Saturday, April 25, 2015

ACC Issues "Urgent" Message, But To Whom?

The American College of Cardiology (ACC) leadership, troubled by the "complex situation" presented by the changes in re-certification by the American Board of Internal Medicine (ABIM), issued an "urgent message" yesterday on their blog.

This message hinted at the ACC's pathway forward: to create a "second task force" to "aggressively" explore "whether an alternative board should/could be developed by ACC for our members." They then add a cautionary note, stating "while working as rapidly as possible, we want to be cautious, realizing the great complexity of the situation."

So what are cardiologists and cardiac electrophysiologists to think of this latest "urgent message?"

It is clear that the ABIM's MOC program as it exists can no longer be considered legitimate. However, the ripple effects of the scandal of the ABIM and its Foundation are so far reaching that every single member board of the American Board of Medical Specialties' MOC constructs' twenty-four member boards will open themselves to scrutiny once the financial genie leaves the bottle.  It is not easy to unravel a monopoly when it's found to be (1) scientifically unfounded, (2) corrupt, and (3) profitable to the many leaders of these unaccountable non-profit organizations' leadership.

The era of the gilded age of non-profit organizations controlling medicine is coming to an end and every one of the scientific non-profit organizations that have hid behind their secretive walls for so long know it.

That's why this message was so "urgent."

-Wes

Thursday, April 16, 2015

A Promising Week of Firsts

It was quite a week for America's practicing physicians.  For months the frustration over the lack of accountability of the American Board of Internal Medicine (ABIM) and the American Board of Medical Specialties Maintenance of Certification (MOC) program had been building.  Even anger, an emotion few physicians have time for, was mounting.

Then something wonderful happened.

Physicians stopped working for a moment and picked up the phone. For many, it was the first time they had ever called a Senator's office.  For others, the first time they had written one.

Here's a few examples from Twitter:

For US Senators in Washington DC (or their staffers), it was also the first time they had heard from front line working physicians rather than physician-lobbyists knocking on their door.  Weren't working physicians supposed to just be "excellent sheep?"

But there they were: a pediatrician calling over her lunch hour, a family practice doctor taking a few moments between patients, or a cardiac electrophysiologist ("What's that?" they asked) reading EKGs and calling.

From all over the country.

It was almost as if you could hear them asking, "Why are these doctors calling?  What do you mean there's an anti-trust suit pending?  I thought they wanted this SGR Reform! What is this MOC thing anyway?"

(Click to enlarge)

Last night we had a group meeting of some forty cardiologists in our practice.  Everyone listened politely to the administration explaining their new initiatives, new plans for growth, things we could do better, how the SGR Reform Bill, HR2, had passed.  Doctors listen politely. But there was a buzz in the air.

Younger doctors were questioning if MOC was still part of the bill. They were questioning the regulatory establishment, wondering if they should join the American College of Cardiology if they supported the passage of HR2 that included MOC. Questioning.  Reenergized. Hopeful.

Practicing doctors might not have won the battle to stop the ABMS Maintenance of Certification program from being incorporated into our new health care law, or for parts of the program being used as a medical registry for physician reporting purposes in H.R. 2.  But the other night they won something much better: they learned that they weren't powerless.  They remembered that being  "accountable" for peoples' lives is very different than being "accountable" for dollars.

Thanks to all who raised a voice, wrote a letter, and took a stand against MOC.  I can't tell you how great it was to see so many physician nationwide come together so quickly to stake a stand on this remarkably divisive and corrupt program that extends, like a hydra, throughout our entire health care system.

We have have good reason to smile.

Congress and the public now know about it too.

-Wes




Tuesday, April 14, 2015

Why Journalists Need Maintenance of Certification

Well, well, well, this little blog got a mention in the New York Times Well health care blog last evening in a post entitled "Board Certification and Fees Anger Doctors" by Joshua Krisch.  Too bad what really upsets doctors is not certification, but the proprietary RE-certification monopoly known as the ABMS "Maintenance of Certification" (MOC) program. At least the post includes a dashing public relations photo of Richard Baron, MD, the president and CEO of the American Board of Internal Medicine (ABIM) sporting a neatly-pressed casual sport coat with a hipster purple shirt while he appears to be earnestly conversing with a "board service" representative. 

