Monday, December 28, 2009

The Real Reason the AMA Supports Health Care Bill.

The AMA's support for health care bill as approved by the Senate and House and now in reconcilliation has consternated both liberals and conservatives alike the past few months. Many, including myself, have supposed that the AMA sees the bill as benign to it's monopoly of health delivery in the US and therefore find it the least of its worries. Other concessions (like the disclusion of the public option which would have driven down prices) have made the bill easy for the industry to swallow. And because there's really no reform to the "reform," the industry supports this mandate of money to the medical industry. A mandate that comes with no real regulation of medical delivery, which the AMA has traditionally strongly opposed, being the teeth that have gnashed at reform and any bill of patients' rights in the past.

But a new article at the Chicago Tribune reveals the underbelly of the business of medicine and the financial gains the AMA will reap from this fake "reform" bill:

As Democrats tout the American Medical Association's endorsement of their health care overhaul, critics are pointing to their studious sidestepping of a little-known monopoly that sends millions into the trade group's coffers each year, saying it's no surprise the Democrats were able to gain the AMA's support.

The AMA, which this year reversed its long-standing opposition to such changes, holds the exclusive rights to the medical billing codes that doctors are required to use when they submit bills to insurance plans. They are the equivalent of a bar code for nearly every medical procedure, from transplanting hearts to tucking tummies and scoping colons.

It is a monopoly that critics say gets in the way of making health care less expensive and potentially more effective.

The arrangement is the product of a once-secret deal, struck in the early 1980s, that allowed the government to streamline billing procedures for its insurance programs by setting a single code set as the standard. Under that deal, the AMA maintains and updates the codes at no cost to the government, but generates millions each year selling the code books and software licenses to doctors and insurers.

Sen. Tom Coburn, R-Okla., an obstetrician, said doctors are "adamantly opposed" to the health care bills, and pointed to the code monopoly to explain the AMA's support.

"The [code] revenue's protected," Coburn said during debate on the Senate floor. "That's the revenue the AMA gathers from the payment system that continues to be fostered in this bill, which is their main source of revenue."

The original deal related only to
Medicare and other government insurance programs. Since then, Congress has expanded the regulation to require the codes to be used in electronic billing transactions with private insurers. Some interpret the agreement to be revocable at any time through a simple rule-making process. Critics question whether the AMA can represent the interests of doctors while it relies on revenue that comes from a government-sanctioned monopoly.

AMA President Dr. James Rohack would not disclose how much the group raises from the codes each year, but he said that it is a portion of the $70 million claimed from sales of "books and products" in 2008. Membership dues raised $44 million for the AMA that year.

"There's an inherent conflict of interest," said Kathryn Serkes, director of policy at the Association of American Physicians and Surgeons, a competing doctors' group that has been challenging the code monopoly for years. "The AMA has a vested interest in keeping those codes going and keeping that system going because they're making money from those, tens of millions of dollars every single year."

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