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18 Voices: Forum on the AMA's $70-Million CPT Royalty Includes Calls for Action to End the Subsidy PDF Print E-mail
Written by John Weeks   

18 Voices: Forum on the AMA's $70-Million CPT Royalty Includes Calls for Action to End the Subsidy

Summary: The Integrator article that reported the $70-million royalty the American Medical Association (AMA) receives via the CPT coding system stimulated a burst of reader response. Here are notes, reflections, suggestions and responses from 17 readers: Allina integrative care director Lori Knutson, RN, BS-HN; past AHMA president Bill Manahan, MD; former ATHM editor David Riley, MD; Alternative Medicine Integration Group president Richard Sarnat, MD; Holistic Primary Care editor Erik Goldman; CAHCIM past-chair Vic Sierpina, MD; university president Jim Winterstein, DC; AANP past-president Michael Traub, ND, DHANP; author and educator Marc Micozzi, MD, PhD; NPRI executive director Carlo Calabrese, ND, MPH; an unnamed federal policy-maker nurse; ACC executive director David O'Bryon, JD; AANP president-elect Michael Cronin, ND; past ACAM president Ronald Hoffman, MD; past APMA executive director Candace Campbell; integrative clinic owner Chris Foley, MD; journalist Daphne White, CHMT; and educator-clinician Louise Edwards, ND, LAc.
Send your comments to
for inclusion in a future Integrator.

ImageThe Integrator's
The AMA's $70-Million Taxation without Representation: Is it Time for a "CPT Party" Revolt?" stimulated a fine burst of reader response - despite the fact that I had not one but two typos in my e-address on the response line in the article. (Apologies to all.) Many have forwarded the story inside their organizations. Others have sent the link on to those individuals they know in the federal policy arena. A number of others have suggested things that might be done to move information to action.

The ending of this subsidy is the "campaign finance reform" portion of healthcare reform. Power-relationships in the debate over our future would shift if one guild among the many didn't have this $70-million war-chest and privileged access to the Center for Medicare and Medicaid Services (CMS). (For another look at how deeply embedded the AMA is with CMS, check out this Wall Street Journal October 26, 2010 article based on work at the Center for Public Integrity: 
Physician Panel Prescribes the Fees Paid by Medicare.)

These wide-ranging comments from readers have in common an abhorrence of the present system of subsidizing the AMA. I conclude with some thoughts on next steps. Thank you all for this robust exchange, and to
Mary Jo Kreitzer, RN, PhD for stimulating the exploration.
____________________________


Image
Should the FTC be called in?
1. Should the FTC and Department of Justice investigate the AMA-CPT for restraint of trade?


One reader forwarded the article to "an
individual who used to work as a nurse policy person on the Hill." That nurse policy person wrote a note back to my reader in which she stated:
"Yes!  I was appalled when I was on the Hill at how much hidden power is controlled by the CPT coding system!!  Maybe DoJ (Department of Justice) and FTC (Federal Trade Commission) should investigate AMA for restraint of trade!"
Comment: This seems like the kind of issue that the Alliance for Natural Health might consider. I have no idea what the grounds might be. Lawyers?


Image
Bill Manahan, MD
2. Holistic leader Bill Manahan, MD: "Definitely time for reform ..."


Integrator
adviser Bill Manahan, MD is a longtime leader in holistic medicine associated with the University of Minnesota School of Medicine.
Your investigative reporting on CPT codes brings to light an unfair practice that may have made sense 30 to 50 years ago, but at this time is truly an anachronism. I suspect that most of us had no idea that the AMA was making large profits from being in charge of the CPT code.  It is definitely time for reform.  It is also scary that only 18% of medical doctors are part of the AMA.  That puts a lot of power in the hands of a very small number of medical doctors.  Keep up the good work."
Comment: Yes, in another time it maybe made sense. Now there seems to be a sort of violation of the separation of church and state in the special role of the AMA relative to government. This is especially true when you look at this in connection with the AMA's power to prioritize Medicare expenditures detailed in this WSJ article noted above.


