UNFINISHED BUSINESS: first, the boards, MOC, and rapacious financial conduct

Under Unfinished business we wryly observe that MOC (Maintenance of Ceritification) remains viable and unwell. We now know without doubt that ABMS specialty board physicians and executives are profiting from MOC fees which, allegedly, are supposed to support the not-for-profit educational mission of our traditional (since 1922) specialty boards. In fact, reasonable argument can be made that the original not-for-profit motif of the boards has been converted into one of personal gain that belies the legal enablement of the boards under 501(c)3 rules and regulations. What is called for now is an investigation by the FTC (for possible restraint of trade) and by IRS (are the boards conducting themselves in conformity with the law governing 501(c)3 organizations)? 

Here's some grist from the mill, in this case, from the 990 Form filed by the American Board of Psychiatry and Neurology (ABPN) in 2015:

The MD president was allocated $613,314 as "reportable income from the organization (W-2/1099-MISC)." In addition his "estimated amount of other compensation from the organization and related organizations" was $322,686.

Four ABPN Directors are listed as having received "reportable compensation" ranging from $175,947 to $246,012. In addition, the same four got additional "compensation from the organization and related organizations" ranging from $73,914 to $83,546.

Two managerial remunerations were reported as $111,661 (with an additional $50,351 listed as "other compensation") and $106,552 (with an additional $37,608 listed as "other compensation").

The VP of Research came in for $286,384 plus $99,668 for "other compensation"). 

Other remunerations were equally fat.

Here's the point: if a 501(c)3 organization has high enough expenses including salaries it is obvious that it can't make a profit if all of the money it takes in gets distributed to private hands inside the organization in the form of expenses. In this way, a not-for-profit organization can make more money for its officers, directors, trusteee, and others than can a true for-profit business.

Is this the way we want our ABMS boards to function?

References

"Specialty Boards Profiting from Physician MOC Fees," MEDSCAPE, 08/01/2017

"Medical Staff Votes Against Mandatory MOC," WORKCOMPCENTRAL, 01/22/2016

Form 990 (2015), Part VII, Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees, page 8.

ARE THE STAKES AT MOC (MAINTENANCE OF CERTIFICATION) TOO HIGH TO GIVE UP?

Scandalous overreach by the proponents of Maintenance of Certification (MOC) invites investigation by the Federal Trade Commission (FTC) and by Internal Revenue Service (IRS). 

FTC should determine whether or not trade is being or is likely to be restricted by the tenets of MOC doctrine and its financial operatives. IRS, meanwhile, should examine whether or not the ABIM Foundation meets IRS 501(C)3 requirements. The question is whether or not there is reliable evidence that MOC revenue is being diverted into the pockets of selected individuals.

Many observers think that is the case and that the amount of money paid out in personal remunerations seems exorbitant. This finding forces the question, namely,  to what extent the ABIM Foundation is a charitable organization or a well heeled 501(c)3 enterprise. 

Here are some facts and figures:

The president & CEO of ABMS (American Board of Medical Specialties), according to IRS Form 990, received total compensation of $779,487 for tax year 2013;

The ABPN (American Board of Psychiatry and Neurology) CEO in 2012 received total compensation of $843,591 -- according to IRS Form 990 for that year;

The ABIM (American Board of Internal Medicine), schedule J, Form 990, for 2012, reports base compensation for the president-CEO as $628,952;  

Reported base compensation for Senior VP/COO, ABIM, was $464,747;

Base compensation for the Sr. VP/CIO, ABIM, was $382,092;

Base compensation for the Senior VP/COO,  ABIM, was $326,520;

Base compensation for Senior VP/CFO,  ABIM, was $452,630.

-- not too shabby especially when one keeps in mind that these figures do not include income from what IRS refers to as "related organizations". In order to see this additional money jockeying, just go to Schedule J, IRS Form 990, and look at lines i and ii -- add 'em up and weep. Not to worry. Increased fees down the road re MOC will take care of any shortfalls. 

Readers are invited to check out this data by looking up Form 990 information. We expect to add to this report from time to time so stay tuned.  These figures show why MOC will not be easily vanquished -- the stakes are too high.

WHEN PATIENT CARE INTERFERES WITH REQUIRED DATA INPUT, IT'S THE PATIENT WHO LOSES

First, a word of congratulations to the CEO of the American Academy of Neurology whose reportable compensation from the organization (W-2/1099-MISC) in 2014 was listed as $596,190 and whose estimated amount of other compensation from the organization and related organizations was reported at $35,338 (total of $631,5280).

In 2015 the respective amounts in these two categories grew to $657,503 and $36,142, respectively, an overall increase of  $61, 313 in reportable compensation and an overall increase in both categories of $62,117 (for 2015 the total was $693,645).

Next,  look at the American College of Cardiology (ACC) where the Chairman/president's reportable compensation from the organization was $258,551 and whose "other compensation" was listed as $70,000 (total = $328,551).

Why is ACC financially outstripped by AAN when it reports about 49,000 members to AAN's 30,000?

Neither organization has committed to full scale opposition to MOC or EHR with its attendant penalties for non-compliance. 

AAN, meanwhile, in its December 2016 issue of AAN News, proudly announced that "AAN Lobbying Helps Ease Impact of MACRA Changes on Neurologists" -- a "new program involves a two-track system for Medicare reimbursement"-- actually, what members really want is a Zero Track System -- THAT is what AAN and ACC should be using its net assets to acccomplish.

Both organizations in the opinion of this writer are applying their assets to greasing through MOC, EHR, and similar programs desired by government and/or insurance companies. Both organizations give pricey seminars, continuing educational course, and examinations to members. The need for enhanced organizational income is real.

Dues alone will not pay for the high level of staff and CEO remuneration that have now replaced clinical devotion as the hallmark of the medical profession. This writer's opinion is that the boards and their financial allies can derive mutual income benefit if they can dominate CME (Continuing Medical Education) by making their courses and programs mandatory.  

The net result is less time spent with patients, more time spent doing computer input for EHR to avoid financial penalties for non-compliance, and time actually taken away from true Continuing Medical Education (CME) which produces real benefits for patient and physician alike. 

Patients may not see these issues straight away: what they see are doctors whose focus is on a near-by computer screen during what they thought was going to be a personal medical visit. 

References

AAN News (American Academy of Neurology), V. 30, # 12, December 2016

ACC website (American College of Cardiology, Official site, www.acc.org)

"Maintenance of Certifcation (MOC): a rising business opportunity," 15 May 2015, The Weinmann Report (www.politicsofhealthcare.com) 

IRS Form 990 for 2014; 2015, AAN, and 2015, ACC

"Medical Staff Votes Against Mandatory MOC (Maintenance of Certification Requirements)," 16 January 2016, The Weinmann Report (www.politicsofhealthcare.com) 

"Medical staff votes against Mandatory MOC, Workcompcentral. 22 Jan 2016