Dermatologists Will Be Targeted in Healthcare Reform

Kate Johnson

March 17, 2012

March 17, 2012 (San Diego, California) — Regardless of the fate of the Affordable Care Act, physicians in general, and dermatologists in particular, will be targeted as healthcare reform proceeds, Jack Resneck Jr., MD, told a packed audience here at the American Academy of Dermatology 70th Annual Meeting.

"Whatever you think about the Affordable Care Act...dermatology will be a target in the next few years," said Dr. Resneck, who has joint appointments as associate professor of clinical dermatology at the University of California at San Francisco and the San Francisco Institute for Health Policy Studies.

Dermatologists account for just 1% of physicians in the United States but 3.5% of Medicare expenditures, so they face growing attention from policy makers, he said.

"With the skin cancer epidemic, there may be incredibly good reasons for this, but it puts us on the radar screen."

The attention has led to "a perception problem in the eyes of other physicians who...probably don't have realistic ideas about what most of us actually do in our practices on a daily basis," he said.

Skin cancer is now the sixteenth mostly costly Medicare diagnosis, accounting for $2.9 billion annually. This is almost half of the $6.8 billion spent on cardiology. The rate of growth of some procedures, such as Mohs surgery, has increased by 400% over the past 15 years, said Dr. Resneck.

"This may be entirely justified [because] we have a massive skin cancer epidemic...[but] it gets people's attention in policy circles on the hill and at Medicare, and they tend to come after you."

As a result, the Relative Value Update Committee (RUC) has been assigned to review, among other dermatology codes, Mohs codes, pathology codes, and actinic keratosis codes in the next year. "And we know what happens when codes go to RUC — they do not get increased.... If you happen to be surveyed on how much work you do for these codes, do not ignore those surveys," he said.

Additionally, "we have seen efforts by other specialties over the past couple of years that substantially could impact our practices," he told Medscape Medical News. A coalition group, known as the Alliance for Integrity in Medicine, even suggested to the deficit super committee that the Stark exemption for in-office ancillary services be eliminated, he explained. "This effort, which would alter our ability to provide dermatopathology services in our offices, may be a sign of things to come."

It is not just dermatology but medicine in general that is "in trouble in terms of figuring out how to fund what we do in years to come," said Dr. Resneck.

Although this pressure is largely due to the federal budget deficit, there is also pressure from business over the amount it is having to pay insurance companies. Private insurance has become unmanageable for many low-income employers such as Walmart or Target, which face employee health-insurance premiums that exceed the amount they pay in salaries, he said.

Tax revenue and discretionary spending are currently garnering the most attention, and blame, but future projections show that Medicare and healthcare spending are on the trajectory to become the overwhelming driver in spending growth. "This is not a sustainable course; and it makes the Social Security crisis look very meager," he said.

Dermatologists "have to take some responsibility for figuring out where savings are going to come from, "because if we keep sticking our heads in the sand, as we have tended to do in the past, somebody else is going to reshape the system without our input," Dr. Resneck explained.

Dr. Resneck has disclosed no relevant financial relationships.

American Academy of Dermatology (AAD) 70th Annual Meeting: Presented March 16, 2012.


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