By Abby S. Van Voorhees, MD, September 2, 2013
Life has always been full of awkward changes. Take, for instance, what happened in 1752 in the British Empire. The King decided that it was time to start using the Gregorian calendar in place of the Julian one, now 11 days out of sync with the Earth’s place in the heavens. Up until that point politics between the Protestants and the Catholic Church had kept the Brits attached to the Julian calendar. The change in calendar meant that in 1752 the date of Sept. 2 was immediately followed by the 14th. Riots broke out as the peasants protested, thinking that the monarchy had deprived them of two weeks of life. Those with property, however, saw it differently — they quickly realized that they would receive the next month’s rent only two weeks after the last payment. They touted the advantages of this adjustment. Always winners and losers when change occurs.
This reminds me of what’s going on in payment reform vis a vis dermatology; this month we’ve provided you with an update. Jack Resneck Jr., MD, sums it up by saying “dermatology has a bull’s-eye on its back.” Clearly the federal government is fearful of the enlarging demographics with the baby boomers approaching the retirement age and is working hard to curtail costs. Why are they focusing on dermatology? While dermatologists make up just 1 percent of all physicians, we are responsible for 3.5 percent of all Medicare expenditures. On average 76 percent of our income comes from our procedures. The AADA is doing all it can to impress upon the RUC, Congress, and other governmental agencies that we should not weather the brunt of this storm. Hopefully, at this moves forward we’ll feel less like the peasants of 1752, and more like the ruling classes.
If Mohs surgery is a part of your practice, then be sure to read our coding column. Rules for billing of biopsies and frozen sections when doing Mohs are clearly laid out. Be sure to take note of the requirement that only the physician doing the surgery can perform these services. As more of us utilize mid-level providers, it is critical to be aware of these rulings.
Kids with melanoma...the only thing worse than making this diagnosis would be missing it. Our Acta Eruditorum column on new diagnostic criteria is crucial reading for everyone. ABCD apply, but not as we know them. Read about the alternative pneumonic device taught to us by our own Kelly Cordoro, MD:
A = Amelanotic
B = Bleeding, Bump
C = Color uniformity
D = De novo, any Diameter
We all will want to commit this to memory so that we improve our detection of these dread malignancies in children. I guess things are always changing... hopefully for the better with improvements in our diagnostic accuracy and in our calendars. Hope you each had a great summer, and by now have your children plugged back into school. With four of mine in either college or graduate school, I am glad to see them all settled and their tuition bills paid. Now if we could just work on change when it comes to tuition bills.
Enjoy your reading.