Ms. Pipes states: “Much of that dissatisfaction stems from the organization’s support for President Obama’s contentious health care reform package.” The survey, conducted by physician recruitment firm Jackson & Coker, discovered that more than three times as many doctors believed that the quality of American health care would “deteriorate” rather than “improve” under ObamaCare; and nine of ten physicians think ObamaCare will have a negative impact on their profession. Most member driven organizations would collapse with such negative trends; but the AMA survives by collecting up to $70 million from its exclusive relationship with the federal government to provide CPT Codes in direct conflict with medical doctors.

The Current Procedural Terminology (CPT) code are maintained by the Chicago-based American Medical Association to describe medical, surgical, and diagnostic services and is designed to communicate a uniform set of information about medical services and procedures to physicians, patients, accreditation organizations, and payers for administrative, financial, and Medicare and Medicaid billing coders. These codes have been designated by the U.S. Department of Health & Human Services to be published for treatment guidelines and billings.

Federal and state spending on health care is $1.1 trillion; about 42% of all healthcare spending in the U.S. last year. CPT codes set average physician and hospital reimbursement rates. For example the average physician rates for treating Medicare beneficiaries is 81% of the rate private insurers pay and for Medicaid patients the reimbursements are just 56% of the private rate.

American Medical Association 2009 revenue according to “Hoover’s Company Profiles” was $248 million; with $70 million of income coming from “publishing”. This is an especially large percentage of revenue, considering that the AMA membership dues were only $42 million.

The AMA is adamant that this publishing involves over 100 books; but the AMA refuses to break out what part is not CPT code related. The sensitivity to full disclosure of CPT revenue is further heightened by the May 2009 announcement that 100 members of AMA’s 1,200 member staff would be laid-off; presumably due to falling membership dues.

On July 16th 2009, the AMA shocked the physician community by publicly endorsing the House Healthcare Reform Bill; which was passed on March 23 2010 as the Patient Protection and Affordable Care Act. Nick-named ObamaCare, the Law conveniently maintained the AMA’s monopoly on CPT billing codes. Dr. Daniel Palestrant founder of SERMO, the largest online exclusive physician’s network, summed up medical doctor frustration with the AMA:

“With estimates ranging that 15-40% of each healthcare dollar spent going towards administration overhead and administrative overhead and physicians largely blaming CPT codes for this problem.”… “ In the healthcare debate it is rare that we find a single issue that all parties can agree is a big part of the problem. Too much paperwork and complexity in the billing process is one of those few things. … “For most physicians, Current Procedure Terminology or CPT codes have become a defining aspect of how we must practice medicine. They have become the “currency” of healthcare, mandating all manner of payments to physicians from the most complex surgical procedures to routine office visits. In the process, the CPT coding system has turned into an incredibly complex system of codes, modifiers, and exceptions.”

ObamaCare was sold to the public as good medicine; based on the strident support of the American Medical Association. Given the crumbling AMA membership; the preservation of CPT coding system in ObamaCare represents the ultimate collusion of convenience between the business side of the AMA at the expense of physicians and patients.
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The group is helping make the case to patients across the country about why Obamacare might be bad for their health.  Rather than spin, these doctors are offering facts born from their decades of practicing medicine on America’s frontlines.  They know the consequences for the quality of care when the government gets involved and the folly of many of the reckless assumptions the Obama plan makes.

Dr. Dorin recently appeared on my show and has been kind enough to share some of his personal insights.  As the townhalls of two summers ago showed us, the best way to fight Obamacare is at the grassroots level with cold-hard facts.

Here is what Dr. Dorin and his colleagues wanted to share with us.

An Open Letter Debate Challenge On Obamacare

It is my duty as an American to question any orders or directives from a superior ‘officer’, even the President of the United States, if those orders conflict with my responsibility to uphold the principles and Constitution of the United States, and if they impede my work to preserve the sanctity, safety, and security of its citizens.  Further, I am concerned that there has not been an honest, open and transparent discussion on the true merits of ObamaCare, which the public fully understands.

To this end, I hereby challenge any top leading expert in America who is a supporter of the President’s vision for our national medical system to a fair and open public debate.

As a board-certified specialist in anesthesiology, medical director, military officer, small business owner, and family man, I am troubled by several themes laced within the thousands of pages of the President’s health care reform law.  I’ll leave it to the majority of states who have sued the administration to sort out the proper interpretations of the 5th and 10th Constitutional Amendments. What concern me most are the five gravely flawed underpinnings:

1.  The attempt to ’socialize’ and ‘equalize’ health care “providers” so that the lines of distinction between physicians, nurses, and ancillary personnel are blurred.  Why?  Are the hundreds of years of tradition and time-honored values embodied in the M.D. (medical degree) of no significance?  Does the President not see consequences of his actions to elevate non-physicians to practice beyond the safe boundaries of their scope of training?