Image
Lori Knutson, RN, BS-HN
3. Lori Knutson, RN: "Our ability to do our work requires exposing the underlying causes"


Lori Knutson, RN, BS-HN, runs the nation's most significant inpatient-outpatient integrative care operation for Allina Hospitals & Clinics, based out of the Penny George Institute. She addressed both me and Mary Jo Kreitzer, RN, PhD, the integrative nurse researcher whose query provoked my exploration of the topic.  

"Kudo's to you for bringing awareness to the presenting problem of the AMA/CPT code 'energy block' that has somehow covertly managed to stay quite hidden in the meridians of our dis-eased healthcare system.  Our ability to move this very important work forward does, at times, require exposing and experiencing the hidden devices of underlying cause.  Sometimes debriding is the right medicine.  I am sure that as the uprooting of our healthcare system unfolds there will be more surprises (learning's?).  Hopefully we have come to a point in our society that we realize its time to come together, let go, and remember 'We the People' created this and 'We the People' are obligated to make it right for the whole.
Comment:  Knutson's comment recalled to mind the metaphor of a healing crisis, in which things seems to get worse as they are actually getting better. It will take a good struggle (things seeming worse) to wrest the family jewels from Dear Old Dad. 


Image
Carlo Calabrese, ND, MPH
4. Carlo Calabrese, ND: "A monopoly on coding by one discipline will necessarily reflect that discipline's customs"


The first response I received from whole practice outcomes researcher Carlo Calabrese, ND, MPH, from my good friend and colleague who serves as executive director of the Naturopathic Physicians Research Institute (NPRI) was: "Holy dingus, this is a pretty impressive sally!" I told him I'd be happy to include this is the Reader Forum but asked if he had anything more to add. He offered this:
"Procedure coding is a valuable discriminator of different activities, establishing thousands of potentially well-defined categories of healthcare behavior. This is a valuable, in part, to allow different activities to be economically assessed. Coding is a reflection of the activities of a discipline and how practitioners structure their time. 

   
"A healthcare procedural coding system
should be universally applicable and acceptable. 
."
 
 
"A monopoly by a single healthcare discipline on the creation of the codes and their structure will necessarily reflect the customs of the discipline establishing it.  Nurses and CAM practitioners have felt the need to develop parallel coding systems in order to adequately define their own activities due to the lack of coverage of aspects of their care in 'Current Procedural Terminology' for medical doctors. 

"A healthcare procedural coding system should be universally applicable and acceptable.  In the coming era of electronic health records, finer discrimination among the activities of all types of practitioners and variants of care will help yield the benefits in healthcare improvement that are possible with widespread use of electronic data.

Comment: Just the facts. And the fact is, the AMA lens will never yield the "facts" about other disciplines, and thus will prevent us from adequately assessing the value of other practitioners. Garbage in, garbage out.


Image
David Riley, MD
5. Editor David Riley, MD: 
"If you can't (code) it, it doesn't get stocked, and it can't be purchased..."

New Mexico-based David Riley, MD, is a long-time integrative practitioner who may well have coined the "integrative medicine" term. He has had a relationship with ABC Codes (formerly Alternative Link), an alternative coding system developed to better capture alternative medicine and nursing practices. Riley, who was until recently the editor of Alternative Therapies in Health and Medicine, is presently exploring ideas for a new journal. He suggested "some fact checking re. initial monopoly and relinquishing of the monopoly" - which I haven't done. Caveat emptor.

"Great article/exposé on coding.  

"It is ironic, given your article, to reflect on attending a meeting on coding a bit more than 10 years ago held in Chicago and hosted if I am correct by Michael Beebe, the then director of the AMA coding system.  

"Some of the senior members of the CAM community (MDs practicing acupuncture and NDs) wanted to 'play with the AMA' and get CPT codes for two reason:  they were the 'real' codes, and they were afraid if they used an alternative to CPT their service fees would be discounted. 

   
" I think we can dream on if we think
that the AMA, a guild for physicians, will
every offer substantive codes for non-docs."
 
 
"I have come to recognize (and this was underscored at the recent meeting in DC) that there is value in having representation on the CPT coding panel to get the language changed from things like 'MD' to 'all licensed health care providers,' particularly in the area of E/M [Evaluation/Management] codes. However, I think we can dream on if we think that the AMA, a guild for physicians, will ever offer substantive codes for non-docs.  

