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.

WHY DOES THE AMERICAN BOARD OF INTERNAL MEDICINE FOUNDATION SHIFT ASSETS OVERSEAS?

More and more, healthcare is joining the industrial complex, read industrial-medical complex, similar to military-industrial complex, or, by way of abbreviation, MFF (Money First and Foremost).  Here's part of the inside story about ABIM: 

1) The ABIM founded the ABIM Foundation;
2) The ABIM Foundation shares its home address in Philadelphia with ABIM;
3) The ABIM Foundation's assets are recently reported to be $81,831,953;
4) The ABIM Foundation was initially funded by $55 million reportedly derived from examination and testing fees -- the $55 million came from the original ABIM which touted re-certification as though it were a public service or an effort to promote the public good by upgrading medical practice.
5) In effect, however, much of the money has been diverted into the waiting pockets of CEOs, board presidents, and other key officers and employees. By way of example, last year Dr. Richard Baron's remuneration was $812,000.  Meanwhile, countless physicians around the country were struggling to come up with enough money to "re-certify." To this extent, physicians with bona fide credentials were being squeezed out of practice in a form of trade restraint evidently not appreciated by the Federal Trade Commission (FTC). Organizations operating under the 501(c)(3) banner such as ABIM now appear to be working for goals not distinguishable from for-profit entities.

That's not all: A CONDO HERE, AN OFFSHORE ACCOUNT THERE ... 

6) The ABIM Foundation owns and/or operates a $2,356,267 condominium in downtown Philadelphia. The money to buy same was derived entirely or in part from the fees charged to hapless physicians who believed they had to recertify to stay in practice.

7) Now as the heat gets hotter, we're advised that the ABIM Foundation has transferred about $6.5 million into offshore accounts in the Cayman Islands and Dublin.

8) At a symposium in California about one year ago a document was distributed showing how one former ABIM physician officer was awarded stock options.

What's needed? HAS FTC AND IRS GIVEN PASSES TO ABMS ORGANIZATIONS? 

The Federal Trade Commission (FTC) should determine whether or not trade is being restricted; IRS, meanwhile, should examine whether or not the ABIM Foundation meets IRS 501(c)(3) requirements. Are its earnings lining the pockets of private shareholders or individuals?

For many observers the answer is yes. The amount of money paid out in personal remuneration appears exorbitant if the ABIM Foundation is a non-profit or charitable organization. It appears to many observers, this one among them, that IRS needs to review the tax classification of the ABMS boards and their associated organizations. At the same time, FTC needs to assess to what extent the covenants of MOC (Maintenance of Certification) are trade restrictive. 

References

Dr. Wes: "Standing up for the practicing physician"

ABIM Foundation Moves Assets Offshore, 5/20/16 

Change Board Recertification

Anti-MOC

Op-eds, The Weinmann Report, since 2012

MAINTENANCE OF CERTIFICATION (MOC): a rising business opportunity!

Continuation of our Money and Medicine Series

Maintenance of Certification (MOC) has become the latest repository of profitability for physicians and others with an ear to current business practices in America. The idea put forth is that MOC is useful for making sure that physicians keep up to date -- never mind that all 50 states have already imposed mandatory Continuing Medical Education (CME) that requires physicians to take post-graduate courses to maintain licensure. These courses are expensive and often require travel. These programs have generated money for the entrepreneurs who run them. Now the specialty boards want in on the loot. The American Board of Internal Medicine (ABIM) is an example of the extravagance to which these programs may go.

If we study the IRS Form 990 for ABIM for Tax Year 2012, we see that the ABIM president and CEO received base pay of $465,687 to which was added $44,742 in "bonus and incentive compensation ." One may ask with reasonable curiosity why a base pay of nearly one-half million dollars would need another forty-four grand for "incentive compensation." We'll have to put that question to the ABIM board. We may presume with reasonable medical probability that it was not to avoid a "consolation" stipend.

However, that's not all. In addition to the $465,687 for base pay and the $44,742 for "bonus and incentive compensation," the president and CEO was also awarded $83,654 in retirement and other deferred compensation, plus "non-taxable benefits" of $34,869.

The total for this compensation package was $628,952. not bad for not even having to lift a scalpel or a stethoscope! And, yes, we have similar information for other boards, more on the other boards in future issues. In the meantime, know that there were 15 or more persons at ABIM who were compensated $190,000 or more. Impatient scanners of this information may on their own look up Form 990 for each of the specialty boards and for the ABMS itself (American Board of Medical Specialties). In short, ABIM has itself become a rising business prospect.

As for the purported usefulness of MOC, one respondent to this unproved assertion wrote  (viz., blog of Dr. Wes, 5/14/15) that "there is no evidence MOC improves performance ... this is just poor marketing and another ABIM/ABMS fabrication."  The Florida Medical Association (FMA) voted that MOC should not be used as part of the criteria that hospitals use to designate medical staff. More  state medical associations should follow this example. In the meantime, MOC appears overrated as an educational tool and underrated as a money-making machine.

