Sunday, September 28, 2014

HIDING IN PLAIN SIGHT: THE DETERIORATION OF MEDICINE-a disgusted physician tells the real story


by John Tedeschi, MD

(Robbinsville, NJ) – It’s happening so gradually you hardly notice it at first.  It’s a slow and deliberate erosion, targeting your family doctor, someone who will soon become a thing of the past. 

Thanks to politics, insurance companies, special interest groups and other organizations, medicine is changing:  the way it’s provided; who it’s provided to; exactly who the providers are and their qualifications; how much it costs and, literally, “who lives and who dies.”  The old saying “follow the money” has never been truer than today. 

On the surface, the bureaucrats are pretending to have the best interest of the patient in mind when it comes to medical coverage and healthcare.  One wonders, though, when the architect of the Affordable Care Act questions the quest for life after 75.

In reality, Ezekiel Emanuel says it’s a matter of saving money – and where the money IS ultimately spent, it’s directed to special interest, profit-making organizations.  Benefit to the patient is secondary.

It’s all carefully choreographed -- better than a Broadway musical.

As a result, physicians around the country are up in arms over unsafe and unethical insurance and federal regulating policies.  These policies remove the trusted, precious and irreplaceable ‘doctor/patient relationship’ in favor of healthcare “rationing’ that is based on previously established Third World standards.  And physicians have nowhere to turn for help.  The AMA (the American Medical Association), long the advocate for the nation’s doctors, abandoned the needs of the physician years ago and has its own agenda.  Today, only 14% of the nearly 400,000 licensed physicians are still members.

Doctoring just isn’t the same.  The practice of medicine, its costs and medical policies, are now dictated and controlled by groups that don’t know the first thing about medicine, nor the people it serves.  At one time, the practice of medicine in America was the envy of the world.  Unfortunately, it has now been radically segmented.

The individual human rights and patient care needs are completely eroded and purposefully ignored.  And more and more great doctors and educators, whose hands are tied, are simply giving up or leaving the country altogether.

It’s a national disgrace. 
Getting a flu shot at Wal-Mart or CVS, for instance.  Do these walk-in-off-the-street retail stores even know -- or care -- about the history of the patient and whether or not it’s safe to administer medicine of any kind?  Flu shots are not for everyone, but they have no way of knowing.  You find yourself in the hands of pharmacists who’ve just recently received a ‘crash course’ in how to immunize, a process mandated by the companies for which they work.

And even TV producers are realizing it’s a joke.  In a recent episode of one sitcom, a son asks his father, “Hey, where have you been?”  The father replies, “I got a flu shot at the pharmacy, because who better to administer medical care than the guy who puts price tags on flip-flops?”

Did I already use the words “national disgrace?”  

Then, there are the rapidly emerging, drive-thru urgent care centers.  Do you see a real doctor, or are you treated by a nurse practitioner or physician assistant who ‘looks and acts’ like a doctor?  Plus, it’s an uncontrolled data collection center of your personal information.

Regardless of issue, doctors are now told how much time we can spend with each patient; 
what tests we can and cannot request.  We are now forced to re-certify more frequently and answer questions, in many cases, unethically, just to serve their financial needs. 

We are told what kind of treatment can be provided to older patients, a type of  “too old to treat” approach because of the life expectancy of the patient and the cost to the federal government.  Even prescription medications that will effectively help the patient are routinely rejected by insurance companies and Medicare in favor of less expensive, ‘generic’ drugs that are archaic and simply don’t do the job. And we are aware, of course, of the conflict of interest of insurance companies having stock in the drugs that they do approve.  It’s really sad.

The entire emphasis is not just based on saving money, but also ‘making money’ at the expense of human life and quality care.

We saw what happened to the VA under government control.  Now the government wants to administer and control all of healthcare, nationwide? 

The Affordable Care Act, neither ‘affordable’ nor ‘caring.’  Not a political statement; a fact.  Ask any ‘real’ doctor.

The so-called “watchdogs” are not watching.  The government agencies established to “protect American citizens” from these abuses are not doing their job.  Where are our protectors?  Where is today’s Paul Revere who can set out to “warn us.”

Why does society accept this?  Are we ignorant, na├»ve, apathetic?  Probably.  One thing’s for sure:  We’re on our own.

Think about that.  But not for too long; you’ll give yourself a headache.”


Doctor John Tedeschi is a primary care-family doctor in Robbinsville, New Jersey, who has been practicing medicine for more than 30 years. He lives in Morrisville, Pennsylvania.

