Mandates vs. Real Medicine

Bob Maurer, D.O. writes:

Yesterday, in Atlantic City, I moderated a seven hour program on the Business of Medicine. One two-hour presentation consisted of some of the most onerous and burdensome mandates that physicians have to face today: HIPAA, ICD-10, and
Medicare CPT codes.

There is nothing in these mandates that has anything to do with patient care.

This past Friday, I went to an old time osteopathic physician for an ENT visit. He did not use a computer, a code book, or a pen. What he did use were his ten fingers, along with his eyes, his ears and his brain. He had a pleasant smile and a good amount of compassion.

A good doctor should be a doctor who is attentive to his patients, not a doctor who is forced to spend most of his time complying with government mandates and regulations.

To paraphrase a statement once attributed to Patrick Henry:


Reevaluating politically and bureaucratically based medical licensing

Guest post by Paul Kempen, MD, PhD
The natural history of any bureaucratic entity must include the generation of rules, procedures, restrictions, forms, fees, investigations, penalties, and educational material which shows how vital the respective entity is for the nation, civilization, etc. These productions are the lifeblood of the entity, since its first duty and task is to survive and expand its power. And its resistance to attrition and extinction can be as intense and extended as that of a biological organism fighting to survive. A very telling example is the Board of Tea Tasters: it took 20 years of bipartisan efforts spanning four administrations to finally close it down, after 99 years of existence and millions of tea brews, collections of samples, reports, stats, and permissions/restrictions of tea importation.
However, what we must observe with regard to our Medical Boards and Institutions is that our own profession has begot them. One hundred years ago, the Hippocratic “hypocracy” (leadership of hypocrites) of our allopathic forerunners decided to get the competition of homeopaths, naturopaths, and others out of business by resorting to the police powers of the governments. Medical Licensing was born, not as a private credentialing and certification agency, but as a general patent grant of exclusive economic rights, contrary to the US Constitution and to the British pro-market revolution initiated by the 1624 Statute of Monopolies, but very much in keeping with the burgeoning crony capitalism that swept the 20th century, introducing socialism through the back door of the progressivist movement and the figment of government-business cooperation, the American version of fascism.
The sea change that followed in medical ethics was not immediately apparent, as the medical hypocrisy alleged its continued commitment to the patient-centered Hippocratic values, even as behind the scenes it allowed vast inroads of the coercive-collectivistic values of a Platonic type of medical ethic. As you might recall, 24 centuries ago, in The Republic, Plato advanced the concept that the physician’s allegiance is to himself and the other holders of power, not to the patient: “The business of the physician, in the strict sense, is not to make a profit but to exercise his power over the patient’s body.” And Plato clearly explained, “This then is the kind of medical and judicial provision for which you will legislate in your state. It will provide treatment for those of your citizens whose physical and psychological constitution is good; as for the others, it will leave the unhealthy to die, and those whose psychological constitution is incurably corrupt it will put to death.”
It is of course high time for us to re-evaluate the sordid achievements of the politically and bureaucratically based Medical Licensing that we live and practice under today. Far from being crazy, its standards and procedures only reflect the natural course and propensities of this century old arrangement.
To put it more allegorically, no pact with the devil can portend the eternal life and perpetual happiness that the deceiver promised in order to get the agreement signed.

ABIM responds to a physician’s letter

(name of physician and ABIM administrator omitted)

Dear Dr.  ?????,

Thank you for your inquiry about the governance of the American Board of Internal Medicine (ABIM).  As you may know, ABIM is not a membership society, but a physician-led, non-profit, independent evaluation organization. ABIM diplomates do not pay “membership dues”; the fees paid to ABIM are for participation in our Certification and Maintenance of Certification programs.

