of the AMA rather than the making of CPT codes? Is it because the words "physician" and "patient" do not appear in their mission statement?

With an estimated 22 million people currently unemployed in the United States and with states making plans to reopen their economies, a medically cogent path forward out of this pandemic is desperately needed.

It is with that background that I had the opportunity to read this opinion piece by Paul Kempen, MD, PhD that I took the liberty of republishing here. Admittedly, there are no perfect answers right now, but we all need to do our part to bring some semblance of normalcy to our lives again since this situation is likely to continue for some time (I have taken the liberty of making minor edits and have added a few hyperlinks for clarity):

Personal Health is a Personal Responsibility to Enable National Health

Paul Kempen, MD, PhD

"It really amazes me as a physician and health care expert, that while the government and general population expect doctors, nurses - yes, ALL hospital health care workers (HCW) down to the janitor - to go to work every day to care for severely and clearly infected patients, the expectation that the general population cannot even perform daily tasks in low risk environments seems severely misplaced. Being out of doors has even been declared “illegal” in some places. We have seen the country “closed for business” and production capabilities, lives and personal welfare, decimated. If all HCWs are able to work in clearly infected environments, why are citizens unable to protect themselves in low risk environments? Why are there not clear and effective educational and production mechanisms for ensuring regular daily living activities promoted in all media at this time? I have NEVER seen a public educational clip on HOW to correctly wear a mask but have repeatedly seen “experts” without and improperly wearing masks. Are factories and businesses still (really) unable to provide PPE and distancing between workers? WHY? If we can put a man on the moon, we cannot provide education and PPE?

Of course, the lack of Personal Protective Equipment (PPE) has been the serious issue. Government/CDC/WHO “Expert Action” has been unable to address to date the singular outstanding shortage of N95 masks, gowns, and hand disinfectant, or provided accurate and specific instruction/education on personal protective measures. Instead, concentrating on ventilator production (to treat disease) and “testing” to identify infections remains “the answer”. In medicine, we typically test to identify infection based on symptoms - as a healthy, negative tested individual is not protected by the test (due to false negatives) and can become infected by those providing tests to hundreds per hour.

These deflective and reassuring measures apparently resulted politically from “overstated need” by “hot spot Governors” looking for “quick answers” and sound-bytes. Even our CDC “health care experts” got it wrong (or was this merely political decisions): CDC statements initially recommended that civilians should NOT wear masks (because of the shortage), when clearly, masks are the single most important protection against air-born, respiratory infection dissemination. The first thing I personally did when I heard of COVID in January was to order ten N95 masks. Even today, 4/16/2020, three months after the first diagnosed infections were reported in January, this country still does not have enough N95 masks for every citizen. Why? Sending in Navy Hospital ships to NY and LA flies in the face of “Carnival line contagion” episodes: After admitting only 40 patients, the USNS Comfort was infected. The USS Mercy was similarly infected. Will it be also “quarantined”? The medical personnel would have been better utilized on land based stations - but that big red “X” would have not been able to provide the political statement and reassurance in NY harbor.

We have been through infectious hysteria before: The HIV epidemic in the 1980s, which led to important “universal precautions” for self-protection. The SARS (2003) and MERS (2012) Corona infections occurred and should have led to testing and treatment mechanisms decades ago. Flu epidemics occur every year and kill 30-60,000 people-just like COVID and our lessons here should be applied for all future flu seasons-which are coming. Needed measures now include production and education to enable return to economic stability - the ONE essential of any country “at War”:

Instead of forcibly pulling citizens without masks off of a subway train, the CDC and government experts should have ramped up N95 mask production in January to insure at a minimum, one N95 mask per citizen per week. (Editor's note: To be fair, hind sight is aways 20/20) Make N95 masks universally available at no cost to everyone now, including child sizes. They can be disinfected repeatedly by baking at 180 degrees F for 30 minutes. This should NOT require 30 days for each state to insure production for each member of state’s society. (This is much cheaper than $1,200 checks for every tax payer!) Educational commercials should appear hourly and instruct ALL citizens how to wear masks appropriately, the difference in mask types and identify mask type abilities to protect you. Mandating everyone appearing on television to be wearing appropriate masks correctly, as examples to foster compliance, is as possible as legally forcing everyone on an airplane to undergo instruction on how to fasten a seat belt in 2020.

Surgical and home-made masks catch (only most) personal, exhaled droplets and protect to a limited degree those around you. N95 masks will, when correctly worn, eliminate 95% of particles in your INHALED air from reaching you if worn correctly. HCW are “fitted” for N95 masks when hired under OSHA mandates, that is, specifically instructed in proper use. Civilians need this instruction also.

Cut your beard off, shave daily to maximize N95 mask “fit” and effectiveness. Wear masks at all times when not alone and do not touch your face unless immediately after hand washing. Wash your hands frequently (whenever possible contamination occurs), shower and change clothing daily to reduce personal contamination.

If you show signs of infection, contact your doctor for definitive advice and wear at minimum a surgical mask at all times while avoiding others. DO NOT go to hospitals or drive through testing sites if healthy - these sites are high risk areas and those testing hundreds of civilians per hour may well be a significant vector for transmission from infected to those heathy. The tests require invading your body and with unknown hygiene - i.e. out there on the streets where there is no ability to wash hands between individual tests (and I am sure they do not change PPE between each person, given the shortage).

Testing, currently unavailable and with unknown reliability, should be reserved for those with probable/known infection and done in facilities with hand washing between individual tests, unless self testing kits become readily available and are dropped off/mailed in bio-infection labeled and protective packaging (which seems unlikely or reliably possible for general populations).

In addition, we should be testing ALL deaths for COVID presence, instead of declaring all deaths automatically as COVID, as appears to be the current methodology. This is needed to yield REAL numbers.

