Advocacy efforts are vital to future of specialty

June 20, 2014

I’ve been very busy the last few weeks, starting on May 1 at the American College of Mohs Surgery meeting, the May 16-17 AAD board of directors meeting, a May 22 American Society of Mohs Surgery meeting, a June 3 meeting in Baltimore to talk to CMS, followed by the AMA meeting June 5-10 in Chicago.

The ACMS meeting has grown to a very large audience, with more than 800 in attendance. I gave my presidential update and then spent most of my time in the hallway receiving donations for AADA SkinPac. With the additional efforts of Brent Moody, Pat Davey and Hugh Greenway, and my wife, Lana Long, we collected more than $160,000. (I am using an iPad mini with a card swiper, so beware.)

People may wonder why I am so zealous about working in this direction. It’s because the federal government is where the reimbursement battle has shifted, and we need money to advocate effectively. A small investment here has great returns for our specialty.

The board meeting agenda was jam-packed and exhausting. Of note, the board unanimously approved the development a request for proposal (request for bids) to develop a data registry and is prepared to invest heavily in this endeavor. Data will help us tell the value and quality assurance story of dermatology to those who help determine reimbursements. We must also have it to define “quality” in dermatology to those making health care policy. Without it, we will not have any parameters to report and will be stuck with truly “meaningless use” criteria. It is going to be a large investment with an even larger member benefit, and this investment is a big reason for you to support a dues increase.

The American Society of Mohs surgery was in Albuquerque, a place I had never been — a place where it rained every day. It was beautiful otherwise and I did take a day off to visit Santa Fe. Bob Durst, Paul Storrs, and I collected $42,000 for SkinPac, which on a per capita attendee basis, was more than I collected at the ACMS.

June 3 I flew to Baltimore to meet with CMS about the Medicare Advantage plan adequacy issue. Ray Welch and Howard Rogers helped me, and we presented convincing data about the gross inaccuracy of the UnitedHealthcare Medicare Advantage plans’ physician roster for dermatologists. We also demonstrated long wait times to see a dermatologist. CMS was sympathetic, but pointed out that they have not received many (or any) patient complaints. You must mobilize your patients to write, call, or email CMS complaining about UnitedHealthcare Medicare Advantage dropping their dermatologist and telling how it has adversely affected their health. Your patients can file a complaint with the Centers for Medicare and Medicaid Services, (through their online form), by writing them at Centers for Medicare and Medicaid Services (CMS), Medicare Beneficiary Contact Center, PO Box 39, Lawrence, KS 66044, or by calling them at 1-800-MEDICARE. Also encourage your patients to write to their senators and member of Congress to inform them of the impact the termination could have on their access to care through Medicare Advantage. I pointed out that one of the mistreated VA patients was a liver transplant recipient who had to wait more than four months to have his squamous cell skin cancer treated.

I, along with all the dermatologic surgical society presidents, wrote a letter and sent it to Lancet Oncology regarding an article that promoted that non-melanoma skin cancers should be renamed IDLE rather than cancer, and that these cancers do not need to be treated, but rather, “watched.” We refuted this assumption with scientific citations and a strong warning not to proceed with those recommendations but treat with cost-effective dermatologic care.

I flew to Chicago from Baltimore for the AMA meeting, where Jack Resneck and Cyndi Yag-Howard were running for AMA posts. I helped campaign, saw some old friends, and learned a lot. Jack and Cyndi both won their elections, which is a huge win for dermatology!

Narrowing networks, Stark law, and CMS physician payment data release

Skin date: 5/5/2014

On Wednesday, May 1, I flew to Chicago to attend the Midwest Business Group on Health’s meeting for health care purchasers.  Approximately 120 human resource staff (and some insurers) attended. Dr. Simon Yoo (Northwestern) and I conducted a skin cancer screening for three hours in the morning, and then I got to speak for 10 minutes. I spoke about the epidemic of skin cancer, what it was going to cost our country, and asked them to protect their workers from ultraviolet radiation (including tanning beds).  I explained dermatology’s cost effectiveness — especially in-office treatment.  It seemed well received.

