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This week’s headlines:
Congressional action

Medicare payment cuts loom as congressional budget negotiations approach year-end deadline
Congress has until Jan. 1, 2013, to pass legislation that averts the 2 percent across-the-board spending cuts to all programs, also known as sequestration, including Medicare, as a result of the Budget Control Act of 2011. The impact of this ‘fiscal cliff’ on Medicare payments is compounded by the expiration of several other economic provisions, including the freeze of the Medicare physician payment Sustainable Growth Rate (SGR), which, when combined with the sequestration, would lead to a 29 percent reduction. Since the Thanksgiving holiday, the Administration and congressional leaders have been exchanging proposals to meet the budget benchmark that would avert the across-the-board cuts.

It is possible that a temporary resolution may be put into place for further negotiations in 2013, including discussions on Medicare physician payment reform. Add your voice to this effort by emailing your members of Congress via the Dermatology Advocacy Network. Contact Blake McDonald for more information.

AADA dermatologists take action to stop Medicare payment cuts, fix the SGR
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), more than 600 dermatologists throughout the country have sent 1,800 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 (see related item above). 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

Stage 3 meaningful use recommendations released
The Office of the National Coordinator for Health Information Technology (ONC) within the U.S. Department of Health and Human Services (HHS) recently released the Health Information Technology Policy Committee’s preliminary recommendations for stage 3 meaningful use of electronic health records (EHR). Building on stage 2 objectives, the recommendations increase threshold percentages to show meaningful use, change stage 2 menu objectives to core objectives in stage 3, and increase patient engagement. Additionally, the committee’s recommendations emphasize the need for increased patient engagement, transitioning from a “setting-specific” approach to a more patient-based focus.

The American Academy of Dermatology Association (AADA) will submit comments to ONC prior to the Jan. 14 deadline. The stage 3 recommendations are expected to go into effect in 2016. View the ONC’s request for comments and learn more about EHR implementation on the AAD HIT-Kit.

American Cancer Society calls on HHS to expedite review of FDA tanning bed classification
The American Cancer Society (ACS) and the American Cancer Society Cancer Action Network (ACS CAN) have sent a letter to the U.S. Department of Health and Human Services (HHS) requesting that it expedite its review of the current tanning bed classification at the Food and Drug Administration (FDA).

Stemming from evidence that exposure to the ultraviolet radiation in tanning beds could lead to skin cancer, in 2010 the FDA General and Plastic Surgery Devices Panel unanimously recommended that FDA reclassify tanning beds and impose greater control over their manufacture and distribution. Currently, the FDA classifies indoor tanning devices as Class 1, the category for items that have minimal potential to cause harm to individuals. Items in Class 1 include adhesive bandages and tongue depressors. The FDA has not yet acted on these recommendations.

The American Academy of Dermatology Association (AADA) has expressed its support of ACS’s and ACS CAN’s efforts on this important initiative. The AADA supports a ban on the production and sale of indoor tanning equipment for non-medical purposes. However, until this action occurs, the AADA supports shifting the classification of indoor tanning devices to the strongest possible category. Read more about the AADA’s advocacy efforts on tanning bed classification.

Private payer activity

UnitedHealthcare announces changes to pharmacy benefit coverage
Effective Jan. 1, 2013, UnitedHealthcare will no longer cover metronidazole gel 1% (Metrogel®) and Clindagel under its pharmacy benefits. The UnitedHealth Group National Pharmacy & Therapeutics (P&T) Committee has deemed Metrogel 1% to be therapeutically equivalent to metronidazole gel 0.75% (generic Metrogel), and Clindagel to be therapeutically equivalent to clindamycin gel (generic Cleocin-T). Both generic products will continue to be covered under the UnitedHealthcare pharmacy benefit.

UnitedHealthcare previously reached out to the American Academy of Dermatology Association (AADA) requesting comments on the coverage strategy for Metrogel 1% in July 2012. The AADA provided responses from several expert dermatologists highlighting the differences between Metrogel and the generic. The AADA is disappointed that UnitedHealthcare will no longer cover Metrogel 1% and is investigating the coverage change. UnitedHealthcare did not request input from the AADA on coverage for Clindagel. For more information, or for questions on these coverage changes contact Jacqueline Buschmann.

Anthem Blue Cross Blue Shield Kentucky conducting educational audits
In an effort to improve compliance with their payer-specific criteria for selecting evaluation and management (E/M) service level and ensuring appropriate use of modifier 25, Anthem Blue Cross and Blue Shield of Kentucky (Anthem BCBS KY) is conducting educational audits of dermatologists. The educational audits will review five medical records from individual dermatologists, and provide specific feedback on each record. Anthem BCBS KY requires Medical Decision Making (MDM) to be one of the two criteria selected for determining E/M level.

Although these audits are educational, dermatologists will be expected to make improvements, and audits that reveal a pattern of improper coding and/or documentation will require future assessment by Anthem BCBS KY. The AADA is aware of this effort, and has been working with Anthem BCBS KY. For questions, or to provide feedback from your educational audit, email ppm1@aad.org or contact Jacqueline Buschmann at (202) 609-6334.

State policy roundup

Dermatologists testify against proposed bill on surgery provisions
Dermatologists representing the American Academy of Dermatology Association (AADA), Dermatological Society of New Jersey (DSNJ), the American Society for Dermatologic Surgery Association (ASDSA), and the American College of Mohs Surgery (ACMS) testified yesterday before the N.J. Assembly Health & Senior Services Committee against changes to statutes that would limit the setting where certain minimally invasive procedures can be performed.

According to Assembly Bill 1824, physicians can perform any of the following procedures only in an office or facility that is accredited by the American Association for Accreditation of Ambulatory Surgery Facilities, the Accreditation Association for Ambulatory Health Care, or The Joint Commission:

  1. Liposuction procedures that involve more than 750 cubic centimeters of aspirate
  2. Procedures that utilize a breast implant
  3. Aesthetic truncal contouring procedures that involve the excision of skin

Brett M. Coldiron, MD, 2013 AADA president-elect, and Robert Paull, MD, DSNJ board member, testified that such legislation could in fact hinder patient safety, access to dermatological procedures, and lead to even higher health care costs in New Jersey. Read more about the testimony.

Following the hearing, the bill passed out of committee and will go on to the full assembly for a vote. The AADA will continue to work with the N.J. state legislature to ensure that the necessary amendments to this bill are made. For more information on this issue, contact Kersten Burns.

2013 state legislative sessions set to convene
Although state legislative sessions have only just recently closed up shop for 2012, several legislatures are already gearing up to convene for the 2013 session. Forty-one states and the District of Columbia will begin in January, followed by five more states in February. Florida’s legislative session will begin on March 5, followed by Louisiana on April 8. California and Maine have already kicked off their 2013 sessions. Learn more about when your state’s 2013 legislative session is scheduled to begin.

The American Academy of Dermatology Association (AADA) is already working with several states to introduce legislation in 2013 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 Kersten Burns to learn more about the resources available for state advocacy, or visit the AADA State affairs Web page. Check your inbox for the January 2013 edition of Dermatology World for several 2012 highlights of state legislative activities and successes.


Editor's note
Dermatology Advocate will be on hiatus for the holidays, and the next issue will be sent on Jan. 11.
Season’s greetings and best wishes for a happy New Year.


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