I have received threatening letters from the AMA on 2 occasions for creating limited-use CPT/RVU tools that allow specialties to review potential pricing for small sets of codes. Both times, I was forced to take these free, non-commercial tools down. At the time, our lawyer said, "Well, you have two choices. You can fight them and, in the end, I think you'll win. But it will take all of your resources and money. Or you can continue to run your business. Pick one." We chose to stay in our primary business.
I thought I should then update the wiki page for CPT codes to point out that the AMA makes tens of millions of dollars a year on forced CPT licensing. A few weeks later, the note was simply erased...by a user who was quickly traced right back to the AMA. You can look through the wiki history and identify this individual quite easily.
You can see one of the versions with the language in there here:
This user, traceable to IP 207.118.34.109, has had only a single contribution to wikipedia - to erase any discussion of the financial monopoly held by the AMA. We've never heard from him or her since. No idea who owned that IP 6 years ago, but I have a guess.
I have much more to say about this issue, but I don't need another letter.
Anonymous - 6 years ago
My understanding is that it isn't against the law to BE a monopoly, but it is against the law to ACT like a monopoly.
Anonymous - 6 years ago
Isn't just the AMA, the AHA is doing the same thing, via a "strategic" subsidiary called HealthForum, with the publicly sourced & maintained billing forms that every insurance institution has de facto adopted and is required by CMS.
John Hale - 6 years ago
It already has been litigated as a copyright misuse claim (PRACTICE MANAGEMENT INFORMATION v. AMERICAN MEDICAL, 877 F. Supp. 1386 (C.D. Cal. 1994).). The judgement was, essentially "If the Fed makes a monopoly but the AMA didn't seek it, it isn't one."
Anonymous - 6 years ago
A related consideration is whether AMA interests are helping to perpetuate the whole bizarre system of E&M codes, which is a significant contributor to note bloat and reduced usability/utility of clinical documentation. A re-examination of the RUC and RVUs, including the way that RVUs are established and updated, is also warranted. The modern era of RVU driven medicine, in combination with E&M codes, worsens documentation by relegating it to thoughtless clicking off of bullet points while simultaneously increasing the time spent in documenting. Although EHRs could certainly benefit from usability improvements, they end up getting a bad rap in causing the recent epidemic of physician demoralization. Rather than vilifying EHRs, we need concerted efforts to clean up CPT, eliminate E&M coding, end the focus on RVUs and examine the roles that special interests are playing in each of these negative influences on health care.
I have received threatening letters from the AMA on 2 occasions for creating limited-use CPT/RVU tools that allow specialties to review potential pricing for small sets of codes. Both times, I was forced to take these free, non-commercial tools down. At the time, our lawyer said, "Well, you have two choices. You can fight them and, in the end, I think you'll win. But it will take all of your resources and money. Or you can continue to run your business. Pick one." We chose to stay in our primary business.
I thought I should then update the wiki page for CPT codes to point out that the AMA makes tens of millions of dollars a year on forced CPT licensing. A few weeks later, the note was simply erased...by a user who was quickly traced right back to the AMA. You can look through the wiki history and identify this individual quite easily.
You can see one of the versions with the language in there here:
https://en.wikipedia.org/w/index.php?title=Current_Procedural_Terminology&oldid=140670491
Look for the July 2007 changes.
The information was re-added and then other folks got in on yanking the chain. Notice this update to the comments:
https://en.wikipedia.org/w/index.php?title=Current_Procedural_Terminology&oldid=221237372#Copyright
Someone then added data from the AMA annual report:
https://en.wikipedia.org/w/index.php?title=Current_Procedural_Terminology&oldid=424343436
Then, in November 2011, one user thought the language should be updated to reflect a more...AMA friendly perspective:
https://en.wikipedia.org/w/index.php?title=Current_Procedural_Terminology&oldid=458650255
This user, traceable to IP 207.118.34.109, has had only a single contribution to wikipedia - to erase any discussion of the financial monopoly held by the AMA. We've never heard from him or her since. No idea who owned that IP 6 years ago, but I have a guess.
I have much more to say about this issue, but I don't need another letter.
My understanding is that it isn't against the law to BE a monopoly, but it is against the law to ACT like a monopoly.
Isn't just the AMA, the AHA is doing the same thing, via a "strategic" subsidiary called HealthForum, with the publicly sourced & maintained billing forms that every insurance institution has de facto adopted and is required by CMS.
It already has been litigated as a copyright misuse claim (PRACTICE MANAGEMENT INFORMATION v. AMERICAN MEDICAL, 877 F. Supp. 1386 (C.D. Cal. 1994).). The judgement was, essentially "If the Fed makes a monopoly but the AMA didn't seek it, it isn't one."
A related consideration is whether AMA interests are helping to perpetuate the whole bizarre system of E&M codes, which is a significant contributor to note bloat and reduced usability/utility of clinical documentation. A re-examination of the RUC and RVUs, including the way that RVUs are established and updated, is also warranted. The modern era of RVU driven medicine, in combination with E&M codes, worsens documentation by relegating it to thoughtless clicking off of bullet points while simultaneously increasing the time spent in documenting. Although EHRs could certainly benefit from usability improvements, they end up getting a bad rap in causing the recent epidemic of physician demoralization. Rather than vilifying EHRs, we need concerted efforts to clean up CPT, eliminate E&M coding, end the focus on RVUs and examine the roles that special interests are playing in each of these negative influences on health care.