Tuesday, January 05, 2010

Why does the AMA support senate and House health insurance bills?

Several blogs have taken up the issue of the AMA 's support of the health insurance bills currently sliding behind the scenes through Congress. Here is a newspaper article that makes the case for a theme that is found in a number of blogs.

Essentially the charge is that the AMA supports the bill because of the fees it receives for what is described as a monopoly of the insurance billing codes (the CPT codes ). Linda Gorman explains it here.

Apparently HCFA and the AMA reached an agreement with the AMA to use AMA's copyrighted CPT Codes (Current Procedural Terminology codes) for Medicare billing purposes. AMA does not report income from their CPT business separately but estimates suggest something in the range of $ 70 million per year,not a large number by today's standards but significantly more than AMA receives from dues. (Only about 15% of physicians now belong to AMA)

The 1983 HCFA-AMA pact originally precluded the use of other codes for purposes of physician outpatient fees for Medicare and Medicaid.A 1997 Ninth Circuit finding that the AMA was misusing a copyright lliminated the exclusivity but by that time the CPT was the industry standard.

Dr. J.J. Rohack had this to say in reply to Gorman's commentary :

This democratic forum of grassroots physicians and medical students directed the AMA in 1983 to have Reagan Administration recognize CPT as the standard for physician coding. At the time, physicians struggled to cope with the multiple code sets used by third party payers, including the government. AMA brought calm to this chaos by securing a physician-driven standard used to describe medical services.


SERMO, the online physician social network, has become very critical of AMA's role in CPT and in fact has severed an earlier working agreement with AMA. See here for comments from SERMO's founder, Dr. Daniel Palestrant.

The AMA has received CPT fees for a number of years, why now have they reversed earlier opposition to universal health care plans? What exactly is the alleged link between the two? I do not claim the two are not related but I am having trouble seeing exactly how that works. I ask my handful of readers for their input.

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