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This week’s headlines:
Congressional action

Dermatologists, patient advocates flood halls of Capitol Hill with dermatology’s message
Last week, nearly 150 dermatologists and patient advocates gathered in Washington, D.C., to present a united voice to Congress on dermatology’s most pressing issues. During the 2013 AADA Legislative Conference, participants held 205 meetings with members of Congress and their staff representing 33 states, to discuss efforts to avert Medicare payment cuts and preserve access to the full range of care that dermatologists provide (including in-office ancillary services), promote the importance of medical research, and raise awareness of the dangers of indoor tanning. Read more about the Legislative Conference in the Sept. 27 issue of the Member to Member e-newsletter. If you were unable to join your colleagues in Washington, D.C., there’s still more work that can be done. Visit the AAD website, log on to the AADA Dermatology Advocacy Network, or contact Blake McDonald at bmcdonald@aad.org to find out how you can get involved.

Study: Patients’ Access to Treatment Act would have little impact on insurance premiums
A recent study conducted by Avalere Health, a healthcare advisory firm, has found that the Patients’ Access to Treatment Act (PATA), HR 460, would not significantly increase medical insurance premiums. PATA would require insurers to charge no more for specialty drugs than they currently charge for the non-preferred brand drug tier, and according to the study, would only increase premium costs by an average of $3 per year for plans with specialty tiers. As a member of the Coalition for Accessible Treatments, the American Academy of Dermatology Association (AADA) supports HR 460, which would help provide greater treatment access for those patients for whom there is no generic or inexpensive equivalent treatment available. The AADA urges all dermatologists to contact their members of Congress to support HR 460. Read the study commissioned by the AADA and other members of the Coalition for Accessible Treatments. For more information, contact Christine O’Connor at coconnor@aad.org.

Dermatology rallies in opposition of limits on Medicare pathology services; more work to be done
During last week’s Legislative Conference, dermatologists and patient advocates urged their members of Congress to oppose HR 2914, the Promoting Integrity in Medicare Act of 2013 (PIMA), which would eliminate the exception to the Medicare Stark Law that allows physicians to provide anatomic pathology, advanced imaging, radiation therapy, and physical therapy services within their offices. In addition to 205 in-person meetings at the Conference, 356 AADA members recently sent 1,116 emails to 295 legislators through the Dermatology Advocacy Network (DAN), to oppose this legislation. However, there is more work to be done — the AADA is calling on all members to log on to the AADA DAN to view and submit suggested language for a letter to their members of Congress opposing HR 2914 and any proposals that would limit dermatologists’ ability to provide pathology services to their patients. (New DAN layout requires member ID – without the preceding zeros – and birth date to login.) For more information, contact Christine O’Connor at coconnor@aad.org. For more information on how to get involved, or to share your congressional contacts, email grassroots@aad.org.

Medicare physician payment reform legislation estimated to cost $175.5 billion
Last week, the Congressional Budget Office (CBO) released its cost estimate of the Medicare Patient Access and Quality Improvement Act (HR 2810), which would repeal Medicare’s flawed sustainable growth rate (SGR) formula and replace it with a system focused on quality incentives and the development of alternative payment models. CBO’s estimated cost of $139 billion of SGR repeal was released earlier this year, but did not account for the payment increases and payment reforms that were included in HR 2810. Prior to breaking for the August recess, the House Energy and Commerce Committee unanimously approved HR 2810. However, the legislation did not include a means to pay for Medicare reform. The AADA sent a letter expressing appreciation for the effort to repeal the SGR while also highlighting some concerns with the legislation. If Congress does not repeal and replace the SGR formula, a 24 percent across-the-board Medicare rate cut will go into effect on Jan. 1, 2014. The AADA is calling on all members to log on to the AADA Dermatology Advocacy Network and submit a letter urging their representatives and senators to repeal the SGR. For more information, contact Shawn Friesen at sfriesen@aad.org.

