Dermatology World January 2011 : Page 6

rounds news in brief – 1 2 –M ON TH EXTENsIO N – ME YMENTS PA ON TE TH EX NsION – 2 0 1 1 RE DICA –1 fter a year of short-term patches in 2010, physicians enter 2011 knowing that their Medicare payments will continue at the same level for the entire year. Both houses of Congress voted in early December to pass a 12-month extension of the previous fix to the flawed Sustainable Growth Rate formula, extending the payment levels for 2010 into 2011 and averting a 25 percent payment cut. Medical societies, including the American Academy of Dermatology Association, will use the year to work with Congress on a permanent solution to the problem. – RiChaRD NElSON 2 A Medicare payment rate frozen for 2011 iOm ups vitamin D recommendation slightly ThE aVERagE u.S. OR CaNaDiaN citizen needs no more than 600 internation-al units (IUs) of vitamin D per day, according to a report released on Nov. 30, 2010 by an Institute of Medicine (IOM) panel. The panel also recommended an intake of 800 IUs per day for those 71 years of age or older. The report, which was released following an evaluation of more than 1,000 published stud-ies and consultations with researchers, contradicts previous individual reports that much of the population suffers from vitamin D deficiency, as well as some physicians who recommend up to 3,000 IUs of the vitamin per day. Vitamin D supplementation has surged in popularity as patients have been told that most of the population is lacking the proper level. “That certainly was an article of faith,” panel member Clifford Rosen, M.D., said in an interview with National Public Radio about widespread belief in a lack of vitamin D among those in the medical community. “I certainly did, coming into the Institute of Medicine committee.” Instead, synthesis of the reports, along with a national survey of blood levels of the vitamin, confirmed for the panel that not only are necessary vitamin D levels lower than previously expected, but that most Americans and Canadians have sufficient levels of vitamin D. Increased food fortification was credited in part for the results. The report noted that “concerns about skin cancer risk pre-clude making recommendations about sun exposure” and that the recommen-dations for daily intake were made “on the basis of an assumption of minimal sun exposure...assuming that all of the vitamin D must come from the diet.” American Academy of Dermatology President William D. James, M.D., said that in light of the report, the Academy may revise the recommended minimum vitamin D intake levels section of its Vitamin D Position State-ment, which was based on previous IOM recommendations and currently suggests 400 IUs for the general population and 600 IUs for those 71 years and older. – JOhN CaRRuThERS 6 Dermatology WorlD // January 2011 –M 2010 medicare quality reporting due Jan. 31 DERmaTOlOgiSTS whO PlaN TO report quality measures to Medicare for 2010 and make themselves eligible for a bonus payment of 2 percent of their total Medicare Part B allowed charges have until Jan. 31 to enter and submit all of their information. The American Academy of Dermatology offered two programs to facilitate this reporting, 2010 PQRI Melanoma Reporting and Melanoma CPAT with PQRI Reporting. More than 500 dermatologists have entered information on the melanoma measures for the 2010 program. In 2011, dermatologists will have three melanoma measures to report in order to make themselves eligible for a bonus payment of 1 percent of their total Medicare Part B allowed charges. Two of the measures were part of the 2010 program; a third, related to the use of imaging studies in patients with stage 0 or IA melanoma, was added for 2011. More information about the 2011 measures and a registry to allow derma-tologists to report them is available at www.aad.org/qrs. – RiChaRD NElSON www.aad.org

Rounds

Medicare payment rate frozen for 2011 After a year of short-term patches in 2010, physicians enter 2011 knowing that their Medicare payments will continue at the same level for the entire year. Both houses of Congress voted in early December to pass a 12-month extension of the previous fix to the flawed Sustainable Growth Rate formula, extending the payment levels for 2010 into 2011 and averting a 25 percent payment cut. Medical societies, including the American Academy of Dermatology Association, will use the year to work with Congress on a permanent solution to the problem. – RiChaRD NelSON iOm ups vitamin D recommendation slightly ThE aVERagE u.S. OR CaNaDiaN citizen needs no more than 600 international units (IUs) of vitamin D per day, according to a report released on Nov. 30, 2010 by an Institute of Medicine (IOM) panel. The panel also recommended an intake of 800 Ius per day for those 71 years of age or older. The report, which was released following an evaluation of more than 1,000 published studies and consultations with researchers, contradicts previous individual reports that much of the population suffers from vitamin D deficiency, as well as some physicians who recommend up to 3,000 Ius of the vitamin per day. Vitamin D supplementation has surged in popularity as patients have been told that most of the population is lacking the