Insure production of ALL treatment/prophylaxis drugs in sufficient quantities and allow doctors the ability to practice prevention, prophylaxis and treatment tailored to the individual patient and their wishes with all available products - including “compassionate” and “off label” prescriptions.

Serious COVID infections occur in under 5% of all infections. Healthy children and young adults appear resilient. Release this mostly-healthy “herd” now, or when the “surge” is over and create the “herd immunity”. In any “war” the young and healthy are sent to fight and maintain the economy, but please, also provide the needed weapons to them (masks and sanitizers). They will volunteer! Perhaps this group is resilient because they are self-immunized by yearly non-lethal common cold coronavirus encounters which account for 20% all yearly colds creating crossover immunization/disease mitigation.

It is time we all recognize your health is YOUR responsibility. Quit smoking, overeating, passing “joints” and crack pipes and other high risk behaviors. The “opiate epidemic” suddenly disappeared from the news with the COVID19 emergence but it is not gone! As a nation, we must insure our economy and production to maintain wartime abilities. Not just tanks and jets, but drugs, testing, ventilators and PPE should have national priority for “in-country” self-sustaining production. Most drugs marketed in the USA are made from Chinese imported materials at this time. This must change. We must take charge of ourselves and our national security in war and disease. We must stop the media and government hysteria and work with facts, real facts, and not politically motivated reassurances made in the moment as acts of reassurance. Restart the economy to provide PPE and drugs tomorrow for all who need them.

In 1933, the worst year of the Great Depression, President Franklin Roosevelt stated in his inaugural address: “So first of all, let me assert my belief that the only thing we need to fear is fear itself - nameless, unreasoning, unjustified terror, which paralyzes needed efforts to convert retreat into advance.”

This was great advice then and seems especially pertinent on 4/16/2020 before we create another modern great depression. If we are at war, we need our economy to provide for the common good and protection of life, liberty and the pursuit of happiness. The media must be used to serve the people and not continue to create paralyzing terror."

I welcome thoughtful comments to this piece.

-Wes

MOC's Irrelevancy To Public Unmasked In Time of Crisis

With the collapse of testing center availability, travel bans, and growing physician clinical demands, the American Board of Medical Specialties' lucrative Maintenance of Certification® program recently proved how unnecessary it was to the public's wellbeing as each of the member boards followed the ABMS's announcement shuddering its entire Spring examination schedule and many maintenance of certification and continuous certification exercises for all medical subspecialties.

The American Board of Family Medicine, which enjoys the richest balance sheet of any ABMS member board with assets of over $137 million dollars, seems to have a hard time letting go however. The ABFM released this multi-page tortuous statement, portion of which is published below:

Changes to Certification Deadlines

At this time, ABFM has made the following accommodations to the deadlines for your continuous certification participation:

All Diplomates with a three-year stage ending in 2020 will have a one-year extension on completing all stage requirements.

For Diplomates participating in FMCLA, the Quarter 1 deadline has already been extended through June 15, 2020; we anticipate extending completion guidelines further for subsequent quarters. For first year participants, we will adjust the meaningful participation guidelines.

Any Diplomate in Year 10 of their certification cycle who opted for the one-day examination will have an additional year to meet their examination requirement.

Any board-eligible family physician with an eligibility end date in 2020, or anyone participating in the Re-Entry process with an end date in 2020, will have an additional year to obtain their certification.

Any Diplomate who also holds a Certificate of Added Qualification with an examination deadline in 2020 will have the option for an additional year to complete the examination requirement.

For those facing financial hardship as the result of the pandemic, we will establish a method for delaying 2020 payments. This will take a short time to be implemented online, but once available, Diplomates will find information about this in their Physician Portfolio.

These extensions do not prevent anyone with a 2020 deadline from staying on the current timeline. Certification activities will be accessible for anyone who wants to use them.


Certification Stage Activity Requirements

We are continuing our efforts to improve our current Knowledge Self-Assessments (KSA) and will begin to support learning on COVID-19 as evidence becomes more available.

Specifically related to the Performance Improvement (PI) requirement, we will be providing a mechanism to meet the PI requirement by telling us about the unprecedented and rapid changes that you had to make in the ways that you deliver care, regardless of practice type or scope.

An extension has been granted to the first quarter deadline for anyone who is utilizing Continuous Knowledge Self-Assessment (CKSA) as part of their certification activities. The deadline to complete your current quarter 25-question set has been extended from March 31 to June 15, 2020. As the experience of the pandemic evolves, further extensions may be needed.

Any Diplomate who had planned to participate in a Group KSA that has been canceled or postponed can still do the activity online in their ABFM Physician Portfolio. The same certification points and CME credit will be applied as if it was done in a group setting.

Seriously?

Let's keep the magnitude of what frontline doctors are doing today in the care of patients during the COVID-19 pandemic, shall we? The above gibberish should be simplified to the following:

"Any ABFM diplomate caring for patients between 1 Feb 2020 and 1 July 2020 and holding a valid medical license to practice medicine while risking their lives and the lives of their loved ones on behalf of their patients during the COVD-19 pandemic has hereby demonstrated all the skills, professionalism, fortitude, and leadership required to establish themselves as a physician in good standing for a lifetime and will receive lifetime certification from the American Board of Family Medicine without restriction. Self-selected continuing medical education for ongoing education, as required by their respective state licensing boards, will be all that is required of these exceptional physician professionals thereafter.""

Instead, the American Board of Family Medicine seems hellbent on proving just how irrelevant, greedy, insensitive, and distracting they are to the care of our patients in this time of unprecedented physical, psychological, and economic need.