2.  The deliberate attempt protect the one segment of society, trial lawyers, who contribute nothing to the care of patients, at the cost of the entire medical delivery system.  Physicians, nurses, hospitals, equipment manufacturers, insurance companies, and patients are all asked to make shared sacrifices to save money and increase access to health care services; in contrast, attorneys are protected at all costs. The ‘trial malpractice reform test centers’ are a joke. The President takes tort reform seriously.  Why not this?

3.  After a year of painstaking discussions and disagreements among lawmakers, the President endorsed over two thousand pages of legal-ese to make a point of his resolve.  Yet after much political chest thumping, Pelosi and Reid, allowed over one thousand waivers to the very law he created.  Why the waste and duplicity?

4.  Great lengths were taken to protect the unions.  Why bail out the unions, but leave the patients and doctors to fend for themselves?

5.  A minority census of doctors-in fresh white coats provided for them at the door-assembled in a White House lawn ceremony purporting to show the solidarity between America’s physicians and the PPACA legislation.  What the President forgot to say to the cameras that day, or since, is that these doctors were only members of the American Medical Association (AMA), an increasingly abandoned and disregarded group with a membership of practicing physicians today of only ten percent.

Furthermore, the AMA receives about one hundred million dollars in exclusive copyright royalties each year from the federal government, a fact not disclosed to the American people.

The President’s misrepresentation of health care statistics to falsely denigrate our current medical system is but another important topic for discussion-one that we can have openly before the American public.  That is should anyone accept my challenge to a debate.

Adam F. Dorin, M.D., MBA is the co-founder of The Doctors National TEA Party and the founder of America’s Medical Society. He lives and practices medicine in Southern California.

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On Saturday, Andrew Breitbart approached doctors signing teachers up en masse and was told he has ‘[Gov. Scott] Walker Pneumonia.’ Upon putting down his real name, and stating he wasn’t sick and that did “didn’t want to get in trouble,” with cameras filing the scene, one of the alleged doctors became suspicious and demanded that the cameras be shut off.

BigGovernment.com blogger Christian Hartsock and prominent Madison-based blogger and U of W law professor, Ann Althouse chronicled the mass fake doctors note sign-ups, as well.

On Sunday, the Teachers Union backed down and told its members attend class on Tuesday.

The University of Wisconsin says any doctors who signed notes did so on their own behalf — and without the approval of the university.

The Atlantic talked with the head of Wisconsin’s Center for Bioethics:

After viewing the videos at my request last night, Dr. Arthur Derse called me up exclaiming, “Holy mackerel! It’s much worse than it looked in the paper. I’m stunned, absolutely stunned.” Dr. Derse is the Director of Center for Bioethics and Medical Humanities a the Medical College of Wisconsin. “When all’s said and done, it’s really the profession of medicine that has the black eye in this case,” he says.

There is no question these doctors are masking political opinion in the white coat of the medical profession, Dr. Derse believes. “The videos are pretty damning.”

It’s sad, but what puzzles me most is how in the world three of the four physicians I can identify from these videos and other media reports are faculty members of UW’s Family Medicine department, and one is a senior resident in that same department. It’s a good training program, committed to providing sorely-needed primary care doctors to the state of Wisconsin. It teaches professionalism, and its faculty are supposed to model integrity. What were they thinking?

They’ve managed to belittle a public trust between physicians, employers and patients. A doctor’s sick note is a serious document. It represents an employer’s desire to verify through a respected, independent, medically qualified third party the fact of an illness and the true need for convalescence. In the videos now circulating online, we witness multiple members of a noted family medicine department trash one of the well-recognized rights and privileges of their profession, with little forethought as to the consequences.

The AMA endorsed Obamacare when member physicians were fiercely opposed. The groups early support was one factor that contributed to the bill’s passage, contrary to the expressed will of the majority of member physicians.

The answer lies in the AMA’s revenue stream. The AMA has been a puppet of the government since the early 1990’s in order to protect their multi-million dollar monopoly on the CPT coding system that all doctors have to use to bill Medicare and insurance companies, the licensing of which provides the AMA over 70 percent of its income.

The AMA earns only a fraction of its revenue from dues it receives from doctors, representing only 17 percent of doctors nationwide, according to their website. The lion’s share of AMA’s revenue, about $118M, comes from the sale of copyright publishing of billing codes for medical procedures and services.

