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Sermo Wars with AMA Over CPT Codes

Cheryl Clark, for HealthLeaders Media, July 9, 2009

"As for Dr. Palestrant's sudden 'change of heart' regarding the AMA, one can only speculate. He ardently courted the AMA when launching his business two years ago, and now he expresses scorn immediately following the end of that business relationship. The AMA door is always open to Dr. Palestrant and all physicians who would like to join with us to make a positive difference in medicine – especially those who feel their views differ from the policies set by the physicians of the House of Delegates. We urge you to join with us to make a positive difference in the lives of physicians and patients in our nation," Heyman wrote.

Meanwhile, the dialogue yesterday on Sermo was approaching 1,000 postings and has been colorful to say the least. While most seem to cheer Palestrant on, not all of them do.

"Dan, you are out of line," wrote one obstetrician gynecologist who objected to Palestrant's use of the survey to criticize the AMA. "The AMA may not represent all my views, but they certainly represent them more than you do. I always thought you created Sermo to allow honest dialogue between physicians. Now it feels like you did it in order to create a platform for yourself."

But far more contributions are like this one: "The AMA having the rights to license CPT codes and forcing us to use them is antitrust in that there is no alternative. This is called a 'monopoly' and is against the law."

And this one. "The AMA, by creating and promoting CPT codes, the same CPT codes which have made our jobs so unpleasant and costly, have clearly shown their allegiance is NOT with physicians, but rather with themselves and insurance companies. . . .They should call themselves the American Insurance Association, since that is who they benefit the most."

Palestrant, a surgical resident in Boston until three years ago, decided to launch Sermo, a Latin word meaning "conversation" to enable physicians who normally practice in isolation to talk to each other.

Sermo does not accept advertising or charge physicians who become users, he says. But it does make money by serving as a vehicle through which pharmaceutical companies, government entities, market researchers and others pay Sermo to access what those practicing on the front lines have to say.

He said the partnership with the AMA was originally a good thing. But over the years, he said, "it became increasingly clear, the AMA didn't care about what we had to say. And we began to have more and more questions about AMA business practices and the size of their community.

"It all came to a head with the current healthcare debate, and our community felt very strongly that the AMA was fabricating its membership numbers. Health reform is now taking place. And the physician community is so angry. We knew we had to take action."

Meanwhile, physician bloggers are having a field day with the fight as well.

"Wow, things are starting to get quite nasty here. The marriage has turned into an ugly war," wrote Joseph Kim, MD, an MIT engineer.

"I'm not sure bashing the most influential physician advocacy organization in the country, in terms of Congressional lobbying power and money, is the most productive strategy right now," wrote blogger Kevin Pho, an internal medicine physician in Nashua, NH. "Politicians will find it easier to ignore multiple, fragmented physician advocacy groups rather than a single, unified physician voice."

Cheryl Clark is a senior editor and California correspondent for HealthLeaders Media Online. She can be reached at cclark@healthleadersmedia.com.

Follow Cheryl Clark on Twitter.

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6 comments on "Sermo Wars with AMA Over CPT Codes"


Ira Kasper M.D, (7/15/2009 at 5:44 PM)
Are there many who remember what medicine was like before Medicare? I don't mean the lack of modern technology or the lack of our new medications. I mean when hospitals were not corporations. When hospitals ran banquets twice a year to make up for their losses. No one died in the street for lack of care, despite what the liberals tried to say. The only thing that has come out of Medicare is increased expenses, a more centralized government, hospital corporations, a trillion dollars going out of medical care to Wall Street, and massive debt. Many years ago I spoke to someone connected in Washington about funding research in endovascular surgery to save billions of dollars from the Medicare budget. I was told right there that no one in Washington cared to save money, they just wanted to control more of it. I doubt if nationalized medical care can be stopped and I know the AMA is not our friend.

Bruce Landes MD (7/14/2009 at 11:15 AM)
I'm impressed by the thoughtful responses here. I have many thoughts about the AMA and its relationship to American physicians. As the president of a 1400+ member physician-operated IPA I have to say there is no possibility that I can represent the thoughts of all of our members, so this is my personal opinion. I agree, if physicians don't know that selling CPT is a major revenue stream for the AMA, then they have probably been paying more attention to the most important thing, their patients' needs. I do have a problem with CPT and E&M coding. Unless they are using a computer template (which is also a risk for "fraud") it is nearly impossible for a physician to fulfill all of the CPT criteria for a given E&M code. The last study I saw (in 2002) showed that three professional coders looking at the same charts would agree less than 25% of the time on the level of the applicable CPT E&M code. If the diagnostic criteria for a disease were so ambiguous, the criteria would be abandoned. This creates a field day for the RACs or private insurers to audit a practice and find "coding fraud". The finding of so much "fraud and abuse" creates a bully pulpit for politicians to imply that we can save a lot of money by the elimination of "fraud and abuse". Our attorney and our accountant charge us for time spent on our needs. It does not have to be "face-to-face" time. I'm also pretty sure they don't meet "face-to-face" with 25 or more clients a day and document each meeting in a legal record and categorize each meeting with 5-digit codes. I know about the 50% counseling rule which is underused and I think the AMA should have set up separate code sequences for evaluation (diagnosis) and for management, to be criteria-based and to be time-based respectively. So I do agree that CPT is seriously flawed, and I don't know how many have challenged the AMA on the flaws. The AMA could do much more for its members and its primary care physicians in particular by restructuring the E&M codes to reflect the true priorities of non-procedural medicine today, which are far more skewed toward management than diagnosis. The fact that the AMA receives money from licensing CPT is much less relevant to most physicians than the fact that CPT E&M is a flawed product.

Walter Rohloff, MD (7/13/2009 at 7:38 AM)
Hats off to Dr. Palestrant ! Dr. Palestrant was correct to point out that the AMA does not represent the majority of physicians practising in the USA. As widely known, a majority of USA physicians are in support of the introduction of at least one universal insurance option, while the AMA has opted once more against the public and the true physician's interests by coming out against universal health care. Universal Health has become the pervasive reality in many countries, an overriding success where ever it has been started. Once adopted in any country, it lead to improvement of costs and quality of care delivered. Income of physicians may be somewhat lower but not necessarily as Great Britain has shown. The AMA, forever fearful of its waning influence, holds againg tight to an outdated health care delivery system. It is time for an alternative representation to emerge similar to the "Marburger Bund" that formed in Germany in response to a "German Physician Chamber" that become focused solely on their own benefit. SERMO with its true encouragement of physician voice interchange on any subject in the national arena may be the building block on which some desperately needed alternative to the AMA may emerge.