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Transcript

The 9% (and Rising) Cut — What Every Dermatologist Needs to Know Now · The Science of Skin

• 0:08
  SPEAKER_00: Hi everyone, I'm Dr.
• 0:09
  SPEAKER_00: Patty Fair, a sports certified dermatologist, and your host for this episode of the Science of Skin podcast.
• 0:16
  SPEAKER_00: So today is a really interesting subject that we're going to talk about.
• 0:20
  SPEAKER_00: We normally are in the science realm of skin care and what's new in deram therapeutics, but we're going to talk about a practice management issue that's top of mind with all dermatologists.
• 0:31
  SPEAKER_00: So I'm excited today to welcome Dr.
• 0:34
  SPEAKER_00: Sandy Johnson.
• 0:36
  SPEAKER_00: And we were just talking about how we know each other, but we don't actually know each other.
• 0:40
  SPEAKER_00: So I so great to meet you, Sandy, and thank you for being here with us.
• 0:45
  SPEAKER_01: Thank you so much, Patty.
• 0:47
  SPEAKER_01: I so appreciate you guys doing the special edition for the Science of Skin podcast.
• 0:51
  SPEAKER_01: It is so important and relevant.
• 0:53
  SPEAKER_00: Super.
• 0:54
  SPEAKER_00: We are very happy to have you here.
• 0:55
  SPEAKER_00: So for those of you who do not know Sandy, I'm just going to give you a little quick bio on her.
• 1:00
  SPEAKER_00: She has a private practice in Fort Smith, Arkansas.
• 1:04
  SPEAKER_00: She's been very involved in the American Academy of Dermatology for a number of years and now sits on the board of directors of the Academy.
• 1:10
  SPEAKER_00: And as I told her when we were chatting before the episode, I have sat in that boardroom.
• 1:15
  SPEAKER_00: It is a big job.
• 1:16
  SPEAKER_00: Everybody needs to be really understanding of what an incredible commitment it is to sit on the board for the academy.
• 1:23
  SPEAKER_00: And Sandy, this is one of those times, which is a crisis time that the board really swings into action.
• 1:30
  SPEAKER_00: And I'm sure everybody out there has heard about the proposed 9% cuts to dermatology reimbursement.
• 1:37
  SPEAKER_00: And why don't you tell everybody what the issue is and then we can talk a little bit about what our members can do.
• 1:45
  SPEAKER_01: So people like you and I, who've been in practice for a long time, have seen decreasing reimbursements through the years.
• 1:52
  SPEAKER_01: And that is because our payments are not tied to inflation.
• 1:56
  SPEAKER_01: It's based on kind of what we do times our direct, indirect, direct expenses, which is like the things we use, and then our indirect expenses, like our rent, our other things that go into it, and then a conversion factor.
• 2:10
  SPEAKER_01: So that conversion factor has gone down through the years.
• 2:13
  SPEAKER_01: And that's why we go to Washington every year to work on that.
• 2:17
  SPEAKER_01: Well, we were surprised this year.
• 2:20
  SPEAKER_01: In July, CMS has dropped three potential, even more devastating things to our practices.
• 2:27
  SPEAKER_01: And we did talk about there could be a potential 9% cut this year, but it could be up to 25% cut the following year, which is even more scary.
• 2:36
  SPEAKER_01: I know.
• 2:36
  SPEAKER_01: How are we going to practice?
• 2:38
  SPEAKER_01: You can't.
• 2:39
  SPEAKER_01: So CMS, um, in this proposal, there's really three things that are affecting us.
• 2:45
  SPEAKER_01: One is the 25 modifier.
• 2:48
  SPEAKER_01: And so the, as we all know, the 25 modifier is applied when we do an EM or a thinking service combined with a CPT or a doing service.
• 2:58
  SPEAKER_01: And what CMS is proposing is that what the lower one is going to be decreased by half.
• 3:04
  SPEAKER_01: So unfortunately, some of our commercial payers are doing this already.