References

"Maintenance of Certification Controversy," Dr. Wes, drwes.blogspot.com, 05/14/15

"Do We Really Need Physician Re-Certification Testing? There has to be a  better way," Manisha Juthani-Mehta, MD, www.psmag.com/health-and-behavior, 4/24/15 (this doctor describes having had to spend $1,720 in 2010 for MOC and $775 for the infectious disease exam, a total of $2,495. She states that the current internal medicine exam costs $1,940. This testing is clearly beyond what is necessary and reasonable; however, it makes doctors jump through hoops while enriching the board and its paid personnel including officers, trustees, and directors). 

"When does a $681,000 salary require additional incentive compensation," The Weinmann Report, www.politicsofhealthcare.com, 04/17/15

"Florida Doctors Fight Back," The Weinmann Report, www.politicsofhealthcare.com, 09/18/14

"Do Doctors Expire in 10 years?" The Weinmannn Report, www.politicsofhealthcare.com, 05/12/14

"Maintenance of Certification," JAPS, V. 18, # 3, Fall 2013, by Christman, K.

"Board certification - a malignant growth," JAPS, V. 16, # 2, by Dubravic, M.

"Disillusionment invades medical practice," The Weinmann Report, www.politicsofhealthcare.com, 02/22/14

"How physicians eat their young," The Weinmann Report, www.politicsofhealthcare.com, 02/12/14

"Money and Medicine," The Weinmann Report, www.politicsofhealthcare.com, 07/21/12

MONEY AND MEDICINE:  a new series in keeping financial score.  

Assets of boards that are members of the American Board of Medical Specialties (ABMS) according to IRS Form 990 for 2009.

Total assets of the American Board of Internal Medicine were $57,586,843. Total assets for the American Board of Pediatrics were $41,759,971.  It is reasonable to ask how this money was earned.

The Chairman of the American Board of Medical Specialties was paid about  $800,000 (OK, maybe a little over that) whereas the Chairman of the American Board of Allergy and Immunology was paid $98,000 (OK, OK, he reportedly worked about two hours per week).  The Chairman of the holding board, the ABMS, received salary of $492,517. It is also reasonable to ask what tasks these chairholders undertook for this level of payment.

As to how the money was earned, our information is that recertification for an allergist in 2011 cost $2,700 while maintenance of certification cost $2,850. These costs don't include costs of courses to prepare for the exams. The boards have found it even more profitable when they oblige their members to take recertifcation exams on a periodic basis with new fees each time.

Reference: Dubravic, Martin, MD: J of American Physicians and Surgeons, V. 16, # 2, Summer  2011, "Board Certification ... A Malignant Growth," 

How about Hospital Administrators?

Hospital adminstrators and CEOs basically command a force of state-licensed professionals including nurses, physicians, and technologists. Yet there is no requirement that the CEO be board-certified or state-licensed. This discrepancy came to light recently at Washington Hospital in Fremont, California where the hospital non-physician CEO was recommended for a salary increase from $614,000 per year to $632,000 with total compensation set at about $857,000 with $245,502 in performance bonuses.

Reference: Artz, Matthew: San Jose Mercury News, 12/27/12

Several years ago State Senator Dan McCorquodale authored legislation to require licensure of hospital administrators. The hospitals squawked loudly and poured money into defeat of the bill. All the same, there were unexpected supporters who also poured in money, e.g., universities  that taught courses in hospital administration and that suddenly saw their walls papered with greenbacks. In the end, the issue became a "juice" bill with each side contributing money hand over fist.

How about the American Board of Medical Specialties?

The Federation of State Medical Boards (FSMB) and the American Board of Medical Specialties (ABMS), non-profit private business entities, reported annual gross receipts in excess of $350,000,000 (see annual IRS Forms 990).

The FSMB reported a corporate lobbying budget of $221,222 although it provides no continuing medical education (CME) to physicians and no direct patient care.

How about the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO)?

Gross receipts for JCAHO were reported at $148,737,915 according to its 2009 IRS Form 990.

References: Orient, Jane, MD: "White paper in opposition to Federation of State Medical Boards," J Am Phys Surg 2008: 13: 23-26.

Kempen, Paul Martin, MD, PhD: "Wrong methodologies to improve medical care."

Conclusions: financial incentives in medicine are now tied to factors other than clinical excellence. Caring for corporate health in medicine is the goal to which many otherwise superb clinicians are redirecting their efforts. Academic associations in addition to boards, seeking profitable affiliations  and courting political influence, are pointing the way. These organizations have become profit centers. National organizations seek clones at the state and county levels. It is not unusual to find that a national academic organization seeks state and regional affiliates so that members pay dues at both national and state or regional levels.

Meanwhile, hospital CEOs eschew demands for licensure even though their responsibility is as much to the public as nurses, physicians, and technologists. In a state of flux such as this one, opportunities are abundant, but not in the care of patients. In due course specialty boards may seek empowerment to license clinical practitioners and in so doing reduce the authority of state boards or even render them obsolete. 

Individual physicians may want to ask their specialty boards and national academies for copies of their IRS Forms 990, then learn how to interpret and  use the knowledge for individual assertiveness.

Our intent is to update this piece from time to time and to include as many readers' comments as possible.