July 18
IN THIS ISSUE / JULY 18, 2018
- FDA approves first topical hyperhidrosis treatment
- CMS proposes major E/M changes, modifier 25 payment reduction: What’s next?
- Survey indicates residents lack confidence in coding, billing skills
- ‘Gag clauses’ cause some to pay more for drugs
- Skin Cancer Prevention Report shows progress, room for improvement
- Could the HPV vaccine treat squamous cell carcinoma?
- FDA warns against use of sterile drug products
FDA approves first topical hyperhidrosis treatment
The FDA has approved glycopyrronium (Qbrexza™) cloth for the treatment of pediatric and adult patients with primary axillary hyperhidrosis. Glycopyrronium is the first FDA-approved, once-daily, topical prescription for hyperhidrosis, and is expected to be available in October. The cloth is applied directly to the skin of the underarms and is designed to block sweat production by inhibiting sweat gland activation.
According to the International Hyperhidrosis Society (IHHS), hyperhidrosis occurs in more than 3 percent of the world’s population — roughly 220 million people. Learn more as experts discuss current and new treatments for this condition in Dermatology World.
Related Links:
- A natural look – Dermatology World (February 2014)
- Academy product: Hyperhidrosis (Excessive Sweating) Pamphlet
- For your patients: All about hyperhidrosis
CMS proposes major E/M changes, modifier 25 payment reduction: What’s next?
CMS has released the proposed 2019 Medicare Physician Fee Schedule that also includes changes to its proposed policies for the 2019 Quality Payment Program (QPP) established under the Medicare Access and CHIP Reauthorization Act (MACRA). Overall, when the rule is finalized, dermatology can expect a 1% decrease in payments — depending on each physician’s individual mix of services. The proposed conversion factor for 2019 is 36.0463.
CMS has proposed several changes related to evaluation and management (E/M) codes, including a proposal to institute new “blended” payment rates for new and established patients for office/outpatient E/M level 2 through 5 visits. Additionally, CMS is proposing a payment reduction for E/M visits billed with a procedure. This policy proposal is similar to the recent private payer reductions for E/M visits appended with a modifier 25, which the AADA has been aggressively and, in many cases, successfully fighting.
The AADA will continue to analyze the proposed rule and will submit comments by the Sept. 10 deadline. Additionally, the AADA plans to advocate against several proposals of concern, including the new blended payment rate for E/M codes and a modifier 25 payment reduction, by:
- Activating a coalition of organizations similarly affected by these proposed changes
- Meeting with the Administration face to face to express the specialty’s concerns
- Advocating with members of Congress as needed
- Implementing a method for members to communicate their concerns to CMS
- Creating template letters for physicians to utilize when communicating with CMS
Survey indicates residents lack confidence in coding, billing skills
A national survey, published in the Journal of Drugs in Dermatology, was distributed to residency programs in the United States to determine how residents learned about coding and billing as well as how much they knew. While a majority of residents surveyed reported both formal and on-the-job training in medical billing and coding, only 37% reported confidence in their abilities. More than 80% of respondents indicated they would be willing to participate in a formal web-based curriculum. Nearly all respondents believed medical coding and billing should be integrated into dermatology training curriculums.
Want to test your coding skills? Check out DW’s latest iteration of its Cracking the Code column.
Related Links:
- Components of evaluation and management – Dermatology World (May 2018)
- Components of evaluation and management 2 – Dermatology World (June 2018)
- Academy product: Digital Derm Coding Consult Pro
- Academy product: 2019 Coding & Billing for Dermatology Manual
- Academy product: Principles of Documentation for Dermatology
‘Gag clauses’ cause some to pay more for drugs
Just because you have insurance doesn’t mean that it’s the cheapest way to purchase your prescription drugs, reports The Washington Post, but it may be unlawful for your pharmacist to tell you that. ‘Gag clauses’ ― buried in the fine print of pharmacy contracts and imposed by pharmacy benefit managers (PBM) ― prevent many pharmacists from letting customers know when the cash price for a medicine is less expensive than their insurance co-pay, unless asked directly by the customer. A recent study published in JAMA identifies prednisone as among the top 20 drugs for which patients paid more using their insurance than if they were to have paid out of pocket.
