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This week’s headlines:
Congressional action

House passes reprieve from Medicare payment cut; Committees clear payment reform proposals
As part of the budget agreement, the House of Representatives has passed a three-month reprieve from the 20.1 percent physician Medicare payment cut that is scheduled to begin Jan. 1, 2014. The Senate is expected to pass the budget agreement with the three-month bridge before adjourning for the year. Additionally, the House Ways and Means Committee and the Senate Finance Committee approved their respective Medicare payment reform proposals which would repeal the sustainable growth rate (SGR) formula and create a new Medicare physician payment system. While the American Academy of Dermatology Association (AADA) is encouraged by these actions, the AADA sent a letter to both committees expressing appreciation for their efforts as well as concerns about the need to ensure positive Medicare payment updates and remove certain penalties under the value-base payment program. The House Doctors Caucus also sent a letter citing several concerns with the House legislation. Both chambers are expected to continue these reform efforts in January. The AADA will continue to work with Congress to replace the system with meaningful reforms that preserve patients’ access to high-quality care and accounts for rising practice costs. The AADA is calling on all members to log on to the AADA Dermatology Advocacy Network and submit a letter urging Congress to repeal and replace the SGR. For more information, contact Shawn Friesen at sfriesen@aad.org.

Coalition calls on Congress to avoid catastrophic workforce shortage
With a physician workforce shortage projected to reach 130,600 physicians in 2025, the American Academy of Dermatology Association, the Association of American Medical Colleges, and other specialty societies are calling on Congress to protect Medicare beneficiary access to health care services by preserving existing Medicare financing for Graduate Medical Education (GME). Medicare’s current cap on financial support for GME prevents teaching hospitals from expanding the number of training positions and often prevents new hospitals from establishing teaching programs. In a joint letter, the organizations stressed that Medicare GME cuts will threaten access to care for millions of current and future patients. For more information, contact Shawn Friesen at sfriesen@aad.org.

President Obama signs legislation strengthening oversight of drug compounders
In response to last year’s nationwide meningitis outbreak linked to tainted steroids, President Obama has signed the Drug Quality and Security Act into law. Passed by the House and Senate in the fall, the law grants the U.S. Food and Drug Administration (FDA) more regulatory authority over prescription drug compounders and creates a uniform national standard for drug supply-chain security. The law preserves and protects the practice of traditional compounding and provides for compounders of sterile drugs to voluntarily register as “outsourcing facilities” that would be subject to FDA regulations and inspection fees. The American Academy of Dermatology Association (AADA), with the support of the American Medical Association and other physician organizations, was instrumental in altering the bill’s language to ensure it would not interfere with the practice of medicine in a physician’s office. The passage of the bill also coincides with the passage of the AADA’s position statement on Pharmaceutical Compounding. For more information, contact Christine O’Connor at coconnor@aad.org.

Senators urge preservation of in-office ancillary services
Sen. Tom Coburn, MD (R-Okla.), Sen. John Barrasso, MD (R-Wyo.), Sen. Rand Paul, MD (R-Ky.), and Sen. John Boozman (R-Ariz.) joined together to oppose efforts to eliminate parts of the exception to the Medicare Stark Law that allows physicians to provide advanced anatomic pathology, imaging, radiation therapy, and physical therapy services within their offices. In a letter to Senate leaders, they argue that removing this exception would require patients to receive these services in more expensive settings — increasing costs to patients and taxpayers. The American Academy of Dermatology Association (AADA) is calling on members to log on to the AADA Dermatology Advocacy Network to contact their members of Congress to oppose efforts to repeal the in-office ancillary services exception and preserve dermatologists’ ability to provide these important services to their patients. For more information, contact Christine O’Connor at coconnor@aad.org.

Federal agency focus

AADA joins legal action stalling United HealthCare Medicare Advantage terminations
The American Academy of Dermatology Association (AADA) joined a group of state and local medical societies in filing an amici curiae brief supporting a lawsuit against United HealthCare which successfully delayed its termination of more than 2,000 physicians from United HealthCare’s (UHC) Medicare Advantage (MA) network in Fairfield and Hartford counties in Connecticut. The amicus curiae was filed at the Federal Court of Appeals for the Second Circuit and urged the Appeals Court to ensure that patients continue to have access to their physicians in UHC’s MA network in those two counties. The AADA’s involvement in the case follows numerous efforts to persuade UHC to stop narrowing its MA network, including a meeting with top UHC officials and a joint letter with the AMA asking the Centers for Medicare and Medicaid Services to intervene. These MA issues garnered attention at a recent hearing at the House Energy and Commerce Health Subcommittee. Additionally, related issues with health plan networks and decreasing provider payments were discussed at a recent hearing of the House Oversight and Government Reform Committee. For more information, contact Leslie Stein Lloyd at lsteinlloyd@aad.org.

AADA seeks technical correction for CPT 17003
The American Academy of Dermatology Association (AADA) recently requested that the Centers for Medicare and Medicaid Services (CMS) issue a technical correction for the practice expense and overall payment rate for CPT 17003 (destruction of premalignant lesions, 2-14). The destruction codes have a valuation error, which resulted in an approximate payment rate of $10 for 2014. The AADA expects that 17003 will likely be reduced to less than $6 in the near future. The AADA advises members to document correctly and to code and bill for what is documented. For more information, contact James Scroggs at jscroggs@aad.org.

Board approves new position on superficial radiation therapy and electronic surface brachytherapy
On Nov. 9, the American Academy of Dermatology (AAD) Board of Directors approved a Position Statement on Superficial Radiation Therapy (SRT) & Electronic Surface Brachytherapy (eBx) for Cutaneous Basal Cell (BCC) and Squamous Cell Carcinomas (SCC). The statement supports surgical treatment as the optimal primary intervention for BCC and SCC and consideration of superficial radiation therapy as a second-line option for the treatment of these carcinomas in circumstances such as when surgical intervention is contraindicated. AAD members are encouraged to read the position statement and be aware of certain aspects of it as they relate to your practice, including coding appropriately for services and compliance with federal and state laws associated with provision of and billing for these services.

CMS delays deadline for Stage 2 meaningful use
The Centers for Medicare and Medicaid Services (CMS) has extended the deadline by which providers must attest to Stage 2 meaningful use criteria for the electronic health record incentive program. Stage 2 will be extended through 2016 and Stage 3 will not begin until calendar year 2017 for physicians and other eligible professionals. Learn more about meaningful use and electronic health records. For more information, contact Richard Martin at rmartin@aad.org.

FDA compiling lists of drug products for compounding
The U.S. Food and Drug Administration (FDA) is calling on the public to nominate drug products or categories of drug products that should and should not be used for compounding. Through the Drug Quality and Security Act (see related item above), the FDA has been tasked with developing these lists of products to create a uniform national standard for drug supply-chain security. Physicians may submit comments and supporting information on drug products and categories that should not be used in compounding here. In a separate form, physicians may submit comments and supporting information on drug products and categories that should be used in compounding here. The deadline for comments is March 4, 2014. For more information, contact Amanda Grimm at agrimm@aad.org.

Application deadline for health insurance exchanges extended to Dec. 23
The deadline for individuals to apply for coverage starting Jan. 1 under state-based health insurance exchanges has been extended to Dec. 23. In November, the U.S. Department of Health and Human Services also pushed back the deadline for consumers to be enrolled in exchanges from Feb. 15 to March 31. Additionally, the deadline for small businesses to purchase coverage for their employees through the exchanges has been delayed until November 2014. As part of the Affordable Care Act, states are required to provide Health Insurance Marketplaces where individuals without health care and small businesses can compare and enroll in various health insurance options. Read about your state’s plan on the Centers for Medicare and Medicaid Services’ website. The American Academy of Dermatology Association has been monitoring this issue and will provide additional information as it learns more about the impact of these health insurance exchanges on the specialty. Read more in the Sept. 2012 issue of Dermatology World. For more information, contact govtaffairs@aad.org.

Private payer advocacy

Tennessee BCBS to cut pathology physician payments in half
Tennessee Blue Cross Blue Shield (BCBS) has notified dermatologists and pathologists that it plans to cut reimbursement for pathology to 50 percent of the Medicare Fee Schedule for all product lines beginning Jan. 1, 2014. The American Academy of Dermatology Association (AADA) is working with the Tennessee Medical Association (TMA) to protest this drastic cut and seek clarification on the scope of the cuts. The AADA and TMA will provide updates on the sites and codes affected by this payment change as soon as more information is available. For questions, contact Leslie Stein Lloyd at lsteinlloyd@aad.org.

UnitedHealthcare announces changes to pharmacy benefit coverage
Effective Jan. 1, 2014, UnitedHealthcare will no longer cover several medications to treat acne, dermatitis, and psoriasis under its pharmacy benefits. The medications include: Calcipotriene Foam (Sorilux™) for psoriasis; Absorica®, Acanya®, BenzaClin®, Retin-A Micro®, and Retin-A Micro Pump® for acne; and Locoid Lipocream® lotion for dermatitis. The UnitedHealth Prescription Drug List Management Committee will exclude these medications from the plan because they have the same or a modified version of an active ingredient that is therapeutically equivalent to a covered or over-the-counter medication. For more information, or for questions on these coverage changes contact Amanda Grimm at agrimm@aad.org.

State policy roundup

New York City adopts stricter regulations on indoor tanning facilities
The New York City Board of Health unanimously adopted new rules that require clearer warning labels about the dangers of indoor tanning and routine inspections of tanning facilities to ensure that tanning devices are operating within the ultraviolet range limits allowed by the U.S. Food and Drug Administration. In 2012, New York State passed legislation that prohibits the use of indoor tanning beds by minors 16 and younger and requires 17-year-olds to obtain parental consent. The new rules will enforce this state law. NYC will also launch a public awareness campaign on the risks associated with UV exposure. For more information, contact Lisa Albany at lalbany@aad.org.

2014 state legislative sessions set to convene
Although state legislative sessions have only just recently closed up shop for 2013, many legislatures are already gearing up to convene for the 2014 session. The American Academy of Dermatology Association (AADA) is already working with several states to introduce legislation in 2014 on indoor tanning, truth in advertising, and other important issues. The AADA encourages dermatologists to reach out to their newly elected and incumbent officials to educate them on the issues that affect the specialty and its patients. Please contact Lisa Albany at lalbany@aad.org to learn more about the resources available for state advocacy, or visit the AADA State affairs Web page.

Political affairs – SkinPAC

SkinPAC to host second annual Derby Celebration
The American Academy of Dermatology Association’s Political Action Committee, SkinPAC, will host its annual Derby Celebration at the JW Marriott Desert Ridge in Phoenix. Grab your Derby hats and join your colleagues on Friday, May 2, at 6:00 p.m. for great food, horse racing, and engaging discussion on ways to keep SkinPAC’s momentum going as we jockey for position in Washington and head down the stretch in the 2014 election cycle. For more information about SkinPAC and the Derby Celebration, contact Katie Jones at kjones@aad.org or 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.

Editor's note
Dermatology Advocate will not be published during the holidays, and the next issue will be sent on Jan. 10. Please visit www.aad.org for information on breaking news. Season’s greetings and best wishes for a happy New Year.

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