Tuesday, July 2, 2013

Hey, hey, AMA! How many codes did you hoard today?

I do not know what all sufficient conditions are for putting more transparency in health care costs in the United States, and reconciling gaps between fee-for-service and cost/value reconciliation based on outcomes.

But as someone keenly interested in controlled vocabularies, I can think of an obvious and necessary condition to giving tech, statisticians, and healthcare informatics folks tools to help contribute to keep costs under control: free CPT and CDT. These codes are licensed regimes -- money makers for the American Medical Association and the American Dental Association. Americans: any healthcare services is billed to you or your insurance using these codes, and the fee-for-service system has a vested monopoly profit interest in making this stuff obscure.

I do not want to knock on fee-for-service models; they are not the problem, though they can contribute (Medicare, for example, has good muscle in price controls on fee-for-service, but that does not check provision of unnecessary services not counseled by evidence-based medicine). We cannot ever really reconcile having transparency and consumer accountability for the per-service, billed a-la-carte, model when the medical billing codes for services provides are hidden behind the licensing regime of some respective monopoly.

This stuff might be painfully obvious -- and seem not copyrightable as mere fact associations (codes to labels), but the bar has historically been set really low by the US Supreme Court for "Originality" in copyright (see Feist v. Rural). So if there is no litigative solution to free these codes from their guilded overlords, my reading says we are stuck with what we have until a political, legislative solution is crafted. Congress needs a plan to free medical coding from the monopolies of the AMA and ADA -- I have to think that there must be a bipartisan way to do this (without getting mired in Congress' other axe grinding over other healthcare policy matters)?   At minimum, if they public is paying for the bulk of the continued use of these regimes, these should be open-source or public domain.

Disclaimer: I work for an academic healthcare organization; my opinions are my own and do not reflect the opinions of anyone else or any organization to which I may be associated.