Dermatology World February 2011 : Page 5

news in brief rounds T B:11.25” S:9.75” T:10.5” House repeal unlikely to slow reform implementation he House of Representatives voted 245-189 to repeal the Patient Protection and Affordable Care Act, last year’s health system reform law, on Jan. 19, fulfilling a pledge made by Republicans during the campaign. The vote on the repeal bill, which the Congressional Budget Office said would raise the federal deficit by $230 billion over the next 10 years, was largely symbolic; the Democratic Senate majority is unlikely to take up the measure (which the CBO said would result in 32 million more Americans without health insurance) and President Obama has vowed to veto it if it reaches his desk. For more information on the reform law’s price tag, see p. 28. In the meantime, the Centers for Medicare and Medicaid Services and other agencies continue to publish rules implement-ing various provisions of the reform law, including the new Physician Compare tool (see p. 6) and an upcoming rule on account-able care organizations (see p. 8). – riChArD NelsON budget neutrality requirement drops medicare conversion factor A COrreCTiON issueD bY The Centers for Pennsylvania passes truth in advertising bill effOrTs bY The PeNNsYlVANiA Academy of Dermatology and Dermatologic Surgery culminated in the adoption of a new truth in advertising law on Nov. 23, 2010. The bill, sponsored by representative Jennifer Mann, amended a previous health care facilities act to require physicians, nurses, and other health care professionals to wear iden-tification that features their picture, name, credentials, and standard-ized description — i.e., “physician,” or “nurse practitioner.” A number of dermatologists, including John Laskas Jr., M.D., and Bruce Brod, M.D., led the effort. In addition, Dr. Laskas gave a presentation at the American Academy of Dermatology’s 2010 Legislative Conference on the topic. Dr. Laskas focused on the content of the bill and strategies to move it through the legislative process and featured a model for health care name tags that corresponded almost exactly with the guidelines in the bill. The new law adopts a number of policy recommendations put forth by the American Medical Association’s campaign on truth in advertis-ing, which the Academy supports. It also follows on the heels of similar recent efforts in Illinois, California, and Arizona. In January, the clock began ticking on Pennsylvania’s health department, which under the new law has 90 days to develop interim truth in advertising regulations and 18 months afterward to finalize a set of permanent regulations. -JOhN CArruThers Medicare and Medicaid Services means that physicians will see a lower conversion factor — the multiplier that determines the dollar value of a given service — in 2011 than they may have initially expected when Congress prevented a 25 percent payment cut from taking effect. But changes to practice expense RVUs and other updates mean that payments should remain level overall, with dermatolo-gists potentially seeing small gains. The correction lowered the conversion factor by 8 percent, from the 2010 value of $36.8729 to $33.9764. The change will be processed automatically; no claims holds or resubmissions should be required. An updated version of the table of values for key dermatology codes that appeared in the De-cember issue of Dermatology World appears on the Academy’s website at www.aad.org/ gov/regulatory/medicare/Final2011Medi-carePaymentParameters.html. – riChArD NelsON Dermatology WorlD // February 2011 5

Rounds

House repeal unlikely to slow reform implementation The House of Representatives voted 245-189 to repeal the Patient Protection and Affordable Care Act, last year’s health system reform law, on Jan. 19, fulfilling a pledge made by Republicans during the campaign. T he vote on the repeal bill, which the Congressional Budget Office said would raise the federal deficit by $230 billion over the next 10 years, was largely symbolic; the Democratic Senate majority is unlikely to take up the measure (which the CBO said would result in 32 million more Americans without health insurance) and President Obama has vowed to veto it if it reaches his desk. For more information on the reform law’s price tag, see p. 28. In the meantime, the Centers for Medicare and Medicaid Services and other agencies continue to publish rules implementing various provisions of the reform law, including the new Physician Compare tool (see p. 6) and an upcoming rule on accountable care organizations (see p. 8). budget neutrality requirement drops medicare conversion factor A CorreCTiON issueD bY The Centers for Medicare and Medicaid Services means that physicians will see a lower conversion factor — the multiplier that determines the dollar value of a given service — in 2011 than they may have initially expected when Congress prevented a 25 percent payment cut from taking effect. But changes to practice expense RVUs and other updates mean