Nice.

While the article fairly disclosed some of the issues that bothers physicians, it was remarkably devoid of what really irks physicians, especially the egregious and corrupt financial transactions of the ABIM uncovered on this blog in December 2014.  Follow-up investigations have found that the ABIM repeatedly funneled $30.6 million to their separate non-profit, the ABIM Foundation that is lead by the same officers between 1998 and 2007.  It appeared this transfer of "grants" was used to supplement an investment portfolio that had already exceeding $55 million and included a $2.3 million condominium complete with a chauffeur-driven Mercedes S-class town car, and leadership conferences at 5-star hotels.  All while the ABIM was bleeding cash and growing a deficit from negative $10 million to negative $43 million.

More recently, even more concerning allegations regarding the ABIM's financial and tax disclosures were revealed by veteran journalist, Kurt Eichenwald of Newsweek. So it goes without saying that I was disappointed that Mr. Krisch failed to mention or investigate any of these financial dealings of the ABIM in his reporting.

Clearly, it appears journalists need Maintenance of Journalism Certification, too.

You see, the public demands such certification. After all, an Institute of Journalism Report published in 1999 showed that journalism errors contribute to 999,000 over-treatments and approximately 5000 deaths each year.  Beyond quality, subscribers need to be assured they're getting "value" from their costly annual New York Times subscription.

Fortunately, a new American Board of Journalism Specialties (ABJS) exists to assure quality journalism that not only meets, but exceeds, societal standards. The ABJS has assembled a whole host of subspecialty member boards with salaries commensurate with the medical subspecialty board executives to establish credentials for each category of US journalism.  These include the American Board of Health Care Journalism (ABHCJ), the American Board of Finance Journalism (ABFJ), The American Board of Business Journalism (ABBJ), the American Board of Entertainment Journalism (ABEJ) , the American Board of Sports Section Journalism (ABSSJ), and the American Board of Weather Reporting Journalism (ABWRJ) and the American Board of Style Journalism (ABSJ).   Each member board nominate speciality advisors who provide content for the once-every-ten-year high-stakes secure examination that assures quality reporting in each journalism category.  Literature supporting the benefits for Maintenance of Journalism Certification is second to none. While the costs are different for each category of journalism, they harmonize well with prices set by the American Board of Internal Medicine's MOC program. Furthermore, the examination occurs in industry-standard computerized Pearson Vue Testing Centers that promise comfort and security with the finest of palm reads and cavity searches prior to testing.

Our most recent Maintenance of Journalism Certification (MOJC) results shows that only 78% of journalists pass the ABJS's recertification test on their first try, demonstrating the rigorous nature of the testing.  Don't worry, though, 96% of journalists ultimately pass their examination. Journalists who fail just have to attend a Board Review course developed by their respective ABJS member board to assure they are fed the correct answers for a just a few thousand dollars more.  Once completed, repeat testing fees are kept at a reasonable $750. And for those who fail?  Well, we're really not sure what happens to them.

The secure exam tests mastery of mathematics through calculus, statistics, English Literature, and Written Composition.  Strunck and White's "Elements of Style" are extensively utilized to assure the highest of testing standards. Journalists undergoing this mandatory evaluation every ten years can rest assured that each of the secure examination questions have been carefully vetted using psychometric testing techniques.  Because of the time, energy, and golf games missed to create these questions, paired with the need to maintain the utmost secrecy in fairness to all, divulging test questions to other journalists is strictly forbidden. In the event of such a breach, the ANJS will have no choice but to use every legal means to punish the journalist, resulting in suspension or revocation of the journalist's writing credentials and ability to practice their trade. Freedom of the press in such a circumstance means nothing.