-Wes

The Great Suppression

Interesting opinion piece from the American Institute for Economic Research appeared online framing the "Great Suppression:"

I write on Saturday morning March 28, and right now there are two contrary strains about to collide. On the one hand, you have scientists reducing their death-rate predictions further and further, lopping off zeros by the day. On the other hand, this is accompanied by appalling levels of despotism, even to the point of National Guard checkpoints at state borders and restrictions on what you can buy even at “essential” stores. This gigantic gap between emerging professional medical consensus and appalling policy ignorance is revealing as never before the practical impossibility of scientific public policy.

Then you have the cascade of unintentional and unexpected outcomes of the rush to coerce. It began with Trump’s disastrous block on flights from Europe that sent millions scrambling for tickets and led to an unspeakable crush of people standing shoulder-to-shoulder at our nations’ airports, contradicting the demand that people social distance just when the virus was revealing itself as highly contagious. The very opposite of intended results!

That’s just the beginning. I doubt seriously that the political class in this country, as low a regard I have it, set out to destroy all that we call civilized life, instantly generating millions of unemployed workers and bankrupt businesses all around, not to mention a pandemic of utter hopelessness on the part of vast swaths of the world’s population. Still, this is what they have managed to achieve. This is what their pretense of knowledge – as opposed to actual wisdom – has unleashed on the world, with incalculable human cost.

As for economics, are we talking recession? Depression? Those words indicate cyclical changes in business conditions. My friend Gene Epstein suggests another term for what we are going through. The Great Suppression. There will be months, years, and decades in which to more clearly observe the countless ways in which the supressors piled error upon error, blockage upon blockage, to add to the grotesquery.

What truly should inspire us all right now are the grocers, pharmacists, truck drivers, manufacturers, doctors and nurses, construction workers, restaurant workers, service station attendants, webmasters, volunteers of all sorts, philanthropists, and specialists in a huge variety of essential professions who keep life functioning more or less. And let us not forget the “unessential” people (it’s an incorrect and vicious term) who have innovated ways around the Great Suppression to continue to serve others, keep the rent being paid, and food on their tables. They are the means of salvation out of this mess.

The market, hobbled and bludgeoned, still loves you.

As for the politicians, Andrew Cuomo has admitted some of the error. In a much-welcome change, he has even deregulated medical services. There’s just a hint of humility and humanity embedded in these statements and actions. We need more of that, vastly more, if only to contribute to calming things down long enough to gain some perspective, and, hopefully, some eventual realization that in the “land of the free and the home of the brave” a virus should be regarded as a disease to mitigate and cure, not an excuse to bludgeon life on earth as we know it.

-Wes

Adjusting to Our "New Normal"

It's hard to image what life was like a month ago since so much has changed. The world seems surreal right now: little to no traffic, the hustle and bustle of our cities gone, and the quiet. So much quiet.

Life has changed significantly in our home, as I attempt to strip at my backdoor after returning from work, wash my hands, wipe my keys, phone, and wallet down, then head up stairs for a shower and change of clothes before familial reentry. I sleep in a different bedroom, shower in a different bathroom, and wonder (like a worker after the Chernobyl accident) what my viral "load" is at any point in time. Every accidentally-aspirated chicken noodle soup noodle and results in a coughing spree clears a room. I scratch my nose: "do I need to wash my hands again?"

Life as a physician is really weird now. We are healers and potential vectors all at the same time.

Yet so far we are lucky. Italy announced 969 deaths in a single day yesterday. Many, if not all of them, died alone. The ripple effect on their families must be enormous. And the poor doctors, nurses, health care workers there. New York is starting to feel this too. Will it get this bad here?

Our hospital system has been very proactive and open about the situation with us. They acknowledge the worldwide shortage of personal protective equipment (PPE). They are conserving necessary supplies for those most likely to confront new patients or those with suspected or confirmed COVID-19. All OR's and emergency procedures require full PPE, which is awkward when a non-COVID-19 patient enters: where is the transition to full PPE made? In the holding area? The lab itself? It's all a work in progress. Ventilators? Enough now, but later? Sands shift.

Still, it's impressive to see an ambulance bay converted to a negative flow screening area. Separate hospital's ICU and inpatient ward adapted for designated for COVID-19 patients. Contignecy plans for overflow are already in place. Outpatient drive-thru testing established for people who are most likely to warrant testing and have taken an online screening questionnaire. Six-foot markers are on the floor in the cafeteria, meetings, if they occur at all, are via Zoom or teleconference. Nearly all patient visits are virtual. Elective cases are a thing of the past. 425 physician volunteers are on standby - for extra duty - sometime.

At first, then percentage of people tested with positive coronavirus tests in 24 hrs was 15.8%, then 17.2%, and this AM was 19.1%. 7% of those hospitalized. Lots and lots of testing, planning, wondering, waiting. Today we admitted more people in a single day than everyone that was admitted when we started monitoring a week ago. It's coming.

The preparation seems so logical, but I wonder: will we be overwhelmed? We really don't know. But the non-COVID patients are still out there too: the LVAD patients with ICD shocks, the kids with broken bones, the baby deliveries, heart attacks, cancer patients, and patients with complete heart block, and more. They haven't stopped coming but they, too, are scared.

It's reassuring to see so many good folks giving it their all: from the doctors, nurses, administrative staff, clerical workers, laboratory staff, environmental workers, engineers and transporters. We work together - we have to - and with that effort comes the rekindling of respect for the special skills of everyone.

Once relatively simple things to treat take much more strategic coordination now. Atrial flutter w/rapid rate in a patient with fever and cough just a month ago would get a TEE/cardioversion without a moment's hesitation. Now, that patient is COVID-tested, isolated, procedures performed in full personal protective equipment, and tensions between colleagues heightened. The truth is, the vast majority of us that contract the disease will recover, but no one wants to be that other statistic. Patients need us. Families need us. So we wear a mask, we wash our hands, we wipe our tools, keys, keyboards, phones, then strip, wash and reenter. Are we effective? Honestly, I have no idea, but what else can we do?

