On Call: The Newsletter of the Alliance of Specialty Medicine

Winter 2022

Alliance Sets its 2022 Federal Agenda

Goals for the second session of 117th Congress remain payment fairness and removing barriers to care

 

Representatives of the Alliance of Specialty Medicine met virtually in early January to discuss their federal agenda for the second session of the 117thCongress.  The specialty docs also welcomed their newest member, the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS).

 

As its newest member, AAO-HNS brings the Alliance membership up to 15 national medical specialty societies and adds 13,000 more doctors’ voices for a specialty docs’ headcount of well over 100,000 specialty physicians nationwide.  You can read more about AAO-HNS in a feature story in this newsletter.

The Alliance’s federal agenda remains focused on promoting greater access to specialty care.  For this session of Congress, we will continue to ask lawmakers to address the significant barriers to care created by health insurance companies through prior authorization and step therapy.  Prior authorization is a cumbersome process that requires physicians to obtain pre-approval for medical treatments or tests before rendering care to their patients.  The process for obtaining approval is lengthy and typically requires physicians or their staff to spend the equivalent of two or more days each week negotiating with insurance companies — time that would better be spent taking care of patients.  Step-therapy protocol works along these same lines by establishing a specific sequence in which prescription drugs are covered by a group health plan or a health insurance issuer.  In addition, step-therapy protocols may require patients to try and fail an insurer-preferred medication before the physician-prescribed medication is covered.  Many insurers have instituted this practice to help control the costs of expensive medications.  However, while this practice may initially reduce insurer costs, it can have devastating health consequences for patients and ultimately lead to more expensive health care costs in the long run.  The Alliance has endorsed bipartisan legislation to address both prior authorization and step therapy; the Improving Seniors’ Timely Access to Care Act (H.R. 3173/S. 3018) and the Safe Step Act (H.R. 2163/S. 464).  You can learn more about this issue by reading the Alliance’s Prior Authorization and Step Therapy Issue Brief.

On the reimbursement side, most specialists were staring down significant Medicare reimbursement cuts at the end of 2021.  These cuts totaled almost 9% due to arcane federal budget policies and budget neutrality rules governing code changes in the 2021 Medicare Physician Fee Schedule (MPFS).  While Congress acted in December to stave off some of these cuts, lawmakers and policy leaders need to do more to address federal budget and Medicare reimbursement policies.  The Alliance has written to Congress about this issue and will continue to advocate for them to hold hearings and work with the provider community to explore long-term solutions to these recurring problems.

The Alliance also remains active in the regulatory space.  We most recently wrote to Centers for Medicare and Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure on the Department of Health and Human Services’ Notice of Benefit and Payment Parameters for 2023.  In our letter, we urged CMS to finalize its proposals aimed at ensuring adequate provider networks in Marketplace plans and highlighted challenges consumers face in accessing specialty medical care as issuers eliminate or block specialty and subspecialty physicians from their networks as a cost-saving measure.  Too often, consumers do not realize the limitations of their plan’s provider network until an unexpected medical condition arises.  The Alliance also expressed concern about the manner in which specialists are removed from networks, usually based on flawed performance metrics, and leave specialty providers little recourse for network re-entry.  We recommended that CMS take a number of steps to address narrow networks, including requiring plans to account for the full range of specialty and subspecialty providers and to provide reasonable notice regarding termination and options for network re-entry, among other suggestions.

SPECIALTY SPOTLIGHT – Our Newest Member!

Welcome to the American Academy of Otolaryngology-Head and Neck Surgery

 

The Alliance of Specialty Medicine is proud to welcome its newest member, the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS).

The AAO-HNS represents otolaryngologist-head and neck surgeons—the specialists who treat the ears, nose, throat, and related structures of the head and neck. With approximately 13,000 members across the world. AAO-HNS is also one of the oldest medical and surgical specialties in the United States, with the Academy recently celebrating the 125th anniversary of its founding in 1896.

It is the mission of the AAO-HNS and its Foundation to engage members and help them achieve excellence and provide high-quality, evidence-informed, and equitable ear, nose, and throat care through professional and public education, research, and health policy advocacy.

We are committed to the enactment of legislation that will strengthen the delivery of, and access to, quality healthcare services. In addition, we are dedicated to identifying and combating harmful coverage policies that threaten access to quality otolaryngology-head and neck services.

We provide comprehensive lifelong learning to members through education, clinical tools, and practice management tools to help meet the challenges of otolaryngology practice and build mastery throughout their careers.

We offer the only otolaryngology-specific clinical data registry, which provides a multifaceted approach to the way data is collected to support evidence-informed research studies and clinical trials that will spearhead the specialty’s growth in patient outcomes, quality, public reporting, and more.

The AAO-HNS throughout our rich 125-year history has experienced an extremely active and engaged membership and volunteer base who have contributed countless hours of time and expertise for the advancement of specialty and patient care in all arenas, including advocacy, education, and research.

The AAO-HNS is excited to join the Alliance of Specialty Medicine and looks forward to working with its members to find ways to improve the healthcare environment for our members and the patients that they treat.

For more information about the American Academy of Otolaryngology-Head and Neck Surgery, please visit www.entnet.org.

Skin Cancer Is Color Blind: ASDSA Honors Black History Month

 

Delays in skin cancer diagnosis during the COVID-19 pandemic have only exacerbated an existing disparity among people of color. To raise awareness and honor Black History Month, the American Society for Dermatologic Surgery Association (ASDSA) is promoting its “Skin Cancer is Color Blind Campaign.”