"If the AMA can't even offer codes for nursing do you think they will ever offer codes for acupuncture? I liked your 'under my thumb' allusion.

"It is interesting that the dentists pulled out and established their own code sets some years back.

   
   "CPT codes are relatively unique to the US. 
In other parts of the world there is
no AMA to block coding efforts."

"I have been told that at the time the AMA formally implemented the CPT codes they were granted statutory monopoly by CMS. (I believe) this was rescinded some years later (1997?) under threat of legal action, but by this time it didn't really matter, they owned coding in the US.  And CPT codes are relatively unique to the US.  In other parts of the world there is no AMA to block coding efforts.

"Maybe this time around things will be different.

"The best way to keep a product out of the grocery store is to not give it a bar code - if you can't track it, it doesn't get stocked, and it can't be purchased..."
Comment: Looking abroad may be the first step. In fact, I hear that the next round of ICD codes may pose a challenge to the AMA's hegemony. (Check question #8 here.)  Then AMA coding director Michael Beebe's May 30, 2002 statement on the AMA's "plans for developing codes and descriptors for alternative therapy" which references negotiations with Alternative Link is available here.


Image
Jim Winterstein, DC
6. NUHS president Jim Winterstein, DC: "He who holds the gold makes the rules ..."

Jim Winterstein, DC is president of the multidisciplinary National University of Health Sciences (NUHS) in Lombard, Illinois. He is routinely connected to the payment and delivery system as a board member of Alternative Medicine Integration Group, an Integrator sponsor.
"Excellent article that reminds us all that 'he who holds the gold makes the rules.' In this instance, the 'gold' is the CPT and the AMA certainly does hold that 'close to the vest.'

"Their 'patient safety' argument reminds me of the Wilk vs. AMA trial in which they used the same argument. It did not hold up then and it does not need to now. You have made public some little known but much needed information. Keep up your outstanding work."

I wrote back to Winterstein with the information reported through the Center for Public Integrity about the "secretive" AMA committee that basically decides how large the buckets will be for each discipline when Medicare resources will be dispensed. If a campaign took on both of these issues, I said, we'd "have a tiger by the tail." Winterstein wrote back:
"Oh, we have a tiger by the tail alright and for many decades this one has hunted successfully wherever and whenever it wished to. Perhaps the time has come, as it always does, for the cycle to change. Getting the real attention of the right legislators is necessary and I think (US Senator Tom) Harkin and (US Senator Orin) Hatch are key as well. Regardless, however, the $20-million that the AMA is able to spend on the process can be very intimidating as we have all learned, BUT that is no excuse to stop trying. We did win Wilk vs. AMA and with a coalition of various non-allopathic providers it can happen again and even better this time!"
Comment: Coalitions. Here is the beginning of a dream team. 1) Coalition for Patient Rights, 35 organizations, led by nurses and including many integrative practice groups, specifically established to defend against AMA suppression of others; 2) Patient Access to Responsible Care Alliance (PARCA), an organization of advanced practice nurses, psychologists, optometrists, physical therapists and including chiropractors, that often chaff under MD control; and 3) Integrated Healthcare Policy Consortium (IHPC), a lobbying organization for the integrative practice field. Now we just need to scare up the impassioned donors who would like to have a hand in creating this change by helping knit these forces together to boost healthcare toward the multidisciplinary, collaborative, mutually respectful future that the AMA resists.


Image
Victor Sierpina, MD
7. Victor Sierpina, MD: "Collusion with CPT, AMA and major insurers including CMS"

Vic Sierpina, MD is the integrative medicine lead at the University of Texas Medical Branch at Galveston and immediate past chair of the Consortium of Academic Health Centers for Integrative Medicine. We wrote:
"I was speaking about this yesterday to an attorney, J Stuart Showalter who is writing a 6th edition of his book on The Law of Healthcare Administration.

"When he asked me if health reform would significantly affect my practice, I alluded to this collusion with CPT, AMA, and major insurers including CMS.

"This CPT thing has driven reimbursement for years and it is amazing the amounts of money involved. I wonder how much it costs them to update it annually?