Thanks to everyone who have sent prayers, words of encouragement, and support by staying home. We will all get thorough this.

Take care out there and take comfort in the fact that you're not alone.

-Wes

The "Risk and Distraction" of MOC

From the American Board of Internal Medicine:

We did not come to this decision lightly, but we believe removing the potential risk and distraction of sitting for a spring exam is the right thing to do for our diplomates and for the country at this time. Learn more: https://www.abim.org/media-center/Coronavirus-Updates.aspx

Physicians can help make sure this risky, unproven, and "distracting" ABMS board "maintenance of certification" (MOC) requirement never returns by supporting the plaintiffs working to end this monopolized program here.

-Wes

MOC's Sword of Damocles and the Platinum Rule

The current issue of Mayo Clinic Proceedings has an article entitled "Maintenance of Certification and the Platinum Rule: An Existential Crisis" by Richard G. Ellenbogen, MD, E. Sander Connolly Jr, MD, and Fredric B. Meyer, MD. I encourage all to read it and the accompanying editorial by Suzanne M. Norby, MD from the Division of Nephrology and Hypertension and Mayo Clinic.

It is clear that MOC has morphed into a money-making endeavor for legions of third parties, including insurance companies, hospitals, and a myriad of other corporate interests eager to capitalize on the control and sharing of physician data. While the concept of using the "Platinum Rule" to guide the evolution of MOC is a step in the right direction, the "MOC existential crisis" will not end until the "Sword of Damocles" (as the authors aptly put it) is removed from working physicians' heads. We simply cannot work with the threat of the loss of our professional careers if we fail to purchase the unproven MOC (and any other required "continuous certification" product).

The ABMS MOC paradigm will only survive if becomes truly voluntary and its lack of purchase will not affect our right to earn a living.

-Wes

P.S. (Updated 9 Feb 2020 @ 13:45PM CST) As we have seen time and time again, the physician influencers and apologists of the American Board of Medical Specialties (ABMS) have historically abandoned their moral imperative to working physicians and their patients to “first, do no harm.” Corporate interests invariably supersede this ethic. It should come as no surprise, then, that the lead author of this piece has a similar track record working for the National Football League.

Physicians wishing to support the plaintiffs in their ongoing effort to end Maintenance of Certification are encouraged to contribute here.

PA Medical Society and MOC

Are medical societies advocating to end the unproven American Board of Medical Specialties' Maintenance of Certification (MOC) mandate or are they burying the controversy?

In 2016, the Pennsylvania Medical Society (PAMed) issued a strongly-worded "Vote of No Confidence" against the American Board of Internal Medicine (ABIM).

Good luck finding that earlier statement on PAMed's webpage concerning MOC now.

Instead, we see the following soothing pablum regarding PAMed's MOC position:

PAMED Position

Supports efforts to:

• Improve MOC
• Prohibit MOC as a condition of licensure, insurer credentialing and reimbursement, or hospital admitting privileges

The accusations in PAMed's original 2016 Vote of No Confidence against the ABIM were significant:

" 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 other 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 the ABIM's motivation for their recertification process was primarily driven by little more than financial mismanagement."

In 2017, a resolution was passed by the AMA House of Delegates demanding an independent audit of the ABIM. This lead to the following response from the ABIM to James Madara, MD, President of the AMA. In that response by the ABIM, the American College of Cardiology was quoted as vouching for the ABIM's financial statements because of this statement issued to their membership:

In addition, the ACC's accounting staff have reviewed and discussed the ABIM’s publicly available financial statements with an outside accounting firm and have found the statements to be in compliance with Generally Accepted Accounting Principles, as utilized by not-for-profit organizations in the United States.

The problem is, the AMA and the ACC have interests in selling physician data and each organization has representatives on the board of PCPI.org alongside representatives from UnitedHealthcare. PCPI and the ABMS share the same office address. Therefore, the financial "audit" demanded by the AMA House of Delegates in 2017 and accepted by the AMA's President Madara was never "independent."

Pennsylvania physicians represented by PAMed need to confront their medical society's current leadership concerning MOC and the lack of independent financial audit demanded by the AMA House of Delegates. One thing working physicians in Pennsylvania (and elsewhere) don't need: corporate physician shills more interested in themselves and their political aspirations than the support of front-line physicians who care for their citizens.

-Wes

The Certified Deceit and Exploitation of US Physicians

For the past seven years, I have devoted a significant amount of my time to investigating and telling the true story of US physician "board certification." That story has been one of deceit, private back-room deals, profiteering, and (worst of all in my humble opinion), the exploitation of working physicians and the patients for whom they care.

This writing has not come without its personal and professional costs, but when the story is one that affects the corruption of the largest single contributor to the US economy, what else should I have expected?

As I reflect on what this side job has exposed, it would be naive and dishonest to suggest that physicians are exempt from bearing some responsibility for rising healthcare costs in America. But it may go much further than that: our medical profession and its hallowed physician education regulatory system comprised of the unchecked Accreditation Council for Graduate Medical Education (ACGME) might be the very reason things were allowed to become so out of control. Our non-profit tax laws with their opaque reporting requirements have allowed huge "non-profits" to go unchecked in America - and most of those "non-profits" are in healthcare. (Just take a stroll by the American Medical Association (AMA) building in downtown Chicago sometime to get a feel for the magnitude of the problem.)

Why should the physician education and credentialing systems in America be exempt from such corruption?

Well, they are not.

