By Mark Lebwohl, MD, May 01, 2015
Like many specialists, dermatologists are facing an array of challenges that span beyond our daily patient encounters. In my April column, I mentioned several of these obstacles — from narrowed networks to restrictions on prescription medications to onerous administrative burdens on our practices. All of these issues may appear solely affect us as providers. However, these challenges affect our patients directly. The more insurance companies and policymakers squeeze physicians, the less access our patients have to specialists and their valuable care. Our patients’ interests align with ours to a large degree and they are willing to help us because of that. As a result, we must partner with our patient advocates and give their issues the spotlight. We must make 2015 the year of the patient.
In the past, we have seen many examples of how effective patient involvement can be. Years ago, the precursor to CMS — the Health Care Financing Administration (HCFA) — issued a proposal that would revamp Medicare payments by changing the way dermatologists code for their services by classifying skin as one organ. That would have made a comprehensive skin exam the equivalent of a blood pressure check and would have changed our reimbursements drastically. Our specialty and many other medical organizations sent hundreds of letters in opposition to this change. However, the only organization that got a response from HCFA was the National Psoriasis Foundation. They had pointed out that psoriasis of the scalp is treated differently than psoriasis of the face, nails, or elbows, and that each part of the body had to be treated differently. As a result of this strong patient opposition, the HCFA scrapped its proposal and agreed to count each part of the skin separately.
Another example of the value of patient advocacy is CMS’s 2014 proposal that would institute cuts to phototherapy services by up to 60 percent as part of a plan that would equalize payments between physician offices, hospital outpatient departments, and ambulatory surgery centers. The AADA advocated strongly against this proposal, but letters from patients came pouring in as well. In the 2014 Final Rule, CMS delayed finalizing the proposal because our patients made them realize that instituting this proposal would close many phototherapy units and patient access to care would be diminished.
Additionally, recently we have been calling on Congress to repeal and replace the sustainable growth rate (SGR) formula, and so have our patients because without a sustainable Medicare physician payment system, our patients lose access to care. As a physician who treats psoriasis, I know that every patient is different and I often spend a lot of time with each. Their treatments also require a lot of monitoring. Patients on methotrexate or cyclosporine often get my cell phone number because I want them to be able to call and ask about drug interactions which could be dangerous. Many patient advocacy groups have sent letters in favor of repealing and replacing the SGR formula because they recognize that if we are paid less for our services, we will have to see more patients to pay the bills. This takes time away from all of our patients and, most disconcertingly, our sickest patients. At press time, Congress has passed the SGR legislation. For more information, visit www.aad.org.
These are just a few examples of how our issues align with our patients’ and how working together can generate productive policies and impede dangerous ones. Going forward, we have a number of challenges on the horizon that will require this team approach. I call on all Academy members to not only get involved with Academy advocacy activities, but to support our patient organizations. When we go to Congress and CMS we are seen as self-serving. When patients go before these policymaking bodies, they have a much louder voice. I encourage the entire membership to join me in activating our strongest patient advocacy efforts yet. Give your patients’ issues the floor.