By Robert Durst, MD
Each year the Advisory Board (AB) of the American Academy of Dermatology and Association (AAD/A) convenes to deliberate on important issues to individual practitioners and bring proposed policies in the form of resolutions to the Academy’s Board of Directors (BOD) for consideration. The AB plays a critical role as the Academy's sounding board and the largest forum for action by and among grassroots members of the Academy. Why is the AB important to state societies? The AB acts as a liaison between state and regional dermatology societies and the Academy. It's an effective way bring your society's concerns to a dedicated team working on your behalf.
On Sunday, March 23, 2014, during the AAD’s 72nd Annual Meeting in Denver, Colo., your AB met to discuss proposed resolutions and vote on potential future Academy policies. After the resolutions were distributed, the AB and BOD discussed the proposals at their May meeting and took action on whether to adopt or not adopt based on current AAD/A policy, activities, and programs.
The docket of 2014 resolutions was unique in that it encompassed a wide array of ongoing concerns, as well as new ideas for recurring problems and original policies designed to shape Academy activities in the coming years. Below is a summary of each proposal and BOD action.
Maintenance of certification:
The AB agreed that maintenance of certification (MOC) continues to be a problem and should be adequately researched to determine whether or not it improves quality of care. The AB directed the AAD to encourage the American Board of Dermatology (ABD) to create alternative categories for diplomates who have gone through initial certification with the ABD and have remained in good status with the Board, but choose not to participate in MOC. Additionally, they voted in favor of the AAD creating a survey to study the effects of MOC recertification on dermatologists’ end-of-career decisions and whether they continue to remain in practice or retire earlier as their ABD certification expires.
The Board of Directors voted to refer this resolution to the Council on Education and Maintenance of Certification for further study.
New communications strategies:
The AB passed two resolutions relating to AAD communications. The first reemphasized their support of using the terms "surgical" and "surgery" instead of "procedural" and "procedure" in all AAD communications. The second called on the Academy to investigate new communications strategies aimed at young audiences that promote the expertise of dermatologists and encourages members of the public to protect themselves and their skin. The new strategies include the development of children's books, comic books, smart phone applications, and public service announcements for radio stations, blogs, and websites across the country.
The Board of Directors reaffirmed existing policy that calls on the AAD/A to use the term "surgical" instead of "procedural" in its communications and referred the resolution regarding new communications strategies to the Council on Communications. The AB Executive Committee is currently working on a communications proposal to present to the Council on Communications at the Academy's Summer Meeting in August.
Truth in advertising:
As various states are allowing nurse practitioners to practice independently with little or no physician supervision, the AB felt strongly about addressing the AADA’s position on scope of practice. Members brought forth a proposal that called on the AADA to promote the expertise and skills of residency-trained dermatologists; educate the public, legislators, and regulatory bodies about the differences in training between dermatologists and non-physician extenders; and support truth in advertising. Additionally, the AB addressed the expansion of telemedicine by adopting a position that states the preferred standard of care for a dermatology visit is a direct, in-person examination by a board-certified dermatologist.
The Board reaffirmed the telemedicine resolution based on a recently approved Position Statement on Telemedicine, while the resolution regarding truth in advertising was referred to the Council on Government Affairs, Health Policy and Practice.
Federal Clinical Laboratory Improvement Amendments (CLIA) Program:
The AB believes that regulatory oversight of physician-performed microscopy doesn't improve a practitioner’s skill or proficiency in performing it, and therefore, passed a resolution that directs the AADA to encourage CLIA enforcement officials not to adopt new regulations unless they are evidenced based. The AB also passed a resolution to lobby Centers for Medicare and Medicaid Services (CMS) to include Tzank smears, molluscum smears, gram stains, scabies prep, and hair mounts in the physician-performed microscopy category of laboratory testing.
While the Board did not adopt the latter resolution, they did refer the first resolution to the Council on Government Affairs, Health Policy and Practice, as a larger effort to address these concerns is currently being developed among various AAD/A committees.
Burdens on small and solo practices:
The AB passed policy that calls on the AADA to continue to advocate for the delay of ICD-10 and actively support legislation that seeks to delay the code set, as they feel the transition will cause a major disturbance to private and solo practices. The AB is concerned that the conversion to new ICD-10-ready coding software will be too expensive for individual practices and will not improve patient care — only burden practices.
In regard to electronic medical records, members of the AB adopted a policy that calls on the AADA to seek legislation that would grandfather private practices, particularly small or solo practices, from having to adopt EMR mandatory rules, and promote delays of EMR requirements until a system is in effect that is affordable, efficient, safe, and most of all, maintains patient confidentiality.
As permanent repeal of the SGR continues to be a priority of AADA, the AB felt it was important to address the AADA’s position on the Medicare Provider Payment Modernization Act (MPPMA) and similar and future measures that they believe increase the regulatory burden on the practicing dermatologist. The proposed policies called on the AADA to investigate MPPMA’s unfunded mandates, decreased reimbursements, and protect the ability of physicians to opt out of Medicare, Medicaid, or other government authority. The Board shared concerns on the future of the changing health care environment and how it will affect small or solo practices. Ultimately, the Board referred these proposals to the Council on Government Affairs, Health Policy and Practice for further study.
The AB Executive Committee will continue to work with the AAD/A councils to strengthen the AB's proposals and ensure the grassroots voices of the organization are being heard. Representation at this meeting and engaging in AB policy discussions throughout the year is vitally important to your society’s voice being heard by the Academy. All state, regional, local, and metropolitan dermatology societies that are categorized as a 501(c)3 or 501(c)6 organization may select a member of their society, who is also an Academy member, to serve a minimum two-year term on the Advisory Board. If you would like more information on the Advisory Board, please contact Ashley Cook at firstname.lastname@example.org.
Dr. Durst, MD, is a private practicing dermatologist in Topeka, Kan. He has served on the Advisory Board for over 10 years and is currently the chair. Dr. Durst is a member of the AAD/A Board of Directors, the Organizational Structure Committee, and Council on Government Affairs, Health Policy and Practice.