• 3:07
  SPEAKER_01: But if CMS does this, it's going to be devastating.
• 3:11
  SPEAKER_01: So if you treat somebody for say because in so I'm in rural Arkansas, somebody comes in to treat both acne and warts, drove two hours, took off work.
• 3:20
  SPEAKER_01: I'm going to have to decide do I treat their acne or warts, or do I not make enough money to pay for it and just and you know and supplement that treatment.
• 3:29
  SPEAKER_01: It's really, it's really bad.
• 3:30
  SPEAKER_01: Yeah.
• 3:30
  SPEAKER_01: So it's really scary.
• 3:31
  SPEAKER_01: And so, and that affects all practice, all practices of medicine, not just dermatology.
• 3:37
  SPEAKER_01: And so that's that's the big that's number one is the 25 modifier.
• 3:41
  SPEAKER_01: Okay.
• 3:42
  SPEAKER_01: Number two is indirect expenses.
• 3:45
  SPEAKER_01: So dermatology, this number isn't is not fact-checked, but we think that dermatologists have the highest indirect expenses because we have so many other things that we put into our practice.
• 3:58
  SPEAKER_01: We're not doing telemedicine mostly.
• 4:00
  SPEAKER_01: We're we we we have so many disposables, we have a lot of staff.
• 4:05
  SPEAKER_01: Some people say it's 10 assistance to every one dermatology practitioner is average.
• 4:11
  SPEAKER_01: And so, yeah, so the costs of running a dermatology practice, the indirect expenses are so high.
• 4:17
  SPEAKER_01: So if they so CMS does not see that.
• 4:20
  SPEAKER_01: And so if they change the indirect expenses, it's gonna be more than a 10% cut.
• 4:26
  SPEAKER_01: We're not sure that number right now, but the board has been, we meet on a regular basis virtually, we are taking this very seriously.
• 4:34
  SPEAKER_01: So the indirect expenses might be a bigger hit than the 25 modifier for some dermatology practices.
• 4:41
  SPEAKER_01: And and then the third, the third issue is CMS wants to take the RUC, um, the AMA out of representing in the RUC.
• 4:50
  SPEAKER_01: And so right now, medicine, the House of Medicine, has a place where we can influence um the cost the reimbursements, um, the relative value units, and how um medical practitioners get paid.
• 5:03
  SPEAKER_01: Well, if the AMA is taken out of that, we we we're not gonna have a voice.
• 5:08
  SPEAKER_01: We're not gonna have a voice.
• 5:09
  SPEAKER_01: And so they can just pick these numbers out of the air and decide, but well, this is what it is.
• 5:15
  SPEAKER_01: And so that's really how we decide.
• 5:17
  SPEAKER_01: And so the American Academy of Dermatology, um, under the great leadership of our president, Marat Alam, we are so thankful he's our president this year.
• 5:27
  SPEAKER_01: He is, as you know, if you've ever met him, I think everybody gets a Christmas card from him every year.
• 5:31
  SPEAKER_01: I mean, he is one of the most diligent, hardworking people.
• 5:35
  SPEAKER_01: So he is putting in so many hours.
• 5:37
  SPEAKER_01: And then two other dermatologists I'd like to give a shout out are um Amy Derrick, who practices and who has practices in both Illinois and Florida.
• 5:45
  SPEAKER_01: She's, I think, putting in 80 hours a week working on this, and Andy Weinstein, who practices in Florida, who um is the president-elect and going to be the president next year.
• 5:55
  SPEAKER_01: And so working so diligently and putting in so many hours, and then our entire board and um Rod, um, kind of I don't know if he has a sixth sense or what, but he put forth these tasks force trying to get ready for the other cuts that we expect every year from legislation.
• 6:13
  SPEAKER_01: But it just so happened that we were ready.
• 6:16
  SPEAKER_01: We were prepared when this hit from CMS that we already had these task force ready.
• 6:20
  SPEAKER_01: And so the AADA has been working fearlessly and tirelessly to try to combat this as much as we can.
