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This week’s headlines:
Congressional action

Congress, White House fail to avoid sequestration cuts to physician payment, medical research
Congress and the White House have failed to stop the across-the-board spending cuts to funding for Medicare physician payment, medical research, and other cancer prevention and control programs. The across-the-board cuts reduce Medicare payments to physicians by 2 percent. The U.S. Department of Health and Human Services has confirmed that the 2 percent payment reduction to Medicare providers and insurers will be for services provided on or after April 1.

Additionally, funding at the National Institutes of Health (NIH) and the Centers for Disease Control and Prevention will be cut 5.1 percent. This will result in $1.5 billion cuts to the NIH budget which could lead to 1,380 fewer research grants, a loss of up to 20,500 jobs, and a $3 billion decrease in economic activity. Cancer research funding will also be cut by $250 million. Electronic health record incentive payments will also be cut by 2 percent.

AADA staff will continue to monitor these issues and provide updates as information becomes available about how Medicare physician fee changes will affect your practice. Contact the AADA Government Affairs Department with any comments or questions at govtaffairs@aad.org.

House passes stop-gap funding measure
On March 6, the U.S. House of Representatives passed a six-month stopgap spending bill for Fiscal Year 2013, ending Sept. 30, 2013, which would freeze existing appropriations levels for most accounts. H.R. 933 includes $15 million for the Peer-Reviewed Cancer Research Program which funds research for melanoma and other skin cancers, pediatric brain tumors within the field of childhood cancer research, genetic cancer research, pancreatic cancer, kidney cancer, blood cancer, colorectal cancer, mesothelioma, and listeria vaccine for infectious disease and cancer. The U.S. Senate will address this spending bill next week. Contact the AADA Government Affairs Department with any comments or questions at govtaffairs@aad.org.

AADA responds to Medicare physician payment reform proposal
The American Academy of Dermatology Association (AADA) sent a letter to members of the House Ways and Means Committee and the Energy and Commerce Committee in response to their recent request for feedback on a proposal that would repeal the sustainable growth rate (SGR) formula and eliminate the estimated 25 percent across-the-board Medicare rate cut scheduled to go into effect on Jan. 1, 2014. Additionally, the proposal would reform Medicare’s fee-for-service payment system to better reflect the quality and efficiency of care provided.

Overall, the AADA agreed with several aspects of the proposal, including the inclusion of a transition period that would provide time to test various payment and delivery reform models to ensure that the reforms do not hinder patient access or pose an undue burden on physician practices. However, the AADA did express concern regarding the use of the term “efficiency” without clearly defining the term, and urged the committees to allow physicians and their respective specialty societies to define quality measures. Read the AADA’s letter on SGR reform.

The AADA will continue to work with key policymakers on this issue, and will continue to advocate for permanent reform that strengthens the Medicare physician payment system and protects Medicare patients. For more information, contact Shawn Friesen at sfriesen@aad.org.

Jordan Slutsky, MD, receives 2012 AADA Advocate of the Year award
The American Academy of Dermatology Association (AADA) has recognized Jordan Slutsky, MD, as the recipient of the 2012 Advocate of the Year award for his commitment to advocating on behalf of the dermatology specialty. Dr. Slutsky was honored at the SkinPAC/Dermatology Advocacy Network (DAN) reception at the American Academy of Dermatology’s 71st Annual Meeting in Miami Beach, Fla.

Dr. Slutsky led the way in using the AADA’s DAN website to contact Congress — answering every call to action, contacting his state and federal legislators on dermatology-related issues such as skin cancer prevention and Medicare physician payment reform.

Dr. Slutsky serves as a clinical instructor in dermatology at Saint Louis University where he has just completed his American College of Mohs Surgery fellowship. A graduate of Colgate and Stony Brook University Medical School, Dr. Slutsky was chief resident at both Stony Brook and Northpoint Veterans Affairs Medical Center and has recently accepted a position as a Mohs surgeon at SUNY Stony Brook. For more information on the AADA Advocate of the Year award, contact Blake McDonald at bmcdonald@aad.org.

Federal agency focus

AADA Board of Directors unanimously approves position statement on pathology billing
In the face of the rapidly changing health care environment, on March 2, the American Academy of Dermatology Association's (AADA's) Board of Directors unanimously approved a position statement on anatomic pathology billing, affirming its commitment to quality care, patient access, and ethical and legal standards of practice.

