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This week’s headlines:
Congressional action

Congress approaches ‘fiscal cliff’ during lame duck session
As a result of the Budget Control Act of 2011, Congress has until Jan. 1, 2013, to pass legislation that averts the 2 percent across-the-board spending cuts to all programs, known as sequestration, including Medicare. This ‘fiscal cliff’ is compounded by the expiration of several other economic provisions including the freeze of the Medicare physician payment Sustainable Growth Rate (SGR). The administration, members of Congress, and their staff are negotiating around the clock to come up with the necessary spending cuts, and changes in fiscal policy to avoid the sequestration and the expiration of popular tax policies.

The key to progress on any resolution will be how much each of the respective sides are able to reach a compromise on policies related to several key issues, including taxes and entitlements. There is a possibility that a resolution will not be reached. However, alternatively, a temporary resolution could be put into place for further negotiations in 2013, including discussions on Medicare physician payment reform. Read more about Medicare payment reform.

Stop cuts to Medicare physician payment
Hundreds of dermatologists have heeded the American Academy of Dermatology Association’s (AADA) recent call to action asking AAD dermatologists to send emails to their members of Congress urging them to permanently repeal the flawed Sustainable Growth Rate (SGR) formula. So far, through the Dermatology Advocacy Network (DAN), 567 dermatologists throughout the country have sent 1,700 emails to Congress encouraging them to take steps to avoid a scheduled 29 percent cut to Medicare physician payments that will go into effect on Jan. 1, 2013—27 percent of this amount is due to the SGR formula, and an additional 2 percent will be imposed by the budget sequester. Time is running out; make your voice heard by members of Congress and ask them to stop the cuts to Medicare physician payment. Visit the AADA DAN Action Center to learn more about how to get involved, or contact Blake McDonald for more information.

Federal agency focus

CMS Physician Fee Schedule analysis: Complex repair code cuts for 2013
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. CMS accepted the majority of the American Medical Association Relative Value Update Committee (AMA RUC) recommendations for the complex repair codes, with some exceptions.

In the 2012 Final Medicare Physician Fee schedule rule, CMS identified 13152, eyelid, nose, ears, and/or lips, 2.6 to 7.5 cm, as potentially misvalued due to the code being Harvard-valued with annual allowed charges equal to, or greater than, $10 million. Therefore, CMS required that 13152 be surveyed, which necessitated a survey of the entire family of complex repair codes in 2012. The American Academy of Dermatology Association (AADA), the American Academy of Otolaryngology — Head and Neck Surgery, and the American Society of Plastic Surgeons presented the survey results to the AMA RUC in April 2012.

While values were roughly maintained at current payment levels for most of the codes in the complex repair code family — and some actually increased — the final 2013 fee schedule included a reduction to 13152 by 13 percent, and 13132 (forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands, and/or feet 2.6 to 7.5 cm) by 16 percent — which are mostly due to a cut in physician work relative value units (RVU). For 13152, the physician work RVU was cut 23.08 percent; the practice expense RVU was cut 4.4 percent. For 13132, the physician work RVU was cut 27.36 percent; the practice expense RVU was cut 7.59 percent. The impact of the 2013 final rule will be greater if Congress fails to issue a freeze to the Sustainable Growth Rate. View the impact of the 2013 Physician Fee Schedule Final Rule on the complex repair codes as well as other key dermatology codes.

As previously reported, 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 has joined forces with other organizations, whose physicians will also be affected by these cuts, to formulate a strategy for responding to CMS to ensure the fair and accurate valuation of dermatologic services.

In addition, the final rule contains a number of refinements to policy initiatives. CMS will reduce the threshold for reporting the electronic prescribing measure (eRx) from 225 to 75, add an appeals process and two additional penalty exemptions for participating physicians, and allow group practices of 2 to 24 eligible professionals to participate in the eRx program in 2013. Read more about refinements to policy initiatives within the final Fee Schedule. For additional analysis of the final rule, check your mailbox for the December issue of Dermatology World.

Throughout the year, the AADA has actively weighed in on this rulemaking process with regard to important provisions affecting physician payments. CMS did accept the majority of the AMA RUC recommendations on almost 30 dermatology codes that were surveyed in 2012. Read the AADA’s comment letter to CMS on the proposed 2013 Medicare Physician Fee Schedule. Read the full text of the final rule.

The AADA will submit comments to CMS prior to the Dec. 31 deadline, and asks that physicians provide feedback directly to the AADA. For more information and to provide feedback, contact the AADA at 202-842-3555 or govtaffairs@aad.org.

AMA House of Delegates addresses workforce shortage, physician payment cuts, ICD-10
At the November American Medical Association (AMA) House of Delegates Interim Meeting, delegates introduced a policy to mitigate the physician workforce shortage by calling for an expansion of the U.S. Department of Health and Human Services (HHS) J-1 visa waiver program to allow for 50 positions per state.

The program allows international medical graduates to waive their return-home visa requirement if they agree to complete a two-year residency in a Health Professional Shortage Area — as designated by HHS. The program is currently capped at 30 positions per state. The House of Delegates also re-affirmed the AMA’s position to oppose cuts to graduate medical education (GME) federal funding that could cause residency programs to close.

AADA delegates along with the Dermatology Section Council also worked with other organizations to successfully advocate for a resolution to oppose the Centers for Medicare and Medicaid Services’ (CMS) changes in Relative Value Units that are in excess of those recommended by the AMA/Specialty Society Relative Value Scale Update Committee (RUC).

The HOD also adopted a resolution that opposes the transition to the new patient diagnosis coding set ICD-10 and supports delaying any mandatory transition until the ICD-11 coding set — currently open for review and comment — is released. Currently, CMS is requiring that providers switch to the ICD-10 codes by October 2013.

Read more about the AMA House of Delegates interim meeting.

AADA provides practice management resources on health system reform
In an effort to help physicians navigate the Affordable Care Act of 2010, 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. Learn more about ACOs and your practice, as well as in-depth information on health system reform from Dermatology World.

State policy roundup

AADA supports Ohio truth-in-advertising bill
The AADA sent a letter to the chair of the Ohio House of Representatives Health and Aging Committee in support of HB 607 which would require health care professionals to disclose their license in printed, electronic and oral advertisements. The bill would also require health care professionals to wear an identification card or badge that includes the professional’s photo, name and license information when providing direct care for a patient.

In the letter, the AADA stated that those who regulate and deliver medical care have an obligation to inform the public of the qualifications and limitations of the persons providing their care prior to treatment. All providers should identify or disclose their degree or field of study, board certification and licensure to each patient. Read more from the AADA’s letter of support. Get information and advocacy resources related to truth in advertising in the AADA’s State Advocacy Toolkit.

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.

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