"As you know, the ABC Coding solutions have offered another option more user-friendly for complementary practitioners with great granularity regarding service types, provider types, etc. This would be an advance if insurance and Medicare would also accept these codes in parallel or instead of the CPT codes.

"The moneyed interests would likely fight tooth and nail to continue to defend CPT as the sole game in town.

"Thanks to you and Mary Jo for doing the expose on this matter."
Comment: Sierpina's comment underscores what significant elephants in the room were the AMA's CPT ownership and the parallel AMA guidance of Medicare payments during the entire healthcare reform debate. It shouldn't surprise that US medicine would attempt to fix something without addressing these underlying causes.


Image
Marc Micozzi, MD, PhD
8. Mark Micozzi, MD, PhD:  Recalling the IHPC meeting with the AMA on CPT


Author and sometimes integrative medicine academic Mark Micozzi, MD, PhD was stimulated to recall another coding-related meeting nearly a decade ago of integrative practice interests and what is now CMS.  He starts with his response to my question about whether it is time to end the subsidy:
"Yes. Do you remember the story about our IHPC [Integrated Healthcare Policy Consortium] group led by [attorney] Alan Dumoff which met to prepare testimony to CMS re the expansion of CPT codes under their contract to AMA? AMA showed up and guaranteed expansion of their HCPAC [to representatives from other disciplines] for addition of CPT codes. This was all in February 2003.

"The highlight was the group going to Ford's Theatre one night with (then IHPC executive director) Matt Russell to see (comedian) Mark Russell and running in to then US Surgeon General Carmona. It is a good story."

Comment: The IHPC-led meetings led to an expansion of AMA's CPT advisory group, HCPAC (Health Care Provider Advisory Committee) to include representatives from the naturopathic and massage fields. Carmona had used Mark Russell's services during his campaign for the US Surgeon General. It is good to be reminded of the fun associated with some of this work. Let me see, I was on sabbatical in Costa Rica while Micozzi, Russell, Dumoff, Bruce Milliman and otheres were working this.


Image
Would Captain Kirk have allowed this?
9. Michael Cronin, ND: "How different our system would have been had Captain Kirk played Dr. Kildare!"


Michael Cronin, ND, sent this response based on his decision to follow my hot-linked reference to the era of Dr. Kildare when the AMA's cozy relationships with CMS and the CPT were cooked up. Cronin is co-founder of Southwest College of Naturopathic Medicine and president-elect of the American Association of Naturopathic Physicians.

"Great article. I did follow the Dr Kildare link and learned that William Shatner turned down the role."  
He notes that under "Fun Facts" on the link it says that "over 30 actors auditioned for the lead role with William Shatner (aka Star Trek's Captain Kirk)  the eventual winner, though he then declined it. James Franciscus was also offered the role but had committed himself to another (eventually unmade) series at the time." Then Cronin adds:
"It can only be imagined how differently our health care system would now be if Capt Kirk had taken charge."
Comment: Now the next theme for up to 250 word reader reflections is "how would our health system be different if Captain Kirk had taken charge?" Discuss amongst yourselves.


Image
Ronald Hoffman, MD
10. Ronald Hoffman, MD: "Finally a laudatory comment to your publication ..."


Integrative medicine leader and radio host Ronald Hoffman, MD was, like Foley (below) was last seen in these pages opposing my view about Berwick. Hoffman is the past president of the American College for the Advancement of Medicine. He wrote:
"We've had our differences on health policy, John, but you're dead-on with this one.  I wholeheartedly support your efforts!
Hoffman suggested that the theme be on his radio show. I asked if I could publish his comments and he responded: "It would be my pleasure to finally add a laudatory comment to your publication. ;-)."
CommentAh, the uniting power of a common enemy! Let me rephrase that in more correct terms: " ... common opposition to the bad behavior of the AMA leaders ..."

Image
Michael Traub, ND, DHANP
11. Michael Traub, ND: "Ready to join the CPT - Consumers for Pluralistic Treatment - party ..."