Senate Cancer Coalition calls for increased funding for medical research
Citing numerous recent advances in medical research, members of the Senate Cancer Coalition, co-chaired by Sen. Diane Feinstein (D-Calif.) and Sen. Johnny Isakson (R-Ga.), called on their colleagues, at a briefing this week, to end the sequester and increase funding in the upcoming budget for cancer research at the National Institutes of Health (NIH). The American Academy of Dermatology Association (AADA) attended the briefing which focused on several NIH achievements, particularly advances in immunotherapy, which have resulted in amazing breakthroughs in cancer treatment. Roslyn Meyer, PhD, a melanoma survivor, shared her successful experience in a NIH clinical trial for a treatment known as adoptive immunotherapy or TIL therapy. Throughout the year, the AADA works with several coalitions, including Once Voice Against Cancer and the NIAMS Coalition, to advocate for increased medical research funding to reduce the incidence and deaths attributed to skin cancer, to promote new treatments for skin diseases and conditions, and to decrease health care costs overall. The AADA is calling on all members to log on to the AADA Dermatology Advocacy Network and submit a letter to members of Congress to end the sequester and increase medical research funding and urge them to join the congressional Skin Cancer Caucus. For more information, contact Christine O’Connor at coconnor@aad.org.

Federal agency focus

HIPAA compliance deadline Sept. 23
Dermatology practices and other entities must be in compliance with new provisions in the Health Care Portability and Accountability Act (HIPAA) by Sept. 23, 2013. Among the provisions that affect dermatology practices is one that requires any improper use or disclosure of personal health information to be considered a breach that triggers official notification requirements, unless the organization in question carries out a risk assessment and determines otherwise. The American Academy of Dermatology (AAD) has developed resources to help members prepare for the compliance deadline including A Guide to HIPAA and HITECH for Dermatology which outlines new HIPAA compliance obligations and provides model policies and procedures. The AAD has also developed a three-part on-demand webinar series, the HIPAA and Omnibus Final Rule, explaining the history of HIPAA and identifying steps dermatology practices should take to prepare for the compliance deadline. Read more about the new HIPAA provisions that will affect your practice.

Medaus Pharmacy recalls sterile compounding products
In the wake of the recent fungal meningitis outbreak that was traced to tainted steroid injections, Medaus Pharmacy is voluntarily recalling several sterile compounded products because it cannot confirm that the quality control testing performed on these specific lots by an independent, third party laboratory met all safety standards. View a list of the affected products. Although there have been no reports of adverse events related to the use of these products, Medaus is asking health care professionals to stop use and return them to Medaus. Read more about the voluntary recall. For more information, contact Amanda Grimm at agrimm@aad.org.

MedPAC seeks to define future of ACOs; test innovations in payment and delivery
With the initial three-year Accountable Care Organization (ACO) Medicare Shared Savings Program contracts set to expire in 2015, the Medicare Payment Advisory Commission (MedPAC) delved into recent developments and the future of Medicare ACO models at its September meeting. MedPAC announced that it will conduct interviews with participants in Medicare ACOs to determine necessary improvements, and discussed whether the ACO programs could move more aggressively toward the two-sided model — sharing both savings and losses — and how that would impact ACOs and providers, including specialists. MedPAC discussed possibly establishing benchmarks based on service use, beneficiary incentives to encourage use of in-network providers, and changes to quality measurements. Learn more about ACOs at the ACO Resource Center. MedPAC also looked at whether features of several innovative payment and delivery test models could be included in the Medicare program. Read more highlights from the MedPAC meeting. For more information, contact Richard Martin, JD, at rmartin@aad.org.

FDA approves botox as treatment for crow’s feet
The U.S. Food and Drug Administration (FDA) approved onabotulinumtoxinA to temporarily alleviate severe lateral canthal lines, also known as crow’s feet, in adults. Previously, the FDA approved onabotulinumtoxinA for the treatment of chronic migraine, severe underarm sweating, eyelid spasms, the misalignment of the eyes, and glabellar lines — wrinkles between the eyebrows, known as frown lines. The FDA encourages health care providers to report adverse effects when using botox to treat crow’s feet. Read more from the FDA. For more information, contact Amanda Grimm at agrimm@aad.org.

