The AMA is demanding that a healthcare information company stop using association data that allows consumers to compare their doctor's charges with standard billing rates.
Myhealthscore.com, a Phoenix-based Web site that allows consumers to provide patient satisfaction feedback on their doctors and insurers, had posted the Current Procedural Terminology codes for about three months until receiving a letter from the AMA, warning it to remove them. The CPT codes are a standardized billing mechanism used by healthcare providers and third-party payers.
The letter warned: "Your use of the AMA's intellectual property is unauthorized and may be a violation of the AMA's copyright, and as such, it may be a violation of federal law. Until we have entered into a license agreement with you for use of CPT on your Web site, we are requesting that you immediately remove all CPT-related material and/or the ability for users to receive CPT by way of your Web site."
The Arizona company says the AMA codes constitute a monopoly on the market and it's unfair for the AMA to charge it $1 million a month to post the codes on its site.
Rob Pickering, founder of the Web site, says the $10 annual license fee per user, which the AMA charges anyone who publishes its data, is inappropriate because Web sites get multiple hits, unlike organizations that publish hard copies of data. Since myhealthscore.com gets about 100,000 hits a month, that calculates to $12 million in payments to the AMA a year.
"I have nothing against the AMA," Pickering says. But, he added, "Consumers have the right to know what the benchmark is for procedures being performed by a physician."
Yank Coble, M.D., an AMA trustee and clinical professor of medicine at the University of Florida in Jacksonville, says he doesn't know what the big deal is. He says he never looks at the CPT codes because his office staff handles that information, and he suggests patients just ask their doctor what he or she charges.
"Knowing the code doesn't necessarily give you much data on that," Coble says.
"It sounds like it would be much easier to misinform people with a highly technical code than inform them."
Pickering says patients, especially those without insurance, need a benchmark to be able to compare a physician's fees.
"That's another reason why you don't just ask the doctor," Pickering says. "You have no way of comparing."
David Ellig, owner of patient advocacy firm Med-Ed in Mesa, Ariz., says the AMA is right to protect its copyright.
"Unfortunately, I'd agree with the AMA on that point," Ellig says. But he says charging $10 per user is excessive.
The AMA has licensed CPT codes to publishers and others who have incorporated the codes into software.
In 1998, CPT codes generated $15 million in revenue for the AMA. Coble says it represents about 5 percent of the AMA's total budget.
"I don't want to hurt their revenue stream," says Pickering. "We believe the more information the consumer has, the better informed decision they can make. If they've been able to legally maneuver on a copyright law and can get a revenue stream of $15 million, I can understand some of their hesitation. I just don't agree with it."
Jane Orient, M.D., the executive director of the American Association of Physicians and Surgeons, says the CPT codes are difficult to interpret.
"I think it is outrageous that the AMA should be profiting from these codes," she says. "They have a tremendous financial incentive for making it ever more complex."
The AMA was instrumental in getting Medicare and fiscal intermediaries to adopt the CPT codes as a way off establishing payment uniformity, but Coble contends anybody, including insurance companies, can develop their own codes.
"It's kind of hard to see how it is a monopoly," Coble says.
He says HCFA has an agreement with AMA to publish the CPT codes, but HCFA could quit using them after providing 90 days' notice.
"Certainly, as far as I know, it is used voluntarily by other insurers," he says. "They, too, could have different systems."
Orient says the ability of HCFA to cancel the AMA contract at any time limits the AMA's ability to defend doctors effectively against the federal government. She says she would rather see the codes available at cost from the government printing office.
Coble says a sophisticated system is necessary to keep up with the rapid developments of diseases and new technologies.
Pickering says he's not interested in developing new codes and would be open to working in partnership with the AMA to provide more information to consumers.
Angela Gonzales covers healthcare issues for the Business Journal in Phoenix.