What are the biggest challenges facing the specialty?

Academy President Abel Torres gives an overview of what the Academy is doing for its members and the specialty



In July, the Academy held its Summer Meeting in Boston. At the Plenary Session, Academy President Abel Torres, MD, JD, addressed the membership, outlining the challenges and opportunities facing the specialty. This video above is a recording of Dr. Torres' address and the transcript is below. Click here to access the slide presentation that was shown during the speech.

torres-abel.jpgBy Academy President Abel Torres, MD, JD

For an organization our size, with the number of members we have and the length of time we have been organized, it is imperative for us to look to the future of the Academy and what we should be providing for our members.  In order to find the answer to this, we spoke to several of our up-and-coming leaders of the profession to find out “What keeps you up at night” so that we may answer these questions for the future and help our members and the specialty of Dermatology succeed.

In addition to these challenges for our dermatologists, what are the biggest challenges to the specialty of Dermatology?

  • Payment reform, including demonstrating the value of the specialty and preparing for APMs and MIPs
  • Access to dermatologists, including the challenge of narrowing networks
  • Access to pharmaceuticals, particularly with the increase in drug prices
  • And, positioning the specialty with legislators and policymakers, and within the House of Medicine

The Academy’s response to address all of these can be summarized in these ways. We are:

  • Advocating on issues that we can have a positive impact
  • Demonstrating our value through science and quality measure for the greater good
  • Collaborating with our members in addressing challenges
  • Educating our members in innovative and meaningful ways
  • Communicating our clinical expertise, through educational forums and on advocacy issues
  • Creating ways to provide dermatologic care to at-risk populations
  • Evaluating the future of the specialty to build the pipeline

Advocacy efforts

Let’s talk about advocacy first and foremost. The AADA advocates on behalf of the dermatology specialty with policymakers and lawmakers on all levels.

The AADA is actively engaged in representing dermatologists’ best interests before Congress, State Legislatures and regulatory bodies, and federal agencies, such as the Centers for Medicare and Medicaid Services, Food and Drug Administration, Centers for Disease Control and Prevention and the National Institutes of Health.  

Another critical area with Advocacy is private payer advocacy.  The AADA works with national insurers and individual health plans to influence policies that could negatively affect our patients’ access to care.  

The top key advocacy issues that we are addressing in 2016 include:

  • Developing and piloting alternative payment models for dermatologic services
  • Protecting patient access to treatments
  • Making health plan networks transparent
  • Promoting policies that expand teledermatology services
  • Preserving physician-led dermatologic care, and
  • Adopting policies to prioritize skin cancer protection

Payment reform has been, and continues to be, a focus of the AADA, and the Academy is developing models and resources to help our members adapt.


What is MACRA?  It is CMS’ new way of paying physicians that replaces the flawed SGR formula for calculating Medicare payments.  The AADA is dissecting the rule and determining which potential legislative issues to address.

The potential upside is that MACRA penalties will be less than the penalties for PQRS plus meaningful use plus value-based payment modifiers.

However, the MACRA rule as it is proposed is not perfect.  It needs more time before implementation and needs to accommodate smaller specialties such as dermatology.  The AADA is leading the way to broaden the discussion and bring about change by submitting a thoughtful comment letter to CMS, initiating discussions on the Hill and sponsoring action at the AMA this year.

Patient access to care

Patient access to dermatologic care also is a key priority for the Academy.  We are all concerned about the rising cost of treatment and its effect on our patients.  

The Academy’s Task Force on Drug Pricing and Transparency is focusing on the issue of escalating drug prices and patient access to therapies and working on these issues in three ways:

  • Examining the issues and working to identify policies that can help alleviate patient cost burdens;
  • Engaging with the broader health care community to collaborate on solutions; and
  • Advocating for policies that can help patients gain better access to medications, while avoiding burdensome out-of-pocket costs.

The AADA also continues to advocate on access issues, including supporting the Patients’ Access to Treatments Act, which limits out-of-pocket costs for patients in some cases.

The Academy is working through a number of multi-stakeholder coalitions at both the federal and state levels, and is working to establish a dialogue with stakeholders directly to, at a minimum, create transparency about costs and open up options to patients.

Network adequacy

Network adequacy continues to be a challenge facing our specialty, though the AADA has been very successful to date in addressing this issue.

The AADA met with members of Congress and the White House, and brought our specialty’s concerns to Federal Regulators, State Legislators and Insurance Commissioners.  The AADA sent a letter to and met with CMS to detail concerns, developed a patient advocacy letter template, and led the development of a multi-association letter to CMS.

As a result of this effort, in 2015, the National Association of Insurance Commissioners updated its Network Adequacy Model Regulation to govern marketplace plans.

