September 18
IN THIS ISSUE / September 18, 2019
- HPV vaccine to treat common warts?
- DW Insights and Inquiries: Calcipotriene and 5-fluorouracil — Dermatology’s new dynamic duo?
- Government green-lights co-pay accumulator programs for 2020
- Howard Rogers, MD, PhD, testifies to House committee about prior authorization burdens
- Hurricane Barry triggers MIPS extreme and uncontrollable circumstances policy
- Medicare Beneficiary Identifier (MBI) transition period nearing its end
HPV vaccine to treat common warts?
A study, to be published in JAAD, evaluated the effects of intramuscular versus intralesional bivalent HPV vaccine for the treatment of recalcitrant common warts and found that the intralesional injection may be the better therapeutic option.
Twenty-two adult patients with multiple recalcitrant warts were injected with intramuscular bivalent HPV vaccine at zero, one, and six months, or until complete clearance of warts. An additional 22 patients were given an intralesional injection of 0.1 to 0.3 ml of bivalent HPV into the largest wart at two-week intervals until clearance, or for a maximum of six sessions.
Complete clearance of warts was observed in 18 patients (82%) from the intralesional group and in 14 patients (63%) from the intramuscular group, although the difference was not statistically significant. The clearance rate of the warts was significantly faster in the intralesional group (3.22 months vs. 4.75 months).
Related content:
- Yeast rising: Predicting the efficacy of candida antigen immunotherapy for warts – DW Insights and Inquiries (October 2017)
- Patient education pamphlets
- For your patients: Warts
DW Insights and Inquiries: Calcipotriene and 5-fluorouracil — Dermatology’s new dynamic duo?
Chatting with my chief resident, Tia Pyle, I was lamenting the recent comparative report that ingenol mebutate (and other treatments) did not fare as well as 5-fluorouracil (5-FU) for treating actinic keratoses (AKs). I had become enamored with ingenol mebutate’s short course of therapy. Although patients are delighted to only apply a medication for two or three days, compared to several weeks, I now must explain that 5-FU reigns supreme in terms of AK clearance.
Dr. Pyle asked me in her quiet, compelling manner, “Dr. Heymann, why don’t you try the combination of calcipotriene (calcipotriol) with 5-FU? You only have to apply it for several days!” Keep reading!
Government green-lights co-pay accumulator programs for 2020
The Departments of Health and Human Services (HHS), Labor, and Treasury, announced they will not enforce HHS’s policy limiting private health plans’ use of accumulator programs to prescription brand drugs for which a medically appropriate generic equivalent is available. Under insurance plans with a copay accumulator policy, copay coupons given to patients by brand-name drug manufacturers will no longer count toward patients’ deductibles and out-of-pocket maximums.
The government found that the policy conflicts with existing Internal Revenue Service (IRS) guidance that requires high-deductible health plans to exclude all drug and manufacturer discounts when calculating patient contributions toward plan deductibles. The Departments will permit health plans to use accumulator programs and exclude the value of manufacturer coupons from annual cost-sharing limits regardless of whether medically appropriate generic equivalents are available until a revised policy is issued for the 2021 plan year.
Read about how co-pay accumulator programs have escalated the battle between insurers and drug makers while patients pay the price in Dermatology World.
Related content:
Howard Rogers, MD, PhD, testifies to House committee about prior authorization burdens
On Sept. 11, Connecticut dermatologist Howard Rogers, MD, PhD, along with three other physicians, testified before the House Committee on Small Business about burdens of prior authorization requirements, including delayed patient care, physician burnout, and worse outcomes.
Dr. Rogers, who owns a small private practice, spends 70 hours a week on prior authorizations, which requires two full-time staff at a cost of $120,000 in salary and benefits.
"One-quarter of all communications in my office, be it phone calls, faxes, emails, EMR notifications, payer portals — they are all associated with prior authorizations, and the kicker is that most of my patients' prescriptions and repairs eventually get approved, but only after exhaustive efforts of calling insurers and appealing denials," Dr. Rogers said in his testimony.
Watch a video of the hearing and read Dr. Rogers’s testimony.
Hurricane Barry triggers MIPS extreme and uncontrollable circumstances policy
The Centers for Medicare and Medicaid Services (CMS) has determined that the automatic extreme and uncontrollable circumstance policy will apply to MIPS-eligible clinicians in FEMA-identified Louisiana parishes. Clinicians participating in MIPS in these areas will be automatically identified and receive a neutral payment adjustment for the 2021 MIPS payment year. All four performance categories during the 2019 performance period (Jan. 2, 2020 - March 31, 2020) will be weighted at zero percent, resulting in a score equal to the performance threshold. If the identified MIPS clinicians choose to submit data on two or more MIPS performance categories, they will be scored on those categories and their 2021 payment adjustment will be based on their 2019 MIPS final score.
Note: At this time, there are no FEMA-designated disaster areas resulting from Hurricane Dorian. DW Weekly will alert readers about any future disaster-area declarations related to Dorian.
Related content:
- Experts offer advice on emergency preparedness planning for your practice – Dermatology World (August 2019)
- MIPS reporting resource center (AADA Practice Management Center)
- Academy product: 2019 MIPS Reporting Module
- Tips on getting the most out of malpractice insurance – Dermatology World (August 2018)
Medicare Beneficiary Identifier (MBI) transition period nearing its end
CMS has replaced the Social Security number-based Health Insurance Claim Number (HICN) with a Medicare Beneficiary Identifier (MBI) on the new Medicare cards. For patients who have not communicated their new MBI, physicians can access a secure MBI search tool through their Medicare Administrative Contractor (MAC). Starting Jan. 1, 2020, CMS will only accept claims with the MBI listed. During the transition period, CMS will accept either the HICN or the MBI for CMS claim adjudication. For additional information, visit www.cms.gov/newcard.
Related content:
