Tuesday, January 26, 2016

Love, Ethics, and the Quality Assessment Industry

"I think that commercialization of care is a big mistake. Health care is a sacred mission. It is a moral enterprise and a scientific enterprise but not fundamentally a commercial one. We are not selling a product. We don’t have a consumer who understands everything and makes rational choices — and I include myself here. Doctors and nurses are stewards of something precious. Their work is a kind of vocation rather than simply a job; commercial values don’t really capture what they do for patients and for society as a whole.

Systems awareness and systems design are important for health professionals but are not enough. They are enabling mechanisms only. It is the ethical dimension of individuals that is essential to a system’s success. Ultimately, the secret of quality is love. You have to love your patient, you have to love your profession, you have to love your God. If you have love, you can then work backward to monitor and improve the system. Commercialism should not be a principal force in the system. That people should make money by investing in health care without actually being providers of health care seems somewhat perverse, like a kind of racketeering."

- Avedis Donabedian
* * *

Don Draper in the finale of Mad Men
Many of us recall the final scene of Mad Men where Machiavellian dealmaker, philanderer, and ad mogul Don Draper sits in lotus position finding either true inner peace or the next cynical direction from which to profit. This scene came to mind as I read another apparent conversion experience by Robert M. Wachter, MD in his recent opinion piece in the New York Times on how the metric measurement business fails physicians and teachers. Remarkably, Dr. Wachter, once the Chairman of the  American Board of Internal Medicine (ABIM) that is responsible for "continuously" measuring, re-testing, and re-certifying US physicians, seemed to pivot from his former self by quoting a few of Avedis Donabedian's words on quality assessment suggesting "the secret of quality is love." Unfortunately, Dr. Wachter conspicuously failed to acknowledge the full context of Donabedian's words.

Robert Wachter, MD, as "Elton John"
SHM Meeting 2014
Mandalay Bay Casino, Las Vegas and
Modern Healthcare's Most Influential
Physician Executive and Leader 2015
(Full video of the performance here)

I suppose if he can transition from a physician executive to a "down to earth" Bob Wachter, MD hitting "high notes" as Elton John at the Mandalay Casino while simultaneously profiting from a company that now under federal investigation for overbilling Medicare, why not?  Such is our current reality of politics, medicine, and corporate cronyism.

It was nearly four short years ago that Dr. Wachter wrote that we needed the ABIM's Maintenance of Certification program "more than ever." Perhaps the lucrative Digital Party in medicine was just too big for the ABIM leadership and the members of its Foundation to ignore. At the time, those in Wachter's World held the view that assuring physician quality meant physicians not only had to be re-certified every ten years but soon had to participate in some form of the ABIM's measurement program every two years for the sake of  "external stakeholders and a troubled public."  As a result, physicians were required to perform unproven practice improvement exercises, perform un-monitored research on themselves, and become glorified data entry personnel to continuously "maintain" their "board certification" or risk losing their right to practice. All of these exercises were subsequently revealed to be primarily for the medical industrial complex's extraordinary monetary gain and undisclosed political activities.  Such "love," indeed.

The expanded ABIM board certification requirements after 1990 have served as the goose that laid the Golden Egg for condo purchases, chauffeur-driven Mercedes rides, spousal travel fees, undisclosed corporate consulting arrangements, corporate mergers, political influence and the program's continuing transition to Assessment2020 - much of these occurring while Dr. Wachter served as a Director or Chairman of the ABIM. For the ABIM and its parent organization, the American Board of Medical Specialties (ABMS), success in the digital medical world still appears to mean the doctor-patient relationship has to be owned, bartered, and commoditized to serve their bottom line without really understanding all that this entails to the doctor, their patients, and the credibility of our profession.

If Bob Wachter, MD is a true physician advocate and is now having a genuine conversion experience, he would be speaking out about these abuses of physicians' trust. In fact, as the "Most Influential Physician Executive and Leader 2015," he would be leading this charge. Or perhaps I am missing something.

Meanwhile, despite all of the fast-paced changes in health care under way, the same rubber soles continue to speed down linoleum hallways, call lights blink, keyboards pound, family meetings are held with tears shed, young physicians wonder how they'll pay their educational debt, productivity quotas expand, administrative meetings multiply, patients grow furious about their rising premiums, co-pays and deductibles, physician autonomy and morale withers, and patient access to their doctor shrinks.

