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This week’s headlines:
Congressional action

AADA urges Congress to stop medical research funding cuts
As a member of the One Voice Against Cancer coalition, the AADA joined other advocacy organizations this week in sending a letter to House and Senate leadership urging them to work together to avoid the upcoming sequestration cuts that will significantly affect medical research and cancer funding. If Congress fails to act by the end of 2012, the National Institutes of Health will face a $2.5 billion cut in funding, and funds for the Centers for Disease Control and Prevention will be cut by $464 million. These cuts would be devastating to current and future research funding and would threaten millions of dollars dedicated to the prevention and treatment of cancer. The AADA is strongly advocating that Congress work quickly to avoid these cuts and protect important funding that affects the lives of millions of Americans.

AADA signs American Medical Association letter urging SGR repeal
On Oct. 15, the AADA and more than 100 other medical associations and societies signed a letter from the American Medical Association that urges the Senate Finance, House Ways and Means, and Energy and Commerce Committees to permanently repeal the flawed Medicare payment formula known as the Sustainable Growth Rate (SGR). The letter also offers suggestions for replacing the SGR, including a transition to “physician-led, patient-centered” payment models, as well as guiding principles on how to build a new Medicare system that improves physician delivery of care, and consequently, quality of care for patients.

This letter comes at a pivotal time when physicians face a 27 percent Medicare payment cut on Jan. 1, should the SGR be allowed to take effect. In addition, under the budget agreement made last year, the sequester process could cut Medicare payments 2 percent in the new year, creating a combined 29 percent cut. Such cuts would be devastating to physician practices and would threaten access to care for millions of Americans. The AADA continues to meet with policymakers to advocate for a repeal of the SGR and overall reform of the unsustainable Medicare physician payment system.

Private payer activity

Deadline for Blue Cross Blue Shield Association lab claims filing policy
AADA staff members have been working with the College of American Pathologists (CAP) to address a Blue Cross Blue Shield Association (BCBSA) claims filing guideline that requires independent clinical laboratories to file claims to the BluePlan in the state that the specimen was drawn. While the implementation date varied by plan, BCBSA required that plans enforce the change by Oct. 14.

In August, AADA and CAP staff held a conference call with staff at BCBS Illinois and its parent company Health Care Systems Corporation to discuss the negative implications of this policy on physicians and patients. The AADA and CAP also sent a joint letter to BCBSA in September, and held a follow-up conference call last week. Although the issue has yet to be resolved, BCBSA has provided the AADA and CAP with resources for contracting with the Blue plans. The AADA will continue to pursue a workable resolution and provide additional information and updates. For questions on individual plan contracting, please contact Jacqueline Buschmann.

Blue Cross Blue Shield Tennessee revises consolidation policy
In May, the Tennessee Volunteer State Health Plan—a subsidiary of Blue Cross and Blue Shield of Tennessee (BCBS TN) and the state’s Medicaid program—notified network providers of its plan to consolidate lab services to Quest Diagnostics. BCBS TN also implemented a list of laboratory services that would be excluded from this policy. In the most recent version of the exclusion list, however, CPT 88305 was excluded for outpatient use but not excluded for in-office use. The AADA has been working in conjunction with the Tennessee Medical Association and the Tennessee Dermatology Society to get CPT 88305 on the exclusion list. For questions regarding this policy or the AADA's actions, please contact Jacqueline Buschmann.

AADA working with Horizon Blue Cross Blue Shield New Jersey on pathology claims policy
As previously reported, Horizon Blue Cross Blue Shield of New Jersey (Horizon) notified its network pathologists that they must be affiliated with a hospital-based practice in order to remain in-network. Dermatologists are excluded from the hospital affiliation requirement, but still need to be board-certified unless previously ‘grandfathered in’ to the network.

In the letter to pathologists, Horizon stated that the only allowable practice location for providers in Horizon’s managed care network (HMOs) is hospital-based. Horizon also clarified that LabCorp is the exclusive in-network clinical laboratory service provider for managed care plans (HMOs) and the preferred provider for members enrolled in other product lines (PPOs).Therefore, office-based pathology services for members with PPO plans will now be considered out-of-network. This policy went into effect on Oct. 14.

The AADA is working with the Medical Society of New Jersey, the Dermatological Society of New Jersey, and the College of American Pathologists to further clarify and resolve this issue. For questions regarding this policy or the AADA's actions, please contact Jacqueline Buschmann.

Dermatologists still exempt from Aetna policy change
The AADA continues to work closely with Aetna following the exemption of dermatologists and dermatopathologists from its requirement for in-office laboratories to be both CLIA and CAP accredited. Aetna erroneously sent a letter dated July 10, to several dermatologists about the change. However, the letter was intended for all other specialties and Aetna continues to confirm that there are no new changes to its policy related to this exemption. Aetna has informed the AADA that it will be notifying providers that the policy change is delayed and will go into effect on April 1, 2013. If you receive this notification, Aetna has reconfirmed that dermatologists and dermatopathologists will continue to be exempt.

State policy roundup

Kansas’ highest court upholds cap on non-economic damages
The Kansas Supreme Court upheld a provision of the state’s 1988 tort reform law that imposes a $250,000 cap on non-economic damages in medical malpractice cases. The court’s 5-2 opinion ruled that enacting the cap was rationally related to a valid legislative purpose, and therefore constitutional. The 1988 cap law was intended to ensure the availability of quality health care for patients by maintaining the affordability of malpractice insurance for health care providers. The court noted that the cap’s intent serves legitimate state interests.

Further, the court’s decision rested on the fact that health care providers in the state are required to carry liability insurance and participate in the Health Care Stabilization Fund. Together, these requirements provide patients—who have given up the right to recover unlimited pain and suffering damages—a guaranteed source of recovery.

The court also noted the state’s failure to raise the cap on damages since the law was enacted 24 years ago, but it did not find such inaction to mean the statute was unconstitutional.

Read the Kansas Supreme Court’s full decision on this case, Miller v Johnson.

AADA promotes National Healthy Skin Month
The AADA is assisting members and state dermatological societies in promoting November as National Healthy Skin 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 National Healthy Skin 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.

Leadership opportunities

Robert Wood Johnson Foundation seeks health policy fellow applications
The Robert Wood Johnson Foundation is seeking applications for the 2013-2014 Health Policy Fellows program. The program offers a minimum of a one-year stay in Washington, D.C., for mid-career health professionals with an interest in health and health care policy. Fellows will actively participate in health-policy processes at the federal level and use that leadership experience to improve health, health care and health policy. The deadline for submitting references is Nov. 7. Full applications are due Nov. 14. Read more about the Robert Wood Johnson Health Policy Fellows, or visit the 2013-2014 Call for Applications to find out more on how to apply.


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