By Kelley Redbord, MD
In addition to attending many of the over 350 educational workshops at the AAD’s Annual Meeting in March 2014, members also spent a considerable amount of time in Denver discussing state policy issues affecting dermatologists and their patients. Members of the State Policy Committee (SPC) identified 12 policy priorities to guide the AADA’s state advocacy agenda, which is divided into three tiers. The ranking represents a guideline to most effectively using Academy resources to wield influence and protect dermatologists and their patients.
Truth in advertising reigns as the number one state policy priority. Data from three nationwide studies demonstrate that patients are often unsure who is providing their health care and overwhelmingly support legislation requiring medical advertising materials to clearly designate the education, skills, and training of all health care professionals promoting their services. Scope of practice and supervision of physician extenders in order to provide physician-led team-based care to our patients is a close second. The AADA works through the state legislative and regulatory processes to ensure that patients have accurate and truthful information regarding the health care services they receive from practitioners to define the practice of medicine and tighten/enforce regulations to ensure that, as the workforce expands to include greater use of physician extenders, structures are in place to ensure patient safety.
In third and fourth place are issues surrounding office-based surgery and indoor tanning regulation. In regard to office-based surgery, the AADA’s goal is to ensure that rules governing the office setting are fair, reasonable, and appropriate, and that they are written based on existing research and evidence related to patient safety and the level of the procedure performed. The AADA will continue to work with a broad coalition of stakeholders to push for greater regulation and oversight of the indoor tanning industry, including stronger age restrictions and penalties for noncompliance.
The second tier of priorities includes five issues: network adequacy and transparency, anatomic pathology, medical spa standards, compounding and biosimilars, and teledermatology. The first issue in this tier — and highest priority in the group — is network adequacy and transparency. Changes in the health care system have resulted in payers dropping providers from their networks as a means to reduce cost (See Narrowing Networks feature). Priority number six is anatomic pathology services. The AADA will advocate retaining a dermatologist’s ability to choose his or her own dermatopathologist and to bill for one’s work. The seventh priority directs the AADA to ensure medical spas conform to standards that will protect patients.
There has been an increase in compounding regulation; however, it’s important for dermatologists to have access to topical compounds in the office setting without overly burdensome regulations. In addition, the AADA supports legislation that notifies physicians when a pharmacist substitutes a biosimilar for a biologic. Finally, the AADA supports policy changes that allow dermatologists to expand the use of telehealth services to meet the needs of underserved communities across the country including — through the implementation of pilot projects — modifications to state licensure restrictions, liability concerns, and reimbursement for store-and-forward technology.
The third tier of priorities includes health system reform implementation, opposition to taxes on cosmetic procedures or medical provider taxes, and regulation of tattoos and body art.
While there are numerous issues outside of the 12 listed above, the SPC believes these areas reflect the most pressing issues affecting the specialty of dermatology today.
Dr. Kelley P. Redbord, deputy chair of the Academy’s State Policy Committee and chair of the Grassroots Advocacy work group, is in private practice in Rockville, Md., and Vienna, Va., and is an associate clinical professor at The George Washington University.