Fortunately, rather than standing idly by, practicing doctors are mobilizing. They are realizing that the bloated and costly bureaucratic arm of our profession has lost its way and are working to restore its integrity. Practicing physicians are finding they have a voice and are not powerless against these corporate entities that unjustifiably risk compromising their ability do their job. With these efforts, members of Wachter's World are beginning to realize they're at risk of losing their golden goose:
Last week, Andy Slavitt, Medicare’s acting administrator, announced the end of a program that tied Medicare payments to a long list of measures related to the use of electronic health records. “We have to get the hearts and minds of physicians back,” said Mr. Slavitt. “I think we’ve lost them.”
Despite these concerns of a few of our bureaucratic medical policy elite, practicing physicians remain little more than an account to be landed, a work to be optimized. To them, practicing physicians represent an opportunity to invest in new corporate ventures like Health2047, no doubt for the "love" that's involved. The respectful partnership that practicing physicians would like to have would not include the many corrupt financial practices and undisclosed conflicts of interest of the AMA and the ABMS specialty board credentialing system, their collaborating subspecialty societies, and numerous for-profit physician reporting businesses. They invoke ethics, morals, and "love" at their own risk.

In my career, I'm unaware of a broader breach of the trust of working physicians and of medical ethics by fellow colleagues than by those who secretly created the ABIM Foundation in 1989 and then funneled over $55 million of testing fees collected from working physicians while hiding its existence from physicians and the public until 1999. Yet many in our academic and bureaucratic physician community continue to support this testing agency that appears to have been expanded solely for political, corporate, and personal gain, and are indifferent to them using strongman tactics with physicians. What a perverted form of "love."

This system must change.

As health care moves forward in these uncertain times, a few of Donabedian's (other) words on quality assessment, uttered a month before his death, are prescient:
"It is the ethical dimension of individuals that is essential to a system’s success. ... Commercialism should not be a principal force in the system. That people should make money by investing in health care without actually being providers of health care seems somewhat perverse, like a kind of racketeering."
Perverse indeed.

Right now there are residents who have no idea how they'll ever pay off their educational debt and millions of patients who can't afford insurance or their drugs. If the House of Medicine can't look inward at its own bloated, self-serving, bureaucratic ranks of the ACGME that are sucking the life from direct patient care, what does this say about the prognosis for US health care?

As Tina Turner once sang, "What's love got to do with it?"


Reference: Donabedian A. A founder of quality assessment encounters a troubled system firsthand. Interview by Fitzhugh Mullan. Health Aff (Millwood). 2001 Jan-Feb;20(1):137-41.

Wednesday, January 13, 2016

Are ABIM-certified Physicians Research Subjects?

I logged on to the ABIM website last evening and was greated by this pop-up screen. It seems the ABIM is in the business of "research" at my expense to "understand how to improve health care."  They are mandating that I enter my "practice characteristics" in a 15-minute survey. 

Yet I have no idea what the ABIM's "research" entails, I have not been informed how that "research" will be conducted, nor how it might affect my ability to practice medicine, or if  my information will be sold to other entities for a price on the basis of the ABIM's valuable "research." Since we know that the ABIM has partnered with companies like Premier, Inc (which just purchased CECity, Inc a subcontractor for the ABIM from 2010-2014) for $400 million, I would like to review the research protocol the ABIM is conducting, the risks and benefits to me for that research, and how my data will be used and protected.

The ABIM should be aware that the Department of Health and Human Services has VERY specific rules and regulations (45 CFR 46) about how "research" is to be conducted, particularly as it pertains to the protection of human subjects like myself who have increasingly found their ability to practice medicine in a hospital setting compromised unless we participate in the ABIM's Maintenance of Certification (MOC) program. We have not been given proper informed consent and, instead, find that this data entry in "mandatory for all Board Certified physicians enrolled in Maintenance of Certification (MOC)." Furthermore, physician's are aware their "MOC status" is being sold by the American Board of Medical Specialties (ABMS) via its ABMSSolutions.org website to a whole host of third parties for a fee.

