By Abby S. Van Voorhees, MD, June 02, 2014
For my entertainment before writing this column, I Googled the month of June to consider the various holidays that were upon us. A few like Flag Day and Father’s Day were obvious. But did you know that June 8 is Name Your Poison Day? While no one knows who came up with the expression it is presumed to be about choices of alcohol. Generally it connotes choosing amongst only bad choices, but that is not always the case. Sometimes the expression is also used more neutrally. My new-found awareness of this holiday got me thinking about this issue of Dermatology World; it too could be summed up that way.
Let’s start by considering our feature on the status of the Affordable Care Act. The increase in Americans with health insurance is certainly a good thing. However, so far the changes in health care have been less than rosy for dermatology. As we look across the country we hear about increasing barriers to dermatologic care. Clearly the main strategy to curtail health care spending is to limit access. We see networks being narrowed in many of the Medicare Advantage plans. And even those physicians reportedly still on the rosters are not available for patients to see. Brett Coldiron, MD, gives us examples of dermatologist panels being composed of the dead and the no-longer practicing...hopefully these two groups are not the same, but neither is helpful to a patient with a skin problem. Dermatology is not the only specialty affected; cardiology and nephrology are having the same issues. Read about the efforts of the AADA to combine forces with other disciplines to address this. We will keep you informed as a class action suit fighting these kinds of moves by insurers works its way through the courts in Connecticut. We are just in the beginning skirmishes of these fights; all of dermatology needs to be paying attention.
Gatekeepers are also again amongst us. Many of us remember them from the 1990s. The gatekeeper is no longer an independent primary care doctor; it is now the powerful ACO. The single internist might yield to the wishes of his or her patients to see their preferred dermatologist, but it’s not as clear that an ACO will be as malleable to the needs of the individual patient. And, how about those of us who are part of ACOs? Big questions remain about who we will most be serving. If that wasn’t enough, we also write about the impact of higher deductibles on many of our patients. We are a country of people who want health care without cost...and writing a check for those dermatologic visits feels painful to many of our patients. Through the derm lens the ACA so far looks like “name your poison” for dermatology.
If that weren’t enough, we are ever-more regulated and scrutinized. You might not like it, but don’t be unprepared for what is expected. Whether it is knowing about the correct usage of incident-to billing with non-physician clinicians, if CLIA proficiency testing is needed for your practice, or how best to communicate with other physicians in a HIPAA-compliant manner, rules proliferate. We sum up with Cliff Lober’s piece on strategies for surviving a RAC audit. More poison choices.
We write about a lot of poison this month; fortunately there is some sweet stuff too. I enjoyed interviewing Dean Morrell, MD, for this month’s Acta column. Nice to realize that higher isotretinoin dosing might allow for even more prolonged benefit for our acne patients. Some of you may find sweetness in the idea of concierge dermatology—read about it.
Enjoy your reading!