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Sermo Wars with AMA Over CPT Codes

Cheryl Clark, for HealthLeaders Media, July 9, 2009

"The AMA alone foots the bill. While these expenses are recouped and profits are gained from the sale and licensure of CPT products and information, the AMA uses this income to tackle a sizable agenda on behalf of America's patients and physicians – initiatives such as health insurance coverage for all Americans, Medicare payment reform, relief from unfair managed care business practices and championing important public health issues, to name just a few," she said.

Two years ago, when the relationship began, it was forged as a kind of trade. The AMA News ran ads for Sermo to recruit participants. In exchange Sermo let the AMA access the physicians' online conversation to get feedback from the front lines of medicine, for use in shaping legislative or organizational policies.

Yesterday, the AMA said its board member, Joseph M. Heyman, MD, posted this statement in response to Palestrant's on Sermo July 1.

"We need to set the record straight on the information in Dr. Palestrant's post. The truth is that AMA membership numbers are public information, and there has been no precipitous decline in AMA membership over the last two years, as Dr. Palestrant suggests," Heyman wrote. "With about a quarter million members, the AMA is the largest physician organization in the country, and through the AMA House of Delegates, comprised of elected physician and medical student representatives from all state and national medical specialty societies, it is the only physician organization that gives all physicians a voice in the future of medicine."

"Twice a year the AMA House of Delegates meets to debate and vote on in public the most important policy matters facing medicine today. Last month, for example, the AMA House of Delegates met to vote on key elements of health system reform. It was a vigorous debate that ended with the following declaration of commitment: AMA supports health system reform alternatives consistent with principles of pluralism, freedom of choice, freedom of practice and universal access for patients.

"At that same meeting, President Obama chose to give his major health reform speech to AMA physicians. Not only has President Obama shown that AMA physicians are integral to the health reform process, but a recent Kaiser Family Foundation poll shows that the American people trust physician groups like the AMA to do the right thing on health reform as well."

Heyman said in his post that AMA advocacy is "well documented and unfailing. We are actively engaged to permanently fix the broken Medicare physician payment system and have a big victory on that this week," and continue to work on antitrust, medical liability reforms, a streamlined insurance claims system, and so much more. "As for relationships with insurers, we continue our high-profile fight against insurer abuses that hurt physicians and patients."

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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.