Change is coming

Waves of change are sweeping health care, but dermatologists don’t have to suffer the consequences. Simply knowing what is on the way can help prepare for the shift. This was the goal of the forum “The Future of Dermatology: What Changes are Coming and How Can We Prepare?” (F096).

MACRA — the Medicare Access and CHIP Reauthorization Act — is a prime example.

MACRA resources

“MACRA is not going to go away,” said Sabra Sullivan, MD, PhD, clinical adjunct professor of dermatology at the University of Mississippi. “It is not what we would like it to be, but it is not what it was two years ago. And you don’t have to spend $15,000 or $20,000 on a consultant to survive. It is easy to avoid reimbursement cuts in the future.”

Simply meeting the minimum reporting requirements, which requires little more than submitting data to DataDerm™, the Academy’s CMS-approved qualified registry, is sufficient to avoid future penalties. It takes very little additional effort to open the potential for incentive payments.

“It doesn’t matter if you are in academics or private solo practice,” Dr. Sullivan said. “You need to be aware of MACRA.”

Patient access
Restoring and preserving patient access to treatment is a growing issue. A show of hands revealed that nearly every dermatologist in the audience has patients who can’t access appropriate treatment because of cost.

“The future is providing access to care,” said Bruce A. Brod, MD, clinical professor of dermatology at the Perelman School of Medicine at the University of Pennsylvania. “The White House has done nothing on this issue, but Congress has already passed legislation to help our patients gain access to drugs.”

States are also moving to improve access. Maryland, Nevada, and New York now require increased transparency to justify certain Medicaid drug price increases.

Nevada has also banned gag clauses that prevent pharmacists from telling patients that paying cash may be cheaper than their insurance copays for certain drugs.

The jury is still out on the impact of biosimilars. In 2016 alone, the FDA approved biosimilars for infliximab, adalimumab, and etanercept. Legal and regulatory hurdles have delayed marketing. So have pharmacy benefit managers.

Data to the rescue?
In order to protect our specialty from the variety of payment pressures, dermatology needs to collect and own its own data. The AAD is already moving in that direction with its advances with DataDerm™.

“If you collect poor data, you will make poor decisions,” said Marta J. Van Beek, MD, MPH, chief of staff at the University of Iowa Clinics and Hospitals.

“Right now, everyone is collecting inaccurate data on poor surrogates for patient outcomes in dermatology. They are using costs, readmissions, frequency of visits, and patient satisfactions. These are not data points that correlate with patient outcomes,” she said.

CMS is no better when it comes to collecting appropriate quality data.

“How well you do on MIPS has to do with how well the data on what you do is collected and how you compare to others,” she explained.

It might seem obvious to dermatologists that step therapy is more expensive than starting patients on the appropriate biologic as the initial therapy, but we need data to back this up.

Nor are there data showing that primary care might use multiple visits or multiple medications to treat an incorrect diagnosis, when a dermatologist might only need one visit and one medication to correctly diagnose and successfully treat a disease.

The first step in setting quality standards is collecting appropriate and accurate data. Which is what DataDerm™ does. The database interfaces directly with electronic medical records to collect data to avoid extra work by the physician.

“We can make our own quality measures,” Dr. Van Beek said. “But we have to have comprehensive data. The more dermatologists who participate, the more feasible it will be to develop dermatology specialty quality measures that are meaningful to physicians and patients.”

In early February, DataDerm™ had 1,020 active practices and a total of 2,930 clinicians submitting data with a total of 6.4 million unique patients and 15 million patient visits. The system needs more practices, more practitioners, and more data.

“The AAD needs data to show expertise and value of our profession,” she added. “And you need data to demonstrate your own value and outcomes. We can use data to transform our specialty. But if we don’t collect our own data and write our own narrative, others will do it for us. DataDerm™ was designed by dermatologists for dermatology.”

 

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