Needless to say, I won't enter this information until the ABIM makes public the "research" protocol they are conducting.

Richard Baron, MD, ABIM President and CEO, needs to explain to all ABIM diplomats why they are ignoring Health and Human Services regulations on the protection of human subjects (physicians) in their collection of "practice characteristics" for the purpose of improving health care.


Tuesday, January 12, 2016

Archived ABIM Website Disappears

Anyone who has followed this blog for some time knows that much of my research on the American Board of Internal Medicine (ABIM) and the ABIM Foundation was performed using Internet Archive's Wayback Machine available at http://www.archive.org.

It seems the ABIM no longer wants a record of the changes they make to their ABIM website recorded at archive.org and have opted to have all ABIM archived web pages available after 1 January 2014 removed from the archive.org website. While this is not illegal and any website can opt out from having their web page modifications tracked on the archive.org website, this development is not consistent with the ABIM's promise of transparent policies and practices toward practicing physicians.



Sunday, December 27, 2015

The Maintenance of Certification Controversy 2015: The Year in Review

With so much controversy surrounding the American Board of Medical Specialties' (ABMS) Maintenance of Certification (MOC) program in 2015, especially as it pertained to the American Board of Internal Medicine (ABIM), I thought it would be helpful to recap some of the earlier announcements about the ABMS MOC program, and then summarize this year's most pertinent developments to serve as a springboard for 2016. To keep it simple, I will use a timeline approach of the developments as I've seen them occur. (Remember: hind sight is always 20:20.)

  • 24 July 2012 - ABIM announces Medicare payment incentives for participation in their MOC program on their website.

  • August 14, 2012 - Robert Wachter, MD assumes chairmanship of the ABIM, writes missive on his industry-sponsored blog justifying why board certification "matters more than ever." This post shows anticipated collusion for acceptance of MOC as a "quality measure" between Medicare, the Joint Commission, the Federation of State Licensing Boards, and the ABIM Foundation's Choosing Wisely campaign. Wachter fails to mention his simultaneous affiliation as director of IPC The Hospitalist Company, Inc., a company that "is the nation's leading national physician group practice focused on the delivery of hospital medicine and related facility-based services" in that announcement.

  • 27 Apr 2013 - Drs. Wachter and Cassel named to Modern Healthcare's "Most Influential Physician Executives."

  • 1 Aug 2013 - Robert Wachter, MD receives 1,355 shares of IPC The Hospitalist Company stock options valued at $50.68 per share (Market Value: $68,671.40).

  • 12 Jun 2013 - ABMS lobbies Chairman Upton and Ranking Member Waxman of the US House of Representatives Energy and Commerce Committee to have MOC program included in MACRA (the SGR Fix bill) as a physician quality measure.

  • 30 June 2013 - Christine Cassel, MD to step down from ABIM as President and CEO of ABIM and ABIM Foundation. Earns $1.7 million as she leaves to begin work at the National Quality Forum.

  • 1 July 2013 - Richard Baron, MD becomes ABIM and ABIM Foundation President and CEO

  • 25 Sep 2013 - Christine Cassel, MD issued 3706 shares of Premier, Inc (PINC) stock

  • 31 Dec 2013 - Physicians who participate in MOC program by Dec 2013 are able to claim 0.5% payment incentive from Medicare

  • 1 Jan 2014 - ABIM offers either one-time (every 10-years) or annual payment plan option for its MOC program.

  • 2 Jan 2014 - Robert Wachter, MD receives another 2,640 shares of ICP The Hospitalist Company stock options valued at $58.50 (Market value: $154,440)

  • 10 Dec 2014 - Study appears in JAMA showing no effect of MOC program at improving patient outcomes.

  • 16 Dec 2014 - The first detailed review of the MOC corruption appears on this blog with the publishing of "The ABIM Foundation, 'Choosing Wisely' and the $2.3 Million Condominium."

  • 31 Jan 2015 - A virtual tour of the ABIM Foundation's condominium is published.

  • 3 Feb 2015 - ABIM issues previously unimaginable apology to the physician community stating "ABIM clearly got it wrong" but fails to mention the financial, tax filing, and financial conflicts of interest of its President and CEO and members of its board leadership.

