2006 Outlook
Physician payment under Medicare, medical liability reform, access to isotretinoin, and funding for skin disease research will once again top the agenda for the American Academy of Dermatology Association (AADA), the lobbying arm of the American Academy of Dermatology.
iPLEDGE
Starting this March, dermatologists and other prescribers will need to be registered and activated under the iPLEDGE program in order to prescribe isotretinoin. The new mandatory registry program has come under fire from a number of dermatologists who say it is burdensome and will unnecessarily restrict access to the drug. Officials at AADA are continuing to work with the FDA and the iPLEDGE program to make improvements. For example, AADA wants to see written material made available online, more patient kits available to physicians, and less of a lag time between when physicians register and when they can be activated under the program. They are also pushing to make isotretinoin available to the indigent under the iPLEDGE program.
Medical Liability Reform
AADA will also continue to press members of Congress for meaningful medical liability reform, specifically reform that is modeled after California's Medical Injury Compensation Reform Act of 1975 (MICRA). But officials at AADA said that are flexible on the amount of the cap. The House has repeatedly passed legislation capping noneconomic damages at $250,000. But the issue has continued to remain stalled in the Senate.
Reimbursement
Reimbursement for physicians under Medicare is another top priority, according to the AADA. At press time, physicians were facing a 4.4% payment cut under Medicare, although last-minute congressional negotiations were underway for a possible 1% increase. Temporary fixes aside, physicians need a permanent change to the way their payments are calculated, said Dr. Margaret Parsons, AADA's chair of the council on government affairs and health policy and practice. Congress needs to change the way it calculates the Sustainable Growth Rate formula to better reflect the actual cost of providing medical care, she said, adding that a cut in Medicare payments has a much broader impact since the fee schedule used Medicare influences private insurance reimbursement rates. "A lot of us are very concerned about how hard it will hit us across the board," Dr. Parsons said. Dr. Parsons said a cut could limit access by patients as dermatologists choose to limit or drop Medicare patients from their practice. Even if the cuts don't result in a mass exodus from Medicare, fewer students may choose medicine as a career, said Dr. Brett Coldiron, of the University of Cincinnati. And existing dermatologists may convert their practices to concierge practices as a way to escape declining payments from Medicare and private insurers, he said.
Research Funding
Last April, the AADA and the Society for Investigative Dermatology released a report that estimated the burden of skin disease to be about $37 billion. This year, the AADA will continue to seek increased funding for the National Institutes of Health in an effort to boost skin disease research efforts.
Botox Guilty Pleas
Several of the major players in a scheme to distribute counterfeit Botox for use in humans pleaded guilty in federal court last November. The defendants—who include two physicians, two naturopaths, and four companies—are alleged to have purchased more than 3,000 vials of botulinum toxin type A and other ingredients in a formulation design to imitate Allergan's Botox product and sold them to health care providers. Dr. Bach McComb pleaded guilty in November to one count of felony misbranding in violation of the federal Food, Drug, and Cosmetic Act. Later that month, naturopaths Dr. Chad Livdahl and Dr. Zarah Karim pleaded guilt to one count of conspiracy to commit wire fraud, mail fraud, and misbranding, and one count of mail fraud. Dr. Robert Baker also pleaded guilty to one count of mail fraud. In addition, Toxin Research International Inc., Powderz Inc., Z-Spa Inc., and The Cosmetic Pharmacy Inc. all entered guilty pleas to one count of conspiracy. Sentencing for all parties is schedule to take place on Jan. 26, according to the U.S. attorney's office in the Southern District of Florida.
More on Drug-Only Treatment
The number of patients entering treatment for both alcohol and drug abuse problems has declined, but the number of patients getting substance abuse treatment alone has increased, according to data from the Substance Abuse and Mental Health Services Administration. The National Survey of Substance Abuse Treatment Services: 2004 found that of the 1.07 million people enrolled in substance abuse treatment on March 31, 2004, 46% were receiving both drug and alcohol abuse treatment, down from 49% in 1998. Another 34% were in treatment for drug abuse alone, up from 27% in 1998, while 20% were in treatment only for alcohol abuse, down from 24% in 1998. "These data will assist SAMHSA and state and local governments assess the nature and extent of service provided in state-supported and other treatment facilities, and forecast treatment resource requirements," said SAMHSA Administrator Charles Curie.