From the earliest reports of a multi-million dollar condominium purchase by the same non-profit organization that created the "Choosing Wisely®" campaign to promote health care cost savings, the hypocrisy of US board certification was laid bare. With not-so-difficult internet Google searches, it was just a matter of time before the multiple deep-pocketed corporate ties between US physician board certification and Big Tobacco, Big Insurance, Group Purchase Organizations, and the Health Care Quality and Safety Industry became evident. Even our most widely respected health care journals, many of which were owned by state medical societies or physician specialty societies, published innumerable articles with an editorial blind eye to these financial conflicts. Even the Chief Medical Officer of the American Board of Internal Medicine is just a hired corporate consultant. To that end, is it any wonder that the so-called "voluntary" ABMS board certification product is now anything but voluntary for physicians, as trillions of health care dollars exchange hands in hospitals and insurance companies whose corporations believed the published propaganda?

This is why the "Maintenance of Certification" (MOC) story must be told and understood. Continuing the cover-up only serves to fan the flames of physician burnout and risks loss of more frontline highly-trained physicians to other professions.

Thankfully, the true history of AMBS board certification was recently published online. But it was not published in a medical journal. It was published in the public Siva v. American Board of Radiology antitrust lawsuit case docket.

And what a complicated and tortuous story it tells.

It is a story of public deception.

It is a story of physician exploitation.

It is a story of greed.

It is a story of trying to use Maintenance of Certification to control state's sovereignty over medical licensure.

It is a story of money for bureaucrats, hospitals, and numerous corporate interests at the expense of the youngest and most vulnerable physicians.

It is a story of a sophisticated self-serving physician education and credentialing racket.

And now, you can read the 79-page story here.

Let's hope Judge Jorge Alonso (who initially dismissed the case against the American Board of Radiology) reads it, too.

-Wes

P.S.: Please consider supporting the Plaintiffs in their ongoing David vs Goliath MOC legal battles.

Who Is the ABIM Chief Medical Officer?

Drs. Richard G. Battaglia and Richard Baron
(Image from the ABIM Blog)

Who is Richard G. Battaglia, MD?

In 2015, the American Board of Internal Medicine (ABIM) announced Richard G. Battalgia, MD as their new Chief Medical Officer (CMO). This was the same year the American Board of Medical Specialties (ABMS) paid $922,479 to PriceWaterhouseCooper LLP (PwC) for "Management Consulting:"

What the ABIM website fails to mention with their announcement, is that Mr. Battaglia worked for PwC for 14 years, 3 months before being "hired" by the ABIM.

Is Dr. Battaglia, the ABIM CMO, concerned about medical education of physicians or merely a consultant purchased by the American Board of Medical Specialties to "clean up" the ABIM Maintenance of Certification (MOC) mess?

The ABIM website only says this about their CMO:

"Dr. Battaglia, a board certified internist, is Chief Medical Officer (CMO) of the American Board of Internal Medicine (ABIM). There, he leads ABIM's effort to incorporate feedback from practicing physicians and key stakeholders into clinical aspects of all of ABIM activities, including Certification and Maintenance of Certification (MOC).

Previously, Dr. Battaglia served as a primary care internist with Health Care Plan/Univera, a multi-specialty, staff model practice in Western New York before transitioning into leadership roles, including Medical Director of the Medical Centers Division and Senior Vice President, Medical Affairs/Corporate Medical Director. He also served as Medical Director/Chief Medical Officer of large multispecialty medical groups in Western New York. He has participated in national quality initiatives focused on physician group practice and health maintenance organizations. For more than 10 years, he devoted time to The National Committee for Quality Assurance, including a term as Chairman of the committee charged with accreditation decision-making. Most recently, he was a consultant (emphasis mine) for national and international organizations, including academic medical centers, health systems, community hospitals, medical groups, payers and national physician certification organizations.

Dr. Battaglia received a biochemistry degree from Canisius College, a Jesuit institution in Buffalo, NY. He obtained his medical degree from the University of Rochester School of Medicine and Dentistry. Dr. Battaglia completed his residency through the University of Rochester Primary Care Program in Internal Medicine and also served as Chief Resident."

Maybe PwC's "Unifying Thread" of using (physician) data is the real reason Dr. Battalia promotes "continuous certification" and MOC:

Data is the unifying thread across seven policy areas we highlight here. Privacy, antitrust, tax, regulation of artificial intelligence, and trade are converging around the collection, sharing and security of data.

Physicians subjected to lifelong payments to ABMS member boards for Maintenance of Certification (MOC) and Continuous Certification (CC) should know about Mr. Dr. Battaglia's PwC connection. Just like they should have known about Christine Cassel, MD's connections to Premier, Inc, Kaiser, and CECity, and Dr. Wachter's connections to the The Hospitalist Company and Teamhealth.

When considering patient safety and care quality, a corporate, non-clinical, damage-control medical consultant for a Fortune 500 accounting firm should not be Chief Medical Officer of the American Board of Internal Medicine.

-Wes

Visible Cracks

it was a clinic day like all the rest
until it wasn't
she was there with her son and granddaughter
winded
legs swollen "for a month"
afib, fast rate despite cardizem CD 300 mg daily, diabetic meds, norvasc.
EKG with LVH, RBBB, LAFB.
BP 178/84, HR 124
rales
meds to be started, but help?
EMR->no doctor
a nurse practitioner?
4:45 pm-> all gone
see you in two days
no appointments.

i wake too early
staring up
mind swirling
cases ahead
remembering her
and me
alone.

