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A panel assembled at the American Academy of Dermatology (AAD) 2023 Annual Meeting encouraged the audience of dermatologists to advocate together for needed changes in payment, access, and practice.
First, Bruce A. Brod, MD, MHCI, of the University of Pennsylvania, and chair of the AAD Association Council on Government Affairs and Health Policy, outlined some of the academy’s advocacy priorities, chief among them access to care. Brod called it “soul-crushing” when prior authorization requirements get in the way of patients receiving the scans or treatments their doctor feels are necessary. He cited research finding that dermatologists could see 5 to 8 additional patients per day if prior authorization requirements were eliminated.
Another policy concern is ensuring adequate reimbursement, Brod continued. He noted that reimbursement rates through Medicare have increased only 9% since 2001 while the costs of running a practice have increased 47%. The opportunities to effect change include leveraging existing relationships and educating new members of Congress on the value of dermatology, he said.
One particular access conundrum surrounds the prescribing of isotretinoin, for which the FDA Risk Evaluation and Mitigation Strategy platform crashed and is still undergoing fixes, Brod noted.
“While there have been many repairs to that broken system and it’s better than it was when it went live,” he said, “there are still hurdles to prescribing isotretinoin, and it creates health inequity.”
Next, Brett M. Coldiron, MD, of the University of Cincinnati and past president of AAD, took the stage to describe the power of focused advocacy. He relayed an example of when his state’s medical board wanted to require dermatologists to have hospital operating room privileges to perform simple office surgeries like excisions. Armed with study findings from the literature showing the safety of in-office dermatological surgeries, he and a cohort of dermatologists who opposed the proposal were able to prevent it from taking effect.
He highlighted the potential of AAD’s DataDerm clinical registry to provide a robust source of evidence for dermatologists to use when arguing their priorities, and reminded the audience that reacting to change is within their power.
“You don’t need permission or a special portfolio to determine where your specialty is under attack and help identify a tipping point and push your focused advocacy,” he concluded.
Another area where focused advocacy will be essential is in resolving the ongoing lidocaine shortage that has stymied dermatologists in recent years, said Eric Millican, MD, of the University of Utah, and chair of AAD’s Regulatory Policy Committee and Drug Shortage Workgroup. By working to understand the root cause, which turned out to be a manufacturing bottleneck rather than a raw ingredient shortage or a regulatory barrier, the dermatologists can exert pressure to get the manufacturing lines moving again. He also suggested telling patients about the shortage so they can become advocates as well.
His main takeaways for the audience members, many of whom also voiced their frustration, were to conserve supplies of lidocaine when possible and to “hang in there—there is some hope on the horizon.”
Building on the session’s theme of preparing for future changes in dermatology, Ross Lane Pearlman, MD, of Northwestern Feinberg School of Medicine, spoke about the application of big data, artificial intelligence, and machine learning in dermatology. DataDerm is being used to report Merit-based Incentive Payment System measures to CMS, but beyond that, he said, “we want to really know the story of a patient, and not just how many [tuberculosis] tests were ordered that year.”
Pearlman addressed the fears that technological advances could replace dermatologists, given dermatology's status as a visual specialty. New deep learning apps are being used to distinguish benign vs malignant moles, but they are only as good as the data that go into them. To illustrate this, Pearlman described a cropped image as “clearly a melanoma,” only to reveal that it was in fact a splotch on a banana.
“This is the weakness of image recognition systems that use deep learning,” he reminded the audience. “You’re not actually looking at the whole clinical picture; you’re looking at an incredibly biased image that’s been selected by an individual.”
Despite all the buzz surrounding ChatGPT, it’s not capable of thinking or making informed medical recommendations, he said. Still, artificial intelligence does hold promise for automating the pattern-based tasks that take up so much of the practicing dermatologist’s time.
“Hopefully, mundane tasks that degrade our relationship with our patients will be made more simple and more straightforward," he said.
Finally, session moderator Sabra Sullivan, MD, PhD, a dermatologic surgeon with Dermatology Associates LLC in Mississippi, discussed the state-by-state nature of many concepts of interest to dermatologists, including scope of practice expansion and supervision. Her work involves educating patients on their choices so they can understand when to be treated by a physician vs a physician assistant or nurse practitioner. Recent efforts included the defeat of a bill in New Hampshire that would have allowed naturopaths to act as medical spa directors, as well as the passage of a law in Indiana that prohibits use of the term dermatologist by nonphysicians.
Looking forward, Sullivan said, “we’re not done. We’re just starting, and there will be a new something every day—lidocaine, Accutane, political matters—but we need to keep carrying the torch for taking the best care of our patients.”