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The American Academy of Dermatology Association (AADA) is pleased to present the inaugural edition of Dermatology Advocate, your source for news on health care policy that affects your practice. This new advocacy-focused e-newsletter is designed to keep you up-to-date on the latest news in Washington, D.C. and state capitals and with private payers, focusing on the AADA's involvement with ongoing issues of importance to the dermatology community. If you have any comments or questions, please email the AADA's Washington D.C. office at govtaffairs@aad.org.

This week’s headlines:
Congressional action

AADA calls on Supercommittee to fully repeal the SGR this fall
The AADA recently joined the American Medical Association (AMA), along with the broader physician community, in urging the Joint Select Committee on Deficit Reduction (the Supercommittee) to include a full repeal of the flawed Medicare sustainable growth rate (SGR) formula in any legislative package delivered to Congress by the imposed deadline of Nov. 23. As was reported in last week’s Academy E-news, the Supercommittee is charged with crafting a bill that reduces the federal deficit by $1.2 to $1.5 trillion and may consider the entire federal budget as it looks for cuts. The letter highlights that the continued delay in fixing the SGR has escalated the cost of permanent payment reform from $48 billion in 2005 to $300 billion today. In addition to the long-term costs, the letter also points to the scheduled 29 percent across-the-board payment cut that physicians face beginning on Jan. 1, 2012 when the last temporary fix authorized by Congress expires. These severe cuts threaten the long-term viability of the Medicare program and patients’ access to quality dermatologic care.

Federal agency focus

MedPAC proposal would dramatically cut specialty payment rates
The Medicare Payment Advisory Commission (MedPAC), which advises Congress on Medicare payment policy, met Sept. 15 to discuss draft recommendations to repeal the sustainable growth rate (SGR) formula by using a broad range of budget offsets. Specifically, the proposal would freeze Medicare payment rates for primary care services and cut payments for specialty services by 5.9 percent for the next three years followed by a seven-year freeze. As dermatology is facing a potential revaluation of several primary CPT codes over the next two years, this proposal is of particular concern. MedPAC will release more details on this proposal in the next week and is planning to vote on the draft recommendations at its October meeting. The Academy is preparing a direct response to MedPAC and will provide additional details to members as they develop.

FDA reviews medical device approval process
The FDA convened a public hearing on Sept. 16 in response to a July 2011 Institute of Medicine (IOM) report on the FDA’s process for premarket review and approval of medical devices. The report highlights significant shortfalls in the FDA’s current 510(k) device review process and essentially calls on the FDA to scrap its current process and replace it with a much more rigorous method. The 510(k) process is a premarket approval process for medical devices whereby a proposed medical device is shown to be as safe and effective as or "substantially equivalent" to a device already approved and on the market. Many dermatologic creams, phototherapy bulbs, fillers, etc., are regulated as devices by the FDA. Stakeholders, including physicians, patient advocates, industry and healthcare providers, were participants in the hearing. Academy staff attended the meeting and will continue to carefully monitor the progress of the FDA's reevaluation of the medical device premarket approval process.

State policy roundup

USA Today highlights concerns with unqualified cosmetic surgery providers
Last week, USA Today published a two-part, 7,000-word series focused on cosmetic surgery. The series addressed invasive cosmetic procedures, including liposuction and face lifts, performed under local anesthesia or with minimal sedation. USA Today’s coverage centered on board-certified plastic surgeons as the only appropriate provider of cosmetic surgery; and highlighted several policy concerns. The AADA along with the American Society for Dermatology Surgery Association sent a letter to the editor in response to the story, noting dermatologists’ training, education and expertise in performing cosmetic surgery. The AADA continues to work with state dermatologic societies, state medical societies, and other national medical specialties to address policy concerns regarding the performance of cosmetic medical procedures in unregulated medical spa facilities, truth in advertising and transparency of provider credentials (including board certification disclosure), and office based surgery/use of anesthesia. On Sept. 21, USA Today published an editorial reiterating the need for patients to check out their doctors and calling on state regulators to do more to protect patients.

District of Columbia seeks to regulate tanning facilities
Earlier this month, the District of Columbia Department of Health issued proposed regulations for indoor tanning facilities. The 45-page proposal provides for licensure, inspection and standards of operation for tanning facilities. The proposed regulations also ban the usage of tanning devices for minors under the age of 14, and require in-person parental consent and accompaniment for minors 14 and 15 years old and one-time, in-person parental consent for minors 16 and 17 years old. The District is currently among the 14 states and territories that do not have any government oversight of the tanning industry. The AADA has solicited the support of the Washington, D.C., Dermatological Society to submit joint written comments to the D.C. Department of Health by the end of this month.

Private payer activity

AADA engages Humana on critical policy issues
On Sept. 20, AADA representatives attended a meeting with Humana at the American Medical Association. The meeting covered a broad range of issues including physician profiling, pay for performance, narrow provider network programs, Medicare Advantage, administrative simplification, Accountable Care Organizations (ACOs), and employed physicians.

Of particular interest to dermatology, Humana clarified its process and methodology for economic profiling, which has been the basis for development of its narrow provider networks. Humana is developing these networks in six markets and four states, reportedly based on pressure from the large employer community and the Medicare Advantage program. The AADA, AMA and other specialty and state societies expressed strong opposition to removing physicians from networks based on costs alone.

At the meeting, Humana also addressed its acquisition of Concentra, a network of more than 300 practices, and its Dartmouth group pilot ACO with Norton. Specifically, they wanted to discuss opportunities that may exist for physicians and private payers to collaborate around ACOs and employed physicians.

The AADA will continue to engage Humana independently, to discuss issues unique to dermatology, and in collaboration with the AMA and other organizations as appropriate.

Political affairs – SkinPAC

SkinPAC to host contributors' dinner
SkinPAC will be holding a private dinner event for its contributors on Oct. 3 at 6:30 p.m. during the AADA’s Legislative Conference in Washington, D.C. The location will be 901 Restaurant and transportation will be provided to and from the hotel. As is tradition, the dinner will feature a congressional keynote speaker on health care policy and politics. In years past, U.S. Reps. Charles Boustany, M.D., Nita Lowey, and David Scott have addressed the attendees. If you would like find out more about this event, or R.S.V.P., please contact Sam Hewitt, AADA manager of political affairs, at (202) 712-2609, or by email at shewitt@aad.org.

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 SkinPAC from accepting contributions from foreign nationals. Federal law requires SkinPAC to use its best efforts to collect and report the name, home mailing address, occupation, and the name of the employer of individuals whose contributions exceed $200 in a calendar year.

Upcoming events

2011 AADA Legislative Conference boasts record registration
From Oct. 2 – 4, more than 120 AADA members, dermatology practice managers and administrators, and patient advocates will convene at the Washington Court Hotel, in D.C., for the AADA Legislative Conference. This year’s conference, which set a record for registrants, is headlined by a keynote address from political columnist George Will, a plenary session headed by former AMA President Nancy Nielsen, an interactive media seminar, a grassroots training session and a political update by Stu Rothenberg.

Registration is now closed, but if you are interested in attending in 2012, please the contact AADA grassroots staff.

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