-Wes

The Study We Weren't Supposed to See

Most US physicians are well-acquainted with the American Board if Internal Medicine's (ABIM) breathless claims of ABIM board certification and Maintenance of Certification's benefits. These have included:

• The Public Expects It
• Physicians Value It
• Amount of clinical experience does not necessarily lead to better outcomes or improvement of skills
• Certification is Associated with Better Care

But what about the harms of constant testing and its affects on physician burnout? Wouldn't it important for the ABIM to mention that their OWN study on 34 subjects, funded by US physician testing fees in the form of grants from the ABIM Foundation and authored (in part) by ABIM staff and consultants, has found that Certification and MOC:

• "lead to higher measures of depersonalization and emotional exhaustion."
• "may be an important source of medical errors related to clinical reasoning tasks in practice."
• yet are considered the "Gold Standard of physician performance."

These are their words, not mine.

Where are these results published on the ABIM or ABIM Foundation website?

Shouldn't U.S. physicians who paid for such poorly conducted/self-promotional "research" be entitled to disclosure of (1) how much granbt money was paid to USUHS, (2) why the funding agency was allowed authorship of this "research," and (3) why the data contained in this work were not disclosed to ABIM diplomates on the ABIM website?

-Wes

Please contribute to help support the legal effort to end Maintenance of Certification nationwide.

ABIM Antitrust/RICO Lawsuit Notice of Appeal Filed

Today, the official Notice of Appeal was filed in the United States Court of Appeals for the Third Circuit in Pennsylvania. It appears the ABIM's legal headaches regarding Maintenance of Certification (MOC) are far from over.

Working physicians can help the plaintiffs in their David-versus-Goliath effort to end the unproven American Board of Medical Specialties' MOC program by contributing to Practicing Physicians of America's GoFundMe page created on their behalf. We have almost reached our $400,000 goal. (Your contribution may be tax deductible before year's end - please consult your tax advisor.)

-Wes

Just In Time for Christmas: The MOC Legal Juggernaut Intensifies

With the recent back-to-back announcements that the class action antitrust and racketeering lawsuit against the American Board of Internal Medicine (ABIM) and the antitrust lawsuit against the American Board of Radiology were dismissed (e.g., the ABIM announcement and ABR announcement), doctors everywhere - both young and old - seemed resigned to the fact that they will have to be subjects to lifelong extortion of private American Board of Medical Specialties member boards and their affiliates if they wanted to practice medicine in the United States.

But fear not, dear colleagues. I bring you tidings of great joy. The first great Supplemental Opposition to the Motion to Dismiss the lawsuit against the American Board of Psychiatry and Neurology (ABPN) was filed yesterday that promises to renew the call for justice on the basis of proper legal procedural grounds:

Defendant American Board of Psychiatry and Neurology (“ABPN”) illegally ties its initial certification product, which it sells to new doctors to demonstrate completion of their medical education and assess the quality of their residency program, and its MOC product, which it requires some older doctors, but not all, to purchase throughout their careers to demonstrate lifetime learning or forfeit their initial certification. ABPN brings to the court’s attention Kenney v. American Board of Internal Medicine, No. 18-5260, 2019 U.S. Dist. LEXIS 164725 (E.D. Pa.Sept. 26, 2019) (“Kenney”), and Siva v. American Board of Radiology, No. 19 C 1407, 2019 U.S. Dist. LEXIS 200645 (N.D. Ill. Nov. 19, 2019) (“Siva”). Kenney came first, followed by Siva which “agree[d] with the reasoning in Kenney.” Id. at *11.¹

Nothing in those opinions changes ABPN’s unlawful conduct. A critical reading of the opinions and application of the universally accepted rule that well-pleaded factual allegations and all reasonable inferences therefrom must be taken as true compels the conclusion that Kenney and Siva were, respectfully, wrongly decided.

¹  The tying claims in Kenney were dismissed with prejudice without plaintiffs being allowed to amend, the court finding as a matter of law that separate products could never be alleged. Plaintiffs are appealing that ruling. The claims in Siva were dismissed without prejudice and plaintiff is filing an amended complaint on January 10, 2020.

The supplemental opposition to the ABPN motion to dismiss then outlines multiple legal reasons why the plaintiffs believe the decisions were wrongly decided. In essence, the attorneys are arguing that the facts in this case were not even allowed to be considered past the judges' chambers.

We can anticipate that the multitude of moneyed interests behind Maintenance of Certification will stop at nothing to assure this unlawful program continues unchecked.

Still, a bit of hope and cheer is always welcome for working physicians this time of year.

Merry Christmas!

-Wes

P.S.: On a separate legal note:

Remember the Puerto Rican physician, Jaime Salas Rushford, MD, whom the ABIM revoked his board certification and dragged him through the court system since 2012 with a dismissed time-barred cheating claim while the President and CEO of the ABIM simultaneously failed to disclose her conflicts of interest with Kaiser and Premier Inc? Yesterday, the judge issued the following order to expedite the counterclaim suit filed against ABIM by Salas Rushford:

The American Board of Internal Medicine may file its motion for judgment on the pleadings no later than December 18, 2019. Dr. Salas-Rushford will respond no later than January 2, 2020. The Board may reply no later than January 9, 2020. The case schedule will be discussed at the scheduling conference to be held on January 31, 2020. Signed by Judge Francisco A. Besosa on 12/11/2019. (brc) (Entered: 12/11/2019)

It seems that case will soon be coming to a head, too.

Readers wishing to support the brave physician plaintiffs involved in these lawsuits trying to end the unlawful Maintenance of Certification program are encouraged to contribute to their GoFundMe campaign.

