Most Americans cringe at the mention of the American Medical Association. Patients often see it as a powerful lobbying force that only protects doctors’ interests. They might be interested to know that most physicians, ourselves included, don’t think it even does that! The AMA often acts more in its own business interest than for its physician members or the patients they serve.
The most recent flap is over CPT codes. “CPT” stands for “Current Procedural Terminology,” aptly characterized in a recent Wall Street Journal story as the “authoritative dictionary of physician billing.” The AMA enjoys a copyright monopoly on the CPT system at the same time that the government requires physicians and others to use it every time they see a Medicare beneficiary.
The CPT code system attempts to assign a unique code number to the infinite number of possible medical procedures and diagnoses. For example, the code “49505” stood for one variety of hernia surgery. Code “99201” was for a limited, 10-minute office visit with a new patient. Other coding systems have been set up for diagnoses, such as the ICDA system. In everyday practice, Dr. Internist obviously doesn’t call Dr. Surgeon on the phone and say “Sam, I’ve got a guy in my office for a CPT 99201. I found an ICDA 550.90.” Doctors use words, not numbers to describe their work. The codes were set up so that clerks without any medical training could punch them into a computer to match up doctors’ billings with insurance company payments. It boils down to non-medical clerks assigning payment values to the physician’s work.
The government mandate wastes valuable time and effort trying to figure out the most precise CPT code number, often a formidable task. This time and energy would be better spent diagnosing and treating patients rather than feeding the bureaucratic Medicare paper shredder. Ironically, this CPT monopoly has increased healthcare costs at the same time that the government complains about them.
Licensing the CPT system and sales of CPT codebooks are apparently very lucrative for the AMA. Even though the association usually doesn’t release such numbers, AMA documents revealed that in 1997, the margin from licensing one of its data products, the AMA Physician Masterfile (used to match up doctors with prescribing information from pharmacies) “was $10 million, on revenues of $11 million, and expenses of $1 million.”
The AMA makes about a $150 million profit from non-dues sources, including CPT code products, database licensing, etc. The lowest priced complete CPT, the paperback CPT 2001 Standard Edition, sells for $49.95. Although the AMA does deserve some payment for its work, we don’t believe it’s entitled to monopoly profits from a system mandated by the government,especially when it works against the interest of patients and doctors.
Entrepreneur Timothy Pickering established a Web site, now called Myhealthscore.com, to provide patients with information about medical procedures and their costs. He initially used the CPT coding system, thinking that his use was consistent with the AMA’s stated goals. He was forced to stop using the system because the AMA demanded $10 every time someone looked up a CPT code on his Web site. He compares this to a restaurant charging $10 just to look at the menu.
We recommend a federal law placing the AMA’s CPT code in the public domain. We believe it would be better for the government to pay the AMA a reasonable amount rather than asking doctors and patients to cover this mandated expense. The result would be more informed patients, the ability of the patient to make cost comparisons, more choice and ultimately better healthcare.
Michael Arnold Glueck, MD
Robert J. Cihak, MD
(Glueck, of Newport Beach, and Cihak, of Aberdeen, Wash., write frequently on healthcare issues.)