• 6:27
  SPEAKER_00: Well, it's certainly uh wonderful that you were prepared for this, that you had those task forces in place.
• 6:34
  SPEAKER_00: Yeah, that was a premonition, I'm sure, on his part.
• 6:37
  SPEAKER_00: Um, so talk about what can the members do?
• 6:40
  SPEAKER_00: What well maybe we should talk about what are the resources from the I'm sure the AAD has got plenty of resources for the members to look at and to access, and then what what would we want members to do?
• 6:50
  SPEAKER_00: What would be the call of act call to action?
• 6:53
  SPEAKER_01: Thank you so much, Patty.
• 6:55
  SPEAKER_01: So um, on you know, on first and foremost, so the AAD has created um simple, it takes 30 seconds to click on and notify your representatives.
• 7:07
  SPEAKER_01: Your legislators are there, they're there to represent us.
• 7:10
  SPEAKER_01: And so click on that link as a dermatologist, send that link to your staff.
• 7:15
  SPEAKER_01: You can click on it, it's voter voice at AED.
• 7:18
  SPEAKER_01: You can all your staff should click on it.
• 7:20
  SPEAKER_01: There's a special letter that you can send from the staff, and then include your patients.
• 7:24
  SPEAKER_01: There's a special letter your patients can click on it, it takes 30 seconds.
• 7:27
  SPEAKER_01: The more we can inundate, the better.
• 7:29
  SPEAKER_01: We've already sent over 40,000 letters, but we only have until mid-September to make this happen, early September.
• 7:37
  SPEAKER_01: And we want to have a united voice from dermatologists.
• 7:41
  SPEAKER_01: And so if we all send the same message, it's gonna be a much better message.
• 7:45
  SPEAKER_01: But then, um, and then the second thing I ask is please donate to SkinPack.
• 7:50
  SPEAKER_01: Um, we are we need that money.
• 7:53
  SPEAKER_01: We are hiring the ADA is hiring lobbyists to help us.
• 7:56
  SPEAKER_01: We are attacking this through both the executive as well as CMS, as well as our legislators, and using every ploy, every tactic we can.
• 8:05
  SPEAKER_01: Um, and so please donate to Skin Pack.
• 8:07
  SPEAKER_01: The max you can give is$5,000.
• 8:09
  SPEAKER_01: My husband, who's a Mo surgeon, and I have donated$5,000 each every year.
• 8:14
  SPEAKER_01: We consider it the best return on investment.
• 8:16
  SPEAKER_01: We all buy insurances.
• 8:18
  SPEAKER_01: I mean, uh we spend so much money in insurance owning our own practice, but every year we spend that$10,000 each, knowing that it's the best return on investment.
• 8:27
  SPEAKER_01: It's going to protect our specialty.
• 8:28
  SPEAKER_01: So please, if you've never given before, please give now to SkinPack.
• 8:32
  SPEAKER_01: Um, the AADA needs your money to help us.
• 8:35
  SPEAKER_01: We are not Republican, we are not Democrat, we are, as Andy Weinstein says, we're dermocrats.
• 8:41
  SPEAKER_01: And so we support whoever supports dermatology.
• 8:44
  SPEAKER_01: So please give to SkinPack.
• 8:47
  SPEAKER_01: And then this year's legislative conference is going to be so important.
• 8:50
  SPEAKER_01: Um, I think we're already sold out, but it's mid-September, and um, together we're going to go to DC like we do every year.
• 8:58
  SPEAKER_01: It's my favorite derm conference.
• 9:00
  SPEAKER_01: We all get together, um, we advocate for our patients, you know, we say patients first.
• 9:05
  SPEAKER_01: It's it's my favorite.
• 9:06
  SPEAKER_01: I am have the honor of not only serving on the board of directors, but being the grassroots advocacy task force chairperson.
• 9:13
  SPEAKER_01: So I get to lead the meeting again this year.
• 9:15
  SPEAKER_01: And oh, it's going to be such a big important meeting.