With the explosion of online content of varying quality, the public has demanded that continuous learning take place.  Beginning in January, 2014, a new, even more rigorous continuous certification process has been developed that incorporates Practice Improvement Modules (PIM) in addition to the secure examination.  With this program, journalist will have the option to "pay-as-you go" every two years or cough up the full re-certification fee up front to assure they will be listed on CertificationMatters.org as "Meeting Journalism Standards." PIM will require that journalists participate in survey collection of colleagues' assessment of their workplace and worth to society. Questions concerning quality of their fax machine, computer power, and diversity of reporting to avoid racial, gender, or age bias will be included. Survey results are transmitted non-securely to the ABJS website so the information can then be purchased by concerned stakeholders like ABC, CBS, NBC, CNN, HBO, Huffington Post, Style Magazine, Cosmopolitan, the New York Times, and the Leapfrog Journalism group to censor stories that might not meet journalistic professionalism standards. In addition, a portion of journalist's testing fees will help fund the Choosing Wisely Investment Club that has been looking for a really nice condominium in SoHo.

Finally, such a journalism certification process will harmonize nicely with the unproven ABMS Maintenance of Certification program that is slated to be incorporated as a medical registry in the Medicare SGR Repeal Bill, H.R. 2.

Same concept.  Same money. All for the "public good."

"Ridiculous," you say?  "Outrageous?"

Now you know why doctors are angry.

-Wes


Monday, April 13, 2015

Remember Working Doctors, Call Your Senator TODAY

If you believe it's not okay to have the corrupt, coercive, and anti-trust ABMS MOC® Medical Registry as part of the Medicare SGR Replacement ill H.R. 2, CALL YOUR SENATOR TODAY and ask that IT BE AMENDED BEFORE BEING SIGNED INTO LAW TO REMOVE THE ABMS MOC Medical Registry from Social Security Law, Section 1848:

First, look up your Senators' names, entering your zip code here.

Be SURE to call the Capitol switchboard at (202) 224-3121 and ask to be connected to each senator's office.
  • Remind them that you are an actual WORKING physician, not one who pretends to represent physicians on Capitol Hill.


  • Remind them that they are about to sign a piece of legislation that allows a group of 25 independent nonprofit organizations to monopolize the requirement that you pay nearly $1000 per year (between their fees, travel, time away from work, and lost revenue, per Dr. Charles Culter's video explanation 2 Dec 2015) to maintain your ability to practice your trade if they sign H.R.2 into law.  Remind them NO OTHER PROFESSION has such a requirement to maintain their credentials to practice their trade.


  • Remind them that there is NO INDEPENDENT PROOF that the American Board of Medical Specialties MOC® registry has EVER been proven to improve patient care.


  • Remind them that the American Board of Medical Specialties NEVER disclosed the fact that they are being sued in Federal Court for possible anti-trust violations while lobbying Congress and THE SUIT IS STILL PENDING.


  • Remind them that the American Board of Internal Medicine (ABIM), the largest non-profit of the group of non-profits, grew its  debt to $43 million in losses and offset those losses by auditing gimmickry called DEFERRED REVENUE to the tune of $76 million, which gives the appearance that the MOC medical registry contained in H.R. is being used for cover.


  • Tell them that the both the ABMS and ABIM appear in your view to have committed tax fraud because they have reported on their Form 990's to have not lobbied Congress, when, in fact, they have.


  • TELL THEM THEIR BILL MUST BE AMENDED BEFORE IT CAN BE PASSED to remove the MOC Medical registry as a "value" registry for inclusion in H.R. 2.

PLEASE CALL TODAY.

No one else will do this for you.

-Wes

Sunday, April 12, 2015

Medicare SGR Replacement Bill: "An Unwarranted Role of Medical Specialty Boards"

From Merrill Goozner at Modern Healthcare Magazine:
"The law not only scraps the sustainable growth-rate formula for physician payment, it consolidates the diverse programs for rewarding or penalizing physicians. The CMS no longer will calculate separate payments for reporting quality measures, improving performance or meeting meaningful-use standards.