Monday, September 22, 2014

How To Discourage a Doctor from doing the right thing

This is one of the most informative pieces I have read in years as to how the medical profession is being tied by the ankles:
“Though physician compensation accounts for only about 8% of healthcare spending, decisions that physicians strongly influence or make directly – such as what medication to prescribe, whether to perform surgery, and when to admit and discharge a patient from the hospital – have been estimated to account for as much as 80% of the nation’s healthcare budget. To maintain a favorable balance sheet, hospital executives need to gain control of their physicians. Most hospitals have already taken an important step in this direction by employing a growing proportion of their medical staff..............

Tuesday, September 16, 2014

NBCRNA IRS 990s and the exponential growth of profits in this non-profit!

Gross receipts $3,292,415

Gross receipts $8,001,719

Gross receipts $16,570,001
So you see an exponential growth in income at this NBCRNA and there is certainly NOT an exponential growth in that profession in these 3 years! ALl information is on file at, or as a NON-profit they  are REQUIRED to provide this information on request-and I wonder what they will charge you for that!

Tuesday, August 12, 2014

MOC the Pablum for the masses of the ABMS

MOC is all just Pablum for the masses and there is no better analogy: see: 
ANother invention that SEEMED a good idea which is NOT!

Is Pablum Necessary? New recommendations on what baby's first foods should be (hint: it doesn't include infant cereal) 
by Teresa Pitman 
In the 1920s, many babies were being fed with homemade formulas that consisted primarily of sweetened cow’s milk and water. Doctors at Toronto’s Hospital for Sick Children wanted to find a baby food that could supplement this formula, as many babies of the time showed signs of vitamin deficiencies and malnourishment. 
In 1931, they invented Pablum, a powder that could be mixed with water or milk and spoon-fed to even quite young babies. The original ingredients included: ground wheat, oatmeal, cornmeal, wheat germ, bone meal, brewer’s yeast and alfalfa plus added vitamins and minerals. It was the first infant cereal, and it quickly became the standard first food for babies. 
Over time, many companies began producing their own variations. Because of concerns about allergic reactions, most now use just a single grain (such as oats or rice). 
But times have changed. As more babies are once again being breastfed, and the quality of formulas available to parents has improved, recommendations about adding complementary foods have also changed. The Canadian Pediatric Society and the World Health Organization now both recommend that babies be exclusively breastfed for six months, and then continue breastfeeding with added solid foods for two years and beyond. 
When a baby starts on solid foods at six months or later, there’s no need for a highly processed, semi-liquid food like Pablum or another infant cereal. These babies are ready for REAL food! In fact, the World Health Organization recommends that babies be offered the foods that are part of the family’s usual healthy diet. 
- See more at:

Saturday, August 9, 2014

Putting Quality on the Global Health Agenda-NEJM & IOM crap

I read the article praising Institute of medicine political statements from the NEJM and wrote the following (naturally not accepted for publication). I used real definitions to define the problem, not politically motivated ones:
Placing the “mea culpa” in real terms regarding "quality healthcare".
The recent perspective on quality in healthcare continues to miss many essential realities. Quality is also defined as:”A measure of excellence or a state of being free from defects, deficiencies and significant variations.”
Rehashing the Institute in Medicine’s particular brand of definition, emphasizing: “it is safe, effective, patient-centered, efficient, timely, and equitable” simply does NOT describe modern medical care:
Safe: The very nature of healthcare (surgery, drug administration, anesthesia and procedures) is extremely dangerous, while this fact is typically minimized in expectations and when obtaining informed consent.
Effective: Typically the patient’s ability for self-healing is only promoted by treatment, typically introducing drugs and procedure related specific known dangers in the process-often as dangerous as the disease itself.
Patient centered: Increasingly emphasis decries utility of preventive care including PSA, mammograms, pelvic and even routine yearly physical exams-emphasizing cost effectiveness over patient centricity.
Efficient and timely: would require maintenance and preventive care-currently not emphasized-see above.
Equitable: you cannot purchase health, only health care. Poverty and lifestyle remains after healthcare, as a causative factor.