  • 3 Feb 2015 - Physicians (especially this one) are not impressed with ABIM's announcement that failed to acknowledge ABIM's history of serious financial and public reporting actions. Work continues to uncover what's being hidden.

  • 16 Feb 2015 - ABIM initially fails to publish full financials for 2014 until pressured to do so. Apparent cover-up continues.

  • 10 Mar 2015 - Veteran Newsweek reporter Kurt Eichenwald publishes his first take on the MOC controversy with his article entitled "The Ugly Civil War in American Medicine."

  • 11 Mar 2015 - ABIM Board Chairman David H. Johnson, MD issues statement attempting to discredit Eichenwald's article claiming "numerous and serious misstatements, selective omissions, inaccurate information and erroneous reporting." Johnson disputes claims that ABIM pass rates have fallen, that ABIM has a monompoly on re-certification, claimed that Eichenwald was "selective" about the data presented and has a "poor understanding" of the tax records, and that Eichenwald had failed to disclose his wife was an internist.

  • 30 Mar 2015 - New board (NBPAS.org) formed and doctors are moving on after more of the financial transgressions come to light.

  • 3 Apr 2015 - Dr. Robert Wachter, the former chairman of board at the ABIM, tops Modern Healthcare's Top Fifty Most Influential Physician Executives and is "not afraid to challenge the status quo." Not surprisingly, Dr. Christine Cassel again makes the list as well.

  • 7 Apr 2015 - Kurt Eichenwald's next Newsweek article on the ABIM MOC program, "A Certified Medical Controversy," is published and begins to target many of ABIM Board Clair David H. Johnson's criticisms.

  • 8 May 2015 - Consequences to physicians who fail their unproven MOC re-certification secure examination published online.

  • 21 May 2015 - Kurt Eichenwald's third expose on the ABIM's finances called "Medical Mystery: Making Sense of ABIM's Financial Report" hits the pages of Newsweek disclosing the unreported lobbying efforts and the convoluted and large payments made to the ABIM leadership including $1,712,847 made to Christine Cassel, MD in fiscal year 2014.

  • 22 May 2015 - Richard Baron, MD publishes another official ABIM response to Kurt Eichenwald's articles claiming "we have never made any effort to obfuscate, hide or delay ABIM's financial information." Baron did not acknowledge that they failed to release all of their audited financials (see 16 Feb 2015 entry on this timeline). Baron also fails to mention that the ABIM failed to release 12 years of audited financials requested by a reporter from the Wall Street Journal in August 2014. Additional attempts to obtain the reports from the PA Attorney General's office were also unsuccessful. Financial data were only obtained after a request was made to the office of the Pennsylvania governor's press secretary.

  • 23 May 2015 - ABIM, it's finances, and the great revolving door collusion between the National Quality Forum, the ABIM, ABIM Foundation, and other specialty organizations published.

  • 31 May 2015 - The ABIM's tax-filing cover-up of its lobbying activities with Congress exposed.

  • 29 June 2015 - Robert Wachter, MD attempts to defend the actions of the ABIM on his blog after leaving his post as Chairman and speaks out. No corporate conflicts of interest are specifically mentioned by Dr. Wachter. Comments to his post are worth a read.

  • 28 July 2015 - An independent cost analysis of the ABMS MOC program in published before print in the Annals of Internal Medicine.

  • 15 Aug 2015 - ABIM Foundation tries to bury its old "About Us" webpage that claimed the creation date of the Foundation was in 1999 by editing the page to disclose the correct date of origin (1989) and then includes information regarding "$55 million" that was transferred from the ABIM to its Foundation from 1989 to 2007. The amount transferred was actually much larger and made secretly without disclosing the Foundation's existence to the physician community or public until 1999. The reasons for the secrecy and large annual payments made to the now defunct 1838 Investment Advisors (a spin-off of Drexel Burham Lampert financial fiasco - most of whom were indicted) made during that time have never been investigated or disclosed. One thing is now clear: it does NOT appear the sole reason for creation of the ABIM Foundation was to define and promote the term "medical professionalism" as originally claimed by the Foundation.

  • 9 Sep 2015 - The ABIM's prior activities stumping for Big Tobacco in 1963 are revealed, lending less credibility to their claim that their certification program is for "public good."

