Dermatologists are feeling the squeeze

Are you a squeezed dermatologist? I am afraid many of us are entering this uncomfortable position with little space for relief. What do I mean by being squeezed? I am alluding to the place where dermatology has been relegated in the new modern order of medical care. A place where we will need to blaze new territory in order to continue to deliver the best we have to offer in skin, hair and nail care.

Dermatology is being squeezed as medically necessary clauses are being inserted into insurance contracts with the provision that the physician can be removed from the plan if guidelines are violated. While cosmetic procedures have not been covered for quite some time, the definition of “medically necessary” is not clear in most patient’s minds.

Medically necessary to the patient is the unsightly appearance of skin tags around the neck; however, benign skin tags do not meet the insurance perception of medically necessary. Hence, the dermatologist is squeezed trying to explain to the patient why she or he will need to pay for skin tag removal in addition to paying a copay for the medical treatment of their psoriasis.

Pricey medications

Dermatology is being squeezed as the best medications for treating a given condition are $400-$800 a tube and many brand name medications are now off formulary. This creates challenges when patients expect to see excellent treatment results, which the dermatologist can deliver, but not without the best medications. Dermatologists are only as good as their ability to prescribe, given the correct diagnosis.

Patients frequently call back wanting more affordable medications, only to call back again, stating the provided alternative was ineffective. The dermatologist is being squeezed, as less effective treatments must be used due to tremendous medication inflation.

Dermatology is being squeezed as medical care in this country moves toward only covering procedures that save lives rather improving the quality of life. Dermatologists are fortunate to take care of one of the most adaptable and rapidly healing organs of the body. Problems are visually recognized early and treated efficiently prior to the onset of severe issues. This means that skin disease is rarely fatal and one could argue that the only condition that should be covered is malignant melanoma. Thus, the dermatologist is squeezed, as the efficient early cost-effective care that is delivered results in little mortality.

Avoiding the squeeze

How do dermatologists avoid the squeeze? We need to be cohesive and creative. First, we need to be sure that patients are educated on what constitutes a medically necessary procedure and dermatologists should deliver uncovered services for a fair cash price. Second, dermatologists should familiarize themselves with available cost effective formulary medications and encourage patients to do the same.

Finally, dermatologists should be sure to recognize those insurance plans that do not cover dermatologic care. I think part of avoiding the squeeze is helping patients better understand healthcare issues. With proper education, patients will want to give their dermatologist a hug and a squeeze!