By failing to recognize that quality healthcare starts with having health and maintenance, whereby the patient is the primary source of health, we will never get past placing blame on physicians and health care systems for inadequate quality. Physicians cannot consistently replace that, which is already lost. The continued emphasis on “adverse outcomes” blaming heathcare systems, ignores the many patient centered causes of sickness including poverty, handguns, rampant drug, tobacco and alcohol abuse, obesity and multiple other life style choices including “extreme” and professional sports-which are not typically terminated by the patient, even after problems are treated and causality confronted. Adverse outcome continues to be defined as anything less than an optimal desired (advertised) outcome typically=restitutio ad integrum! This “failure” is not equal to malpractice, deficient or even inadequate care. Patients come to hospitals, when problems become severe and baseline health is marginal, increasing the risks from receiving care.
The example of the inability to decrease maternal mortality by financing all deliveries in hospitals is not surprising, as provision of care introduces specific risks (a la Semmelwiess or modern expected risks): I.e. failure to provide adequate pre and postpartum care, C/section rate risks are certainly as, or even more important, than delivery in a hospital vs home . We need to quite blindly accepting corporate definitions from the IOM or elsewhere and accepting all blame for complications.

As an anesthesiologist and for example, where the expectation is to provide general anesthesia (versus no anesthesia needed) for a MRI scan, in the most extremely hostile physical environment known, to merely “take a picture”, expected complications will always prevail and provide “adverse outcomes”. It is time to capture all inherent/statistical/expected risks and start tabulating adverse outcomes based in the real world.

This is the article available at:
Putting Quality on the Global Health Agenda
Kirstin W. Scott, M.Phil., and Ashish K. Jha, M.D., M.P.H.
n engl j med 371;1 july 3, 2014

Thursday, August 7, 2014

Public Health & Policy MOC: Dissecting the Issues MedpageToday

Public Health & Policy

MOC: Dissecting the Issues

Published: Aug 6, 2014
Paul Kempen, MD, PhD, has been actively investigating the certification industry and background, introducing the term "regulatory capture," which he defines as the use of laws to create compliance with corporate self- serving programs. Kempen is an anesthesiologist now in private community practice after decades of academic practice. He regularly posts and his blog.


Sunday, July 27, 2014

FLorida Joins list of states resolving to Oppose MOC-the best set of resollutions yet and serve as example to any state without!

Today, the Florida Medical association House of Delegates passed the following resolution without a single vote of dissent among the 300 delegates in attendance: .

RESOLVED, That the FMA acknowledges that the certification requirements within the MOC process are costly, time-sensitive, and result in significant disruptions for the availability of physicians for patient care, and therefore, the current MOC programs should be modified; and be it .

RESOLVED, That the FMA opposes any efforts to require Maintenance of Certification (MOC) program as a condition of medical licensure, or as a pre- requisite for hospital/staff privileges, employment in State of Florida/county medical facilities, reimbursement from 3rd parties, or issuance of malpractice insurance; and be it further .

RESOLVED, That the FMA advocates that the lack of specialty board recertification should not restrict the ability of the physician to practice medicine in Florida. .

RESOLVED, That the FMA monitor the American Health Legal Foundation who is seeking legislation to prevent hospital staffs and insurance companies from refusing to credential physicians who do not participate in the MOC program. .

RESOLVED, That a copy of this resolution be transmitted to the AMA House of Delegates.

The number of states openly opposing this regulatory Capture= Extortion is on the rise and this set of resolutions should serve as template for EVERY state on MOC