  • 23 Sep 2015 - Graph of the growth in ABIM MOC Fees from 2000-2014 published showing at least 244% growth in cost (16.3%/year - far exceeding inflation) to internists over that 15-year time period.

  • 25 Sep 2015 - ABIM's own Maintenance of Certification First-Time Pass Rates from 2000-2014 are published and document a negative pass rate trend line over that period of time in every subspecialty of internal medicine except Geriatric Medicine. The data trend stands in stark contrast to ABIM Board Chair David H. Johnson, MD's statement regardng MOC pass rates made 11 March 2015.

  • 11 Nov 2015 - Concerning conflicts of interest with Christine Cassel, MD and the little-known company CECity, Inc. are published. Cassel's long-standing relationship with Premier, Inc. raises real questions regarding possible insider funding of CECity to prop up its value prior to its purchase by Premier, Inc. on 4 August 2015 for $400 million.

  • 23 Nov 2015 - TeamHealth (TMH) acquires IPC The Hospitalist Company for $80.25 per share netting Dr. Wachter and his university, the University of California, San Francisco, a comfortable profit.

  • 23 Nov 2015 - Graph of ABIM legal fees pre-ABMS MOC program (instituted in 2005) vs. post-MOC (ongoing) appears.

  • 29 Nov 2015 - ABMS's income stream for selling daily updates of physician certification status from the unproven and un-vetted data gathered from its member boards via ABMSSolutions.org disclosed bringing the legitimacy of the entire ABMS MOC empire sharply into question.

  • 6 December 2015 - A copy of the physician sanction letter issued June 8, 2010 surfaces on this blog and gives a glimpse into the strongman/boss tactics used by the ABIM to protect their certification monopoly. The tactics used to track down physicians late after they participated in a board review course years before are now coming under intense scrutiny.

  • 16 Dec 2015 - ABIM announces its intent to extend its practice assessment decision through 2018.

  • 17 Dec 2015 - Christine Cassel, MD leaves her role as the President and CEO of the National Quality Forum (in charge of setting "quality" standards for the nation's hospitals) to join the leadership team of Kaiser Permanente's School of Medicine. Dr. Cassel had long-standing financial dealings with Kaiser since at least 2003.
Yes, folks, it has been quite a year. Still, various member boards of the ABMS continue to try to modify and "improve" the highly conflicted and ethically corrupt ABMS MOC program. While I would like to have other things to write about on this blog from time to time, I find it important to continue to expose the corruption and financial conflicts created by the ABMS and their member boards. 2016 promises more developments as others begin to dip their toe into exposing this complex and unfortunate story.

My prediction for 2016: the ABIM collapse under its own spending weight but not before "grants" are issued from the ABIM Foundation back to the ABIM to support its operations.

If the ABIM does collapse, what happens to the certification process for US internal medicine physicians? Clearly, significant change (including electable board members and disclosure of conflicts of interest publicly) are of paramount importance. Returning board certification to a lifetime designation also seems paramount since the MOC program continues to prove itself as highly destructive to our profession.

So stay tuned in 2016. It promises to be an interesting year as more revelations regarding the ABMS MOC program develop.


Addendum: 28 Dec 2015 @13:04 - Post updated to include 27 Dec 2012 and the failure of Dr. Baron to report his conflicts as Director of the Seamless Care Model Group in the NEJM publication. Also, 28 July 2015 was added to include the cost analysis of the ABMS MOC program published in the Annals of Internal Medicine.

Addendum: 28 Dec 2015 @ 13:21 - 27 Dec 2015 deleted from timeline - Author of the NEJM piece was Robert Baron from the University of California, San Francisco, not Richard Baron, MD - hence why there was no disclosure of this conflict on the NEJM publication. I regret the error.

Addendum 30 Dec 2015 @ 10:45 - Timeline updated with additional information revealed on 23 Sep 2015 and 23 Nov 2015 regarding growth of costs and legal fees.

Wednesday, December 16, 2015

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

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

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

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

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

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

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

We'll see.

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

Getting It Wrong Again

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

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

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

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

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

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

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

One can only hope.