ABIM's Dark Side Needs More Light

From the recently filed "Objections to Deadlines due to Completion of Discovery" by Plaintiff Jaimie Salas Rushford, MD in Puerto Rico Federal Court comes public evidence of mafia-like tactics used against physicians by the American Board of Internal Medicine (ABIM) to protect their certification testing monopoly:

(Click image to enlarge)

So to summarize some of what has transpired at the ABIM to maintain their physician testing monopoly:

1. The ABIM secretly created the ABIM Foundation in 1989 for the purpose of laundering over $70 million of physician testing fees from 1990-2007 for various personal and political agendas, including the purchase of a 2-bedroom luxury condominium, art collection, and offshoring of Cayman Island retirement funds.
2. They published a white paper in 2002 in two major medical journals, the Annals of Internal Medicine and the Lancet, entitled "Medical Professionalism in the New Millennium: A Physician Charter" (which, given these revelations, should both be retracted in my opinion).
3. They used a strongman convicted of impersonating a police officer and carrying an unregistered firearm as their Director of Test Security with access to physicians' most sensitive personal information.
4. They forced a physician who admitted to wrongdoing to pay $15,000 to remain board certified on the condition that physician also serve as an informant.
5. They continue to drag a vulnerable physician through the court system for what will be at least eight years to maintain their monopoly and hide the truth.

The American Board of Internal Medicine needs to be held accountable to working US physicians and the public for their actions. I believe their irresponsible and undisclosed financial and political dealings, paired with these mafia-like tactics, deserve full transparency and appropriate judicial scrutiny. 

Physicians deserve better. The public deserves better.

It's past time we shine a bright light on this racket.

-Wes

Watching Our Healthcare Hindenburg Burn

Just before Thanksgiving, 15 physicians were notified they will be replaced by less-experienced and cheaper nurse practitioners at the nearly $1 billion Edwards-Elmhurst healthcare system here in Chicago. Doctors, the article says, were "broadsided," perhaps because they were naive to events that occurred in Springfield, IL earlier this year. Thanks to aggressive lobbying, recent legislation was unanimously passed in both the House and Senate Illinois legislature allowing nurse practitioners to practice independently of physicians in any capacity except surgery. Working doctors likely missed this since they don't populate legislative halls - they populate clinics and hospitals caring for patients - or at least most did.

This trend of using more and more nurse practitioners in lieu of physicians appears to be accelerating nationwide as large hospital systems or consolidated primary care clinics with bloated numbers of midlevel administrators look to cut costs. Nurse practitioners are everywhere now: staffing ICUs, Emergency Rooms, and yes, primary care clinics. Some nurse practitioners are used to preferentially fill lucrative surgical pipelines armed with little other knowledge than what a routine case for surgery requires. And while advanced practice nurse practitioners do treat common ailments like earaches and sore throats, often quite well, how many can recognize the warning signs of a case of epiglottitis? What happens to patients then?

Is compromising years of physician training and care experience for cost efficiency really about patient care or cost savings or a facility's bottom line? Is the inevitable pitting of nurses against doctors in the patient's best interest or the institution's? Who sees the costs supposedly saved by hiring cheaper advanced practice nurses?  Will Edward-Elmhurst Healthsystem suddenly stop spending millions on collection agents who served as second-largest contractor for Edward-Elmhurst Healthsystem in Fiscal Year 2018?

Working physicians aren't without some blame either. Where were the physicians on the Medical Executive Committee of Edward-Elmhurst Healthsystem with this announcement? Did they approve  replacing 15 physician-colleagues for lesser-trained nurse practitioners or fearful of losing their jobs if they didn't "align" themselves with this administrative move? Who is advocating for patients at Edward-Elmhurst Healthsystem (or any other large non-physician run hospital system) now? Anyone?

Can Dr. Google and inexperienced physician posers safely replace the highly trained, experienced physician? No one really knows. This latest move is little more than a grand experiment promoted by healthcare consultants with patients' lives on the line.  Which leads us to ask: is touting a shortage of US physicians really a concern of the Association of American Medical Colleges or just a ploy by other member organizations of Accreditation Council for Graduate Medical Education (like the American Hospital Association) to justify these physician firings so hospitals can pad their bottom line?

Our Healthcare Hindenburg is burning: a bubble of excessive prices, high middleman salaries, a rapidly accelerating physician shortage, competition of healthsystems and patients increasingly unable to pay even basic co-pays for healthcare, medications, and procedures, as they are left to take the financial hit to maintain the health care industrial complex's status quo.

In healthcare, it's "Winner Takes All" with the likes of PriceWaterHouseCooper, McKinsey, and the Advisory Board at the helm.  The competition is fierce.

Patients (and their better-trained frontline physicians) be damned.

-Wes

The AMA and ABMS Member Boards: Banking on the Promise of Private Equity

Recently, I was sent a prospectus for a medical device company that caught the eye of a local Venture Capital funding group. On that prospectus was this paragraph for a "vision" of future of a "clinical decision support system:"

Collects data from the electronic medical record, medical literature, regulatory warnings and other internet-based public information. Provides analysis of intra-procedural progress that integrates this data with procedural imaging and patient status. Includes predictive analytics with the use of cognitive computing to support optimal clinical decision making."

This pitch was little more than a marketed promise of artificial intelligence, of instant processing of black-box algorithms, of equity funding to solve healthcare's less-than optimal patient outcomes using the internet, numbers, cut-copy-and-paste data entry, physician testing scores, in one big algorithmic, dehumanized, robotic mess.

In short, this is what health care market investors see now: a vision where fewer staff, more data entry, and less humanity and human touch are sold as better health care. Worse still, working physicians who remain are being grown and matured in a muzzled petri dish where dissent is openly discouraged by employers and "certifying" bodies.

This data-driven model didn't work out so well for Boeing.

And it won't work so well for health care either.

But don't tell that to the American Medical Association. Because to the AMA, working physicians in the US are little more than data entry ports "Moving Medicine" toward the AMA's latest vision for a business-oriented private equity-driven health care model for tomorrow.

-Wes

Timeline for Justice: ABIM v Salas Rushford

A young resident physician, Jaime Salas Rushford MD, came to New Jersey from Puerto Rico to study for his initial American Board of Internal Medicine (ABIM) board certification examination with an ACGME-approved Arora "Unusual Board Review" course. He later took his examination and passed, making him officially board certified on 8/20/2009.

