By Brett Coldiron, MD, April 01, 2014
During his year as president, Dr. Elston let you know that dermatology is under siege. I want members to know that in this difficult environment, the Academy will continue to advocate for access to quality dermatologic care. We will be an active advocate both in D.C. and in the states. And, most importantly, we’ll fight to protect patient interests. Indeed, a recent White House visit gave the AADA an opportunity to put the spotlight on an issue of great importance for many of our patients, especially those who need our help the most.
Along with the Academy’s executive director and CEO, Elaine Weiss, JD, and our directors of legislative and regulatory affairs, I went to the White House on Feb. 3 to discuss this issue with an Obama administration health policy advisor. We alerted the White House to problems we’ve seen in UnitedHealthcare’s Medicare Advantage plans in several states, including Connecticut, Florida, Massachusetts, Ohio, and Rhode Island. They’re eliminating many dermatologists from the panels of these networks with no reason given and, sometimes, without notifying patients in a way that would let those patients enroll in a different plan to maintain access to their doctors.
How many dermatologists are being eliminated? How insufficient are the resulting networks? We wanted to present a compelling, data-driven case, so we reviewed the dermatology rosters of UnitedHealthcare’s Medicare Advantage plans in Boca Raton, Fla., Hartford, Conn., Providence, R.I., and my home city of Cincinnati. These plans like to claim that they offer a multitude of dermatologists but the reality is very different. We found a 70 percent error rate in their provider directories — seven in every 10 dermatologists they claimed a patient could call up and book an appointment with were either dead, retired, residents, had moved, were no longer seeing new patients, or were focused exclusively on dermatopathology or Mohs surgery. Many of the dermatologists seeing new patients worked part time.
Why would an insurer be willing to put such a disappointing directory in the hands of patients? The reason appears to be the cutback in reimbursement for Medicare Advantage plans; at the reduced payment levels, it makes financial sense for insurers to try to drive their sickest patients back into traditional Medicare. But that’s a bad deal for those patients, who find themselves paying more for gap insurance and prescription medicines. It is also important to note that if there are no physicians to see, there will be no bills to pay.
And, of course, what began in Medicare Advantage will spread to the insurance exchanges, a point we made clear to the White House. During our 40-minute meeting, we made sure to note that while politics have not killed off the Affordable Care Act, furious patients who have insurance but can’t see their doctors could do the trick. That message clearly resonated: Two days later the administration announced that plans sold on Healthcare.gov next year will first have to submit a provider list to be reviewed to ensure that it includes enough doctors and hospitals to serve patients. Our staff is already at work on a prototype that we believe will help the administration assess the supply of dermatologists in networks.
And our message isn’t just being heard by the administration; after our White House meeting I paid a visit to Rep. Kevin Brady, chair of the health subcommittee of the House Ways and Means Committee, where we discussed both network insufficiency and the importance to patients of the in-office ancillary services exception, which allows, for instance, patients to receive a pathologic diagnosis and Mohs surgery in a single day rather than traveling back and forth several times to be treated. I also attended a dinner with House Majority Whip Rep. Kevin McCarthy, where I again stressed the importance of these two issues for patients.
Ensuring that patients have health insurance is a noble goal, but we know that it doesn’t mean anything unless those patients also have access to doctors. The Academy was one of the first medical societies to raise the alarm about this, and you can be sure we will continue to fight for patients’ ability to receive the dermatologic treatment they need.