• 9:18
  SPEAKER_01: And I'm so excited for this meeting.
• 9:21
  SPEAKER_01: If you've never attended, please consider attending in the future.
• 9:24
  SPEAKER_01: Yeah, it's it is quite an experience.
• 9:26
  SPEAKER_01: And then one other thing is um when you ask something of your legislators, um they get asked stuff all the time.
• 9:33
  SPEAKER_01: And so please consider doing something to support them.
• 9:37
  SPEAKER_01: Invite them into your practice, continue, consider contributing to their campaign.
• 9:42
  SPEAKER_01: But I mean, it's not tit for tat, but um, you know, they need to know who you are.
• 9:47
  SPEAKER_01: They need to know the impact that you make as a dermatologist and the devastating impact these cuts will make on us.
• 9:54
  SPEAKER_01: Please, um, please, you know, ask for their help, but give them something to let them know why it's important.
• 10:01
  SPEAKER_00: All of those are great action items.
• 10:04
  SPEAKER_00: And thank you so much for being here, Sandy, and for for raising the awareness of this issue.
• 10:09
  SPEAKER_00: And I think most importantly, we need to mobilize dermatologists.
• 10:13
  SPEAKER_01: Yes.
• 10:14
  SPEAKER_00: So we will a united force is really important during times like this.
• 10:19
  SPEAKER_01: Yes.
• 10:20
  SPEAKER_01: We can't let this crisis go um unnoticed and unrecognized.
• 10:24
  SPEAKER_01: Thank you so much to you.
• 10:25
  SPEAKER_01: Thank you so much to my good friend Ted for allowing me to be on and sharing this message.
• 10:30
  SPEAKER_01: And thank you to everybody out there joining forces together.
• 10:34
  SPEAKER_01: Together, we can always achieve more than individually.
• 10:36
  SPEAKER_01: And let's save our specialty.
• 10:39
  SPEAKER_00: Absolutely.
• 10:40
  SPEAKER_00: And thank everybody for listening.
• 10:42
  SPEAKER_00: Just a reminder: the Science of Skin Summit is right around the corner.
• 10:44
  SPEAKER_00: We're about three and a half weeks away from Austin, Texas.
• 10:47
  SPEAKER_00: Sandy, you have a special invitation.
• 10:49
  SPEAKER_00: Of course, you'll be probably in Washington.
• 10:52
  SPEAKER_00: We conflict a lot with the wall, unfortunately, that September time frame, but you got to do Clinic.
• 10:59
  SPEAKER_01: We brought um to the very first skin of science, our whole team came to New York and we had great time.
• 11:05
  SPEAKER_01: And I'm already, I think I might have been one of your first people to register for the longevity summit.
• 11:10
  SPEAKER_01: We're super excited.
• 11:12
  SPEAKER_01: I know we are too.
• 11:13
  SPEAKER_00: We are to bring your husband, by the way.
• 11:15
  SPEAKER_00: We are, we are.
• 11:16
  SPEAKER_01: We're so excited about it.
• 11:17
  SPEAKER_00: Fantastic.
• 11:18
  SPEAKER_00: And I know most of you out there know in February of 2027, Dr.
• 11:22
  SPEAKER_00: Lane and I are starting a science of skin longevity summit.
• 11:25
  SPEAKER_00: This is such a top-of-mind topic with all dermatologists, aesthetic physicians, as well as anybody practicing medicine right now.
• 11:33
  SPEAKER_00: I say longevity is medicine 3.0, so we all need to, you know, come up to speed.
• 11:38
  SPEAKER_00: It's going to be a really exciting time.
• 11:40
  SPEAKER_00: Sandy, thanks again for joining us.
• 11:42
  SPEAKER_00: Everybody out there, call to action, all dermatologists on board.
• 11:47
  SPEAKER_00: Skin pack donations, super important, as well as contacting your legislature.
• 11:51
  SPEAKER_00: Thanks and everybody have a great day.
• 11:54
  SPEAKER_00: Thank you.