The AADA is focusing on:  defining quantifiable network adequacy measures, the criteria used for termination and patients’ access to providers, as well as disclosure of those criteria; and ensuring accurate network directories.

Prior authorizations

Another challenge that we all face, and that the Academy is evaluating, is the burden of prior authorizations.  To find ways to ease the burden on our members, the Academy is:

  • Conducting an upcoming survey of a sample of members to better understand the prior authorization work flow and burden
  • Conducting office visits to learn from member experiences and to speak directly with the staff processing the prior authorizations
  • Launching an online community forum
  • Developing a toolkit to help members deal with the burden of prior authorizations


The Academy also is looking to the future.

In an era when everyone from insurers to government entities are gathering data about health care outcomes, owning our own clinical database will help you align patient care in real time, in your practice setting, and align physician and patient-reported outcomes.

To serve dermatologists in our practice and the needs of the specialty as a whole, the Academy invested in DataDerm, a clinical data registry built by and for dermatologists to enhance quality reporting for the future. 

DataDerm provides the opportunity for dermatologists to demonstrate the quality of care they already provide.   It will allow you to:

  • Assess measures which are easily captured, widely applicable to several common skin diseases, meaningful to patients, and support your practice
  • Align physician and patient reported outcomes
  • Collect data meaningful to real practice and real quality care
  • Help you benchmark your practice against national averages so you can:
  • Rank providers in your practice against national averages
  • Enhance practice innovation and quality improvement
  • Help protect patient access to your services
  • Ease your reporting burden and integrate with PQRS
  • In future, simplify data gathering and reporting for meaningful use

New educational resources

The Academy has a strong commitment to education.  The AAD helps our members fulfill their education needs by providing more than 500 credits of CME through a variety of formats, including our Annual Meeting and Regional Courses, as well as self-study materials that are available in print, online and via mobile applications and the very popular “Question of the Week

Also this year the Academy has been a very strong voice in advocating for change within MOC –another thing that’s been keeping us up at night – to make this certification more relevant to the practicing dermatologist.  We believe we are making strides in this direction with the ABD.

The Academy recently launched the new Online Learning Center, which is a new educational portal that provides one entry point for AAD members and non-members who are completing educational activities.

The Online Learning Center allows you search, plan and track all your activities in one location:

  • Easily search AAD educational activities
  • Keyword search function lets you find activities based on topic area
  • Search filters allow you to find activities based on subspecialty, ABMS core competencies, or tailored to your learning preference
  • Conveniently manage and track education activities
  • Receive personal notifications for unclaimed activities when CME credit is about to expire

Another way the Academy helps our members in this changing environment is through the practical application of scientific data.  

Burden of Skin Disease Report

The Academy currently is undertaking an update of our Burden of Skin Disease Report, which addresses skin disease cost and quality of life.

The updated Report will report on the total cost of each of several diseases, including the cost of treatment, and identify days of lost work and life cost of each disease.

The Burden of Skin Disease Report has been an invaluable resource to the specialty of Dermatology, and we hope to release the findings of the updated report by early in 2017

Specialty positioning

With all of the programs aimed at helping our members navigate change, how is the Academy educating the public and positioning the specialty in this new environment? 

As we face this changing healthcare environment, it is more important than ever for our specialty to be well-positioned with legislators and policymakers, as well as in the House of Medicine.  To that end, this year, the Academy is launching a specialty positioning campaign.

The Academy conducted research in 2015 to identify misperceptions that persist about the specialty:

  • Outside of skin cancer, we do not treat serious disease;
  • Access to dermatologic care is difficult; and
  • We are not team players within the House of Medicine.

This year, the Academy will launch a campaign to demonstrate, with real world stories, the facts versus myths about dermatologists.  One component of the specialty positioning campaign will be meeting with our physician peers to open the dialogue and begin changing the narrative about our specialty.

In addition to specialty positioning, what is the Academy doing to educate the public?  The AAD conducts the SPOT Skin Cancer campaign, with free skin cancer screenings.

This program has led to 2.5 million free screenings since 1985.  These screenings have identified 255,000 suspicious lesions and 28,500 suspected melanomas.

Each May, the AAD promotes easy to read patient education pieces such as the ABCDE’s of melanoma and also invests its resources into educating the public about the dangers of tanning to prevent skin cancer.  

The Academy is well aware of the issues facing dermatologists in the changing healthcare environment and is working on behalf of all of us and the specialty to navigate these changes.  Through advocacy, education, practice management tools and the practical application of scientific data, the Academy is working to help dermatologists and the specialty of Dermatology remain successful in delivering care to our patients.

If you would like additional information about any of these areas, please visit our website at www.aad.org.

I hope provides an overview of what the Academy is doing for our members and the specialty.