Saturday, July 26, 2014

The death penalty, the ABA and political extortion of physicians by the Boards

Three major journals have now published about the extortion of american physicians-the political force of certification revocation-and ONLY the ABA (anesthesiology)  of all boards has done this. Please consider the following and anyone needing a copy of any article contact me off line. The first is particularly salient-the second displays the ABA's firm and clear position that certification loss threatens ability to practice and should be used to extort physician complliance to board's whims-decided by 20 pompus individuals who do not practice medicine, but politics:
Societal and Medical Ethics: Regarding Execution by Lethal Injection
Multiple recent opinions regarding physician execution and corporate American board prohibitions raise many important issues. (1-3) As physicians and definitive experts, we are obliged by society to participate in many aspects of dying: terminal care, ICU admissions or denials (fiscal and physical triage), euthanasia, withdrawal of life support, abortions, heart beating and non-heart-beating organ donation and “do not resuscitate” classifications and indications. Such involvement as anesthesiologists has recently been deemed “imperative” (4) In modern industrial societies, over 90% of ICU deaths are “managed events”. (5) Organ donation euthanasia is being discussed as a means to facilitate the supply of needed organs, as have been invasive non-heart-beating methods. (6) Optimally, organs are recovered from heart-beating donors: perhaps it is time to discuss or provide medical care to recover all useful organs from the
condemned, who choose to donate organs before circulatory arrest, as an act of contrition, to benefit living patients and increase their hope of living. Brain dead donors are as legally “declared dead”, as are those condemned to die and are without hope of further life. Death is certain at this point. Ronald Phillips, a condemned murderer, has recently been denied the opportunity to donate organs and benefit others, which would have been readily possible, humane and practical, using standard heart beating donor methods. ( 7, 8) Why refuse and to what purpose?
Times have changed since the American Medical Association (AMA) issued it’s opinion
guideline first issued in 1980 and last revised in 2000, stating, "A physician, as a member of a profession dedicated to preserving life when there is hope of doing so, should not be a participant in a legally authorized execution. The AMA now represents less than 20% of physicians and by no means, the profession as a whole. Medical ethics must reflect contemporary society, which even the AMA openly declares. The US population danced in the streets after Osama Bin Laden was “terminated”. Drone attacks are now contemporary federal policy-even directed at US citizens. Organ recovery has been a priority for over a decade in the US. The Ohio Medical Board recently specifically prohibited involvement in “the actual administration of the execution agent itself”, while only two death-penalty states, Illinois and Kentucky, specifically bar doctors from the execution chamber. No one should be forced to participate in an execution, be restricted from following their conscience, voicing their opinion
or performing legally sanctioned actions including “consulting with ……. lethal injection personnel”.
The only board, the American Board of Anesthesiology (ABA) and original signer issuing the prohibition noted: “Even though board certification is not required to practice medicine, in many fields it is a de facto requirement for physicians to practice within their specialties.” (2) The ABA has thus threatened to revoke certification for capital punishment involvement of any kind, including consulting distant from the actual act. Dictating as a dozen corporate enforcers without legal mandate, assuming to represent the profession and threatening an individual’s employment ability without a voice of the diplomates, who are not members but merely rent the diplomate under current artificially created corporate recertification licensing, is a mere political ploy, remaining itself unethical and frankly un-American. The prohibition of involvement in lethal injection occurred with significant dissent from the national American Society of Anesthesiologists. * It is noteworthy that the Boards have used this same threat and
regulatory capture to force physicians to subscribe to their corporate programs, profiting only the boards (netting $400 million annually), while devoid of outcome based data demonstrating any quality improvement from their certification or recertification programs, in spite of repeated attempts over decades. (9) This was summarized in the ABIM’s own internally sponsored Meta-analysis. (10) These corporate and political actions raise serious questions as to the ethical nature of these boards themselves, operating without effective external oversight by the profession itself. “Business ethics” should not supersede professional ethics, who do not serve or represent the professionor society at large.*

Personal Communication, Alexander A. Hannenberg, MD

1) Waisel DB: Revocation of Board Certification for Legally Permitted Activities. Mayo Clin Proc. 2014;89:869- 872.
2) Truog RD, Cohen IG, Rockoff MA. Physicians, medical ethics, and execution by lethal injection. JAMA. 2014 Jun 18;311(23):2375-2376.
3) Sawicki NN: Clinicians' involvement in capital punishment--constitutional implications. N Engl J Med. 2014;371:103-105.
4) Papadimos TJ, Gafford EF, Stawicki SP, Murray MJ. Diagnosing dying.
Anesth Analg. 2014 Apr;118(4):879-82
5)Widdicombe NJ, Van Der Poll A, Gould A, Isbel N. Donation after cardiac death in nonsurvivable burns. Anaesth Intensive Care. 2013;41:380-385.
6)Wilkinson D and Savulescu J: Should we allow organ donation euthanasia? Alternatives for maximizing the number and quality of organs for transplantation. Bioethics. Jan 2012; 26(1): 32– 48.
7) Associated Press: Death row inmate's wish raises ethical questions November 14, 2013. Available at: Accessed 7/19/2014
8) Kempen PM: Lethal Injection, Anesthesia, Medicine and Organ Donation – Ethical and Clinical Considerations Regarding the Pending Supreme Court Case: Baze vs Rees. The Open Anesthesiology Journal, 2008, 2, 7-12.
9) Kempen PM: Maintenance of Certification and Licensure: Regulatory Capture of
Medicine. Anesth Analg. 2014 Jun;118(6):1378-86.
10) Sharp LK, Bashook PG, Lipsky MS, Horowitz SD, Miller SH. Specialty board
certification and clinical outcomes: the missing link. Acad Med 2002;77:534–42 

Wednesday, July 16, 2014

Two new websites oppose MOC!