Instead, the CMS will substitute a composite MIPS score for each physician participating in the Medicare program. When measured against clinical peers, a physician's score could result in the agency rewarding or penalizing him or her up to 5% of annual revenue starting in 2020. That rises to 9% of revenue for 2022 and beyond.

While the program is designed to be revenue-neutral, it allocates $500 million for rewards, just in case a majority of physicians turn out to be like the kids at Lake Wobegon and achieve universally high composite scores.

The overall score will be based on how well participating physicians perform in four separate categories: quality measures (30% of the total); resource use (30%); achieving meaningful use (25%); and clinical practice-improvement initiatives (15%). Each component will be determined by agency rulemaking and stakeholder input.

But some stakeholders are being given a greater say in the process (others are invited to participate, of course). The law, for instance, asks “eligible professional organizations” to recommend quality measures for use in the program. It defines eligible professional organizations as “nationally recognized specialty boards of certification.”

It also says physicians can achieve the maximum score on the clinical practice-improvement component by being part of a certified medical home or “comparable specialty practice.” The law gives “eligible professional organizations” the ability to make that determination. The bill also mentions “practice assessments related to maintaining certification” as one way to achieve a maximum clinical practice-improvement score.

The special role given physician specialty boards in the SGR replacement bill heightens the stakes in the recent controversy swirling around the costly and complicated recertification process at the American Board of Internal Medicine, one of the largest boards in the nation. A rival group is seeking to substitute continuing medical education credits for recertification test-taking, which the ABIM and patient and consumer advocacy groups oppose.

The flare-up has brought some of the more unsavory and unscientific aspects of the self-regulating physician recertification process to light. A recent New England Journal of Medicine perspective by ABIM critic Dr. Paul Teirstein of the Scripps Clinic noted that the latest studies have shown no relationship between physician recertification and performance on quality measures—the very task given to certification boards in the SGR replacement bill.

Teirstein also accused the ABIM of being “a private, self-appointed certifying organization” that charges exorbitant fees “unfettered by competition” for its products and tests.

The certification boards aren't major powerhouses on the Washington lobbying scene. Last year, for instance, the ABIM spent only $160,000 on the lobbying firm of Mehlman Castagnetti Rosen Bingel & Thomas, according to Senate lobbying records. But that firm's chief healthcare lobbyist, Dean Rosen, once served as an adviser to then-Senate Majority Leader Bill Frist (R-Tenn.), and apparently still has good connections with the staffers who drafted the language of the SGR replacement bill.


As we editorialized here two weeks ago, a permanent end to SGR is the right thing to do. And creating MIPS to replace multiple rewards programs will lessen the administrative burden on physicians and physician practices, and incentivize them to move toward value-based care payment models.

But other stakeholders will need to remain vigilant to ensure that self-interested physician specialty boards don't play an outsized role in setting the parameters of the program—especially when it comes to determining what constitutes quality and clinical-practice improvement."
This is horrible. Our government is about to authorize the use corrupt and completely unaccountable certifying organizations to serve as a metric with which to determine the "value" of health care for our patients and remuneration for working physicians nationwide. In fact, the certifying organizations the bill authorizes are being sued in federal court for possible anti-trust violations. How embarrassing would our U.S. Senators look in the eyes of seniors everywhere if that suit is found in favor of the plaintiffs?  The whole Medicare SGR Replacement Bill, H.R. 2, would fall apart.  Are our U.S. Senators really ready to put their political careers on the line for one flawed bill? (Note the senators who were lobbied were never privy to this pending lawsuit.)

(To think that the policy divisions of our sub-specialty medical societies are also complicit in this scheme is even more appalling.)

Is this what our patients need? Are we, the front line working physicians, going to allow the self-serving money trail of government grants to determine what constitutes quality care for our patients and "value" for  our health care system?