proper level. “That certainly was an article of faith,” panel member Clifford Rosen, M.D., said in an interview with National Public Radio about widespread belief in a lack of vitamin D among those in the medical community. “I certainly did, coming into the Institute of Medicine committee.” Instead, synthesis of the reports, along with a national survey of blood levels of the vitamin, confirmed for the panel that not only are necessary vitamin D levels lower than previously expected, but that most Americans and Canadians have sufficient levels of vitamin D. Increased food fortification was credited in part for the results. The report noted that “concerns about skin cancer risk preclude making recommendations about sun exposure” and that the recommendations for daily intake were made “on the basis of an assumption of minimal sun exposure...assuming that all of the vitamin D must come from the diet.” American Academy of Dermatology President William D. James, M.D., said that in light of the report, the Academy may revise the recommended minimum vitamin D intake levels section of its Vitamin D Position Statement, which was based on previous IOM recommendations and currently suggests 400 Ius for the general population and 600 Ius for those 71 years and older. – JohN CaRRuThERS 2010 medicare quality reporting due Jan. 31 DERmaTOlOgiSTS whO PlaN TO report quality measures to Medicare for 2010 and make themselves eligible for a bonus payment of 2 percent of their total Medicare Part B allowed charges have until Jan. 31 to enter and submit all of their information. The American Academy of Dermatology offered two programs to facilitate this reporting, 2010 PQRI Melanoma Reporting and Melanoma CPAT with PQRI Reporting. More than 500 dermatologists have entered information on the melanoma measures for the 2010 program. In 2011, dermatologists will have three melanoma measures to report in order to make themselves eligible for a bonus payment of 1 percent of their total Medicare Part B allowed charges. Two of the measures were part of the 2010 program; a third, related to the use of imaging studies in patients with stage 0 or IA melanoma, was added for 2011. More information about the 2011 measures and a registry to allow dermatologists to report them is available at www.aad.org/qrs. – RiChaRD NelSON Dialogues will have new editor in 2011 DialOguES iN DERmaTOlOgY, the American Academy of Dermatology’s popular monthly audio subscription program, will have a new editor-in-chief beginning with the January issue. Michael Girardi, M.D., an associate professor of dermatology and residency director of the department of dermatology at the Yale University School of Medicine, is the new editor. He succeeds Jacqueline Junkin-Hopkins, M.D. – RiChaRD NelSON ama adopts policies regarding implementation of reform AT iTS 2010 iNTERim mEETiNg, held Nov. 6-9 in Chicago, the American Medical Association’s House of Delegates considered resolutions related to the implementation of health system reform. The AMA adopted principles for the development and operation of accountable care organizations (ACOs), a payment model the reform law will test that encourages coordination of care between physicians and lets them share in savings achieved by their coordination. The AMA principles stress that ACOs must Be physician led, place patients fi rst, ensure voluntary physician participation, and enable independent physicians to participate. The House also discussed a resolution that would have reversed the AMA’s support of the individual insurance mandate included in the reform law; that resolution was referred for more consideration and a report at the House’s June meeting. The AMA will also pursue congressional action to force Medicare to reinstate consultation codes. Medicare began requiring physicians to report consultations using ordinary evaluation and management codes in 2010. The House of Delegates meeting also provided the forum for launching the AMA’s grassroots and media campaign to halt cuts to Medicare physician payments that were scheduled for Dec. 1 and Jan. 1. Dermatology is well-represented in the AMA House of Delegates by the Section Council on Dermatology, which includes dermatologists representing the American Academy of Dermatology, the Society for Investigative Dermatology, the American Society for Dermatologic Surgery, the American College of Mohs Surgery, as well as dermatologists who represent their state medical societies and the Navy. The Section Council is the collective voice of dermatology in the AMA House of Delegates; members deliberate regarding the issues before the House, determine a position, and usually vote as one to increase the specialty’s infl uence. – RiChaRD NelSON aaDa participates in white house meeting ThE amERiCaN aCaDEmY Of DERmaTOlOgY aSSOCiaTiON was one of a small group of medical specialty societies invited to a Nov. 15, 2010 meeting with the White House and the Centers for Medicare and Medicaid Services (CMS) to discuss issues related to health system reform, specifi cally soliciting physician input regarding the concept of accountable care organizations (ACOs). (See article, left, for the American Medical Association’s new ACO policy.) Jack S. Resneck