How the AMA made medical code writing a multimillion dollar business

Before CPT Codes existed and when ICD-9-CM codes were just being developed, doctors had to write out in words what symptoms a patient had, what the diagnosis most likely was, and what visits, services, and procedures they thought they should get paid for. Then in 1966 Current Procedural Terminology or CPT was designed by the AMA to assist doctors in billing Medicare and health providers using codes. Doctors use the CPT Codes to specify to health care providers the service rendered so that they can get paid.

Headquartered in Chicago (Obama’s hometown, no citation needed), the AMA also controls the CPT Editorial Panel and CPT Advisory Committee, along with the staff which is responsible for editing, adding, and deleting CPT Codes.

Until now, doctors had rarely been politically active (unlike lawyers); their tendency was to back away, knowing they could do little as individuals. For years the membership ranks of the AMA have dwindled, but when the AMA betrayed the very people it was ostensibly meant to represent, doctors began organizing on their own.

“No one came to the forefront of the medical debate for the good of the doctor-patient relationship,” said Dr. Joe Whitaker, who founded the United States Medical Association to repeal Obamacare. “Government run healthcare is impossible to afford and impossible to implement.”

The AMA endorsed Obamacare as a way to protect its medical coding monopoly with the federal government, in-turn, the Obama Administration recieved the medical communities support for socialized healthcare – that was the deal. “Dollars are driving the entire process,” said Dr. Whitaker. “Doctors and patients want a national voice different from the AMA that is not controlled by the educational elite.”

Now, we know why doctors were standing behind the President in lab coats during the healthcare PR events at the White House.

Essentially, where Medicare goes, insurers follow for the guidelines in covered services and baseline physician fee schedules for private payers as well as worker’s compensation and automobile insurance companies in most states, as well as Medicaid and Medicare itself.

What Pelosi has effectively done is saved the insurance companies who use the Medicare fee schedule millions of dollars of payouts to physicians on their claims–regardless if the patient is a Medicare patient.  I’m not seeing the insurance lobby out there right now, are you?  However, on the provider side, the doctor’s lobby groups are outraged at Pelosi’s failure and the damage this inaction will cause physicians–especially private–and force them to layoff employees to make up for the loss in reimbursements to cover their enormous monthly overhead costs.

Pelosi is completely ignorant of the doctor’s fee schedules and how their reimbursements are calculated.  In a multilayered approach and working with the Centers for Medicare and Medicaid Services (CMS), the AMA Resource-Based Relative Value Scale (RBRVS) is used and the AMA/Specialty Society Relative Value Scale Update Committee (RUC) makes annual recommendations regarding new and revised physician services to CMS and performs broad reviews of the RBRVS every five years.  These values have not been adjusted since the 21% fee schedule reduction took effect and for Pelosi to ignore the fact that the doc fix will actually cost doctors to see their patients because their fees will be reduced, but the cost of providing the services and the supplies needed have not gone down and in some cases, continue to rise.  Additionally, student loan payments have not been decreased by 21% for doctors, have they?

The only business segment to ultimately win is the insurance industry.

Real-world exit questions:  If you own a company and your revenue just got nicked by 21%, but your supplies and cost of services has remained the same, how long before you will have to layoff employees to cover your monthly costs?

Do people understand that private practice physicians take most, if not all, of their salaries on assignment?  Physicians must do this because of provider contracts and other variables, but their fees are not a guarantee of payment; claims can be denied in part or in full.  (Some lawyers take their fees on assignment, but it is their choice.)  And now, doctors are being used as political pawns by the Democrats.

Is it possible that the Democrats are attempting to push doctors into the union, say the SEIU?  Only those doctors who are in private practices, not employed by hospitals cannot unionize, so what’s next for them?

Nothing like having a bunch of bureaucrats who have no idea about healthcare, costs of providing services,  running a business, covering overhead, etc. in charge of your salary, covered services, and future.

Finally, this is clearly a Democrat problem, after all, “You won.”  And by that, Americans now understand that to mean that the Democrats are clearly the party of cry-babies, finger-pointers, and blame-shifters.  And job killers, because if your more than $800 billion stimulus and jobs bills actually provided jobs, we wouldn’t need unemployment extenders in current legislation.  Americans would actually be back to work, wouldn’t they, Nan?

Medicare, the federal government’s health care insurance plan for the elderly and disabled established in 1965, is largely funded from payroll taxes and FICA, and supplemented with premiums paid by its beneficiaries. It is administered by the Department of Health and Human Services via the Centers for Medicare and Medicaid Services (CMS), and is the place to look to see how our government will administer a health care system.

