President-Elect Lebwohl: 2015 will be the year of the patient

Editor’s note: Dr. Lebwohl will become president-elect of the American Academy of Dermatology and AAD Association on March 25, 2014 and will become president on March 24, 2015.


By Mark Lebwohl, MD

My fellow colleagues, I am honored that you have chosen me to be your 2015 Academy president and excited to get to work for you on the issues I highlighted in my speech at the Annual Meeting, which you can view here.

Let me tell you a story that influenced my sense of what we should be doing as a specialty. Years ago, the Health Care Financing Administration (HCFA), the precursor to the Centers for Medicare and Medicaid Services (CMS), changed the way we code for office visits and listed skin as one organ. As you know, we are paid by the number of organs we examine per office visit. There was an outcry from dermatologists to change this rule because it severely affected our reimbursement.

Everybody wrote letters in protest, but no one got a response — until Gail Zimmerman, CEO of the National Psoriasis Foundation, wrote a letter to HCFA. On behalf of more than seven million psoriasis patients in the U.S., she eloquently explained that treatment for patients who have scalp psoriasis is vastly different from the treatment given to patients who have psoriasis of the nails, which is different from the way we treat palm and sole psoriasis or psoriasis of the face, and so on. She demonstrated how this flawed policy was shortchanging quality of care.

In response to her letter, HCFA changed its policy to code each body part separately. The difference to the specialty was enormous. Being paid at a higher rate allowed us to spend more time with our patients and provide them with better, more thorough care, especially for complex cases.

Why did HCFA take action on this letter in particular? I believe it was because she was able to articulate the effect of that payment decision on more than seven million patients and the care they were receiving.

This story has stayed with me. That’s why I aim to make 2015 “The year of the patient.”  Placing the emphasis on the patient helps our patients — and us, too.

I know you are all advocates for your patients — putting their health and quality care first — but finances play into that as well. In many countries, economics require that dermatologists see 100 to 120 patients per day. This type of patient load doesn’t allow dermatologists to properly treat complex diseases. But there are ways we can turn some of these negatives into positives.

We need to build bridges to like-minded specialties to maintain our influence in the house of medicine and ensure that the care we provide is fairly valued, both by payers and by our colleagues. We need to make the case that we are important to the health care system. A part of this is combating the image of the “lazy dermatologist.” We’re often first to the office and the last to leave, and we need to counter misperceptions that ignore this. One way is to dedicate ourselves to providing consults at hospitals on weekends and weeknights.

In addition, the restrictions on CME credit are a threat to the specialty. At one time, every local society offered CME credit. The Accreditation Council for Continuing Medical Education (ACCME) has created onerous restrictions to the effect that there now is a great cost to developing CME. The only societies that can afford it are those who take money from pharmaceutical companies because they can’t fund CME creation on their own. We need to bring this issue to the ACCME’s attention to make it easier to offer CME.

… there are ways we can turn some of these negatives in to positives. We need to build bridges to like-minded specialties to maintain our influence in the house of medicine.

Finally, we need to address the big issue on everyone’s minds: Health care reform. It is being thrust on us whether we like it or not. Opportunities lie in the increased number of patients who will have health care insurance in the future. But, unfortunately, this same medical system takes away incentives to refer care to dermatologists. There is a push to reduce the number of specialists.

At the same time, graduate medical education funding is being eliminated, and this may force us to reduce the number of residencies, creating a shortage of dermatologists. Who is going to take care of all those patients?

I can envision a future where clinics are run by PAs. However, they do not have the same level of training and many things that will get missed if these non-physician clinicians are not supervised by a doctor. There are definite risks to that approach. We need to be constructive players in finding a system that provides care to the newly insured without diminishing quality.

I want to reiterate my dedication to being your president. With more than 30 years of experience under my belt, I look forward to working with you and those in other specialties to be a force for dermatology and to continue to provide the best quality of care for our patients.

Dr. Lebwohl is professor and chairman of the department of dermatology at Mount Sinai School of Medicine in New York. He has served as chairman of the AAD’s Psoriasis Task Force, and has directed the AAD's annual Psoriasis Symposium, Diagnostic Update Symposium, and Therapeutics Symposium. He is on the editorial board of the Journal of the American Academy of Dermatology (JAAD) and will take office as AAD president in March 2015.

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