Jr., M.D., chair of the Academy’s Council on Government Aff airs, Health Policy and Practice, represented the Academy. CMS is developing proposed regulations related to ACOs and payment bundling; a draft rule is expected in early 2011. Last year’s health system reform law requires Medicare to pilot test ACOs and payment bundling to determine their potential to lower health care costs and improve health by allowing providers to coordinate care and share in savings. CMS Administrator Donald M. Berwick, M. D., M.P.P., told participants he wanted to hear their views of ACOs and similar models before the rules were completed. (For more on Dr. Berwick, see p. 21.) Dr. Resneck expressed concern to CMS, noting that it is unclear how dermatologists with ideas for improving effi ciency will be able to participate in the new models, as they generally provide care in small practices with multiple payers. – RiChaRD NelSON E-prescribing required to avoid penalty MEDiCaRE PROViDERS whO waNT to avoid a 1 percent penalty in 2012 must report an e-prescribing measure through their claims at least 10 times between Jan. 1 and June 30, 2011; if they report at least 25 times in 2011, they will also be exempt from a 1.5 percent penalty in 2013. CMS requires that this submission be performed through claims; providers are not allowed to use a registry or EHR to avoid the penalty. To report e-prescribing through claims, a physician would need to report the G code G8553 along with a denominator code at least 25 times; potential denominator codes include the codes for new and established patient visits and many others. Exemption from this requirement is available under the following circumstances and must be noted on your claims before June 30, 2011: • Eligible professional does not have at least 100 cases containing an E/M code between Jan. 1 and June 30, 2011 • Eligible professional is not a physician, NP, or PA as of June 30, 2011 • Eligible professional does not have prescribing authority • Eligible professional has less than 10 percent of total allowed charges comprised of E/M codes between Jan. 1 and June 30, 2011 • Eligible professional is in a rural area without Internet access or access to pharmacies that accept electronic prescriptions CMS was expected to announce the G codes to report each of these exemption criteria by mid-December 2010. In 2011, Dermatologists can also earn a 1 percent incentive payment by reporting their e-prescribing through claims, a registry, or an electronic health record (EHR). However, if you plan to participate in the EHR incentive program in 2011, you will not be eligible to collect the e-prescribing bonus. (For information on other EHR bonus programs, see p. 30.) For more information, visit www.aad.org/hitkit. – RiChaRD NelSON Congress: No red flags rule for docs PhYSiCiaNS aRE NOT CREDiTORS for the purposes of the Federal Trade Commission’s red fl ags rule, according to a bill passed by both houses of Congress during its recent lame-duck session. The rule requires creditors to develop and implement identity theft prevention plans; implementation had been delayed fi ve times while physicians and others sought clarifi cation of its applicability. Now it will go forward — but will not apply to medical practices. The American Academy of Dermatology Association joined the American Medical Association and other societies in advocating against the application of the rule to physicians. -RiChaRD NelSON Proposed fraud screening rule lacks iD theft protections A New PROPOSED RulE fROm Medicare would establish physicians as posing limited risk of fraud, waste, and abuse, while designating some other providers as moderate or high risk. However, two proposed provisions raise concerns for physicians. The proposed rule would expand the defi nition of a “credible allegation of fraud” to include “an allegation from any source, including but not limited to fraud hotline complaints, claims data mining, patterns identifi ed through provider audits, civil false claims cases, and law enforcement investigations.” Medicare providers who are the subject of such an allegation may currently have their payments suspended for 180 days (followed, potentially, by an additional 180 days if the investigation is not complete), making this a troubling expansion of the defi nition, which currently reads, “reliable information that fraud or willful misrepresentation exists.” The American Academy of Dermatology Association called on Medicare to limit payment suspensions to 180 days and maintain the current defi nition. Under the proposed rule, Medicare would elevate providers, including physicians, into higher risk categories when evidence suggests that another individual is using their identity in the Medicare program. This would subject such providers to stricter enrollment criteria, such as fi ngerprinting and criminal background checks, and it is possible that their risk category would be publicly posted on a website or other venue. The AADA and the American Medical Association have called on Medicare to create a fourth category to signify the possibility of identity theft. A fi nal, updated rule is anticipated in early 2011. – RiChaRD NelSON

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