In the position statement, the Academy:

  • Affirms the right to bill for one's own work
  • Affirms the principle of freedom of choice of dermatopathology consultants
  • Supports the value of dermatology office labs
  • Expresses concern about the ethical and legal propriety of several pathology billing practices (as detailed in the position statement)

In a statement issued by AAD Past President, Daniel M. Siegel, MD, the Board reiterated that, as with all physicians, dermatologists are under immense pressure to provide high-quality care in the face of declining reimbursements and confront a wide variety of arrangements when billing for professional and/or technical component anatomic pathology services. These arrangements raise compliance issues that require dermatologists to be aware of the potential legal and ethical pitfalls when assessing the appropriate pathology billing arrangement(s).

Additionally, the issue of pathology billing has been in the spotlight as a number of stakeholders – including federal and private payers – have raised serious questions about the economics, utilization, practice, and ethics of anatomic pathology. The AADA Board of Directors approved the position statement in an effort to provide clear guidance for members regarding the ethics of certain billing practices for pathology laboratory services. Additionally, the position statement is intended to ensure that the specialty remains in the strongest position when advocating for the dermatologist’s right to offer the pathology services that they are uniquely qualified to provide.

Read the complete position statement on pathology billing. For a detailed discussion of issues related to pathology billing, read the September 2012 Dermatology World article, In the Spotlight.

AMA RUC to survey AK and Mohs codes
The Centers for Medicare and Medicaid Services has requested that the AMA/Specialty Society RVS Update Committee (RUC) review a list of 70 Physician Fee Schedule high-expenditure procedural codes — representing services furnished by an array of specialties — to appropriately value the codes’ current level of Medicare reimbursement. This month, physicians will be randomly selected to take a survey on physician work for actinic keratosis destruction codes (17000-17004) and Mohs codes (17311-17315).

The American Academy of Dermatology Association (AADA) and the Dermatology RUC Team (AADA, American College of Mohs Surgery, American Society for Dermatologic Surgery, and the Society for Investigative Dermatology) request that physicians take the time to respond to a RUC survey if you are chosen.

Please check your inbox in March to see if you have been randomly selected to take a RUC survey. By participating in this survey, you can help ensure that the resources used for medical care are appropriately valued. For questions and guidance on how to take a RUC survey, contact AADA’s Helen Olkaba at holkaba@aad.org.

State policy roundup

AADA, state societies support biosimilar bills
The American Academy of Dermatology Association (AADA), in partnership with state dermatologic societies, has sent letters of support for biosimilar bills in Oregon and Pennsylvania. Oregon House Bill (HB) 2705, Oregon Senate Bill (SB) 460, Pennsylvania HB 746, and Pennsylvania SB 405 require any pharmacist who dispenses an interchangeable biosimilar to inform the patient prior to dispensing the biosimilar, provide notification of the substitution to the prescriber, and record the brand name or the product name and name of the manufacturer of the biosimilar on the record of dispensing and the prescription label. The AADA worked with the Oregon Dermatology Society (ODS) and the Pennsylvania Academy of Dermatology and Dermatologic Surgery (PAD) to develop and send letters of support.

The bills largely reflect the AADA’s position on the therapeutic substitution of biosimilar products. The AADA, ODS, and PAD recommended that the bills be amended to shorten the notification from three days to 24 hours prior to dispensing, in order to ensure patient safety. Read the AADA and state society letters of support for HB 2705, SB 460, HB 746 and SB 405. To learn more about biosimilars and dermatology review the AADA’s position statement on generic therapeutic and biosimilar substitution and read the August 2012 Dermatology World supplement article on psoriasis biosimilars. For more information, contact Kersten Burns at kburns@aad.org.

AADA opposes proposed office-based surgery rules in Oregon
The American Academy of Dermatology Association (AADA), in partnership with the Oregon Dermatology Society (ODS) has sent a letter opposing proposed changes to the Oregon Medical Board rules on the performance of office-based surgery and cosmetic procedures that would require Basic Life Support certification and written informed consent for Level 1 procedures, specifically those performed under topical or local anesthesia.

The AADA and ODS argued that the proposed rules exceed what is appropriate according to the level of anesthesia, and that the proposal is neither consistent with widely recognized principles for office-based surgery nor does it represent appropriate standards of care. Read the AADA and ODS letter of opposition. For more information, contact Lisa Albany at lalbany@aad.org.

