Wednesday, March 05, 2014

Are the Choosing Wisely leaders becoming impatient with the rank and file docs?

 At least one of them seems to be according to this commentary by the former CEO of ABIM and ABIMF., Dr. John Benson Jr. who is referred to by some as the "father of ABIM". With the respect that designation would imply I think it prudent to take what he has to say seriously.

Basically what he had to say was that the rank and file docs do not seem to be getting the message and more forceful "educational" methods need be employed.

Such as :
 "...hard choices and penalties must go beyond training the next generation"  and

" ABIM could require candidates to achieve a perfect score on questions related to costs and redundant care as a requirement for admission to secure exams for initial certification or MOC."

Yes, the former CEO of ABIM and ABIMF is really saying that candidates for  maintenance of certification (MOC )would have to take a pre-test of Choosing Wisely type material  (and not get any wrong answers) before they could even take the certification exam.


 " CMS, which has the ultimate negotiating position in the form of reimbursement for Medicare services, could only accept negotiated bundled charges. It could also refuse payment for non-compliance with the Choosing Wisely recommendations."

So if you do not comply with our "recommendations" CMS should not reimburse.

 Good grief, it sounds like Dr. Benson thinks the ABIMF Choosing Wisely wisdom should basically be determinative in regard to what sorts of health care we all should and should not have. The adjectives grandiose and hubristic seem to mild to characterize these proposals.I wonder what non-internists physicians think about a small group of internists who believe they should be in charge of so much,or for that matter internists actually in practice.

The Choosing Wisely campaign is spearheaded by the ABIMF which it seems to me to be basically the folks at ABIM. The two legal entities have the same CEO and President. See here for the IRS form 990 for 2011 for ABIMF The foundation at that time had net assets of $ 68,871,66.  Its stated goals are " to catalyze improvements in health care by advancing medical professionalism: In regard to professionalism  as elucidated in the Physician Charter  the foundation's website states the following: :

"The fundamental principles of the Physician Charter are the primacy of patient welfare, patient autonomy and social justice. The Charter also articulates professional commitments of physicians and health care professionals, including:
  • Improving access to high-quality health care,
  • Advocating for a just and cost-effective distribution of finite resources, and
  • Maintaining trust by managing conflicts of interest."
If you think Benson's recommendations are just talk, think again.The ABIM and ABIMF are well funded , have the support of at least one very rich foundation (RWJ) and have so far at least nominally brought about a sea change in medical ethics.I say nominally because I hope many docs have not received the memo.Once the majority of physicians believe their ethical duty is to be stewards of a collective medical resource,patient advocacy and duty to the individual patient will be down the memory hole and as far as physician behavior goes it will be how high to jump and when as the instructions come forth from the medical progressive elite.

1 comment:

Troglodytum Brachiandum said...

It is often such a sad burden on the truly brilliant to drag us along, like a spirited horse pulling a wagon overladen with junk.
I do find that I wind up pulling in a different direction, usually out of sheer contrariness or hubris.
Perhaps that those of us that are not the deciders, should use Medical Marijuana to extinguish these symptoms of individualism.