Michael Traub, ND, DHANP, is a clinician on the Big Island of Hawaii, member of the board of IHPC and a past-president of his national professional association, the AANP.
"Great investigative piece on the CPT subsidy.  If there's interest, I would join the CPT party (Consumers for Pluralistic Treatment?). Would be nice, also, for Congresspeople (i.e. Harkin, Sanders, Mikulski) to sponsor legislation to end this subsidy and help to further emasculate the AMA."
Comment: I can just see the proposed federal legislation, with a non-descript, under-the-radar title: "An Act to Emasculate the AMA." We do need perspectives of some health policy attorneys om what can be done if we are even to dream on creating change here.


Image
Chris Foley, MD
12. Chris Foley, MD: "You can't play with 3rd party currency that tell you what your time is worth"


Chris Foley, MD was last seen here in the Integrator opposing the appointment of Don Berwick, MD to head CMS. Foley has run health-system and community-based integrative centers. He is presently owner of Minnesota Natural Medicine.
"John, John, John....it was on this exact topic that I testified more then 10 years ago when the 'Commission on CAM [White House Commission on CAM Policy] came here to Mpls.  Everyone told me to talk about nutraceuticals, but I insisted on talking about the 'codes' and the payment system.  All were uncomfortable.  Mary Jo (Kreitzer) should remember this.  I said that as long as this system and coding remained in place, CAM was sunk. 

"You are now getting warm!!!!!!!  You cannot play with 3rd party currency (the codes) that effectively tell a practitioner what their time is worth.  It all falls apart from there.  If the George's cute little center were not subsidized by them and the AbbottNW Hospital, it would have failed long ago.  Same with Mark Pacala and American Whole Health which failed after I told [him] that if he tried to play the insurance game he would lose. He did. Lots.

"This is where the real war needs to be played.  I am happy to comment, write more on this if you wish!"
Comment: I personally doubt that the decision to take insurance and use the CPT killed American Whole Health (there ere other factors) and disagree that the Allina initiative deserves to be characterized as  "cute little center." We also disagreed on Berwick. However, I will give it to Foley that he was in the right ballpark a decade ago when he was raising issues about the CPT's limitations. I have invited Foley to provide additional commentary.


Image13. Holistic Primary Care editor Erik Goldman: "CPT is the master control system for the whole medical industrial complex ..."


Erik Goldman is a long-time medical reporter who has for ten years served as the editor of Holistic Primary Care, which he co-founded. 
A past Goldman Integrator submission was an extraordinary piece on the IOM Summit on Integrative Medicine.
"Nice work, John & Mary Jo! The CPT codes are  the master control system for the entire medical industrial complex....and it is a piece of copyrighted intellectual property owned by a trade organization. It is the principal life support for the AMA as an organization and as a political/economic force. Do you know of any other organization that could survive on membership enrollment of LESS THAN 20% of eligible potential members?

   
"The CPT system is one of the gravest
dangers of insurance-based medicine.


"It always struck me as total insanity
when I would hear eager naturopaths,
nurses, massage therapists, midwives
and others clamoring for inclusion
in the insurance plans.

"
Even farm animals do not hasten
to their own slaughter!

 
"Contrary to popular belief---and the AMA's propaganda--this organization does not represent the interests or opinions of most MDs, and it hasn't done so for decades. MD membership--especially among younger doctors--has been declining for years. But membership doesn't really matter when you control the means of transaction for an industry that represents between 15%-20% of the nation's GDP!

"The CPT system is one of the gravest dangers of insurance-based medicine. The insurance systems were, are and will continue to be governed by allopathic/pharmaceutical medical thinking. Which is why it always struck me as total insanity when I would hear eager naturopaths, nurses, massage therapists, midwives and others clamoring for inclusion in the insurance plans. ARE YOU NUTS??? Even farm animals do not hasten to their own slaughter!

"For sure, the Obama plan will create more 'opportunity' for nurses & physician assistants. There are not nearly enough primary care doctors to fill current---let alone future--needs. The government hopes to fill the gap with 'mid-level' providers---i.e. people who can be forced to handle the same workloads (or greater), for lower pay than the already underpaid primary care docs of today. The insurance companies will be fine with that, so long as it looks like it'll save money. 

"Some 'golden age' for nursing!!

