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This week’s headlines:
Congressional action

Take action: Fix the SGR
The AADA Dermatology Advocacy Network (DAN) has re-issued its call to action, asking that all AAD dermatologists send a letter to their members of Congress, urging them to permanently repeal the flawed Sustainable Growth Rate (SGR) formula. Medicare physician payments are scheduled to be cut by about 30 percent in January 2013—27 percent of this amount is due to the SGR formula, and an additional 2 percent will be imposed by the budget sequester.

The AADA is working with the greater medical community to help Congress determine a solution. Recently, the AADA signed on to a letter that offers suggestions for replacing the SGR with new payment models that would ensure that physicians could continue to provide optimal care to their patients. Visit the AADA DAN Action Center to learn more about how to get involved, or contact Blake McDonald for more information.

2012 election results: AADA president highlights strategies for moving ahead
The majority of the results from the 2012 elections are in, and consequently several health care policies will move ahead, particularly with regard to the Affordable Care Act and Medicare. However, American Academy of Dermatology Association (AADA) President Daniel M. Siegel, MD, says significant opportunities to influence the direction of these policies remain. Learn more about the AADA's strategies here.

In an effort to help physicians navigate health care reform, the AADA has developed resources to guide members planning for the impact that reform will have on their practices. The AADA has recently launched the new Accountable Care Organization (ACO) Resource Center—offering background information about ACOs, as well as many of the tools you need to make an informed decision about whether joining an ACO is right for you.

Congress holds hearings on fungal meningitis outbreak
Committees in both the U.S. House and Senate held separate hearings this week examining whether or not the deadly outbreak of fungal meningitis—associated with tainted products from the New England Compounding Center (NECC)—could have been prevented.

The House Energy and Commerce Oversight and Investigations Subcommittee held its hearing on Wednesday. The Senate Health Education Labor and Pensions Committee held its hearing on Thursday. Peggy Hamburg, MD, commissioner of the Food and Drug Administration (FDA), served as a witness in both hearings. Barry Cadden, owner and director of Pharmacy at the NECC, was served a subpoena to testify before the House subcommittee and declined to answer lawmakers' questions on Wednesday, pleading the Fifth Amendment and claiming his right to not incriminate himself.

Lawmakers also questioned the FDA on why it did not follow up on its 2006 letter to NECC that demanded changes to its operating practices. The FDA Commissioner stated that the agency’s authority over compounding pharmacies is a gray area and asked Congress for more clarification and legal authority to regulate these pharmacies.

Last week, the FDA traced cases of fungal meningitis back to two additional NECC products — betamethasone, another injectable steroid, and cardioplegia, a heart drug. Read the latest information on the fungal meningitis outbreak and the FDA’s advice for health care providers on this issue. The AADA will continue to monitor events related to this outbreak, and provided updates as they become available.

Federal agency focus

CMS Physician Fee Schedule update: 88305 reimbursement reduction
On Nov. 1, the Centers for Medicare and Medicaid Services (CMS) released the final 2013 Medicare Physician Fee Schedule rule which will go into effect on Jan. 1, 2013. The final 2013 fee schedule included a significant reduction in reimbursement for the technical component (TC) of surgical pathology code 88305. That code’s TC will be cut by 52 percent, although the professional component (PC) will be raised by 2 percent. Overall, the global value of 88305 was reduced by 33 percent.

The AADA is working with other organizations whose physicians will also be affected by these cuts to determine an appropriate response. The AADA will submit comments to CMS prior to the Dec. 31 deadline, and asks that physicians provide feedback directly to the AADA with thoughts and suggestions about the cuts to the 88305 TC.

A fundamental priority for AADA advocacy is to ensure the fair and adequate valuation of dermatologic services that ensures wide access to care for patients. Throughout the year, the AADA has actively weighed in on this rulemaking process with regard to important provisions affecting physician payments. Read the AADA’s comment letter to CMS on the proposed 2013 Medicare Physician Fee Schedule.

The AADA will continue to monitor developments related to the final 2013 Fee Schedule and provide updates when available. For more information and to provide feedback, contact the AADA at 202-842-3555 or govtaffairs@aad.org.

RUC survey: Call for participation
The AADA strongly encourages physicians to participate in a new survey from the AMA/Specialty Society RVS Update Committee (RUC). Physicians will be randomly selected to participate; responses to the survey will be used to determine the level of Medicare reimbursement for the destruction of pre-malignant lesions-1700X actinic keratosis (AK) codes-procedures. Survey participation is important as this data helps determine the rate at which Medicare and other payers value procedures. Check your email inbox for this survey — responses will be due Nov. 28. Learn more about how to take a RUC survey, or contact Helen Olkaba at 202-712-2612 for more information.

