Advocacy scores big wins for specialty and patient care in 2016

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By Sabra Sullivan, MD, PhD
Chair of the AADA’s Congressional Policy Committee and chair of the AADA’s Council on Government Affairs and Health Policy

Last year, our specialty benefited from a series of remarkable advocacy achievements. Without our American Academy of Dermatology Association (AADA) staff in Washington, D.C., and the participation of our active Academy members, these advocacy achievements would not have been possible. I’m pleased to detail 2016 advocacy highlights below.

Skin cancer prevention and patient health

Securing congressional action for skin health
  • The AADA won passage of the 21st Century Cures Act, which calls for an acceleration in the development of biomedical cures. The legislation provides $4.8 billion for the National Institutes of Health, requires electronic health record (EHR) interoperability with clinician-led clinical data registries like DataDermTM, and includes language prohibiting EHR vendor data blocking.
  • The AADA secured introduction of a congressional resolution supporting everyday sun safety for youth caregivers and encouraging state and local lawmakers to ease restrictions on sunscreens in schools.
  • The AADA successfully increased the number of states that prohibit minors under the age of 18 from using indoor tanning beds to 16, including the District of Columbia.
  • An additional 12 states have passed legislation banning minors under the age of 17, 16, or 14 from using tanning devices.
  • The AADA generated a record-breaking grassroots advocacy campaign on indoor tanning rules. 1,503 AADA members submitted 1,593 comments to the Food and Drug Administration (FDA) urging restricted access to indoor tanning for minors under 18 years of age and educating all users about the dangers of indoor tanning.
  • The AADA hosted a successful Skin Cancer Screening & Prevention Health Fair on Capitol Hill. Among the 190 attendees were 13 members of Congress and myriad key congressional committee staff.
  • The AADA hosted a successful skin cancer screening for state legislators from throughout the county as well as members of the public at the National Conference of State Legislatures’ Legislative Summit. Skin cancer screenings were provided to 106 attendees by AADA members.
Increased visibility of dermatology
  • The AADA drew record attendance at its 2016 Legislative Conference in Washington, D.C., with 184 attendees from 33 states.
Strengthening the "Pro-Dermatology" caucus
  • SkinPAC set a new fundraising record. This builds upon the success of 2015, which was a record year for the PAC in a non-election year.
  • Through the support of AADA members, SkinPAC continues to raise the visibility of the specialty as a leader among physician specialties and within the health policy community in Washington and beyond.

Patient access to dermatologic care

Eliminating patient cost burdens
  • The AADA was instrumental in fighting back Centers for Medicare and Medicaid Services (CMS) efforts to eliminate 10- and 90-day global codes.
  • The AADA secured significant regulatory relief in the implementation of the new Medicare Quality Payment Program. This was accomplished in part by leading the American Medical Association (AMA) House of Delegates in its efforts to develop a cohesive strategy for regulatory relief from the Medicare Access and CHIP Reauthorization Act (MACRA). Dermatology authored and successfully advocated for passage of a resolution to provide for additional flexibility in the implementation of the Merit-Based Incentive Payment System (MIPS) and alternative payment models (APMs).
  • As a member of the AMA Task Force on Pharmaceutical Costs, the AADA assisted with the launch of AMA’s interactive website, TruthinRX.org, designed to educate patients on rising drug prices and empower physicians and the public to advocate against increases in prices.
Protecting patient access
  • After the AADA successfully presented recommendations to the AMA/Specialty Society Resource-Based Relative Value Update Committee, relative values for biopsy were maintained for another year. Also, acne surgery code values were not reduced.
  • The AADA educated the FDA, the United States Pharmacopeia (USP), and the Federation of State Medical Boards (FSMB) on low-risk compounding in dermatology, including office-use compounding, and physician in-office compounding, resulting in further review of these issues. Additionally, the AADA advocated to the FDA to increase access to substances used in dermatologic compounding.
  • The AADA has continued serving as a leader in the State Access to Innovative Medicines (SAIM) Coalition, and has assisted with efforts to minimize the negative impact of pharmaceutical step therapy. These efforts have led to the enactment of laws based on model legislation drafted by AADA and other SAIM members in Illinois, Indiana, Missouri, and New York to ensure a transparent process is in place for patients and physicians to seek a medical exemption from step therapy protocols. In 2016, step therapy bills were considered in Massachusetts, West Virginia, Virginia, Ohio, and North Carolina as well.
  • The AADA worked closely with a coalition of physician organizations, including the Georgia Dermatology and Dermatology Surgery Association, the American Society for Dermatologic Surgery Association, and the AMA, on legislation enacted in Georgia setting forth certain requirements in order for physicians to advertise or represent themselves as being “board-certified.”

Practice and specialty issues

Responding to the changing policy landscape
  • The AADA and other medical specialties enjoyed a victory in 2015 with passage of legislation (MACRA) repealing the Sustainable Growth Rate (SGR) formula. AADA’s strong advocacy with CMS and with Congress resulted in a number of changes from the proposed rule on MACRA implementation, with nearly one in four comments on the proposed rule having been from dermatologists. As chair of the AADA’s Council on Government Affairs and Health Policy, I presented to the U.S. House of Representatives’ Doctors Caucus about AADA member concerns regarding the proposed MACRA rule and the potential impact on solo and small group practices. These and other AADA advocacy efforts helped secure needed changes to the new Medicare payment system when it was released by CMS in 2016. These changes include an increased small practice exemption, flexible start dates, and the inclusion of a new measure, Biopsy Reporting Time.
  • The AADA met with several payers and key policymakers to understand how dermatology could participate in emerging APMs. 
  • The AADA worked with the larger physician community to help provide relief from penalties for non-compliance with the EHR meaningful use requirements, and successfully advocated CMS to shorten the reporting period for demonstrating meaningful use from one year to 90 days.
Adapting to technological advancements
  •  The AADA worked with the larger physician community to help provide relief from penalties for non-compliance with the EHR meaningful use requirements, and successfully advocated CMS to shorten the reporting period for demonstrating meaningful use from one year to 90 days.
  • The AADA, in collaboration with the Physician Clinical Registry Coalition, played a key role in including within the 21st Century Cures Act provisions to require EHR interoperability with clinician-led clinical data registries like DataDerm and language prohibiting EHR vendor data blocking.
  • The AADA worked with the AMA telehealth services workgroup in creating a systematic approach to developing new codes for telehealth services based on families of codes.