that payments should remain level overall, with dermatologists potentially seeing small gains. The correction lowered the conversion factor by 8 percent, from the 2010 value of $36.8729 to $33.9764. The change will be processed automatically; no claims holds or resubmissions should be required. An updated version of the table of values for key dermatology codes that appeared in the December issue of Dermatology World appears on the Academy’s website at www.aad.org/ gov/regulatory/medicare/Final2011MedicarePaymentParameters.Html. Pennsylvania passes truth in advertising bill EffOrTs bY The PeNNsYlVANiA Academy of Dermatology and Dermatologic Surgery culminated in the adoption of a new truth in advertising law on Nov. 23, 2010. The bill, sponsored by representative Jennifer Mann, amended a previous health care facilities act to require physicians, nurses, and other health care professionals to wear identification that features their picture, name, credentials, and standardized description — i.e., “physician,” or “nurse practitioner.” A number of dermatologists, including John Laskas Jr., M.D., and Bruce Brod,M. D., led the effort. In addition, Dr. Laskas gave a presentation at the American Academy of Dermatology’s 2010 Legislative Conference on the topic. Dr. Laskas focused on the content of the bill and strategies to move it through the legislative process and featured a model for health care name tags that corresponded almost exactly with the guidelines in the bill. The new law adopts a number of policy recommendations put forth by the American Medical Association’s campaign on truth in advertising, which the Academy supports. It also follows on the heels of similar recent efforts in Illinois, California, and Arizona. In January, the clock began ticking on Pennsylvania’s health department, which under the new law has 90 days to develop interim truth in advertising regulations and 18 months afterward to finalize a set of permanent regulations. Cms launches Physician Compare IN lATe DeCember 2010, the Centers for Medicare and Medicaid Services (CMS) made a major change to the Physician Directory tool on its website with the introduction of Physician Compare, a tool aimed at helping patients find Medicare-participating physicians in their communities. The site will eventually serve as a repository of physician quality rankings. The new functionality of the site expanded and updated the previous CMS Healthcare Provider Directory, filling in additional details for each health care professional featured. In addition to doctors of medicine and osteopathy, Physician Compare also profiles doctors of optometry, podiatric medicine, and chiropractic.The site lists the doctor’s contact information and address, specialty, degree and clinical training information, and foreign language proficiencies.In addition, the site will allow patients to see whether the physician’s practice reported data to CMS through the Physician Quality Reporting System (PQRS), formerly PQRI. The American Academy of Dermatology Association has expressed concern about including PQRS information, noting that the program has not always accurately reflected physicians’ reporting status and may lead patients to draw the wrong conclusions about individual dermatologists. In late 2011, the second planned phase will add information about whether physicians chose to participate in electronic prescribing. Planned expansions for the site, as yet undated but required by law to have an implementation plan by 2013, include quality of care and patient experience information. Academy updates vitamin D position statement FOllOWiNg The reCeNT rePOrT on vitamin D by the National Academy of Sciences Institute of Medicine (IOM), the Academy has revised its position statement to reflect the new findings. The IOM report, which aligns with the Academy’s viewpoint that vitamin D should be obtained from diet rather than ultraviolet (UV) exposure, concluded that a vitamin D level of 20 ng/ ml should be considered adequate. The report was based on a review of more than 1,000 studies, as well as expert testimony.Further, the report stated that the majority of the population receives adequate vitamin D, largely due to enriched foods. The Academy’s updated position statement reflects these findings, setting the acceptable safe and healthy level of vitamin D at 20 ng/ml. This number assumes minimal sun exposure. Additionally, the statement notes that the long-term safety of levels above 50 ng/ml is unknown. The Academy continues to maintain that vitamin D should not be acquired via unprotected UV exposure due to the risk of developing skin cancer. The full position statement is available on the Academy’s website. Cancer institute research suggests possible melanoma treatment pathway ReseArChers frOm The NATiONAl CANCer iNsTiTuTe (NCI) announced that they have discovered a pathway in mice that allows the development of UV-induced melanoma — and that blocking interferon-gamma along the pathway inhibits melanoma