"Mary Jo is so right on in asking why the other professions should tithe to a master that oppresses them. The deeper question is, What law says you have to work for that Master in the first place?

"Direct-pay practice models on the MD side are popping up all over the country, and there's no reason they couldn't or shouldn't exist for nurses & other healthcare professionals.  Direct-pay need not be overly expensive or 'chi chi,' it strips out much of the stupid burdensome overhead of standard insurance based health care, and it frees practitioners from bondage to the AMA-owned CPT system. What's not to like about that?"
Comment: Goldman and Holistic Primary Care have been providing some doctors a service in exploring other models via their Heal Thy Practice conferences, the most recent in June of this year. I am one of the "nuts" people who thinks we need to work out our relationships with 3rd party payers.


Image
David O'Bryon, JD
14. Association of Chiropractic Colleges exec David O'Bryon, JD: "Statute of limitations ...?"


David O'Bryon, JD is executive director of the Association of Chiropractic Colleges. In that position, O'Bryon, a former Congressional staffer, is involved in a good deal of lobbying work. His first response was quite brief: "Amen!" I asked if he might have more to add. O'Bryon wrote back:
"Perhaps a better one is: Doesn't Pharma even have a statute of limitation on proprietary products? Why none here?"
Comment: Nice idea. Or better yet, the circa 1965 CPT deal should have come with a sticker that appreciated that after a certain date the utility of the agent would expire. We need a post-facto Sunset clause.


Image
Candace Campbell
15. Former IHPC leader Candace Campbell: 'What about those ABC Codes?


Candace Campbell, a past executive director of what was then the American Preventive Medical Association and became the American Association for Health Freedom (and is now the Alliance for Natural Health) wrote a quick question:
"What ever happened to Melinna Gianini's ABC Codes? She was working on codes for alternative practitioners years ago for all the reasons you outline."
I called Giannini. The codes, expanded to include nursing, are in use in some places, including the Dubai Healthcare City. I invited her or her associates to send a commentary.


Image
Richard Sarnat, MD
16. Richard Sarnat, MD: "Hospice is a model of the integrative care which the CPT hinders ..."


Richard Sarnat, MD is an ophthalmologist and entrepreneur in integrative medicine. He is president and co-founder of Alternative Medicine Integration Group, an Integrator sponsor. Sarnat's report on the IOM Summit on Integrative Medicine, for which Sarnat was invited by the IOM to participate, was reported here.  
"Time to point out once again that the emperor has no clothes and we subsidize the mass delusion perpetuated by the profession that they are delivering effective care at a reasonable cost. Neither of these statements is true. Worse, as you correctly state, this continues by taxation without representation to a guild which is blind both to it's own shortcomings and the inevitable integration of all Health care professionals.

"Since reading Medical Nemesis by Ivan Illich almost forty years ago I have known intellectually that the industrialization and institutionalization of our most basic care functions, such as birth and death are at the root of many of our paradigm problems.

"This fact was now played out poignantly as I acted as my father's home based Hospice team leader and physician. His team was composed of all family members: mom , sisters, brother in laws and nephew. He passed quickly and peacefully and in so doing transformed my entire family to discover themselves and each other in a new light. It was my family's greatest trial and their greatest triumph.

"The roles played by nurse care managers, social workers and support staff was exemplary and illustrated how a well thought out and caring model can actually function within the totally dysfunctional "system" created  in part by the narrow focus of the CPT monetized model (see I did get back to the point after all).

"While I am pleasantly surprised that this opportunity exists for true integrative care within our end-of-life model, it only further highlights the precious loss of value that integrative care could afford all of us a little earlier in the life cycle.

"Kudos to the Hospice movement for developing a reimbursement model that actually allows for great home based care."

Richard L. Sarnat MD
Comment: The Chicago Tribune obituary for Leonard A. Sarnat, MD, the father of Richard Sarnat, MD, notes that the elder Sarnat died at 86. Leonard Sarnat's life had, and continues to have, an impact on anyone who finds value from time to time in the Integrator or relationships developed through Integrator ideas or content. Why? Leonard's son, Richard, was an early supporter of the value of the Integrator in fostering integrative care models such as the hospice experience he describes. The firm Richard Sarnat co-founded, Alternative Medicine Integration Group, has been a steady sponsor of this work since 2007, a commitment of over $50,000 to date. Thanks Drs. Sarnat!



