By Brett Coldiron, MD, October 01, 2014
As dermatologists, we have a full plate of issues floating in the air that — when settled — could drastically affect our patients and practices. From indoor tanning regulations to squeezed provider networks, our specialty is facing life-changing policies from all corners of the health care arena. As you have just read in this month’s cover story, the future of many of our priorities will be affected by the election outcomes in November. As engaged citizens, we know it is our duty to vote for the candidate who will best serve our patients and practices. With the 2014 American Academy of Dermatology Association (AADA) Legislative Conference still fresh in my mind, I would argue, however, that there is so much more we should be doing to participate at all policy levels.
This year at the Legislative Conference — held Sept. 7-9 in Washington, D.C. — I joined about 140 of my colleagues for two days of policy and advocacy boot camp. We dug into the unsettled issues facing our specialty and patients. We drilled into our country’s changing payment models and how the use of data and payment transparency will affect the delivery of dermatologic care. We also discussed advocacy at the state level and how to use coalitions to advance our issues, such as indoor tanning, medical research funding, and skin cancer prevention.
One of the most pressing issues that we addressed is the lack of patient access that has stemmed from increasingly narrowed provider networks. As a result of the Affordable Care Act, Medicare Advantage payments were cut from 114 percent of Medicare to 104 percent. Consequently, in 2013 Humana and United Healthcare (UHC) Medicare Advantage (MA) plans started narrowing the scope of the provider networks they offer. Many dermatologists were notified — either directly by the health insurer or indirectly by their patients — that they were being terminated. Additionally, the AADA found that the UHC MA physician network terminations failed to provide a meaningful appeals opportunity, disclose the criteria used to determine the provider’s network status, or give sufficient notification to providers and patients.
Recently, the AADA evaluated five UHC MA networks to determine network adequacy and found that — based on Medicare’s own definition of network adequacy — UHC MA’s networks have an inadequate number of dermatology specialists and subspecialists. Additionally, the network rosters are inaccurate or misleading — listing physicians who are no longer accepting patients and even some who are deceased — and wait times for important dermatologic procedures are through the roof. This disturbing trend is putting our patients’ care in jeopardy, especially those most in need of care.
As a unified group, we took these cold, hard, facts and went to the Hill. All told, our specialty met with more than 180 congressional offices. When I think of a 2011 Congressional Management Foundation survey that found that 97 percent of congressional staffers believe that in-person visits from constituents have an influence on members of Congress, I am confident that our army of 140 made an impact.
However, we cannot stop at one day on the Hill. I call on every dermatologist to get involved beyond placing a ballot in a box. Attend the 2015 AADA Legislative Conference. Visit with your state and local representatives. Learn more about how SkinPAC, the AADA’s political action committee, makes a difference on Capitol Hill. Also, write to your federal members of Congress through the Academy’s Dermatology Advocacy Network. I also encourage everyone to call on their patients who no longer have access to care because of these narrowed networks, and tell them to contact CMS. For more information on narrowed networks, contact David Brewster at firstname.lastname@example.org. As physicians, we are not just concerned constituents; we are experts in public health. We are not just representing ourselves; we are speaking on behalf of our patients. Engaging in advocacy at the individual level will make a dent in the formation, or lack thereof, of the policies that affect our patients and practices.