February 6
IN THIS ISSUE / February 6, 2019
- Nearly half of U.S. physicians are burned out
- AAD/A CEO announces departure this spring
- Anthem to institute new modifier 25 payment policy
- Researchers create new protein that may help cancer patients
- HHS proposes to end PBM rebate protections
- Who has access to dermatology services?
- NCCI and CMS address modifier 59 issues
- 2019 AAD Election ballot packet moved online
Nearly half of U.S. physicians are burned out
Nearly 44% of U.S. physicians are burned out, and 15% are depressed and thinking about suicide, according to a survey conducted by Medscape. The survey — which polled more than 15,000 physicians across more than 29 specialties — found that male physicians are more likely to cope with burnout by exercising (51% males vs. 43% females), whereas female physicians are more likely to talk with friends and family (52% females vs. 37% males). More women eat junk food to cope (38% vs. 27%) and similar percentages of men and women drink alcohol (23% men; 21% women). Check out the AADA’s new burnout resources in the Practice Management Center.
Where is this burnout stemming from? According to Carter Lebares, MD, director of the Center for Mindfulness in Surgery at the University of California, San Francisco, “Anger over a broken system, loss of time with patients, being asked to sacrifice dwindling personal time to ‘fix ourselves,’ and demoralization that the only way out is to quit or severely curtail our work.”
The Medscape survey pinpointed too many administrative tasks as a leading cause of physician burnout (59%), as well as spending too many hours at work (34%). Other factors included electronic health records (32%) and insufficient compensation/reimbursement (29%).
Despite these numbers, 64% of respondents said they don't plan to seek help for depression or burnout and they have not sought help in the past. Comments in the survey suggest that some physicians are retiring earlier because of burnout or depression, which may exacerbate physician shortages.
Learn more about why dermatologists are feeling burned out in Dermatology World.
Related Links:
AAD/A CEO announces departure this spring
American Academy of Dermatology and AAD Association Executive Director and CEO Elaine Weiss, JD, announced in communications to the Board of Directors and staff on February 4 that she will leave the AAD in the spring to pursue a new opportunity as executive director and CEO for the Society of Thoracic Surgeons.
Weiss has served the Academy since 2013, providing oversight and direction through a period of growth and change. “Elaine has worked closely with physician leadership and staff colleagues to strengthen our organization, develop new products and programs, and bolster the array of existing services we provide our members,” said Academy President Suzanne Olbricht, MD. “We have all benefited from her wisdom and her ability to synthesize our discussions at the Board table in order to facilitate our decision-making.”
The Board of Directors will appoint an interim executive director to oversee day-to-day operations while a replacement is identified. A search committee has been formed to begin the work of vetting qualified candidates.
Citing her strong interest in health care and the opportunity to learn more from the hospital-based physician perspective as her motivations for pursuing this new opportunity, Weiss said the decision to leave the AAD was, however, difficult. “Since becoming CEO in 2013,” she said. “I have valued my time with the Academy and cherished the physicians and colleagues with whom I have worked. I take great pride in all that we have accomplished during the past six years.”
Anthem to institute new modifier 25 payment policy
Anthem Blue Cross Blue Shield has announced that beginning with claims processed on or after March 1, 2019, the insurer may deny evaluation and management (E/M) services billed with a modifier 25 on the day of a related procedure when there is a recent service or procedure for the same or similar diagnosis on record. According to Anthem, the use of modifier 25 to support separate payment of this duplicate service is not consistent with correct coding or Anthem’s policy on use of modifier 25. The AADA is reaching out to Anthem to oppose this policy.
Read more about the Academy’s attempts to rein in this policy, and other payer policies in Dermatology World.
Related Links:
- To 25 or not? Part one – Dermatology World (June 2013)
- To 25 or not? Part two – Dermatology World (July 2013)
- NEW: AADA Coding Resource Center
Researchers create new protein that may help cancer patients
Interleukin-2 (IL-2) can be a lifesaving protein for skin cancer patients. However, the dose at which it fights cancer can have life-threatening side effects. Researchers have used computer modeling to design a new protein that mimics the benefits of IL-2 without its dangerous side effects, reports Science magazine.
Researchers and scientists from around the world teamed up to remake IL-2 from scratch. They started by studying atomic maps of IL-2 interacting with the desirable β and γ receptors, as well as the undesirable α receptor. The protein-design software was programmed to maintain the interactions with the β and γ receptors while eliminating the portion that binds to α receptors.
