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This week’s headlines:
Congressional action

Supercommittee failure threatens automatic cuts to Medicare
The supercommittee’s failure to reach a deal to reduce the deficit by $1.2 trillion means Congress has missed an opportunity to address the nation’s fiscal problems, stabilize the Medicare program, and permanently repeal the broken SGR formula. Additionally, this inaction triggers an automatic across-the-board spending cut, called sequestration, in 2013 to achieve the targeted reductions. Under these spending cuts, Medicare physician payments would be reduced up to 2 percent. However, there has been extensive discussion by members of Congress regarding passage of new legislation that would prevent sequestration from occurring.

Over the last several months, the AADA communicated with the supercommittee regarding several legislative priorities including medical liability reform and a permanent repeal of the flawed sustainable growth rate (SGR). (Physicians still face a 27 percent cut in Medicare payments scheduled to take effect Jan. 1 when the last short-term fix expires.) Unfortunately, these proposals fell victim to sharp partisan division over the mix of entitlement cuts and tax hikes — fundamental principles for achieving deficit reduction. A positive aspect of the supercommittee failure is that potential threats to dermatology in regard to proposed pathology legislation that was being discussed by the supercommittee were averted.

Stop cuts to Medicare physician payment
The AADA is calling on all members to log onto the Dermatology Advocacy Network (DAN) and tell your members of Congress to stop the 27 percent cut in Medicare physician payment. Due to the flawed sustainable growth this cut in physician payment will take effect on Jan. 1, 2012. Only an act of Congress can avoid these cuts; that why we need you to write your members of Congress today. The DAN website allows you to quickly send a message to both your senators and congresspeople. Act now to avoid the 27 percent cut.

Federal agency focus

AADA testifies before FDA panel on iPLEDGE program
On Dec. 1, the Food and Drug Administration (FDA) convened a joint meeting of the Drug Safety and Risk Management Advisory Committee and Dermatology and Ophthalmic Advisory Committee to discuss the Risk Evaluation and Mitigation Strategy (REMS) associated with isotretinoin, also known as the iPLEDGE program. The panels also discussed the overall integration of REMS in the health care system. FDA officials and industry representatives presented data and analysis of the program. Andrea Zaenglein, MD, represented the AADA at the open public comment period to highlight the provider perspective on the iPLEDGE program including: provider burden, transparency, program effectiveness and registration of males and females with non childbearing potential.

The panels agreed the overall program is effective and necessary, but acknowledged the need to streamline the process to ensure patient access and minimize provider burden while assuring safe use. Of note, the panel discussed refocusing the program on a 28-day schedule rather than the current 30-day schedule to better align with provider and patient.

The Academy submitted a written comment to the agency in conjunction with providing the oral comments.

Drug shortage concerns remain priority
The AADA has continued to receive communications from members about ongoing problems accessing specific drugs, such as cantharadin, lidocaine, and even tetracycline, due to reported shortages of these drugs in areas across the U.S. In response, the AADA has been actively engaged with the AMA and FDA in working to identify reasons for and approaches to the problem. As noted in the Nov. 4 Dermatology Advocate, 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 is in the process of submitting comments to that report, due Dec. 23, detailing dermatology-specific drug shortages. 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.

State policy round-up

State legislatures wind down for 2011, gear up for 2012
Only seven states (Illinois, Massachusetts, Michigan, New Jersey, New York, Ohio and Pennsylvania) and the District of Columbia remain in session for the 2011 legislative year and will adjourn by Dec. 31 or within the first two weeks of January 2012. Legislation on indoor tanning is still pending in New Jersey, New York, Ohio and Pennsylvania. More than half of the states are in 2011-2012 legislative “carry-over” years, meaning that any legislation that was not acted on with finality, e.g., bills that were left pending in a committee, will still be eligible for consideration when the 2012 sessions commence. Washington state is currently in a special session to address the state’s budget, as is Virginia, to elect new state judges and Virginia Supreme Court justices. Additionally, seven states (Alaska, Arizona, Florida, Georgia., Kentucky, Tennessee, and Virginia) have begun prefiling legislation for the 2012 session. Several bills of interest, including truth in advertising and an indoor tanning teen ban, have already been filed in Florida. The AADA will be coordinating with the Florida Society of Dermatology and Dermatologic Surgery to monitor and comment on these bills. All of the state legislation and proposed regulations the AADA is tracking can be found in the State Affairs section of the Academy’s website along with a toolkit to help members advocate on important state issues.

Private payer activity

AADA urges First Coast to reconsider proposed Mohs policy
In a letter to the medical director of First Coast Services Options, Inc., which is the current Medicare Part B Administrative Contractor for Florida, the American Academy of Dermatology Association urged the contractor to reject proposed revisions to the local coverage determination for Mohs micrographic surgery that would limit who can perform the procedure and require multiple photographs to be submitted with each claim. Draft changes to the local coverage determination, if adopted, would limit the practice of Mohs to physicians who have completed an American College of Mohs Surgery fellowship or procedural dermatology fellowship. The Academy argued that such a change would be “inconsistent with nationally recognized prevailing clinical practice standards” and would ignore the fact that dermatologists receive extensive training in a wide array of procedures as a component of their residency training. First Coast’s draft local coverage determination would also require Mohs claims to include a series of photos, including preoperative photos, which the AADA argued would be of limited value in many cases. The Academy urged First Coast to “limit any requirement considerations for photographs to those physicians suspected of fraud and abuse who have been informed of such suspicions” and to photos of the preliminary biopsy and final surgical defect. The final determination for Mohs micrographic surgery will become effective for services performed on or after Jan. 31, 2012.

SkinPAC update

SkinPAC sets new fundraising record
SkinPAC has surpassed all previous yearly fundraising records by already raising more than $443,000 in 2011. Despite this 20 percent increase over the previous record, SkinPAC and its Board of Advisors are still going strong. With one month left, the SkinPAC Board of Advisors, chaired by Sandra Read, MD, is kicking its peer-to-peer fundraising efforts into high gear and personally reaching out to colleagues who have not yet renewed their investment in SkinPAC for 2011. AADA members who would like to renew their contributions or have never given in the past, can go to www.SkinPAC.org to make a donation. If you have questions about SkinPAC, please contact Sam Hewitt, AADA’s 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 us from accepting contributions from foreign nationals. Federal law requires us to use our best efforts to collect and report the name, physical address, occupation, and the name of the employer of individuals whose contributions exceed $200 in a calendar year.

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