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

Sunday, December 06, 2015

Strongmen, Bosses, and the American Board of Internal Medicine

From John Kass, political reporter from the Chicago Tribune, this morning:
"Chicago is the most American of American cities," Emanuel has said, repeatedly. "It's not just any city. If you want to come and see America, you come to its heartland. And what is the capital of that heartland? Chicago."

Democratic political stars with Chicago ties — from his old boss President Barack Obama to presumptive 2016 Democratic nominee Hillary Clinton — must enjoy hearing it.

Politicians running for the office of emperor in a Republic just love fairy tales.

But there's one thing wrong with the mayor's favorite saying: It's wrong.

Chicago is not the most American of American cities. Chicago is the most Soviet of American cities.

The people of Chicago know this and it's time the rest of the nation understands it, too.

Chicago may appear to be an American city. But it is actually run on the old Soviet model, where the people were bossed for generations by ruthless and cynical strongmen.

The Russians call them strongmen. In Chicago, we call them bosses. But strongman-boss, boss-strongman, what difference, at this point, does it make?

The strongman of Chicago rules by fear. He holds the terrible hammer of big government in his hand. And if you're a corporate titan or a corner shopkeeper, you don't want that hammer to strike you down.
While Chicago is embroiled in a horrible police scandal uncovered by the flow of information via the digital age, I couldn't help but think how true Mr. Kass's words were in terms of US medical care and the control of practicing physicians on the front lines of health care today.

While nowhere near the seriousness of the police story in Chicago, the story of similar strongmen/boss tactics used against practicing physicians is a sad story that has been growing for years. Until recently, physicians have been oblivious to these tactics used by the American Board of Medical Specialties (ABMS) (based in Chicago) and the American Board of Internal Medicine (ABIM) who used their political and professional connections to foist their Soviet-style strongmen tactics on practicing physicians via their board re-certification requirement called "Maintenance of Certification®."

Participate every two years or lose your job.

Participate every two years or never see another penny from a major insurer.

Attend a board certification course that does not bow to the ABMS/ABIM strongmen?

Get sued or sanctioned.

Here's a redacted copy of the ABIM sanction letter sent to a physician who attended the former Arora Board Review course.  It came FedEx to the physician labeled with the instructions "destroy if undeliverable." To my knowledge this letter, sent to some 2000+ physicians who attended the Arora Board Review Course over the years it operated, has never been made public by the ABIM:

ABIM Sanction Letter issued by Lynn O. Langdon, MS,
Chief Operating Officer, ABIM (Click to enlarge)

It is a threatening letter, issued by a non-physician Chief Operating Officer of the ABIM who served as strongman for the ABIM and ABMS and later earned a $297,646 bonus from the ABIM in FY2012 (Page 22). The letter suggests the physician-attendee of the Arora Board Review Course violated a "Pledge of Honesty" and failed to call the obscure and unvetted ABIM Exam Integrity Hotline. And because the ABIM now has "ethical and professional concerns" about that physician, it is "placing a copy of this letter in your file."

Threats. Intimidation.  Strong-arming.

Maintenance of Certification®: the Chicago Way.

To think this whole process was been transported from Chicago to Washington, DC and is now deeply embedded in the Affordable Care Act as a physician quality registry, courtesy of heavy lobbying by the ABMS (and likely the ABIM), is sickening and wrong.

Practicing physicians, like the citizens of Chicago, deserve to know the truth of how and why this occurred.


PS: Ms. Langdon no longer serves as Chief Operating Officer of the ABIM. She was quietly replaced by Nkanta “Nick” Hines, MSc, MBA. Ms. Langdon now serves as a board member of the American Board of Medical Specialties.

Sunday, November 29, 2015

Edging Toward the Tipping Point

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

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

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

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

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

Practicing physicians are funding a profiteering racket.

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

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

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

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

And now we see clearly how all of these privately-held non-profits of the 24 ABMS member boards are colluding together to prop up the very broken ABMS Specialty Board System financially:
Only CertiFACTS’ products connect professionals with board certification information that is updated daily with data provided by the 24 certifying ABMS Member Boards.
Physician ABMS board certification status, updated daily, and shot to a certification database near you. All for the low, low price of hundreds of millions of dollars a year and funded (in part) by every US physician.

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

Always has been.

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

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