Since 1998, the SGR has been a component of the formula used to calculate physician payments for providing services to Medicare patients. It is based on the GDP and not on actual health care practice costs (which have been rising faster than the GDP.) The SGR produced steep cuts in physician compensation for services to Medicare patients, in hopes that by paying individual physicians less, overall health care cost would decrease.

Unfortunately, this approach has failed.

Pay to physicians caring for Medicare patients has been stagnant, while health care costs have gone up. Many physicians report receiving little net income or are barely breaking even for their care of Medicare patients. Congress has stepped in nine times since 2002 to prevent or reverse increasingly larger Medicare physician payment cuts mandated by the SGR formula. As a contingent of its support for the health care reform passed in March, the American Medical Association demanded that the flawed SGR formula be abolished.

The doctors are still waiting.

Congress had chosen to delay the cuts three times this year, but voted Thursday to allow the 21% cut in physician reimbursement to take effect now. The impact of this will be dramatic. Medicare patients & those working in the medical field are already paying the price for Congress’ inaction. An AMA poll of over 9000 doctors last month revealed that delayed Medicare payments had already caused them to postpone or cancel scheduled services to Medicare patients, while 17% of these doctors report holding up paychecks or laying off their staff – with over 1500 workers affected by this. Physicians also report limiting the numbers of Medicare patients they will see, and some have opted out of Medicare altogether.

One might consider Congress’ inability to resolve the SGR predicament as the “anti-health, anti-stimulus bill.” The cost of using the flawed SGR formula was not factored into the cost of health care reform, and it is not going away. What will go away are doctors willing to care for Medicare patients, despite the promise “if you like your doctor, you can keep him.”

The SGR problem should have been solved before comprehensive health care reform was signed into law.

As the AMA has become increasingly politicized in recent years – issuing a statement in support of climate change, for example, in 2008 – a new group of doctors has risen to challenge them.  Like other anti-statist groups that have risen in opposition to the Obama-Reid-Pelosi agenda, Docs4PatientCare are challenging the AMA’s stranglehold on health care matters, just as other groups once challenged the right of the left-leaning American Bar Association to determine what judges are and are not qualified for the United States Supreme Court.  How Docs4PatientCare managed to barge its way into the closed-door meetings of Washington offers a lesson to other groups seeking to have a voice in their federal government.

Founded by Dr. Hal Scherz, a prominent Atlanta physician, the group of doctors expressed concern that like so many other professional groups, the AMA’s leadership have been  thoroughly “Washingtonized” – caring more about the pleadings of other lobbyists on K Street, White House invitations and Capitol Hill committee appearances than the professions they are supposed to represent.  As doctors have taken a battering over several decades from insurance companies, HMOS, and government agencies, Scherz says the AMA was a bystander.

“As the insurance companies become more and more impossible and government intrusion keeps growing, we’ve seen our delivery of care to our patients compromised and our incomes decrease,” he said.

But it was the AMA’s support for ObamaCare that really troubled Scherz and others in his field.

Many doctors run small businesses and by nature are entrepreneurial.  Why then, he wondered, would the AMA favor ObamaCare’s regulatory and taxation burden?   Why would they want a multitude of government panels interfering with the decisions doctors usually make with their patients about care and treatment?  Recognizing that the AMA was compromised, Scherz decided to organize his own group in opposition to the Obama plan.

He recalled how effective talk radio had been the year before in stopping the seemingly unstoppable immigration amnesty bill, and wondered if there was a way for him to get his voice heard on the air.  In fact, Scherz was driving home one night when he heard talk show host Hugh Hewitt ask on the air, “Where are the doctors?” opposing ObamaCare in the health care fight.  Scherz wanted to give him an answer. So when Salem radio brought a “road show” on Obama’s first 100 days to Atlanta last May, he decided to attend.  Listening to Hewitt and other Salem talk show stars like Bill Bennett and Dennis Praeger again ask, “Where are the doctors?” Scherz waited patiently in a long line of people to give them his answer.  But just as he reached the head of the line, the master of ceremonies shut down the mikes for the evening.

Undeterred Scherz called a fellow physician, Congressman Tom Price, and asked the Congressman if he would come address a group of doctors if Scherz could assemble them.   Price agreed and when Scherz got 40 doctors in the waiting room of his office to discuss ObamaCare, the meeting ended with the doctors deciding to form an organization to it.  They christened themselves Docs 4 Patient Care that night and put together enough money to hire an attorney, set up a business structure, and establish a website.