Then, in the midst of very warm temperatures, I flew to Phoenix for the American College of Mohs Surgery meeting May 1–4.  The discussion at this meeting included the impact of tightening physician networks on patient access.  Most of the dermatologists had not yet been excluded from the Medicare Advantage plans, but were concerned about this impending threat.  I explained how grossly inaccurate the physician rosters for these plans are. The bottom line is that if there are no doctors to see, the plans will have no medical bills to reimburse.  I told them that the AADA is studying this, and I believe we are making progress. As a result, in part, of activities we support, UnitedHealthcare has stopped the roll out of these tight networks, although 10 states are still suffering.

I also explained that specialty medicine, and especially dermatology, is under attack.  Our support of efforts to answer that attack is critical since significant change is underway. For example, we are continuously fighting the loss of our Stark exemptions, and payment decisions are being increasingly moved to CMS. A strong Academy in the face of these changes is essential to the vitality of our specialty.

There was also much discussion about the CMS physician payments data release. The ACMS is going to act proactively to educate the group about normal distributions and billing patterns before the next set of numbers are released.

It must be emphasized that the current data has not been confirmed as accurate by physicians and each practice is unique in its use of providers and provision of services. I believe that releasing this data, without a chance to correct or to give context of the individual practice and patient mix is most destructive.  Physicians may be judged without ever having the opportunity to respond. I remind all of you that if you get a media request, ask about the nature of the interview (what does the reporter want to know?), request to revisit the conversation at a later time (set a time so the reporter knows when he/she can expect a response), and contact Melanie Tolley Hall and the AAD communications department for assistance at mediarelations@aad.org.

We have our AAD board meeting coming up (my first as president), and I am studying the material … running the meeting is about 100 times as hard as listening. We have many interesting topics that will require our full attention, including data registries — which are extremely valuable, but can be exceptionally expensive. Initiating this effort will be even more challenging since the recent dues increase proposal failed. Apparently, we need to have more meaningful conversation around the financial needs and benefits you as members would gain from an increase in investment into our specialty. I am sure we’ll be discussing this in the coming months.

Sincerely,

Brett Coldiron, MD

CMS data release, data registries, and other thoughts from the road

Skin date: 4/28/14

Hello, and welcome to my inaugural post to the President’s Road Warrior Blog.  Why road warrior? That is a big part of my job as AAD president — traveling all over the country, engaging with others on many important topics to the specialty.

That’s what I want to share here with you. What topics are we as dermatologists most concerned about and what is the AAD and AAD Association doing with them?

I recently concluded my first few trips as AAD President on the road, which included stops at the Noah Worcester Dermatological Society in California, then to Chicago for the Scientific Assembly Committee planning meeting for the AAD’s 2015 Annual meeting , and then on to the Florida Society for Dermatology and Dermatologic Surgery (FSDDS). It was a whirlwind tour, but a productive one.

Attendees at the Noah Worcester Annual Meeting expressed concern about the future of graduate medical education funding for residents and frustration with ACGME’s strict standards on pay and resident support. I explained that we — the AAD, and more importantly, the ABD — are aware of these concerns and have had discussions about how to make dermatology residencies more self-supporting if graduate medical education funding is cut. Certainly, residents are the life blood of a specialty.

We also had a discussion about the CMS data release. I emphasized that office expenses could represent up to two-thirds of dermatologists’ Medicare payments and that most of the general population is not aware of this. This is a point you should make if patients ask you about your Medicare payments — that a lot of the money goes to keeping the lights on and paying staff.

My next stop was the AAD Scientific Assembly Committee meeting, which met in Chicago to plan our next Annual Meeting. Like many of you, I have attended the Annual Meeting for years and been impressed by the entire experience. It was fascinating to see a meeting born from the concept stage. I was excited to see how speakers are chosen — based on high satisfaction scores and attendance, as well as the best fit for the educational gaps for CME as identified by our members. The AAD is going to start providing aspiring speakers with a list based on these gaps to attract presentations that address members’ most-pressing educational needs. This is what a data-driven future looks like!

After attending the FSDDS assembly, I determined that the state of Florida is not going to explode this month, though there is anxiety about the forthcoming new Mohs local carrier directive. I explained to the assembly that if I were a big Medicare biller, I would want to make sure I was giving my share of support to the work of the Academy. I also pointed out the strong need for data registries; without good data we are defenseless in front of bureaucrats and insurance companies, and that is not a good position for the future of our specialty. With good data we can demonstrate the significant value we add to the health care system to policymakers and payers.

I will leave you with that cheerful thought. Next time I hit the road I am bound for Phoenix, where I will give similar messages to the American College of Mohs Surgery.