By Mark Lebwohl, MD, April 01, 2015
I am delighted to commence my term as your Academy president. It is an honor to serve our profession and our patients. This year, our priorities will continue to focus on preserving patient access and safeguarding the value of dermatologic care. But there is no denying that the path to achieve our goals will be fraught with many challenges. Many are challenges we have battled for years, but there will also be many new issues to test us.
It is no secret that insurance providers are looking to cut costs, often at the expense of our patients. Several Medicare Advantage plans have been narrowing the scope of their provider networks which has reduced patient access to dermatologic care. Additionally, some insurers are changing their payment schemes, not only reducing physician reimbursements but transitioning to high-deductible plans. As a result, patients may think twice about going to the dermatologist regardless of their ailment. If a patient has a concerning mole, precious time and the opportunity for an easy surgical cure may be lost if the patient delays seeing a dermatologist. Many insurance companies are also balking at the price of critical treatments and medications and, as a result, patients are not receiving adequate treatment. Psoriasis patients with extensive disease, for example, are often treated with numerous topical therapies when they should be treated systemically. Because the costs of many of our systemic therapies are high, insurers create many hurdles to their prescription. We must continue to fight for our patients and ensure that they are receiving adequate and timely care.
We are also enduring policy changes from the public sector that will affect how we practice. Convoluted HIPAA regulations and onerous RAC audits aside, we are also facing the removal of 10- and 90-day global periods in the Medicare physician fee schedule in 2017 and 2018 respectively. Additionally, the U.S. Department of Health and Human Services (HHS) recently pledged that 30 percent of Medicare provider payments will go to alternative payment models (APM) by 2016, and 50 percent by 2018. This initiative stems from an increased interest in cutting costs and improving care yet, how the HHS accurately measures the quality of care for these APMs remains uncertain. One thing is for sure: we will have to prove our worth to APMs, such as accountable care organizations, so we are not only invited to join these frameworks, but considered equal partners.
With all of these changes and increased regulations, our patients are feeling the squeeze when trying to get an appointment. In order to fulfill numerous requirements such as EHR meaningful use, continuing medical education, maintenance of certification, and quality measure reporting, we are spending less time with our patients productivity in many offices and medical centers has been reduced by up to a third. So what will our patients do? They will visit non-physician clinicians many of whom go out on their own and pretend to function as physicians or medical spas run by non-physicians. We must figure out a way to bring our time back to our patients, and ensure that there are proper truth-in-advertising regulations in place for those who are eager to pick up the slack.
Dermatology will face a lot of challenges in the near future. Therefore, I call on all Academy members to do their part. Learn more about SkinPAC, the American Academy of Dermatology Association’s political action committee, and find out how SkinPAC can affect many of these items on our list. Write letters it works. When the Academy issues a call to action, log on to the Dermatology Advocacy Network and email your members of Congress. Also, support your patient organizations and ask for their support on the issues that affect our patients in return. When doctors lobby for issues, we are viewed as self-serving; when patients lobby for the same issues, their voices are much louder. Finally, the Academy is fortunate to have a very active Board of Directors and a reliable staff. If you are dealing with an issue, reach out to them. They will be responsive.
There is no doubt that our plates are full this year. However, as you were confident in my ability to lead this great organization, I am confident in our specialty’s ability to work together and make a difference with these important issues so that we can continue to provide the best quality care for our patients. dw