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This week’s headlines:
Congressional action

Bipartisan congressional briefing calls for permanent ‘doc fix’ now
On Oct. 27, Reps. Allyson Schwartz (D-Penn.) and Phil Roe (R-Tenn.) jointly hosted a bipartisan briefing highlighting the importance of a permanent solution to the flawed Medicare physician payment formula. Several prominent health care experts, including Mark McClellan, M.D., former administrator of the Centers for Medicare and Medicaid Services (CMS), attended the briefing and echoed the call for a stable physician payment system. The event was well-attended by congressional staff and representatives from the physician community, including the AADA.

The briefing supported the bipartisan letter Rep. Schwartz sent to the supercommittee earlier this month with more than 100 congressional co-signers urging the committee to include a permanent physician payment fix in its deficit reduction proposal due later this month. Dermatology advocates lobbied their elected officials in support of this letter during the AADA’s Legislative Conference. The AADA, through its Dermatology Advocacy Network, urges you to log on now to easily write your Congressman in support of the physician payment fix.

U.S. Secretary of Health and Human Services Kathleen Sebelius issued a statement earlier this week which also called for the need to fix the sustainable growth rate issue.

Supercommittee concerned about Medicare and Medicaid spending
On Oct. 26, the supercommittee held a hearing to examine discretionary federal spending (dollars allocated through the appropriations process). Congressional Budget Office (CBO) Director Douglas Elmendorf provided an overview of federal discretionary spending; however members from both sides of the aisle agreed that mandatory spending programs, mostly entitlement programs such as Medicare and Medicaid, are the primary drivers of the increasing federal deficit. While discretionary spending was meant to be the focus of the hearing, the discussion often returned to mandatory spending. One of the topics discussed was the potential impact of sequestration on Medicare and other federal programs. Elmendorf estimated that sequestration would reduce “budgetary resources” for Medicare by a total of $123 billion over the period 2013-2021. The committee members agreed that funding for these mandatory programs, like Medicare, must be reined in; however details of accomplishing this were not discussed.

House appropriations bill includes 3.5 percent increase for NIH, cuts IPAB funding
The House Appropriations Committee recently released its fiscal year (FY) 2012 funding bill, calling for a $1 billion increase in funding for the National Institutes of Health (NIH), a 3.5 percent increase over last year’s funding. The bill cleared by the Senate Appropriations Committee called for a cut in the NIH budget by $190 million (a 0.6 percent decrease). With respect to skin cancer funding, while funding for the Centers for Disease Control and Prevention (CDC) Cancer programs were protected in the Senate bill at FY2011 funding levels, the House version cuts CDC chronic disease funding by more than $112 million (13.8 percent). At this time, it is unclear how this cut would be distributed, but such a significant cut to chronic disease funding would likely be very damaging to the cancer control programs.

Additionally, the House spending bill included language to eliminate funding ($15 million) for the Independent Payment Advisory Board, which the AADA has forcefully opposed since its creation under the 2010 health system reform legislation.

Cancer groups continue push for increased research funding
Along with others in the cancer community, the AADA sent a letter to House appropriators thanking them for including $12.8 million for the Peer Reviewed Cancer Research Program in the fiscal year 2012 Department of Defense (DoD) Appropriations Act. The Peer Reviewed Cancer Research Program supports medical research on many forms of cancer, including melanoma and other skin cancers. The AADA will continue to advocate for DoD cancer programs as the House and Senate negotiate final appropriations legislation.

Federal agency focus

CMS extends e-prescribing hardship exemption deadline to Nov. 8
The Centers for Medicare and Medicaid Services have extended the deadline from Nov. 1 to Nov. 8 to file for a hardship exemption to the e-prescribing requirement. Providers who did not meet the requirement of completing 10 electronic prescriptions between Jan. 1 and June 30, 2011 will face a 1 percent penalty from Medicare in 2012 unless they qualify and apply for the exemption. Details on who is qualified for an exemption were reported in the October 2011 issue of Dermatology World. Providers can report an exemption online.

AADA participates in inaugural FDA Health Professional Organization Conference
On Oct. 31, the AADA participated in the FDA's first annual Health Professional Organization Conference. The AADA was invited to speak about the value, opportunities and challenges in partnering with the agency, using this past summer's release of the sunscreen regulations as an example. The day-long conference, involving staff from both the FDA and health professional organizations, highlighted the work with the AADA as an example of a constructive and positive collaboration to amplify common messages promoting public health and prevention.