Opened on July 08, 2014

  1. The American Board of Internal Medicine’s (ABIM) Maintenance of Certification (MOC) program is onerous and provides little value

  2. There is no data that MOC improves patient outcomes

  3. The MOC modules are irrelevant busywork that reduce physician time for patient care.

  4. MOC is costly for physicians and has become a money-making enterprise for ABIM

  5. There is no public demand for MOC

  6. The existing Continuing Medical Education requirements are a preferred approach to life-long learning.

  7. To date, despite numerous calls for change, ABIM has not made meaningful changes to the MOC program

Therefore, I pledge not to participate in MOC unless significant changes are made to the program. If I have previously enrolled in MOC, I will boycott future enrollment unless significant changes are made to the program.

 If you support this pledge, please send it to your colleagues and your hospital medical staff office for distribution.

 Supported by Physicians for Certification Change

The Physicians for Certification Change (PCC) are board certified or board eligible physicians from all specialties who are concerned about the recent changes to Maintenance of Certification (MOC) requirements. Our goal is to influence certification organizations like the American Board of Internal Medicine (ABIM) to change their policy regarding MOC.  We believe recent requirements are onerous, expensive and lack value.  While we do not have complete agreement on every recommendation, most members of PCC believe MOC should be changed in the following manner:
  •  Allow CME to satisfy all MOC biannual activities. Eliminate, or make optional, the medical knowledge, practice improvement and patient safety computer modules that have little practical value.
  • Charge a nominal fee (eg $100 per year) to track annual CME attendance as a substitute for MOC
  • Cut ABIM’s costs and correspondingly reduce initial certification and recertification fees by at least 20% over the next two years
  • Vastly simplify the ABIM website and MOC administrative tasks so physicians do not waste time on administrative activities
  • Members are divided on the issue of requiring recertification exams. Many believe the exam questions are not a reliable gauge of physician’s knowledge. Others favor requiring a recertification exam every 10 years, but the exam should be fair and easily passed by a physician in practice who keeps up with the literature and engages in adequate CME.

Founding members of the Physicians for Certification Change include:
Paul Teirstein, M.D.; Gregg Stone, M.D.; David R. Holmes, M.D.; Martin B. Leon, M.D.; Mladen I. Vidovich, M.D.; Kirk N. Garratt, M.D.; David Cox, M.D.; Andrew D. Michaels, M.D.; Peter B. Berger, M.D.; Chris White, M.D.; Bonnie H. Weiner, M.D.; Jeffrey W. Moses, M.D.; Michael Lim, M.D.; Augusto Pichard, M.D.; Dean Keriakes, M.D.; Samuel M. Butman, M.D.; Andrew Doorey, M.D.; Lloyd W. Klein, M.D.; Allen Jeremias, M.D.; Carl Tommaso, M.D.; Peter Pelikan, M.D.; Ramon Quesada, M.D.; Emmanouil Brilakis, M.D.; James Goldstein, M.D.; Bob Applegate, M.D.; Ted Feldman, M.D.; Morton Kern, M.D.; Charlie Chambers, M.D.; John Hodgson, M.D.; Aaron V. Kaplan, M.D.; Arnold Seto, M.D.; Craig Thompson, M.D.; David Rizik, M.D.; John Hirshfeld, M.D.; Karen Smith, M.D.; Peter Ver Lee, M.D.; Nauman Siddiqi, M.D.; Zoltan G. Turi, M.D.; Amir Lerman, M.D.; Roxana Mehran, M.D.; Igor Palacios, M.D.; Mitchell W. Krucoff, M.D.; Joseph D. Babb, M.D.; Westby G. Fisher, M.D.; E. Magnus Ohman, M.D.; Carlos E. Ruiz, M.D.; Steve Ramee, M.D.; Ajay Kirtane, M.D. & Kimberly A. Skelding, M.D.


Tuesday, July 15, 2014

Academic Medicine will not publish ANTI MOC letter-or even respond to the allegations-making ethical guidelines a joke!

I submitted this and it was rejected-the Academics/MOC carpetbaggers have the journals to themselves...and they like it that way. For instance (an you be the judge):
ABMS Commentary, free advertisement or “publishing-ethical violation”?