Growing past this initial cadre of supporters proved difficult, however.  Scherz spent as much time as he could emailing and phone calling more doctors to join the effort, but the response rate was slow.  So coming home one night from the operating room, he called the Hewitt show and got in on the call-in queue.  Waiting on hold for two hours, he finally got on the air in the show’s third hour.  Delighted to have his missing-doctor question finally answered, Hewitt spoke with Scherz for a lengthy period.

“Then Hewitt blogged about us and put us the website and that made all the difference,” said Scherz.

Having heard the doctor on Hewitt’s program, Salem Radio’s vice president of content, Lee Habeeb, a legendary talk show producer, booked him on other Salem shows including a co-hosting gig with Mike Gallagher in Dallas, Atlanta, and New York. “Mike and his show were coming on strong. So it was just the right moment.  He made our group a focal point of listener interest and it really helped,” says Scherz. This led to television interviews, involving Scherz and other members of the group to get their message out, such as Fred Shessel, one of Scherz’s partners and vice president, Scott Barbour, a prominent orthopedic and sports medicine surgeon, and Todd Rubin,  a local anesthesiologist who started making something of the website (www.docs4patientcare.org).  One talk show listener and activist, Felicia Horton, asked to be brought on as volunteer executive director.

With their newfound growth and publicity, Docs 4 Patient Care made getting heard in Washington their next objective.  Wearing their scrubs and white jackets, the doctors drew attention as they walked the halls of congress and spoke at rallies on Capitol Hill. Often just showing up in the offices of members of the House and Senate, they would manage to get appointments with the members themselves or key staff members.

One particular meeting that stuck out in memories was with the staff of Senator Olympia Snowe, the Maine Republican senator who was being heavily courted by Democrats in the hope of getting some bipartisan window dressing for the Democratic bill.  The meeting was a long one by Capitol Hill standards and the Snowe staff kept bringing up the arguments made by Democrats on behalf of ObamaCare.  But in the face of the doctor’s facts and experience the arguments didn’t stand up long.  Schertz believes Docs 4 Patient Care may have helped make a difference in Snowe’s ultimate, and fateful, decision not to sign on to ObamaCare.

Another memorable incident cited by members of the group occurred when one of their members, Joyce Lovett MD, an African American female pediatrician, got the doctors into a meeting of the Congressional Black Caucus.  A debate opened up over the health care plan and soon the doctors were text-messaging their colleagues visiting other offices around the capitol for reinforcements.  As the room began filling up, the doctors, doing well in the back and forth of debate, seemed to be changing some minds.  At that point, a worried Black Caucus leader and diehard partisan, John Conyers, broke up the meeting, saying the doctors were more interested in embarrassing the first black president than in achieving real reform.   Unused to this sort of political attack, the astonished doctors told other caucus members  how they felt after taking time from their practices and patients to come all the way to Washington only to hear a member of Congress insinuate they were racists.  One caucus member privately dismissed Conyers’ “old ways of thinking,” suggesting that the CBC might be ready for fresh, and more innovative, leadership.

In addition to return trips to Washington over the next 4 months, Docs4PatientCare also helped organize physician led-rallies around the country with hundreds of doctors participating in Atlanta, Los Angeles, Chicago, Indianapolis and Portland.  The rallies proved crucial as the largely Atlanta-based group made new connections in taking on a national character.   Jaime Ronderos MD, a prominent Texas anesthesiologist, who had already organized many of the doctors in his own state, folded  his group in with D4PC. Also coming on board was Marc Neerhof, a perinatologist who is also on the faculty of the University of Chicago and a skillful op-ed writer.  In addition, Reed Wilson, a well-known Los Angeles cardiologist with a business and political background   became a board member.  And finally, as the group showed its interest in working with all health care professionals, Joel Strom, a Los Angeles dentist and experienced coalition organizer agreed to head up an outreach program.

Only last month, the group had its inaugural  board meeting in Atlanta where, in addition to making plans to increase their public and media presence, they inaugurated a fund raising program that would let them run a  full-blown field operation in the elections this Fall. “We want to be out there in the states and let voters know which members of Congress put patient care second and voted for this power grab by Washington politicians,” said Scherz.

But, beyond this, Scherz and the other board members want Docs 4 patient Care to grow into what the AMA should have been.   This means more than defeating ObamaCare.  The group is non-partisan and anxious to work with all those who want to hear from Docs 4 Patient Care on the dangers of state-run medicine. With chapters recently up and running in several states, he sees growth ahead.   That is likely discouraging news for the status quo world of Washington, D.C., but an inspiration for other Americans who see what their government is doing and want to offer an alternative.