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.Tweet