development. Their findings were published online in Nature on Jan. 19. The findings are the latest step in the NCI team’s decade-long progress in exploring melanoma in genetically engineered mice. By irradiating newborn mice with enough UVB to trigger sunburn in human skin, the team was able to observe increased melanocyte behavior, and to determine that this increase was related to the production of interferon gamma by macrophages attracted to the sunburn site. The team found similar interferon-producing macrophages in 70 percent of human melanoma samples. The results suggest that interferon-gamma, which has been thought to contribute to an innate defense system against cancer, under some circumstances may promote melanoma and incite tumor development. “We anticipate that this discovery may change how interferons are used in the clinic as anticancer agents,” said Glenn Merlino, Ph.D., of the NCI’s Laboratory of Cancer Biology and Genetics; interferons are currently being studied as potential therapies for melanoma. The results of this study offer the possibility that the inhibition of interferon-gamma immediately after sunburn might block the carcinogenic activation of melanocytes, making it a potentially effective preventive strategy against UV radiation-induced melanoma. “Our findings raise the possibility that targeting the interferon-gamma pathway may represent a novel, less toxic therapeutic alternative for effective treatment of malignant melanoma patients, who currently have poor cure rates,” Dr. Merlino said. More information about the research is available at www.cancer.gov/ newscenter/pressreleases/MelanomaPath. Dermatologists discuss patient safety, ACO proposals at White house meeting AmeriCAN ACADemY Of DermATOlOgY Association Secretary-Treasurer Robert Greenberg, M.D., and former president David Pariser, M.D., joined representatives of numerous specialty societies, hospitals, and other health care provider organizations for a meeting with the Obama administration regarding implementation of health system reform. Led by Ezekiel J. Emanuel, M.D., Ph.D., the meeting, which took place at the Eisenhower Executive Office Building on Dec. 17, 2010, focused on implementation of patient safety rules related to hospitals and the development of rules regarding accountable care organizations (ACOs). During the latter discussion, Dr. Emanuel and Donald Berwick, M.D., M.P.P., administrator of the Centers for Medicare and Medicaid Services (CMS), heard numerous suggestions from attendees regarding how ACOs should be structured to incentivize providers to coordinate care and foster innovation. Suggestions included allowing providers to work with multiple ACOs — which would be important for dermatologists and other outpatient specialists — and ensuring that incentives account for disease severity. The AADA representatives noted that the risk sharing under consideration would not work if it required dermatologists to share risk for the behavior of other providers over whom they have no control. Publication of a proposed rule related to patient safety and ACOs is expected in mid-February; the Academy responded to CMS’s earlier request for information in advance of the rule, and will comment on the proposed rule to reiterate the specialty’s concerns. To facilitate the Academy’s development of principles and further engagement around ACOs, a working group of the AADA Council on Government Affairs, Health Policy and Practice was recently formed. Information on the proposed rule and the Academy’s concerns will appear in a future issue of Dermatology World. ehr incentive program registration open RegisTrATiON beCAme AVAilAble for physicians and hospitals that wish to participate in the Medicare and Medicaid Electronic Health Record (EHR) Incentive Program through the CMS website on Jan. 3. Under the program, physicians can potentially receive $44,000 over a five-year period through Medicare. Under the Health Information Technology for Economic and Clinical Health Act (HITECH) portion of the American Recovery and Reinvestment Act of 2009, physicians and hospitals that demonstrate “meaningful use of technology” and the adoption of a certified EHR system will be eligible to receive incentive payments from CMS. Physicians who wish to participate must begin their 90-day reporting period for calendar year 2011 by Oct. 3. A list of certified EHR systems — the Office of the National Coordinator for Health Information Technology’s (ONC’s) Certified HIT Product List — can be found on the CMS website. The list features more than 150 EHR products for ambulatory care. In addition, CMS offers hands-on assistance through 62 Regional Extension Centers that offer training, support service, and technical assistance to eligible professionals. Additional resources are available on the Academy’s online HIT Kit. The site offers a number of resources pertaining to EHR adoption and the CMS incentive program.

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