After analyzing and tweaking their options, the researchers settled on a version they call Neo-2/15, which shares only 14% of its amino acid sequence with IL-2. In mouse models of colon cancer and melanoma, the compound reduced side effects associated with α receptors, strongly inhibited tumor growth, and even eliminated tumors in a handful of animals. Regular IL-2 given to other mice didn’t eliminate tumors, according to a study published in Nature. The protein has only been tested on animals, but may soon enter human trials.
Read more about how biologics have revolutionized treatment for metastatic melanoma in Dermatology World.
Related Links:
- New approaches to skin cancer treatment and prevention – Dermatology World (August 2016)
- AAD clinical guidelines: Melanoma
- AAD SPOT Skin Cancer™
- AAD product: Digital patient pamphlets
HHS proposes to end PBM rebate protections
The U.S. Department of Health and Human Services (HHS) has issued a proposed regulation that would exclude rebates — provided to pharmacy benefit managers (PBMs) by manufacturers for prescription drugs — from safe harbor protections under the Anti-Kickback Statute (AKS). “PBMs play an important role in negotiating with drug companies. But if the negotiation favors higher rebates instead of lower cost drugs, it can lead to higher list prices,” said the HHS in a statement. “By proposing to re-design the AKS safe harbors to protect upfront discounts, this proposal, if finalized, would counteract the incentives behind rising list prices. Drug companies would no longer be able to cite their rebate contracts as an excuse to keep raising list prices.” The proposal is estimated to raise Part D premiums and federal spending, but decrease out-of-pocket costs for beneficiaries.
Physicians are often kept out of the loop on current drug prices and costs to patients. Read more about why in this month's issue of Dermatology World.
Related Links:
- What’s happening with drug shortages and what’s being done to resolve the issue? – Dermatology World (September 2018)
- A tangled web: What's happening with drug prices and what's being done to bring costs down? – Dermatology World (September 2017)
A recent study published in JAAD found that dermatology services or referrals were not offered at 28% of the free or low-cost clinics evaluated in the study. About 56% referred patients to local dermatology practices for presumably discounted care. Only 16% of board-certified dermatologists were periodically available onsite with an average wait time of nearly 22 days.
Read more about what the Academy is doing to improve patient access to care in this month’s issue of DW.
Related Links:
NCCI and CMS address modifier 59 issues
Leaders from the Academy are working proactively with the National Correct Coding Initiative (NCCI) — an entity developed by the Centers for Medicare and Medicaid Services (CMS) to promote national correct coding methodologies and control improper coding — to address coding hardship concerns members face due to the NCCI new procedure-to-procedure (PTP) edits. The updates present challenges for members processing claims when applying modifier 59, which ensures appropriate payment for distinct, independent multiple procedures performed by a single provider, in one day.
The Medicare Administrative Contractors (MACs) — multi-state, regional contractors responsible for administering Medicare claims and handling provider reimbursement services — implemented the policy to require modifier 59 be appended only to the column 2 code, overriding CMS’s and NCCI’s previous policy, which allowed modifier 59 to be appended to either column 1 or column 2 code. Modifier 59 is now required on the column 2 code of a PTP edit with a modifier indicator of “1.”
At this time, CMS and NCCI are collaborating with the MACs to accept the placement of modifier 59 on either column 1 or column 2 code of a PTP edit with modifier indicator of “1” when reporting claims, which will reinstate previous CMS and NCCI directives and address this administrative burden for members with a target date of July 1, 2019.
Prior to July 1, 2019, practitioners can submit a claim for two codes corresponding to one of the PTP code pair edits, and it will be denied because modifier 59 has been applied to the wrong code. If this occurs, practitioners may pursue an appeal, stating that modifier 59 has been incorrectly applied to the wrong code. However, once the MACs accept the placement of modifier 59 to either code in column 1 or 2, this should no longer be a problem. To avoid having to go through an appeals process, physicians and practices may consider continuing to append modifier 59 to column 2 until the target date of July 1, 2019, or when changes officially go into effect.
The Academy will continue to keep a close watch on any developments around this issue and will inform membership of any changes should there be any. Learn more about modifier 59, including helpful tables that outline the impacted code combinations when specific procedures are performed with a skin biopsy during the same encounter, in the Practice Management Center. For more coding help, visit the Academy’s Coding Resource Center.
2019 AAD Election ballot packet moved online
Beginning in 2019, eligible voting members will receive an email with an embedded link to view the ballot book and vote online. Voting members with email on file with the Academy will no longer receive an election ballot packet by mail.
- Members who wish to receive a PDF ballot book by email may request it at candidates@aad.org.
- Members who wish to vote by mail may print their online secure voting ballot beginning March 2. NOTE: All ballots must be received by March 16 at 11:59 PM (ET).