Over three years later, he received a letter from Ms. Lynn O. Langdon, Chief Operating Office of the ABIM at the time, that his board certification was suddenly, indefinitely revoked because of claims he "collected and compiled hundred of ABIM examination questions from multiple sources" and that he "sent hundreds of ABIM examination questions" from his email to Arora Board Review. The letter implied he did "not maintain moral, ethical, or professional behavior satisfactory to the Board," engaged in "misconduct adversely affecting " his integrity, and engaged in "behavior that subverts the examination process."

Because the ABIM felt he violated their "Pledge of Honesty," the Board elected to "indefinitely revoke" his certification and "notify the Medical Board in every jurisdiction" that he was licensed.

He had 10 days to appeal that decision through a never-disclosed ABIM "three-stage appeal process" that lasted two years. Following this, he later discovered the ABIM had filed a copyright infringement lawsuit against him.

He describes the ordeal in detail here. In that description, he notes the additional reprimanding of some "2700 physicians," the use of a "spy" sent to the board review course he attended, the secret funneling of millions of dollars of ABIM Diplomate testing fees to create the ABIM Foundation, the raid using federal Marshals of Dr. Arora's home to copy computer files and secure physician's email addresses, and the undisclosed conflicts of interest of Christine Cassel, MD, former President and CEO of the ABIM, none of which were known to Diplomates of the ABIM at the time.

Instead, the ABIM issued a press release that was picked up by the Wall Street Journal and shocked the medical community on June 9, 2010, detailing the sanctioning of 139 physicians for claims of "cheating:"

"Any high-school kid knows that cheating is unfair," said Dr. Christine Cassel, president and chief executive of the ABIM, who called the sanctions "a message and a deterrent."

The ABIM's move springs from a case involving test-prep firm Arora Board Review, which it sued last year. The ABIM's suit alleged that Arora instructors told class members the review questions were from the actual exam and solicited them to supply the company with additional questions they remembered after taking certification exams.

The ABIM and an attorney for Livingston, N.J.-based Arora both said they are in settlement talks. Arora's website says it has "put [its] business on hold until a settlement is reached in the near future."

Materials seized from Arora in December as part of the case included 2,000 emails and audio and other communications from physicians disclosing exam questions, according to the ABIM.

Based on these materials, the ABIM sued Monica Mukherjee of Washington, D.C.; Anastassia Todor of Aurora, Colo.; Pedram Salehi of Los Angeles; Sarah Von Muller of Tulsa, Okla.; and Frederick Oni of Warner Robins, Ga.

Dr. Mukherjee couldn't be reached for comment. Dr. Todor and Dr. Salehi had no comment. Dr. Oni said he didn't know the questions he purchased were from previous tests.

Dr. Von Muller said courses like Arora's are necessary for busy physicians attempting to get their optional board certification.

Dr. Cassel said she doesn't believe sharing or selling actual questions is common. "We have a great deal of confidence that most people don't cheat on this exam," she said, adding that there are "legitimate board-review programs that continue to function." (The ABIM doesn't offer its own review courses.)

The "hundreds" of allegedly infringing questions used by the course were removed from the pool of questions used on the computerized tests starting in 2009. Doctors who took the Arora course but weren't sanctioned or sued will get letters of reprimand, the ABIM said.

The ABIM subsequently lost the copyright infringement lawsuit against Salas Rushford, but his counterclaim lawsuit filed against the ABIM goes on after being recently moved to Puerto Rico Federal District Court.

On 7 Nov 2019, the case management order for this lawsuit was published by the federal judge Francisco A. Besosa with the following timeline:

• 29 Nov 2019 - Objections to Case Management Deadlines and all outstanding pleadings due.


• 3 Dec 2019 - Motions to amend the pleadings or add parties to be filed.


• 31 Jan 2020 - initial Case Management and Settlement Conference


• 29 May 2020 - Motions to Dismiss must be filed


• 30 Dec 2020 - All discovery must be completed


• 9 Apr 2021 - Pretrial and Settlement Conference


• 19 Apr 2021 - Trial Shall Begin (09:00AM)

The wheels of justice might turn slowly, but they are turning. The number of lawsuits currently underway against the ABIM is mounting and while it appears they will stop at nothing to maintain their monopoly, the activities that took place in the case of these physicians need investigation and explanation.

Perhaps now light will shine on the inner dealings of the so-called "voluntary" US Physician Board Certification process that has harmed practicing physicians without accountability or means of due process for years.

-Wes

Is CMS's Value-Based Healthcare System Already Being Gamed?

Take a look at the address of the American Board of Medical Specialties (ABMS) that owns the Maintenance of Certification (MOC®) trademark that is the subject of at least six anti-trust lawsuits (see here, here, and here for instance) underway because MOC binds physicians to their hospital privileges and insurance payments to made to hospitals on behalf of their employed physicians:

Now look at the address of the American Medical Association (AMA)-sponsored PCPI Foundation with board members from UnitedHealthcare, Premier, the American College of Cardiology, the American College of Physicians, several trustees of the AMA, and others:

Recall that the AMA maintains a monopoly on the procedure codes (CPT® codes) for every medical procedure performed in the United States and sells the rights to use that database to insurers and electronic medical record companies. Each of the AMA codes, then, have particular "value" to hospitals and insurers.

The AMA also determines the "relative value system" used by the government coding for weighting physician compensation that strongly incentivizes physician behavior. Some procedures, then, have more "value" to physicians than others. Hospitals know this, too.

Gee, I wonder, with all these codes and friends that stand to profit on the backs of working physicians and our patients, is the Affordable Care Act's value-based healthcare already being gamed?

-Wes