Image
Daphne White, CHTP
16. Integrator columnist Daphne White, CHTP: "Did you see the CPI piece ..."

Sometime Integrator columnist Daphne White, CHTP,  sent notice of the quite related work by Joe Eaton of  the Center for the Public Integrity (CPI) on the AMA's cozy relationship with CMS:
"Just LOVED your piece on AMA and those CPT codes. You might want to send it over to Sen. Grassley's office. From what I gather, he's the only one independent enough and gutsy enough to go after the AMA. (You might also send your piece to the Center for Public Integrity -- see below.) Meanwhile, here's more (infuriating) grist for your mill."
White attached Eaton's article, Little-Known AMA Group Has Big Influence on Medicare Payments, that was published October 27, 2010 through Kaiser Health News, the same date the Integrator CPT alert went out to subscribers. I subsequently spoke with Eaton who indicated the CPI story was part of a broader CPI exploration of Medicare.


Image
Louise Edwards, ND, LAc
17. Practitioner-educator Louise Edwards, ND, LAc: "Anyone working on this?"


Durango, Colorado-based Louise Edwards, ND, LAc  is a long-time practitioner who for years was involved in state licensing and national political efforts for the naturopathic profession. Edward teaches at a number of the naturopathic medical colleges. She put the question: 
"Wow!  I had no idea. Any thoughts about how to deal with this?  Anyone working on it?"

___________________________________________

Overall Comment
Thoughts how to deal with this? How about: Drop everything and organize. Fun, maybe. Another windmill? Maybe. But not possible, for me or any of us, I suspect, to drop everything.

   
Who would have thought that the
transformation of US healthcare
would rest on this necessary
but not sufficient
change?

 
Here is an insight on a direction, a note sent from a reader: "I have been forwarding this stuff to national nursing colleagues and there is a good buzz. We have the American Academy of Nursing meeting in DC the week after next." Forward the October 26 Integrator or the link to the article to your own colleagues, organizations, organizational members and lists. I took the step to urge a leader with the Coalition for Patients Rights (CPR) to send the article to those 35 member organizations. CPR would be a good carrier of this initiative. I have also been part of e-talk about how to get this out to other media, and into the offices of key Senators. Got any ideas? Follow them!

At this point this is all grassroots, "good buzz" as the reader said. There is no question that no single guild should have the control that the CPT and its royalty together give the AMA. I'll keep plugging away, here and there, and share developments as useful. It would be good, wonderful even, to see this through to a positive change. Who would have thought that the transformation of US healthcare would rest on this necessary but not sufficient change? What can you do?


Thanks to all of you for taking the time to share your comments.

Send your comments to
for inclusion in a future Integrator.


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Issues #60-#62 - March-April 2009
Issues #57-#59 - Jan-Feb 2009
Issues #55-#56 - Nov-Dec 2008
Issues #51-#54 - Sept-Oct 2008
Issues #47-#50 - July-August 2008
Issues #46 & -#47 - May-June 2008
Issues #43-#45 Mar-April 2008
Issues #41 & #42 - Feb 2008
Issues #39 & #40 - Dec-Jan '08
Issues #37 & #38 - Nov 2007
Issues #35 & #36 - Oct 2007
Issues #33 & #34 - Sept 2007
Issues #30-#32 - July-Aug 2007
Issues #28 & #29 - June 2007
Issues #26 and #27 - May 2007
Issue #25 - April 2007
Issues # 23 & #24 - March 2007
Issues #21 and #22 - Feb 2007
Issues #19 and & 20 - Jan 2007
Issues #17 and #18 - Dec 2006
Issues #15 and #16 - Nov 2006
Issues #13 and #14 - Oct 2006
Issues #11 and #12- Sept 2006
Issues #9 and #10 - Aug 2006
Issues #7 and #8 - July 2006
Issues #5 and #6 - June 2006
Issues #3 and #4 - May 2006
Issues #1 and #2 - April 2006
All Articles by Subject: 2006
All Articles by Subject: Jan-June 2007
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