Private payer advocacy

Anthem BCBS Kentucky assessing use of modifier 25
Anthem Blue Cross Blue Shield Kentucky (Anthem BCBS KY) is communicating to dermatologists in Kentucky on the results of its recent educational audit on the appropriate use of modifier 25 which revealed a pattern of improper coding and/or documentation. In an effort to improve compliance with its payer-specific criteria when reporting an evaluation and management (E/M) service with a procedure and the appropriate use of modifier 25, Anthem BCBS KY is now conducting audits of dermatologists — reviewing medical records from individual dermatologists, and providing specific feedback on each record. The American Academy of Dermatology Association (AADA) is aware of this audit effort, and has developed resources on proper coding and documentation of E/M and the use of modifier 25. Read more on this issue and review the AADA resources. The AADA is investigating this issue and will provide more updates as they become available. For more information, contact ppm1@aad.org.

AADA opposing Blue Cross Blue Shield Tenn. consolidation of outpatient laboratory services
The American Academy of Dermatology Association (AADA), the Tennessee Medical Association (TMA) and the Tennessee Dermatology Society (TDS) are opposing Blue Cross and Blue Shield of Tennessee’s (BCBST) Volunteer State Health Plan’s (VSHP) consolidation of outpatient laboratory services to Quest Diagnostics. This policy denies dermatologists the ability to perform CPT 88304, 88305, 88312, 88313, and 88342 in their office setting, and permits the billing of these codes only for the outpatient surgical setting. The AADA is working to get BCBS to modify its policy and will provide additional information as it become available. For more information, contact James Scroggs at jscroggs@aad.org.

United HealthCare terminating Florida specialists from Medicare Advantage network
United Healthcare (UHC) has been reducing the size of its Medicare Advantage (MA) network in Florida by terminating providers across specialties, including dermatologists. The American Academy of Dermatology Association (AADA) has learned that UHC-MA is narrowing its physician network across various medical specialties throughout most of Florida in an effort to meet performance benchmarks and management metrics established under Medicare’s Star Program, which would then allow UHC to qualify for incentive bonuses. It remains unclear what criteria UHC is using to narrow their MA network. The AADA has requested that UHC delay implementation of this program and is working with UHC to craft a resolution. In addition, AADA is collaborating with the Florida Medical Association (FMA), the Florida Society of Dermatology & Dermatologic Surgery (FSDDS), and the Florida Society of Dermatologic Surgeons (FSDS) to further investigate this issue. In the meantime, members can appeal the notice of termination with UHC-MA and advise patients on how they may be impacted by termination. With open enrollment starting Oct. 15, patients may be able to select alternate MA plans to retain access to their current physicians. For more information, contact Leslie Stein Lloyd at lsteinlloyd@aad.org.

State policy roundup

Pennsylvania tackles biosimilar legislation
The Pennsylvania Senate and House of Representatives have taken up legislation that would 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 American Academy of Dermatology Association (AADA), and the Pennsylvania Academy of Dermatology and Dermatologic Surgery (PAD), sent letters of support for Pennsylvania HB 746 and SB 405 in March and September. The bill largely reflects the AADA’s position on the therapeutic substitution of biosimilar products. The AADA 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. 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 Lisa Albany at lalbany@aad.org.

Last call for State Advocacy Grant applications
Applications for State Advocacy Grants are due Sept. 30. State societies looking to fund advocacy activities to influence legislation and/or regulatory initiatives in 2014 are encouraged to apply for financial assistance through the American Academy of Dermatology Association’s (AADA) State Advocacy Grant Program. The AADA is offering this program for state dermatology societies to help advance key state health policy initiatives. Visit the AADA State Advocacy Grant program Web page to learn more. For more information, contact Lisa Albany at lalbany@aad.org.

Engagement opportunities

Preserve dermatology’s voice in the house of medicine
Dermatology could lose a vote in the American Medical Association (AMA) House of Delegates (HOD), unless more members of the American Academy of Dermatology (AAD) join the AMA and designate the AAD as its specialty society by Jan. 1, 2014. The AMA recently conducted its five-year review of the AAD to determine the number of representatives it should receive in the HOD, and the number of AAD members in the AMA is down by several hundred. By joining the AMA or renewing your membership, you ensure the specialty’s presence and voice in affecting the house of medicine’s priorities. If dermatologists don’t maintain a strong presence in the AMA, the specialty will lose its voice in this important venue. Renew your AMA membership and designate the AAD as your primary organization of membership to ensure that dermatology has a voice in the house of medicine. Read more about the importance of the AMA HOD in the April 12 issue of the Member to Member e-newsletter.

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