Managing your practice through the COVID-19 outbreak
The Academy’s Ad Hoc Task Force on COVID-19 is monitoring pandemic developments daily, assessing the impact on practices, and providing guidance most relevant to dermatologists. The most current information is being posted to these pages as we have it. Check back for updates.
The AAD has assembled resources on COVID-19, including guidance on how to adjust to the outbreak in your clinic (below), legislative and regulatory updates that may impact you and your practice, information about the business implications of the outbreak, and the latest information on how to use teledermatology to provide care during the outbreak.
Guidance on this page includes:
What steps should I take to protect myself, my staff, and my patients?
The AAD has developed downloadable recommendations for dermatology practices (PDF) based on CDC and WHO guidance. These recommendations indicate that patients being seen for non-essential or elective medical or surgical services should be rescheduled or offered telemedicine service irrespective of their exposure or symptom status. (Updated 3/31/20)
The AAD has created a checklist of steps practices should take. (Updated 4/3/20)
The AAD has also assembled information about the status of risks to personnel in health care facilities (PDF) and will be updating it frequently. OSHA has also provided guidance on how to keep practices safe during a pandemic (PDF). (Updated 4/3/20)
The AAD has also developed information on COVID-19 testing and how to decide who should receive it, based on CDC and FDA guidance. (Updated 4/1/20)
Patients on biologics: Should I continue treatment?
The AAD has developed guidance on this question. (PDF, updated 3/19/20)
What about my iPLEDGE patients?
On March 22 the FDA indicated that “for drugs subject to REMS with laboratory testing or imaging requirements,” which includes isotretinoin under the iPLEDGE program, physicians “prescribing and/or dispensing these drugs should consider whether there are compelling reasons not to complete these tests or studies during this public health emergency (PHE) and use their best medical judgment in weighing the benefits and risks of continuing treatment in the absence of laboratory testing and imaging studies. They should also communicate with their patients regarding these judgments including their benefits and risks.”
The iPLEDGE contractor has indicated to AADA that at-home pregnancy tests and telemedicine visits are acceptable for complying with the iPLEDGE requirements during the COVID-19 outbreak. Dermatologists will still have to enter pregnancy test information for prescriptions to be filled. The table below indicates what has changed.
|Requirement||Changes due to COVID-19|
Prescriber to use best medical judgement to manage their patients.
Please refer to the March 17, 2020 notice from The Department of Health and Human Services Office for Civil Rights (“Notification of Enforcement Discretion for telehealth remote communications during the COVID-19 nationwide public health emergency”) for guidance.
|Pregnancy testing||Pregnancy test can be “at-home.” The tests can be obtained at drug store, grocery store, or online retailer. |
The test results and date performed must be communicated to prescriber.
Prescriber or designee would enter the date performed (specimen collection date) and test results per usual iPLEDGE program process.
|Prescription window||This requirement will not change.|
|Two forms of birth control or abstinence||This requirement will not change.|
How should dermatologists conserve protective equipment and vital medications?
The FDA has outlined several conservation strategies based on supply levels to assist health care organizations and personnel in managing items such as surgical masks, surgical and isolation gowns, and surgical suits. The Academy has developed guidance encouraging members to take steps to preserve protective equipment during the COVID-19 outbreak. Hoarding in all its forms must be avoided so that urgently needed medications and supplies are available for our patients and health care responders on the front lines.
In addition, the Academy advises dermatologists to be cautious with posts on social media which may be perceived as either ‘hoarding’ (masks, medications, or other) or suggesting that specific, unproven treatments may be beneficial for COVID-19 in the absence of data. Medications should continue to be reserved for their indicated use, and for the patients who need them.
As we anticipate shortages for specific medications (some of which have not been publicly announced due to concerns for price gouging), dermatologists should continue to do as they always do: prioritizing patient health and providing the best possible care for all manners of skin disease.
What about my lupus patients who need hydroxychloroquine?
Patients with systemic lupus erythematosus (SLE) and their physicians are reporting difficulties filling prescriptions for hydroxychloroquine due to it currently being explored as a possible treatment for COVID-19. The AADA, along with the American College of Rheumatology, Lupus Foundation of America, and Arthritis Foundation, sent a joint letter to the Administration as well as congressional leaders to highlight the need for action to ensure that patients who need this drug do not have disrupted access.
In addition, the American Medical Association, American Pharmacists Association, and American Society of Health-System Pharmacists recently published a joint statement on the appropriate ordering, prescribing, or dispensing of medications designed to treat COVID-19.
Note: Hydroxychloroquine sulfate is not FDA-approved for treatment of COVID-19, however, based upon limited in-vitro and anecdotal clinical data in case series, is recommended for treatment of hospitalized COVID-19 patients. Read the FDA Letter of Authorization.
The FDA is now allowing pharmacists to compound hydroxychloroquine sulfate tablets due to the shortages of the manufactured version. Dermatologists can have their patients who are having difficulties filling their prescriptions:
Contact A.J. Day, PharmD, Vice President of Clinical Services, Professional Compounding Centers of America, ADay@pccarx.com with their zip code to help connect patients and compounding pharmacies with supply; and
Call compounding pharmacies in their area to see if they have supply by using the Alliance for Compounding Pharmacy's Find a Compounding Pharmacy tool.
How can I help more people get tested?
A shortage of viral transport medium (VTM) and nasopharyngeal swabs is contributing to the testing bottleneck. Dermatologists who have these supplies can consider donating them to local health departments, hospitals, or labs processing tests. The AAD has assembled a list of products to consider donating.
What does the literature say?
JAAD has assembled a page for all articles about COVID-19 and will make them freely available for six months.
Dr. Warren Heymann has addressed the pandemic twice in DW Insights & Inquiries, on March 18 and March 25.
Dialogues in Dermatology has released three free podcasts about COVID-19:
“Navigating Practice During COVID-19: AAD Resources and Embracing Teledermatology”
"COVID-19 Series: What Are We Doing in the Dermatology Outpatient Department? ”
"COVID-19 Series: COVID-19 Dermatology Roundtable"
All three are available now.
What about requirements like certification and MIPS? Does this change those?
CMS has extended the deadline for 2019 MIPS submissions to April 30, 2020, and is considering how to offer flexibility in 2020. The AAD has compiled a list of Improvement Activities members may engage in during the pandemic that would earn them MIPS points.
The American Board of Dermatology recently announced significant changes to MOC for Diplomates in 2020. Dermatology World Weekly interviewed ABD Executive Director Thomas Horn, MD, about the changes.
What do we tell patients about washing their hands?
The AAD has issued a news release: Dermatologists encourage the public to moisturize after hand washing to prevent dry skin and infections.
What guidance are other medical societies and organizations providing?
The AAD has assembled links to guidance from other specialty societies.
These links are provided as a resource; the AAD has not endorsed any organization's COVID-19 guidelines.
(Updated on 4/3/20)