AMA President, Pancreatic Cancer and CPT Codes - A Legacy for Patients?

Dr. Ron Davis, president of the American Medical Association, has been diagnosed with Stage 4 pancreatic cancer.

He joins some well known names who have been diagnosed with this incurable cancer -- Dr. Randy Pausch, and Patrick Swayze. I've lost a personal friend to it in the past year, too.

But Dr. Davis is in a unique position to help others, both those diagnosed with pancreatic cancer, and we patients who have been diagnosed with other problems, too....

This is what he can do:

The AMA is the determination body for all the codes used to diagnose and treat us by doctors who want to get paid by insurance. They are called CPT codes (Current Procedural Terminology). There are thousands of them, mostly 5 digits long, and they are assigned to every little task and service provided by any type of doctor -- primary care or specialist. Oversight of these codes is worth $70 million to the AMA each year.

The problem is this: there is no CPT code for care coordination.

Patients are frustrated constantly (I know, because I hear from them!) about their inability to get any doctor to look at all their records and help them get a clear diagnosis, or make treatment decisions, or even just look at the big picture of their care. Cancer patients in regular treatment aren't told they need a flu shot, because no one is looking at the big picture. Diabetes patients being treated by an endocrinologist don't think about getting a colonoscopy because their specialist is only paying attention to hormones. The list goes on.

When I ask primary care doctors about this, their answer is always the same. "I have no way to bill for that time. There is no billing code I can use to get me reimbursed for it. I would go out of business."

That's a fair answer -- no matter how frustrating it is!

So that means -- the gatekeeper to getting that kind of coordinating care is the AMA. And that's how Dr. Davis can help. His cancer experience will help him understand just how important it is to have someone who can see the big picture -- and I would hope he would take that much clearer understanding, and leave a very positive legacy for patients -- the billing code that will make patient care coordination possible -- the "big picture review" code that patients desperately need.

I wish Dr. Davis well. I know this is a difficult time for him and for his family. And I hope he realizes how good he will feel about leaving such a pro-patient legacy behind.
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References:

How CPT and HCPCS Codes Affect Your Care

How Your Credit Score Can Affect Your Hospital Care