We know people of color are less likely to get concerning areas on their skin checked by a dermatologist ─ often leading to advanced-stage melanoma and other skin cancer diagnoses. This makes it harder to treat. Black reggae legend Bob Marley, for example, died at the age of 36 from melanoma skin cancer that had spread in his body.

ASDSA resources to share and promote:

  • A photo gallery of skin cancer in people of color. Since a picture is worth a thousand words and skin cancer can occur anywhere on the skin, please share the link on your social media accounts with the hashtag #SkinCancerisColorBlind.
  • Interested in bringing awareness to skin cancer prevention in your district? Email advocacy@asds.net for more information on how to set up a free skin cancer screening at health fairs or back-to-school events.
  • Looking for a board-certified dermatologist? Search the ASDSA directory to find a dermatologist near you and view their profile.

For more information on sun-safety initiatives, learn about our SUNucate model legislation and position statement on Sun-safe Behavior in School-aged Children.

About ASDSA
With a membership of 6,400+ physicians, ASDSA is a 501(c) (6) association, dedicated to patient safety education and advocacy. For more information, visit asds.net/ASDSA

 Follow us on social media:

Facebook: www.facebook.com/ASDSAdvocacy

Twitter: www.twitter.com/ASDSAdvocacy

Instagram: www.instagram.com/ASDSAdvocacy

LinkedIn: www.linkedin.com/company/asdsa-advocacy

No More Surprise Bills: Private insurance plans must cover the full colorectal cancer screening continuum

On Jan. 10, 2022, the Biden Administration issued guidance requiring private insurers to cover colonoscopy when needed as a follow-up to a non-invasive colorectal cancer screening test. This guidance will prevent patients from receiving surprise bills for a colonoscopy when they receive a positive result from a stool-based test.

Representatives of AGA, American Cancer Society, American Cancer Society Cancer Action Network, and Fight CRC worked together to urge the Administration to make this change, including last fall meeting with regulators from the U.S. Departments of Labor, Health and Human Services, and Treasury, (which together regulate private insurance plans under the Affordable Care Act) to request they provide direction to private health plans. The Administration’s support for coverage of the full colorectal cancer screening continuum will improve access to life-saving screening.

“Now patients can choose the best colorectal cancer screening test for them without fear of a surprise bill. Patients have full coverage of the full screening continuum — from an initial stool or endoscopic test to a follow-up colonoscopy. Now that the financial barriers have been eliminated, we can focus on increasing screening so we can prevent cancer deaths,” said John Inadomi, MD, president of AGA.

The coverage guidance expands on the requirement that plans start providing the screening benefit to patients age 45+ for plan or policy years beginning on or after May 31, 2022. For health insurance plans that have already been implemented, patients need to check with their insurance provider as they may not include this coverage until next year.

“Ensuring individuals have access to this life-saving screening will significantly reduce suffering and death from this disease,” said Lisa Lacasse, president of the American Cancer Society Cancer Action Network (ACS CAN). “This year alone, the American Cancer Society estimates more than 150,000 individuals will be diagnosed with colorectal cancer, and more than 52,000 will die from the disease. But colorectal cancer is preventable when pre-cancerous polyps are found and removed through a colonoscopy. The announcement from the Tri-Agencies clarifying all private insurance plans must fully cover colonoscopies after a positive non-invasive stool test will save lives from colon cancer. ACS CAN will work to expand this coverage to traditional Medicare and Medicaid beneficiaries to help ensure all individuals who need a colonoscopy are able to access one.”

Colorectal cancer remains the second leading cancer killer in the U.S. despite the availability of preventive screening options. In 2018, just 68.8% of those eligible were screened for colorectal cancer. The challenge of getting people screened was exacerbated in 2020 when it is estimated that colorectal cancer screening declined by 86% during the first few months of the COVID-19 pandemic.

Educating the Public on the ABCs of AMD to Save Sight

Age-related macular degeneration (AMD) is the leading cause of vision loss in older Americans. More than 11 million adults in the US have some form of AMD, and that number is expected to double by 2050. New treatments and imaging advances have made it possible to preserve vision, but only if the condition is caught before too much damage to the retina is done. In fact, knowing the symptoms and seeking immediate care from a retina specialist can help preserve vision and limit vision loss.

During February’s AMD Awareness Month, the American Society of Retina Specialists (ASRS) and its member retina specialists urged the public to pay special attention to their vision, learn more about AMD, and understand the ABCs of AMD symptoms which warrant an immediate visit with a retina specialist for a comprehensive dilated retina exam.

To see for a lifetime, the public should watch for:

A: Altered or wavy lines that should be straight. Cover one eye at a time and look at a door frame or a checkerboard. If the lines look wavy or warped, it may be a sign of AMD. Check for this symptom regularly by using an Amsler grid, black lines on a white piece of paper with a dot in the middle.

B: Blurriness in the center of vision. Blurred central vision can often make it hard to see a friend or loved one’s face clearly.

C: Colors that appear washed out or dull. Any decrease in the intensity or brightness of color should be checked out.

Messages emphasizing the ABCs of AMD symptoms were shared with the public via a news release, social media posts and social graphics, a new consumer podcast on AMD, and an audio news release that aired on more than 290 ABC News radio stations across the country.

More information on AMD and the expert care provided by retina specialists is available at SeeforaLifetime.org.