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This week’s headlines:
Congressional action

Congress passes 10-Month Medicare physician payment fix
Last week, Congress passed legislation to avert the 27 percent cut to Medicare physician payments that was set to begin March 1, postponing the cuts until December. This recent congressional action, which freezes payment rates at the current level, follows a two-month aggressive push by the American Academy of Dermatology Association (AADA) and the physician community urging Congress to permanently repeal the broken sustainable growth rate (SGR) formula. In a media statement, the AADA expressed its severe disappointment that a permanent repeal was not included in the final package, but acknowledged the efforts of members of Congress who fought for a full SGR repeal as part of the legislative package. By continuing to postpone permanent action, the cost of a long-term solution continues to increase exponentially, with the cost of repeal doubling to $600 billion in five years. The AADA calls on Congress to set politics aside and provide a stable payment system for dermatologists, ensuring Medicare beneficiaries continued access to quality dermatologic care.

AADA commends recent congressional hearings examining prescription drug shortages
Over the last few months, several House and Senate committees have held hearings to investigate the cause and effect of ongoing prescription drug shortages in an effort to find solutions to this far-reaching problem. Dermatologists across the country have felt the impact of these drug shortages as they severely affect the availability of a number of commonly used pharmaceutical treatments including lidocaine 1%; fluocinolone, hydroquinone, and tretinoin; bleomycin; and tetracycline. The AADA sent a letter to the committees expressing appreciation for their attention to this important issue and pledging to work with Congress on solutions to address the current shortages, and to reduce the threat of shortages in the future.

Federal agency focus

AADA comments on Physician Payment Sunshine Act proposed rule
In December, the Centers for Medicare and Medicaid Services released a proposed rule to enact a portion of the 2010 health reform law that requires manufacturers of drugs, devices, biologics, or medical supplies to report certain payments or transfers of value greater than $10 provided to physicians or teaching hospitals. The rule also requires manufacturers or group purchasing organizations to report ownership and investment interests of physicians (and their immediate families).

The AADA submitted comments to CMS highlighting its concerns. Specifically, the AADA is urging CMS to consider provisions related to indirect transfers of value and the role of accredited CME providers. The AADA also encouraged CMS to allow physicians to review reports prior to submission and consider the need for third-party reviews. The AADA also signed-on to an AMA letter expanding on concerns regarding the burden of compliance on physicians and the additional requirements in the proposed rule that were not called for in the health reform legislation.

FDA releases guidance documents on biosimilars
On Feb. 9, the Food and Drug Administration (FDA) released much-anticipated guidance documents regarding the approval of biosimilars (also known as follow-on biologics). Unlike small-molecule drugs, biologics are large, complex, protein-based molecules that cannot be exactly replicated as generics.

While these guidance documents are not legally binding, they do provide an idea of the FDA’s approach to reviewing and approving these new therapeutics. The FDA states that it will use a “totality of the evidence” approach to review all biosimilar submissions and encourage manufacturing companies to carefully characterize and determine differences between the biosimilar and brand name product prior to animal testing and clinical trials. The Academy will continue to monitor approval regulations for biosimilars.

HHS announces intent to delay ICD-10 compliance date
On Feb. 14, U.S. Department of Health and Human Services (HHS) Secretary Kathleen G. Sebelius announced that HHS will initiate a request, through rule making, to postpone the date by which certain health care entities have to comply with International Classification of Diseases, 10th Edition diagnosis and procedure codes (ICD-10). Secretary Sebelius states that the delay is not for the implementation of ICD-10, but rather delays the date by which all parties who use the ICD-10 must comply with the new codes. The Academy continues to monitor the Federal Register and HHS bulletins for the publication of the formal notice, which may provide additional details such as a new date for compliance with ICD-10. Information to help members prepare for ICD-10 implementation is available on the AAD website.

AAD assists members with RAC audits
As dermatologists continue to get caught up in the Recovery Audit Contractors (RAC) program, the AAD has helped myriad practices insure against, prepare for and successfully work through the RAC audit process. Recently, a RAC contractor, Health Data Insights, posted an automated audit that affected Mohs surgical cases when reported with pathology billing for the same patient on the same date of service. Two dermatology practices in California and Oregon that received automated demand letters utilized the Academy’s RAC Audit Survival Toolkit and the Appropriate Use of Paraffin Sections during Mohs Micrographic Surgery Position Statement to successfully appeal their claims. Additionally, after concerted advocacy efforts, the Centers for Medicare and Medicaid Services (CMS) have instructed RAC contractors to refrain from sending demand letters; instead CMS itself will initiate demand letters. This should further alleviate unnecessary hardships on dermatologists when defending baseless repayment claims. The RAC Audit Survival Tool Kit and the Mohs position statement can be found online in the AAD’s RAC Audit information center, where you can also access a recent Dermatology World feature exploring how dermatologists can prepare for a RAC audit.

State policy roundup

Tanning legislation considered around the country
Indoor tanning legislation is a hot topic in numerous state legislatures. The AADA is tracking bills related to regulation of the tanning industry in 24 states, including 19 that would ban indoor tanning by minors. On Feb. 14, Michelle Endicott, DO, testified on behalf of the AADA and the West Virginia Dermatologic Society in favor of SB 73. This bill overwhelmingly passed the full Senate body by a vote of 30 to 4. It will now be sent to the House of Representatives to be considered by a house committee. The AADA and the Idaho Dermatology Society collaborated to support legislation to ban tanning for all minors, and requested an amendment to remove reference to phototherapy devices, which was passed unanimously by the House Health and Welfare Committee on Feb. 20. Finally, on Feb. 13, the AADA strongly urged the Missouri House Health Care Policy Committee to combine two pending bills on indoor tanning to prohibit minors 15 and under from using indoor tanning beds and require parental consent for minors 16 to 18 years old. The AADA will continue to work with other advocates opposing indoor tanning around the country to advance these bills. AADA members can visit the Dermatology Advocacy Network to participate in state grassroots advocacy campaigns on this issue and visit the State Advocacy Toolkit for information and resources.