AADA updates position statement on generic therapeutic and biosimilar substitution
In an effort to ensure patient safety, the AADA has updated its position statement on generic therapeutic and biosimilar substitution, supporting a prohibition of generic therapeutic and biosimilar substitution unless several minimal thresholds are met.

Due to their inherent variability — because they are derived from living cells that use recombinant DNA technology — biologics can never be exactly replicated and therefore require additional data to show that they are safe and effective. Dermatology World examined issues associated with psoriasis drug biosimilars in an August 2012 article. The AADA calls on the Food and Drug Administration (FDA) to continue to require additional data regarding the efficacy and safety of generic therapeutics and biosimilar products. Additionally, the AADA asks the FDA to ensure that these products have different names so that medical records can fully reflect the exact medication prescribed and taken.

Read more about the AADA’s position statement on generic therapeutic and biosimilar substitution. Contact Amanda Grimm for more information.

Private payer activity

Novitas Solutions claims denial corrected
The AADA has been working with Novitas Solutions, the new Jurisdiction H Medicare Contractor for Louisiana, Mississippi and Arkansas, which had been denying claims that included the diagnosis code 702.0 for Actinic Keratosis (AK). These denials were contrary to their Local Coverage Determination (LCD) for Benign Lesion Removal L32668.

The AADA advocated to make this correction and learned that the denials were the result of a technical error. Although the National Coverage Determination 250.4 outlines coverage for the treatment of AK, the diagnosis code was not added to the LCD. Novitas gave assurances that they will correct the error and do a mass payment adjustment for reported claim denials for the premalignant lesion CPT code 17000 series. For more information, email ppm1@aad.org.

State policy roundup

HHS extends deadline for health insurance exchange decision
The U.S. Department of Health and Human Services (HHS) has extended the deadline for states to decide if they will build and manage their own state-based health insurance exchange, or work with the federal government to run the exchanges in their states, to Dec. 14.

The Republican Governors Association had written a letter to President Obama requesting that HHS extend the Nov. 16 deadline, citing concerns about future cost-shifting to states and overall implementation.

Under the Affordable Care Act (ACA), states that cannot or do not want to run their own exchanges will work with the federal government to do so. Per the ACA, every state will be required to have a health insurance exchange by Jan. 1, 2014.

Last week, HHS Sec. Kathleen Sebelius extended the deadline for states to submit their plans for health insurance exchanges to Dec. 14. States that intend to partner with the federal government to set up an exchange will have until Feb. 15, 2013, to submit their declaration letter and plan.

AADA encourages members to connect with newly elected officials
As the opening of the 2013 session for state legislatures draws near, the AADA encourages dermatologists to reach out to their newly elected officials to educate them on the issues that affect the specialty and its patients.

The AADA has identified newly elected governors and state officials in several states. This year, in the 11 states which held gubernatorial elections, four incumbent governors were not re-elected in Indiana, Montana, New Hampshire, and North Carolina.

With regard to state legislatures, the 2012 elections resulted in several shifts in political party control. In Arkansas and Wisconsin, the state Senates have Republican majorities as does the Arkansas state House. In Maine, Minnesota and New York, Democrats are now in the majority in the state Senates as they are in the state House/Assemblies in Colorado, Maine, Minnesota and New Hampshire.

The AADA will continue to monitor how the results of the 2012 elections will affect AADA state-level priorities. Check your state’s website for information on the newly elected officials, and how to set up a meeting to discuss the important issues facing dermatology. Please contact Kersten Burns to learn more about the resources available for state advocacy, or visit the AADA State affairs Web page.

AADA offers advocacy assistance to state societies
As the 2012 legislative session has wrapped up in many states, the AADA would like to connect with you about your society’s state legislative plans for the 2013 session and how the AADA can support your efforts. Please contact Kersten Burns to learn more about the resources available for state advocacy, or visit the AADA State affairs Web page.

Political affairs – SkinPAC

SkinPAC sets fundraising record for 2012 election cycle
The American Academy of Dermatology Association’s Political Action Committee, SkinPAC, is celebrating its record-breaking election cycle surpassing the $1 million mark in August to raise more than $1,071,000. Additionally, we are delighted to report that 94 percent of the candidates who received SkinPAC funding won their elections.

SkinPAC’s growth in size and presence is very important as Congress will address many issues affecting dermatologists and their patients, particularly with regard to Medicare physician payment, as well as medical research and graduate medical education funding. For more information about SkinPAC, contact Katie Jones at 202-609-6333, or visit www.skinpac.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.

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