By Dirk Elston, MD, August 01, 2013
As the health care environment changes, dermatology faces a variety of challenges, along with opportunities that may present themselves if we position ourselves appropriately. To determine how the organization should prepare to address both, the American Academy of Dermatology Association held a Health Policy Strategic Retreat May 31 and June 1 at the AADA’s Washington, D.C., office.
The retreat included participants representing all elements of our specialty and included presentations on the changing landscape of health care by Jack Lewin, MD, previously the CEO of the American College of Cardiology, and Jack Resneck Jr., MD, a member of our Board of Directors and the former chair of the Council on Government Affairs, Health Policy, and Practice. Discussions focused on what the Affordable Care Act means for medicine in general and what it might mean for dermatology specifically. Among the points they noted:
- The U.S. spends more than other countries for health care, but outcomes are equal to or worse than those countries.
- New payment models incentivize patients to seek the best price for care, and every specialty will have to find ways to reduce costs. The AADA must gather data to demonstrate the unique value of care by a board-certified dermatologist.
- Dermatologists represent less than 2 percent of physicians, but we project a voice greater than our size through our involvement in organized medicine. Dermatologists have to be at the table at the local, state, and federal levels to ensure our voice is heard as decisions are being made.
- How we are perceived by other physicians and policy makers is critical and we need to acknowledge that we have an image problem. We are viewed by some as very smart, but overpaid and with an easy life. We need to take every opportunity to communicate the work we do within the community. Every opportunity to do a hospital consult, see a patient for a colleague, or volunteer at a cancer screening clinic or indigent clinic is a chance to show our specialty in a positive light. Every opportunity to do work for local, state, or regional medical societies is an opportunity to demonstrate the worth of our specialty in a changing world. [pagebreak]
At the retreat, participants focused the challenges and opportunities ahead by working through possible scenarios for the future. Scenario planning is an engineering tool often used to prioritize work and resources in an uncertain environment. Workgroups considered the possibilities for dermatology under several different scenarios, including one where primary care cements a role as the hub of the health care system, another where accountable care organizations dominate the landscape, and a third where value-based purchasing becomes the prevailing paradigm. Each scenario helped us to identify things that need to be accomplished in order for dermatology to flourish.
Ultimately, the scenario planning produced six areas critical to the future success of our specialty. They include:
- Guidelines, metrics, and outcomes: Defining and demonstrating value by creating a set of quality metrics that facilitate meaningful outcomes research.
- Patients: Understanding their experience, increasing satisfaction, and improving adherence to treatment.
- Primary care: Collaborating to develop mutually beneficial relationships.
- Purchasers: Making the case for the value of dermatology.
- Team care business models: Developing best practices in dermatologic care coordination.
- Telemedicine: Advancing appropriate triage and teledermatology. [pagebreak]
The Board of Directors, the Priorities Committee, and AADA staff will review the six areas and determine the best way to approach each of them. You’ll be hearing more about these plans and their advancement in the months to come.
Thank you to the planning team, which included our president-elect, Brett Coldiron, MD; the chair of the Council on Government Affairs, Health Policy, and Practice, Marta Van Beek, MD, MPH; the chair of our Workgroup on Innovative Payment and Delivery, Kathryn Schwarzenberger, MD; and our new executive director and CEO, Elaine Weiss, along with other key staff in our Washington, D.C. and Schaumburg offices. The outcomes of this retreat will help us chart a course that helps ensure the future of our specialty.