All physicians AND their patients need to stop and pick up the phone Monday morning. Call BOTH your Senators and flood the switch boards. Tell them to vote "NO" on the Medicare SGR Replacement Bill (H.R. 2).

Unless, of course, you think $2.3 million dollar condominiums with chauffeur-driven BMW 7-series town cars is how our nation should define health care "value" in the years ahead for our Medicare patients.

-Wes

Addendum: Here's even more lobbying to CMS that pushed for ABMS "board certification" to be the only board used for CMS's Physician Compare website in Sept 2014.

Friday, April 10, 2015

Working Physicians Were Played; It's Time to Take Action

We've been played.

Played so badly it would make Goodfellas blush.

Remember these words?
"Dear Internal Medicine Community:

ABIM clearly got it wrong. We launched programs that weren't ready and we didn't deliver an MOC program that physicians found meaningful. We want to change that. …"
Doctors thought this was because of the malfeasance that was discovered in the ABIM's dealings with purchasing $2.3 million condominium's with chauffeur-driven Mercedes S call town cars and systematically funneling $30.6 million of our testing fees to an obscure Foundation that markets some version of social justice "professionalism."

Wrong-o boys and girls.

The plan all along was to shift gears and make MOC integral to how Congress would permit the Center for Medicare and Medicaid Services Congress to calculate your "value" as a worker to the health care system. Just do your practice improvement modules and walk backwards and type of a keyboard so they can get paid.

Yes, Virginia, MOC wasn't ready because MOC wasn't part of the "Doc Fix" legislation (H.R. 2) yet, but now it is.

How do I know this? Because ABMS lobbied members of the Energy and Commerce Committee in Congress to have MOC included as part of the "Doc Fix" bill in June, 2013:
We recommend that ABMS MOC® serve as a reporting pathway in the future for more detailed data on performance across the competencies. Making it possible to report through MOC will reduce administrative burden on physicians participating in voluntary professional development activities, will help to assure that there are practice-relevant options for all specialties and that quality measurement will be tied to a disciplined improvement process.
The ABIM wasn't sorry. The ABIM knew from the start that physician payment reform was on its way and a stand-alone MOC program wouldn't be needed because it would be part of the new law! Why else would they opt to "suspend" part IV for two years rather than remove it outright? (Maybe to preserve it just in case the SRG bill didn't pass?)

It's Time to Send the US Senate a Message from Front-line Working Physicians

On Monday before you start work, contact your state Senators by calling the US Capitol switchboard at 1-202-224-3121.  Don't hang up until you speak with your senator or their aide.  Tell them you have patients waiting.  Tell them you're being held up from a meeting. But get through and don't hang up until you do.  The switchboard is open 24-hours a day, but call in the morning, 8 AM EST if you can, to be sure your voice is heard. But get through.

Tell them you want all references to Section 1848 (k)(4) used as determinants of  of a "value-based modifier" struck from the bill (Addendum: this is the section that authorizes the ABMS to use their MOC program - see comments below).  Tell your Senator that if he or she can't do that, then they should vote "NO" because you'll have to pay hundreds of dollars representatives of the independent ABMS member boards every two years to practice medicine and take time away from patients to do meaningless and unproven busywork. The ABMS MOC® program should NOT be allowed to stand in the new SGR repeal legislation (H.R.2) in any form.  Tell them that such a scheme represents taxation without representation.

It is time to send the message LOUD and CLEAR that doctors will not participate in a pay-to-play scheme with the ABMS, ABIM or any other member board every two years to practice our trade.

We MUST take action NOW.

Just do it.

-Wes

Addendum: 
For those skeptical that the ABMS MOC Program is in H.R.2, I have included a few highlighted examples: Page 27 and 28, Page 35, and page 51 as a few examples. Note that HR 2 modifies portions of Social Security Law 1848 that specifies how physicians are paid. Section (k)(4) of 1848 authorizes the American Board of Medical Specialties MOC program to be a medical registry for reporting quality data.  No section of H.R.2 deletes this section and only solidifies MOC as a quality reporting registry.