However, like most standard-setting organizations, ABIM has its roots in membership organizations.  ABIM was created in 1936 by a joint action of the American College of Physicians and the American Medical Association. The founders intentionally incorporated an independent organization to shield themselves from the pressure of dues-paying members and instead established a governance structure that relies on experts in the field to set standards for the profession in the best interest of the public. In fact “of the profession, for the public” continues to be the touchstone for ABIM governance decision-making. Sometimes tension develops between the standard setters and the members of their antecedent membership organizations. However, a well-functioning certifying board needs to be insulated without being insular, listening carefully to those who seek to meet our standard yet remaining independent and evidence-based in the standards and processes we set.

All of ABIM’s standards, policies, programs and products are developed by internists. ABIM’s governance is composed of distinguished physician experts with records of achievement in diverse health care settings, whom ABIM seeks out through open calls for nominations and outreach via a variety of channels, including professional societies.

The purpose of board certification is to offer a credential that distinguishes in a publicly recognizable way those physicians who have met a standard set by their peers from those who do not or choose not to. ABIM’s accountability is both to the public and to the profession of medicine. All diplomates are encouraged to provide us with feedback to help enhance our policies, products and programs. We regularly solicit diplomate feedback through surveys and focus groups, and many enhancements implemented or in development have been a direct result of diplomate feedback. To further enhance the relevance of our assessments, we have recently convened the Assessment 2020 Task Force, which includes a broad array of experts from both inside and outside the profession of medicine. This task force is directly seeking input from our diplomates and other members of the public about what skills a physician needs now and will need in the future. We encourage internist feedback via the Assessment 2020 website and the Assessment 2020 blog.  

I hope this information helps. If you need further assistance, you may reply to this e-mail or call us at 1-(800)-441-ABIM (2246) Monday through Friday, 8:30 a.m. to 8:00 p.m., and Saturday, 9:00 a.m. to 12:00 p.m. EST.



Governance Administrator

When Will ABIM Debate?

Paul Kempen, MD, PhD comments on Medical Economics article, “MOC changes aim to lessen burden on physicians, but debate continues” :

I continue to be astounded that the ABIM refuses to openly debate the topic in an open forum. The Benjamin Rush Society invited the ABIM and ABMS to debate MOC in their home town of Philadelphia last April-they failed to come ( The ABIM does NOT want to debate the issues openly in a neutral forum because the whole extortion process is unwanted by physicians in General, and it provides no index of quality. The ABIM and ABMS are trying to introduce these changes under the radar through the gradual program of lobby congress and hide from Open discussion. MOC is simply a money making extortion program self-serving to the certification industry. The ABIM itself concluded as early as 1986 and themselves published in 2000 the fact that voluntary MOC would not be possible (ANN INT MED 2000; 133:202-08 . THAT is why they imposed it with artificially restricting the certification to 10 then 8 and now to Continuous subscriptions to MOC to maintain a certificate that they themselves deem to be “VOLUNTARY”.

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Dr. Chip on Release of Medicare Physician Payment Data

Please take note that whatever AOA says or CMS for that matter, they are NOT DISCLOSING how many refusals to pay they generated, they are not disclosing how many bill backs they generated over that same time period, they are not disclosing how many cases were given to the FBI for Hunting purposes and they are not disclosing how many patients they refused to allow access to treatment, by denying coverage.

Transparency only for the things that make physicians look bad is actually what they are doing and they created the circumstance that framed all that. I believe that it is not coincidental. We are being made scape goats. And you thought that ended with World War II?