Final 2012 Medicare rule proposes 27 percent cut in physician payments; congressional action needed
The Centers for Medicare & Medicaid Services (CMS) on Nov. 1 released its final rule updating payment rates for physician services paid under the Medicare Physician Fee Schedule for 2012. As expected, the final rule calls for an across-the-board 27.4 percent reduction in payment rates, based on the current SGR formula, which reduces the Conversion Factor from $33.9764 to $24.6712. Unless Congress steps in to avert the cut, payment rates are scheduled to be reduced on Jan. 1.

In the final rule, CMS also upheld its proposal to expand the potentially misvalued code initiative to review high volume codes. Mohs codes 17311 and 17312 and destruction code 17004 were among the 70 codes identified that the AMA/Specialty Society Relative Value Scale Update Committee will now be required to review. The final rule also implements the third year of a four-year transition to new practice expense relative value units based on data from the Physician Practice Information Survey and makes changes in how CMS adjusts payment for geographic variation in the cost of practice. The final rule also updates or modifies aspects of a number of physician incentive programs including the Physician Quality Reporting System, the E-Prescribing Incentive Program and the Electronic Health Records Incentive Program. The AADA will continue analyzing the final rule to assess the net impact on dermatology services, and provide updates through this newsletter and on www.aad.org.

FDA issues drug shortage report, President signs executive order
In response to heightened concerns about an increasing number of prescription shortages in recent years, the FDA issued a report highlighting a number of agency processes that can be improved to help alleviate the problem. These actions include: 1) sending a letter to manufacturers urging them to notify the FDA of any potential disruptions in the drug supply; 2) developing guidance and regulations that enhance the drug shortage information provided by industry; 3) implementing a database to collect and analyze drug shortage information; and 4) supporting legislation requiring industry to provide early notification of any potential drug shortage.

The AADA will be submitting comments detailing dermatology-specific drug shortages. The agency deadline for public comments is Dec. 23, 2011. To help the AADA better understand current drug shortages in the dermatology community, please take a moment to fill out a brief survey regarding dermatologists’ experiences with prescription drug shortages affecting their care of patients. To emphasize the need to address the impact of the worsening drug shortage problem, President Obama signed an executive order on Oct. 31. The order gives the FDA the authority to broaden the reporting of potential shortages of certain drugs, accelerate drug approvals, and provide more information to the Department of Justice on price gouging resulting from drug shortages.

State policy roundup

Dermatology responds to plastic surgery’s ‘White Coat Deception’ campaign
In an Oct. 16 article in the South Florida Sun Sentinel, American Society of Plastic Surgeons (ASPS) President, Malcolm Roth, MD, promoted the credentials of board-certified plastic surgeons to perform cosmetic surgery and discussed the ASPS’s new public relations campaign titled, “White Coat Deception.” The campaign is geared toward raising patients’ awareness that even if a medical provider is wearing a white lab coat, it does not mean they are qualified to perform a specific procedure. The article inaccurately implied that dermatologists are not trained surgeons or qualified providers of cosmetic surgery. The AADA worked closely with the American Society for Dermatologic Surgery, the Florida Society of Dermatology and Dermatologic Surgery, and the Florida Society of Dermatologic Surgeons to respond to the paper with a joint letter to the editor. To date, no letters on this story have been published.

AADA promotes National Healthy Skin Month
The AADA is assisting members and state dermatologic 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. On Oct. 25, Gov. Peter Shumlin (D-Vt.) declared November 2011 Healthy Skin Month in Vermont. The AADA commends Gov. Shumlin for his commitment to the betterment of skin health for all Vermonters. Resources for members to discuss National Healthy Skin Month are available online in the AAD media relations toolkit. Members and state societies that are still interested in pursuing a mayoral or gubernatorial proclamation can contact Kathryn Chandra, assistant director of state policy, at kchandra@aad.org for assistance.

Pennsylvania senate passes bill to regulate indoor tanning salons
In a 48 to 1 vote on Oct. 31, the Pennsylvania senate passed legislation that would regulate the indoor tanning industry in the state by providing appropriate state oversight, prohibiting use by minors under 14, and requiring in-person parental consent (for first use) for those 14 to 18. The Pennsylvania Academy of Dermatology and Dermatologic Surgery (PADDS) has been advocating, with support from the AADA, in favor of this legislation for more than four years. The measure nearly passed the legislature in 2010 but was held due to fiscal concerns voiced by the Governor’s office. This year’s bill, SB 349, now moves to the House for additional consideration. The AADA will continue to support this legislation with the PADDS and send grassroots alerts when appropriate to encourage members to contact their state representatives.

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