Recently, the outspoken resistance of practicing physicians to the American Board of Medical Specialty’s (ABMS)
Maintenance of Certification programs has exploded. The number of commentary articles published by the ABMS
in medical journals, espousing the importance of their own proprietary products and value to society, has also
exploded. These articles are typically written by highly paid executives of the industry,read as unpaid
advertisements of the “home office” and typically fail to present clear disclosure of the inherent corporate ethical conflicts explaining the clear supportive message for MOC. Indeed, to imagine that CEOs and senior vice presidents could be expected to not be protagonists of that corporate proprietary mission, is inconceivable to me. Yet these articles presenting very opinionated “commentary”, continue to find free publication reflecting validation in medical journals. Disclaimers declaring “advertisement” would be more warranted. Furthermore, these following statements:
Funding/Support: No external sources of funding.
Other disclosures: None reported.
Ethical approval: Reported as not applicable.
Contradict rational facts and serve only to obfuscate the inherent corporate advertising clearly identified. The message acclaims MOC, Certification and all aspects of the ABMS well beyond anything demonstrated in outcome based studies from independent researchers.(1) One author, the current President and Chief Executive Officer of the ABFP and the EXECUTIVE EDITOR of JABFM, who earned over $600,000 per
IRS documentation, while stating: “Conflict of interest: none declared” in that journal.
This text is speculative of many possible opportunities, should these ABMS be supported. The fact is, that ABMS
certification has never been documented to matter, in spite of over 5 decades of corporate attempts. Increasingly, the
physician population is exposing the corporate tactics of regulatory capture and distancing themselves from ABMS
“products”. It is time for the editorial boards of all journals to stop providing free advertisements to ABMS
  corporations to sell themselves to the public and physicians. They have corporate journals for such free access. How do editorial boards allow free advertisements without providing “equal time” for opposing viewpoints? Should these ads even be published, including disclosure that indicates “Paid authorship by the ABMS corporate executives”?
Where are the ethics of journal editors and why is the one sided free advertisement of this select corporate entity
Anyone wishing a copy of these articles should contact me off list.

Peterson LE, Carek P, Holmboe ES, Puffer JC, Warm EJ and Phillips RL: Medical Specialty Boards Can Help
Measure Graduate Medical Education Outcomes. Acad Med. 2014;89:840–842.

Thursday, July 10, 2014

ABIM MOC Failure Rates

Dr Wes' post is important but based only on first time takers of the test.

In case you haven't seen his latest:
Also see this graph from Sermo and the implications for those Recertifying:
Sermo | Sign in
If you are a physician licensed to practice in the United States (MD or DO), you are invited to connect with your colleagues on Sermo, the professional network started by physicians, for physicians.
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I would suggest the text there indicates that the FIRST time testers are used as the index for pass/failing. This means it is prejudiced against the OLDER group of test takers (now would this be illegal due to the age discrimination?). If you have been continually exposed to the "latest statistics, etc" you will be better able to regurgitate that which is DESIRED (but also not necessarily true as it will fall in 2-5 years when the "new truth" is told).
It looks even worse on closer exam:

3413 total test takers with 65% pass means 1194 total failed of whole group
1867 of these were first time recerts and pass rate of 80% means 373 failed
This leaves 1546 "repeat or non-first time recertification testers" of which 821 failed!
This is a 53% failure rate among that group of second time recertification testers!
This means with every cycle of recertification you stand to get failed increasingly.
Seems like this is intended to weed out old guys/gals and make room for the young ones- AND YET THERE IS SUPPOSED TO BE A SHORTAGE OF PRIMARY CARE!
So it would seem with every "cycle" of 10 years, you are increasingly failing OLDER people, with indexing on the youngest only!

What are your thoughts to this?
I also actually requested CMS DATA on payments for PQRS-MOC in 2011 (the only year available and the results were published in Med economics which you may find useful as factual data:
Maintenance of Certification must go: One physician's vi...
  The Maintenance of Certification (MOC) program’s expense and time commitments continue to grow, producing greater complexity and more headaches f...
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MOC physician incentives
It is clear not all registered got their money and with 850,000 US docs, with a 2% cut in payments this will be a huge perhaps $2.5 billion cut in CMS payments equal to the "sequester" cuts which cause people to raise hell. This is why I think 2005-6 will be hallmark years for wake-up calls to physicians regarding the MOC extortion and government collusion and I hope results in large numbers dropping medicare and caid as providers-shifting care to Fauxicians.