~ Dr. Chip


CMS Announces Release of Medicare Physician Payment Data—AOA Responds 
Despite strong opposition from the physician community, the Centers for Medicare & Medicaid Services (CMS) will publish how physicians and other health care practitioners billed Medicare for services they provide and what they were paid. CMS announced on April 2 their “intent today to take another major step forward in making our health care system more transparent and accountable. We plan to provide the public unprecedented access to information about the number and type of health care services that individual physicians and certain other health care professionals delivered in 2012, and the amount Medicare paid them for those services, beginning not earlier than April 9.”The information will include physicians’ provider IDs, their charges, their patient volumes and what Medicare actually paid. The data will not identify patients, and CMS will remove data that pertain to physicians with fewer than 11 Medicare beneficiaries. The AOA expressed strong concerns in a letter to CMS on Sept. 5, 2013, regarding the then-proposed release of physician data and urged CMS “to exercise caution when considering the release of individual level physician payment data.”The AOA reiterated these concerns in an April 3 letter and requested:

  • CMS not release such data until it has been proven that the information is actually of value to the public, and that the public can and will use that data in a meaningful manner.
  • CMS provide each physician the opportunity to review their own data and dispute any information before public disclosure.
  • CMS strongly consider the impact and unintended consequences this policy might have for physicians and their patients.

The AOA will continue to advocate that public disclosure of data must be carefully implemented to include proper safeguards and context.

Single accreditation for MDs and DOs by 2020?

Dr. Gina Reghetti comments on Dr. Wax’s letter to AOA (also copied below):

Dr Wax,

I hope he answers back. I wish that we could find an attorney that would file suit due to them restricting our unique trade of Osteopathic Medicine, a national historical healthcare system, that originated in America.

The agenda is definitely against the American way. Osteopathic Medicine, cannot be classified together with Allopathic Medicine. There has to be something that can be filed legally.

Look how far the NPs and PAs have come, yet we are taking another step back to discrimination years ago when DOs weren’t considered doctors. How can this be?

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Letter to AOA on ACGME merger: Problem & new solution

Dear AOA Pres. Dr. Vinn, et al.

This letter is in regard to, “Single accreditation for MDs and DOs by 2020,” in family practice news this month. We have been told by former AOA President Dr Ray Stowers that in recent years Osteopathic schools proliferated too quickly and created the need for more residencies than AOA could supply and government could fund. We were then told last year that the only solution would be to combine our Osteopathic GME with allopathic MD ACGME. In the article Dr. Vinn states, “… But Osteopathic training programs will still retain their unique focus.” He goes on to say, “this is an opportunity to both reinforce and proliferate or principles.” The question I raise is how is it possible to train, reinforce our principal teachings, philosophy and skills while not experiencing the potential disaster of the California experience of 1960?

As a product of, and believer in Osteopathic principles, schools, internships, residency training, postgraduate fellowships and CME, I believe our programs offer unique and distinct advantages over the other possibilities that exist. This unique Osteopathic approach to training, education and practice must be maintained for the betterment of human health. Under the plan to merge osteopathic graduate medical education with ACGME we would be absorbed, overrun and thereby changed to accommodate only the allopathic practice model.

Osteopathic graduate medical education has always strived for independence and excellence. This merger of programs would be a catastrophic mistake in the history of osteopathic medicine. Our DO distinctiveness would disappear from the practice of medicine of the merger goes to completion. The logical sequellae of the merger would be the loss of Osteopathic Medical philosophy in practice, as well as, all of our DO program directors will lose their jobs by the merger completion date of 2020.

I offer the DOs COMITT alternate plan to save Osteopathic training programs: The first step would be control of and smart steady growth of osteopathic schools, not uncontrolled proliferation. Osteopathic training programs produce diverse physicians with a large number of primary care specialty physicians including family medicine, pediatrics, gynecology, etc. The second step is the AOA to bring the data of our current primary care programs’ output to the government authorities and Congress that authorizes money for training programs. If we can mount a organized and cogent movement to convince the Congress and government leaders to champion the cause of primary care specialty training, they will support it for the good of the country’s health and their own political goals. Please consider this approach previous to your acceptance of the ACGME merger program which would destroy our osteopathic integrity.

Best wishes for good health,
Craig M. Wax, DO
Family physician, Editorial Board of Medical Economics
Host of Your Health Matters
Rowan Radio 89.7 WGLS FM

Twitter @drcraigwax
Independent Physicians For Patient independence @IP4PI