States advocate for increased transparency in medical advertising, disclosure of provider credentials
Working closely with the Missouri Dermatology Society Association (MDSA), the AADA supported two pieces of legislation, SB 750 and HB 1622, which would require all advertisements that name a health care professional to identify the type of license held by that individual. In addition, the bills outline specific requirements that must be met if a physician wishes to advertise board certification in a medical specialty.

On Feb. 16, the AADA, represented by Kathryn Chandra, assistant director of state policy, and Nebraska Dermatology Society President Mary Finnegan, MD, FAAD, testified in favor of LB 1032, which would require all health care providers to wear a name tag that clearly identifies their licensure and credentials. The legislation is chiefly supported by the Nebraska Medical Association and mimics laws passed in eight states in the last several years.

The AADA is working closely with the American Society for Dermatologic Surgery Association, the American Society of Plastic Surgeons, the American Academy of Facial and Reconstructive Plastic Surgery, and the Arizona Medical Association to support legislation which specifies that if a physician falsely represents his or her board certification or misrepresents his or her specialty area of training in any advertisements or verbally to patients, that he or she would be subject to disciplinary actions related to unprofessional conduct. The AADA continues to work with state dermatology societies on these pressing pieces of legislation. Information and resources to help dermatologists advocate for truth in advertising are available in the State Advocacy Toolkit.

AADA supports third attempt to strengthen California ban on corporate practice of medicine ban
The AADA sent a letter on Feb. 16 in support of legislation in California sponsored by the California Society of Dermatology & Dermatologic Surgery (CalDerm) and the American Society for Dermatologic Surgery Association (ASDSA) that will increase the penalties for those who engage in the corporate practice of medicine. This legislation has passed the California General Assembly twice in previous years, but was vetoed by then-Governor Arnold Schwarzenegger. This legislation is aimed at improving patient safety in corporate-owned medical spas which often lack physician supervision and oversight (learn more about this issue in the State Advocacy Toolkit). The AADA will continue to work with CalDerm and the ASDSA to advance this legislation.

Tennessee legislation aims to protect patients
Tennessee is another state working to address concerns related to the burgeoning medical spa industry. Legislation introduced in 2011 would have defined elective cosmetic medical procedures and required all facilities offering such procedures to register with the state. In order to improve the provisions of this bill, the Tennessee Medical Association convened several meetings of interested stakeholders throughout the second half of 2011, including the Tennessee Dermatology Society (TDS) and the AADA. These in-depth conversations resulted in new legislation this year. Although the new House and Senate bills make significant improvements from the 2011 legislation, the AADA and TDS believe unintended consequences can be avoided if the definition of “cosmetic medical procedure or treatment” contained in the current legislation is amended. The AADA and TDS have communicated suggested amendments to the House and Senate sponsors of the bills, and will continue to advocate for appropriate oversight of the medical spa industry and the performance of cosmetic medical procedures in Tennessee.

For more information on AADA state policy actions, please visit our State Affairs Web page.

Advisory Board policy resolutions sought
As we approach the annual meeting, the American Academy of Dermatology’s Advisory Board looks forward to hearing the voices of the Academy’s grassroots through the submission of proposed policy resolutions. The Advisory Board convenes every year to deliberate issues of importance to individual practitioners and bring proposed new policies to the Academy’s Board of Directors for consideration.

If there is an issue of interest and/or concern, now is your opportunity to submit a resolution from which an official Academy position might arise. The author or his or her designate must be present to introduce and discuss the resolution at the Reference Committee Hearing on Friday, March 16, 2012, in the Coronado Room of the San Diego Marriott at the Academy’s 70th Annual Meeting. The full Advisory Board will vote on resolutions at the General Business Meeting on Sunday, March 18, 2012. All resolutions and questions regarding the process should be directed to Barbara Greenan, staff liaison to the Advisory Board, at bgreenan@aad.org.

Political affairs – SkinPAC

Dr. Siegel is shaving his head if SkinPAC raises a million dollars
President-elect Dan Siegel, MD, is upping the ante in order to help make SkinPAC a $1 million per election cycle political action committee. He recently pledged to have his head and beard shaved in public if SkinPAC hits its fundraising goal. The first potential opportunity for this event will be the Plenary Session at the 2012 Annual Meeting in San Diego. If the goal is not met by March 16, 2012, SkinPAC will have additional opportunities to reach its $1 million goal by the 2012 Summer Academy Meeting and by Dec. 31, 2012.

SkinPAC and the Dermatology Advocacy Network will host a joint after party on Reception Row at the 2012 Annual Meeting directly following the main Reception Row events for those who have a little more time to kill before their evening festivities begin. The doors will open at 6:30 p.m. on Friday, March 16, 2012 in San Diego Ballroom A of the San Diego Marriott and Marina.

SkinPAC’s political purpose is to solicit and receive contributions to be used to make political campaign expenditures to those candidates for federal elective office, and other federal political committees, who demonstrate understanding and interest in the views and goals of the American Academy of Dermatology Association.

Contributions to SkinPAC are not deductible as charitable contributions for federal income tax purposes. SkinPAC cannot accept contributions from corporate accounts. All AADA members have the right to refuse to contribute without reprisal. Federal law prohibits us from accepting contributions from foreign nationals. Federal law requires us to use our best efforts to collect and report the name, physical address, occupation, and the name of the employer of individuals whose contributions exceed $200 in a calendar year.

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