Minnesota legislation would levy tax on cosmetic medical procedures
The American Academy of Dermatology Association (AADA), the Minnesota Dermatological Society (MDS), and the American Society for Dermatologic Surgery Association (ASDSA) are urging the Minnesota State House of Representatives to vote down House File 661, which would levy a tax on cosmetic medical procedures. The legislation would deem “cosmetic medical procedures” as taxable, but would exempt “reconstructive surgery” from the tax. Arguing that the distinction between cosmetic and reconstructive is not always clear, the AADA, MDS and ASDSA reiterated that such a tax not only invades patient privacy and is difficult to administer, but could cost the state more revenue than it generates from the tax. Read the AADA, MDS, and ASDSA letter of opposition. For more information, contact Lisa Albany at lalbany@aad.org.

Indoor tanning legislation moves forward in three states; fails to pass in Montana
Three bills that would protect minors from the dangers of indoor tanning are moving forward in Missouri, North Carolina, and Oklahoma. Missouri House Bill (HB) 47 has passed the House Committee on Health Care Policy with a unanimous vote of 9-0. The legislation would require anyone younger than the age of 17 to obtain parental or guardian consent in order to utilize an indoor tanning device. In North Carolina, HB 18 which would prohibit the use of indoor tanning devices by minors under 18, passed the Committee on Health and Human Services and will be considered by the House Regulatory Reform Committee. Oklahoma Senate Bill 345, which would ban minors under the age of 18 from using tanning devices, passed the State Senate with a vote of 33-9 and will now move on to the House for consideration.

In Montana, however, HB 456 failed to pass out of committee. The bill would have required any person under the age of 18 to have in-person parental consent in order to use indoor tanning devices.

The American Academy of Dermatology Association (AADA) has been providing assistance to state societies supporting legislation that would protect minors from the dangers of indoor tanning. Read more about the AADA’s state advocacy efforts. For more information, contact Kersten Burns at kburns@aad.org.

AADA requests amendment to Arizona truth in advertising legislation
The American Academy of Dermatology Association (AADA) wrote a letter to the Arizona House of Representatives requesting that it amend Senate Bill 1045 to include a more specific definition of the term ‘board certified’. While the AADA agrees with the bill’s intent to improve transparency of a physician’s specialty certification, the group has requested that the House Health Committee requires that the physicians specify which boards or certification entities they have been certified by. Read the AADA’s proposed language.

The AADA reiterated its position that those who regulate and deliver medical care have an obligation to inform the public of the qualifications and limitations of the persons providing their care prior to treatment. All providers should identify or disclose their degree or field of study, any board-certifications, and licensure to each patient. Read the AADA’s position statement on truth in advertising and professional credential disclosure. For more information, contact Kersten Burns at kburns@aad.org.

Illinois legislation would increase prescribing, practicing authority for advanced practiced nurses
The American Academy of Dermatology Association (AADA) has opposed two Illinois bills that would eliminate written collaborative practice agreements between physicians and advanced practice nurses (APNs), thereby granting APNs the authority to practice independently and prescribe controlled substances without physician oversight.

Although the AADA reiterated its position that coordinated-care teams, including APNs, but led by a physician, are a critical component to the health care delivery system, the AADA expressed its concerns that an APN’s education and training is not sufficient for independent practice, and could therefore jeopardize patient safety. Read the AADA’s letters of opposition to Senate Bill 73 and House Bill 1052. For more information, contact Kersten Burns at kburns@aad.org.

AAD Board of Directors approves position statement on corporate practice of medicine
The American Academy of Dermatology (AAD) and the AAD Association (AADA) Board of Directors has approved a position statement on the corporate practice of medicine at the AAD’s 71st Annual Meeting in Miami Beach, Fla. this week. The position states that the decisions made by the treating physician for the benefit of the patient should not be influenced by corporate concerns that could negatively affect patient health and safety; therefore, the AAD/A opposes any corporate practices or policies that would compromise a patient’s well-being by superseding a licensed physician’s clinical decision-making. Read the AAD’s position statement on the corporate practice of medicine. For more information, contact Lisa Albany at lalbany@aad.org.

Melanoma/Skin Cancer Detection and Prevention Month® advocacy resources available
The American Academy of Dermatology Association (AADA) is assisting members and state dermatological societies in promoting May as Melanoma/Skin Cancer Detection and Prevention Month® as a way to establish or enhance relationships with policymakers. State societies and members are encouraged to contact their governors and mayors to seek a proclamation raising awareness about skin disease.

Resources for members to discuss Melanoma/Skin Cancer Detection and Prevention Month® are available online in the AAD Media Relations Toolkit. Members and state societies who are interested in pursuing a mayoral or gubernatorial proclamation can contact Victoria Houghton for assistance.

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