As 2010 comes to a close, it is important to look ahead to see what we can do as a profession to brighten the future of chiropractic. Among the many bits of information that have come across my computer monitor of late is a very interesting article by John Weeks of The Integrator Blog, "an organizer-writer in the emerging fields of complementary, alternative and integrative medicine since 1983."1 The article points out that the American Medical Association (AMA) has owned the current procedural terminology (CPT) codes for more than 40 years.
- Control: By owning the CPT codes, the AMA effectively keeps a lid on what doctors of chiropractic (not to mention nurses, optometrists, acupuncturists, doctors of naturopathy, etc.) can be reimbursed for. None of the other health care professions is able to create new codes that are more reflective of what they do (and should be reimbursed for) without saying "AMA, may I?"
- Influence: By controlling the CPT codes, the AMA is able to influence health care policy decisions on a national level through its relationship with the U.S. Department of Health and Human Services, particularly with the Centers for Medicare & Medicaid Services. This ultimately translates into undue influence with third-party payers who are unlikely to jump over the CPT code barrier to explore more efficient care options from non-medical providers.
- Money: Weeks estimates that the AMA's CPT-related income is approximately $71 million per year. Not a small chunk of change considering that their membership dues (from less than 20 percent of licensed MDs) is less than $44 million. Here is AMA's income breakdown for 20092 (unfortunately, the CPT-related income is not able to be broken out): membership dues $42.3 million; advertising $23.4 million; periodical subscription revenues $12.7 million; other publishing revenue $19.3 million; books, newsletters and online product sales $50.0 million; royalties and credentialing products $66.4 million; insurance commissions $34.0 million; investment income $9.6 million; grants and other income $10.6 million; and other $0.5 million.
The most important point to all this is what the AMA does with the $71 million of CPT-related income each year. The AMA typically spends between $15 million and $22 million in direct lobbying each year, something it refers to as "advocacy."Much of that lobbying is used to keep chiropractic and other non-medical professions in their place. Add to that "marketing and communications" spending that runs between $13 million and $27 million each year, and almost $50 million is spent each year to advance the AMA agenda.
Other probable uses for the money include the Scope of Practice Partnership (SOPP) campaign that began in 2006 and continues today.3 The Scope of Practice Partnership is designed to oppose any effort by any other health care profession to expand their scope into areas where the AMA doesn't want them.
Interestingly enough, the genesis of Weeks' article was a question from integrative nursing leader Mary Jo Kreitzer, RN, PhD, who founded and directs the Center for Spirituality and Healing at the University of Minnesota. What makes this interesting is that chiropractic is not the only profession looking at the unfair advantage the AMA has established with its continued ownership of the CPT codes. This battle could help us build some exciting alliances with a number of professions, particularly the nurses.
To close, I would like to offer the "recap" from Weeks' article, as it does an excellent job of presenting the important points. In the article, he refers to the various health care professions as "guilds":
- "All guilds must use the CPT if they want to participate in 3rd party payment.
- To do so, they must pay one guild, the AMA.
- This guild is pitted against their efforts to expand their practice scopes.
- In addition, this guild is apparently opposed to multidisciplinary recommendations from the brains of US medicine about the future of healthcare in the United States.
- As is clear in the IOM report, many medical doctors are not aligned with the AMA position. In fact, the AMA that received these $71-million+ each year presently counts only 15%-20% of MDs as dues-paying members."
As I look at our horizon, I can see no better opportunity for this profession to break the bonds of the AMA's hold on the chiropractic profession (and all other health care professions) than through their CPT codes.
- Weeks J. "The AMA's $70-Million Taxation Without Representation: Is It Time for a 'CPT Party' Royalty Revolt?" The Integrator Blog, Wednesday, Oct. 20, 2010.
- American Medical Association Annual Report, 2009.
- "AMA Scope of Practice Partnership Tightens Its Grip." Dynamic Chiropractic, Jan. 15, 2007.
Click here for more information about Donald M. Petersen Jr., BS, HCD(hc), FICC(h), Publisher.