A seat at the table with a full plate


By Marta Van Beek, MD, MPH

Dermatology, like many medical specialties, is under extreme pressure in the ever-evolving health care arena. Not only are we seeing changes that stem from the Affordable Care Act, such as the implementation of Medicare Accountable Care Organizations and the Independent Payment Advisory Board (IPAB), but our specialty is also starting to experience some other significant transitions within the health care environment outside of the Affordable Care Act. There is an ever-increasing push for integration and coordination of health care services, more scrutiny of fee-for-service reimbursements, and new regulatory mandates.

The list of changes in health care is long and daunting. Fortunately, the American Academy of Dermatology Association (AADA) has led our specialty over some substantial hurdles in the past and it will continue to do so in this current state of flux.

In an effort to stay focused on the issues of greatest importance for the specialty, the AADA gathered feedback from key policy committees at the Academy’s 71st Annual Meeting in March to determine the most important advocacy priorities for dermatologists. Based on that feedback, the Council on Government Affairs, Health Policy and Practice reviewed, modified, and approved the advocacy priorities. In April, the AADA Board of Directors approved the AADA’s advocacy agenda for 2013 with the following priorities at the top of the list:

Physician payment and delivery system reform

Just recently, the AADA, along with the greater house of medicine, once again helped avert the scheduled 27 percent cuts to Medicare physician payments. Since then, Congress has been reaching out to the AADA for feedback on how to repeal the flawed sustainable growth rate (SGR) formula. We have been engaged in providing input to policymakers on the implications of various approaches to payment that might replace the SGR.

The AADA will continue to work toward preserving patient access to care, which starts with reforming Medicare’s payment system by eliminating Medicare’s flawed SGR payment formula. When the SGR is replaced, the new payment system will need to acknowledge the myriad ways in which physicians such as dermatologists, provide care to patients.

Likewise, as specialties continue to be scrutinized by private payers over reimbursement rates, the AADA has been proactively engaging with private payers to educate them about the value and uniqueness of dermatologic care.

The AADA will also continue to push for a repeal of the IPAB, and will advocate at all levels to ensure that the development and implementation of other new policies and reforms within the Affordable Care Act take into account the true impact on physician practice and patient access to quality health care.

Scope of practice

The AADA will also work to preserve dermatologists’ ability to provide pathology and office-based surgery services to their patients. In a similar vein, we will also take steps to protect dermatologists’ scope of practice by advocating for policies that enforce the supervision of physician extenders, and rules that ensure that patients have accurate and truthful information regarding the health care services they receive from various health care practitioners.

Patient safety

We will build off of our recent successes regarding skin cancer prevention and education, and will continue to support federal and state legislative and regulatory efforts to educate the public and policymakers about the dangers of indoor tanning. We will continue to work towards greater regulation and oversight of indoor tanning facilities.

Other issues that have been prioritized include advocating for: medical spa standards of practice, medical research funding, measures to shore up our physician workforce, medical liability reform, and much more. Read the AADA’s 2013 advocacy agenda.

Clearly, we have a lot on our collective plate as the health care environment continues to change. Rest assured, the AADA takes these challenges very seriously and understands the pressures that our specialty is facing. The AADA has prioritized these issues accordingly with its advocacy agenda, and will continue to serve as a trusted resource and influential voice with Congress, state legislatures, private payers and regulatory agencies on the most pressing issues affecting our profession and our patients.

Dr. Van Beek is clinical associate professor of dermatology at the University of Iowa Carver College of Medicine and chair of the AADA Council on Government Affairs, Health Policy, and Practice.

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