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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 senior quality editor and California correspondent for HealthLeaders Media. She is a member of the Association of Health Care Journalists.
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