Practice Management

Politicians on Capitol Hill once again have dermatologists - and all physicians who serve Medicare patients - wondering what in the name of common sense they are going to do. Just before Christmas, Congress delayed a 27.4 percent Medicare fee cut from its original Jan. 1 implementation date. The cut is now scheduled, barring any further congressional action, to take effect Feb. 29.

In 2009, the federal government launched its Electronic Prescribing (eRx) Incentive Program. Although this program (which was authorized in the Medicare Improvements for Patients and Providers Act of 2008/MIPPA) is now three years old, physicians remain confused about the details. Fortunately, the eRx Incentive Program is straightforward.

Analyzing 18th and 19th century (Victorian-era) paintings can help dermatologists think beyond their established habits and preconceptions in the search for visual and other diagnostic clues, says Irwin Braverman, M.D., professor of dermatology, Yale School of Medicine.

Dermatologists are increasingly turning to "extenders" - physician assistants and nurse practitioners - to combat a shortage of doctors in the specialty. These mid-level providers and the physicians who hire them say teamwork and training are among the keys for successful collaborations.

At various times throughout my professional career, I have frequently asked many older physicians this question: What was the best thing about practicing medicine during your career? I have always been intrigued by their answers.

The good news is that the battle over the budget in Washington has opened the door to serious consideration for reforming the formula used to pay physicians under Medicare. The bad news? Proposals being considered to pay the tab could bring considerable pain.

I have always looked for evidence of volunteerism on the applications of every candidate seeking a residency training position in dermatology. I've found that medical students who make the effort to volunteer their time to help someone in need truly make the best residents. They are generally caring, thoughtful individuals who recognize that the special gifts they have been given deserve to be "paid back" to society in some way.

A survey by Merritt Hawkins found that patients wait 22.1 days on average to see a dermatologist, with waits ranging from 3.4 to 104.4 days, depending on the geographical location. Physician assistants and nurse practitioners offer dermatologists an excellent way to expand their availability to more patients, but the value of these advanced practice providers goes well beyond scheduling.

Jessica J. Krant, M.D., M.P.H., says one of her goals at her Fifth Avenue, New York, dermatology practice is to go totally paperless. So she has implemented several online options - including appointment booking - that not only eliminate paper, but also help streamline the office's workload. "Patients love it," she says.

Superior service doesn't just happen. Experts say it requires having a proactive plan for an element of medical practice that many physicians unfortunately overlook. As physicians, says Victor J. Marks, M.D., "Service is what we do. We don't make or grow anything. We serve other people."

The Department of Health and Human Services is proposing a new rule that would allow patients to have direct access to their lab test results. The tests that dermatologists send, such as biopsies, can indicate serious medical conditions. On Call asked dermatologists around the country what they think about patients being able to access their lab results directly, without the benefit of the physician's knowledge and experience to interpret their meaning.

Findings from a study examining an association between dermatologist density and melanoma mortality suggest that better workforce distribution may lead to a population-level improvement in mortality related to this malignancy, reported researchers at the 2011 annual meeting of the Society for Investigative Dermatology.

Tanya Kormeili, M.D., was 3 years old when the Iranian Revolution began to unravel her family's life. As pro-democracy Jews living in Tehran, the Kormeilis experienced an erosion of their freedoms with each year of the Ayatollah Khomeini's reign.

With the mandatory integration of electronic medical records (EMR) into the physician's practice, it would seem that future RAC or carrier audits will be seamlessly easy to navigate and win. As more and more dermatologists start using this electronic documentation tool in their offices, however, I am being bombarded by questions and concerns from the new users - both physicians who are clients and those who are not.

Most of us have had experiences of being unjustly accused of poor medical care by a person whose capabilities to make these sorts of judgments are suboptimal at best. What can be done to combat these annoying and sometimes slanderous utterances placed online?

Dermatology practices are busy places where even a small delay in the morning can throw physicians off schedule for the remainder of the day. The result isn't just more stress; it can include unhappy patients and perhaps even staff overtime costs. None of those outcomes is good for you, your patients or your staff.

Medina, Ohio, dermatologist Helen M. Torok, M.D., says her busy practice could spend $3,000 to $5,000 every quarter on a printed and snail-mailed patient newsletter. Instead, creating a business page on Facebook eliminated that expense and allows her to offer patients more timely information.

There's no better time than now to take a fresh look at opportunities to boost your bottom line. Whether it's saving money or earning more, these missed opportunities may be right under your nose. Regardless of the size of your dermatology practice or its position in the local healthcare market, you are likely finding the margin between revenues and expenses is getting narrower and narrower.

As the sluggish economy continues to pinch both patients and practices, dermatologists are working harder to collect what's owed them - and to spend smarter on business expenses.

Few can say that they have served their professions by presiding over not just one or two - but rather, many - regional, national and international societies. C. William Hanke, M.D., M.P.H., can. The Carmel, Ind., dermatologist has been president of 11 professional societies, the largest of which was the American Academy of Dermatology (AAD) from 2008 to 2009.

The Inga Ellzey Practice Group (IEPG), the leading expert on dermatology coding, documentation and reimbursement and a Dermatology Times contributor, has spun off a new company, Ellzey Coding Solutions (ECS).

Even with the latest technology and the best-trained and experienced staff, efficiency isn't a given - you have to work at ensuring well-oiled work flows in your dermatology practice. Using your time wisely is important to your practice's revenue because, unlike those supplies on the shelf, your time can't be stored.

When Amy Derick, M.D., mentors dermatology residents and others who are just breaking into dermatology practice, she comes across not only as a peer, but also as an icon. She's young - 34. She only started practice about five years ago, so the challenges of a startup are fresh in her mind.

Patricia K. Farris, M.D., never thought she'd experience a natural disaster that would wipe out her practice, a city and an entire infrastructure. Then came Hurricane Katrina. "You couldn't call a patient who had a melanoma. It was so beyond, beyond," says Dr. Farris, who practices in Metairie, La. After the 2005 storm, she says, "I was out of business for seven months."

In planning for disaster, physicians should first analyze their specific risks. That's the advice of Italo Subbarao, D.O., deputy editor of Disaster Medicine and Public Health Preparedness and director of the Public Health Readiness Office in the American Medical Association's Center for Public Health Preparedness and Disaster Response.

Before investing in aesthetic devices, physicians need to do their homework and carefully weigh the pros and cons of each device and attend lectures focused on various aesthetic devices and technologies. This approach may help them ultimately choose an aesthetic device that is right for them and their patients.

I am a total proponent of the use of technology. As the owner of two single-specialty billing services, I know the value of using the latest technology to save time, optimize the use of human resources, increase efficiency, reduce errors and redundancy and keep the planet "green." But I want providers to have realistic expectations of what an EMR can offer with respect to billing for services rendered and getting paid by insurance carriers.

One benefit of adding cosmetic dermatology to a practice is that procedures are usually performed on a fee-for-service basis, rather than relying on ever-diminishing insurance reimbursements for medical dermatology. It all sounds good, but what happens when a patient doesn't plan on paying in the first place?

As patients take on more financial responsibility for their healthcare, dermatologists are finding themselves in a challenging new role - being a commodity in a marketplace where patients shop for services. Success in this new environment requires your dermatology practice to retain its current patients, and attract new ones.

The EHR Incentive Program offers bonus payments for eligible professionals who make meaningful use of a certified system. Although the government's initiative is labeled under a single moniker, there are really two distinct programs for eligible professionals: Medicare and Medicaid. When you register for the EHR Incentive Program, you must choose one or the other.