Sen. Susan Collins (R-Maine), along with Sens. Claire McCaskill (D-Mo.) and Debbie Stabenow (D-Mich.), introduced two bills to prohibit the practice of ‘gag clauses.’ “While ending this practice will not directly lower the cost of drugs, it’s an important step toward increasing drug pricing transparency for consumers and demystifying the role of the PBM,” said House Rep. Earl L. “Buddy” Carter (R-Ga.). The AADA sent letters supporting both bills.
Read more about the hoops providers and patients jump through to fill prescriptions in Dermatology World. Need help getting your patients the prescriptions they need? Check out the AADA’s Practice Management Center.
Related Links:
- A tangled web: What’s happening with drug prices and what’s being done to bring costs down? – Dermatology World (September 2017)
- Gargantuan growing generic prices – Dermatology World (May 2015)
Skin Cancer Prevention Report shows progress, room for improvement
The Centers for Disease Control and Prevention (CDC) recently published its fourth annual Skin Cancer Prevention Progress Report, a comprehensive summary of the latest available data that highlights recent developments and successes.
The report indicates that measurable progress has been made since the Surgeon General’s Call to Action to Prevent Skin Cancer was released in 2014, including a slight decrease in the incidence of melanoma among teens and younger adults, and a reduction in the prevalence of indoor tanning among adults and high school students. However, the report notes there has yet to be much progress on increasing the use of sun protection or reducing sunburn.
One way in which the Academy strives to protect the public from the sun is through its Shade Structure Program, which awards grants to public schools and non-profit organizations for installing permanent shade structures for outdoor locations that are not protected from the sun, such as playgrounds, pools, or recreation spaces. Support the program by sponsoring an application or making a donation!
For a deeper dive into teen tanning trends, check out Dermatology World.
Related Links:
- What do you ask your skin cancer patients at follow up visits? – Dermatology World (July 2017)
- Banning the bed – Dermatology World (May 2017)
- Epidemic of skin cancer and cost of treating it attract attention from CDC – Dermatology World (March 2015)
- For your patients: SPOT Skin Cancer™
Could the HPV vaccine treat squamous cell carcinoma?
A single case report of a patient with an SCC, showed that systemic and direct intratumoral injection of 9-valent HPV vaccine resulted in complete regression of all cutaneous malignant tumors, a study in JAMA Dermatology shows. All tumors resolved 11 months after the first injection of the vaccine, and the patient required no further treatment.
The mechanism for the vaccine’s therapeutic efficacy in cutaneous malignant tumors are not yet clear, acknowledged the study’s authors. “The potent therapeutic benefit may reflect a combination of immunologic, antiviral, and antitumor effects of 9-valent HPV vaccine,” they suggested.
When is an SCC the tip of the iceberg? Find out in Dermatology World.
Related Links:
- Academy product: Squamous Cell Carcinoma Pamphlet
- For your patients: All about squamous cell carcinoma
FDA warns against use of sterile drug products
The U.S. Food and Drug Administration (FDA) is alerting health care professionals and patients not to use human and animal drug products intended to be sterile that are produced and distributed by Ranier’s Compounding Laboratory, also known as Ranier’s Pharmacy and Ranier’s RX Laboratory, in Jeannette, Pennsylvania due to lack of sterility assurance.
While the FDA is not currently aware of any adverse events associated with the products, it is asking health care professionals and patients to report adverse reactions or quality problems experienced with the use of these products to the FDA’s MedWatch Adverse Event Reporting program.
When it comes to medical care, hoping for the best but preparing for the worst may be the best defense against adverse events. Read more on how to prevent and manage common adverse reactions in Dermatology World.
Related Links:
