How to Stop Feeding $$$ to a Dragon in the Great Swamp of American Healthcare

When a doctor treats a patient, the patient’s conditions and treatments are then communicated to insurers using the language of the Current Procedural Technology (CPT) coding system, the first edition of which was produced in 1966 by the American Medical Association (AMA).

The federal government eventually granted copyright royalties for the CPT system to the AMA, which in 2011 represented approximately 15%—a vastly smaller percentage than decades ago—of practicing physicians in the United States. It was sort of a “backroom deal” for one of America’s most-prominent lobbying forces (the AMA spent an estimated $347 million across the nation from 1998 through late 2016 to influence legislative decisions). It’s been eight years since the AMA has published membership numbers; and many American physicians have disagreed with decisions by the organization’s leadership. It would be interesting to see what the membership numbers are today. 

Some years ago, the AMA apparently worked out a deal with the Accreditation Council for Graduate Medical Education (ACGME) to be able to forward information about every doctor who entered an ACGME-accredited training program. The AMA would store that information in its Physician Masterfile, using Medical Education (ME) numbers as identifiers. Most physicians were unaware of this; it was all automatic.

The AMA can sell access to that Master file in the form of a license to anyone willing to pay for it.

IQVIA—a multinational, multibillion dollar contract research organization (CRO) that has fused information technology with clinical research and trials—is one such buyer. IQVIA is also a buyer from “payers” (insurance companies) of the data they have received from doctors in the form of CPT codes. Not stopping there, IQVIA buys information from pharmacy chains (the major ones, like CVS and Walgreens), which make big money by selling prescriber and prescription data. NOTE: The prescriber is identified by the ME number.

IQVIA then “mines” the purchased raw information. To use IQVIA’s language, they apply human data science and health benefit analytics to the data through their business intelligence tools. They slice it; they dice it; and they process it to create a product.

The pharmaceutical manufacturing giants want that product and they pay billions each year to the IQVIAs of the world to have it. It’s informational “gold” for their glossy marketing mailers sent to doctors’ offices everywhere. 

Any doctors reading this will now understand how they have become recipients of those voluminous, tree-destroying, informational mailers from pharmaceutical companies who somehow seem to know something about their diagnostic and prescribing habits.

Does this smell “off” to you? Maybe it has the distinctive stench of one of those giant dragons spawned in the Great Swamp of American healthcare.

There are many such dragons in that Great Swamp—a strange ecosystem inhabited by creatures with great maws for swallowing money without doing a thing for the sick that can possibly justify the overhead they add.

What can the doctor who’s alarmed at having played an unwitting part in feeding one of these dragons do about it?

It’s possible, although not easy, to opt out of having supposedly private information peddled and packaged as described above—which is the American healthcare system’s “default” setting for doctors. To escape, doctors must say explicitly that they want out. They should visit the AMA-provided website to stop feeding the dragon. Be forewarned—the process is a test of patience and resolve.

History approves those who come together to slay rapacious dragons. Contrary to modern fables, they’re not benign. They’re not named “Puff” or “Eliot,” and because they have the bottomless appetite of “Smaug,” they can never be trained to stop adding crushing overhead to the American cost of healthcare.

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Marion Mass MD

Marion Mass attended Penn State University, Duke Medical School and did her training in pediatrics at Northwestern’s Robert Lurie Children’s Hospital. She has worked in the hospital, ER, nursery, delivery room, outpatient practice, and urgent care settings. She twice run non-partisan symposiums on Medical Care at the Library of Congress in Washington DC. Most recently at the free to care conference on April 1, 2019. In addition she has published multiple times regarding improving cost and access to care in the Wall Street Journal, Philadelphia Inquirer, The Hill, Washington Times, Penn Live, and the Washington Examiner. She is on the editorial board for the Bucks County Courier times and Doylestown Intelligencier. She is on the board of the Bucks County Health Improvement Partnership, an organization that addresses medical care gaps at the county level. Marion is the winner of the 2018 R William Alexander Award , recognized by her Pennsylvania peers as contributing heavily to political advocacy in healthcare, and in addition is a Pa Medical Society delegate.. She founded Practicing Physicians of America with Dr. Westby Fisher, M.D., of Chicago in 2017. She and her husband Stephen C. Mass, M.D., an otolaryngologist have practiced in Bucks County for over 20 years. They have three children, 20, 18, and 15. 18-year-old Amanda aspires to be a physician… and just published a piece in the AMA’s journal, Physician Family. 

  2 comments for “How to Stop Feeding $$$ to a Dragon in the Great Swamp of American Healthcare

  1. Terry Nugent
    May 25, 2019 at 12:24 pm

    I used to work for AMA and one of its database licensees. Today the AMA data’s value to pharma marketers is primarily as a unique ID. Your tax dollars fund the National Provider Identification (NPI) file which is available for purchase as public information and is comparable to the AMA data.

    The data itself is neutral. It’s use is subject to moral judgment. The good uses are to identify prescribers who could benefit from learning about new treatments and to limit the amount of marketing material disseminated to the select few who are in the company’s target market rather than spewing it out to every doctor on the Masterfile. Marketers want to send and spend less not more on mailings, which by the way are out of vogue due to the digital explosion.

    The bad uses of the data are familiar to you and mostly involve personal promotion by detail reps.

    As to AMA’s businesses, having worked there for a decade and been a close observer since, my lay person’s view is that it is much like data: a neutral instrument. Doctors drive the policies and programs of the association. I have seen AMA shift from a conservative GOP political entity when I was there in the 80s to a Democrat alignment in the 90s. Their positions on gun control, capital punishment and the tragic anti vaccine movement are in alignment with AAP and the more progressive wing if the profession.

    I used to be in charge of convincing physicians to join the AMA (which was roughly as much fun as being in charge of MACV in the Vietnam War) and I found out through hard experience that the academe and AMSA et. al. had done a great job of demonizing AMA. Time makes ancient good uncouth and AMA has changed a lot since the 60s.

    I have no dog in this particular hunt not being in the biz anymore, but I would recommend you take in an AMA ting someday. It’s what you and your colleagues make it and you might be surprised.

    • Bridget Reidy
      June 5, 2019 at 8:46 pm

      Changed since the sixties?! Not enough. Remember they came up with the 1995 E and M guidelines, the first organization to claim having doctors document useless information was a good way to decide payment.

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