Derms talk about goals for 2008

The year 2008 is under way. It's a year that promises a lot of discussion of healthcare delivery and costs, and promises of change.

On Call wondered what direction dermatologists expect to take in their practices in the coming year. What are their priorities for their practices? What are their New Year's resolutions for their practices?

For several of the dermatologists who spoke to On Call, the business end of their practice is slated to get a lot of attention this year as they try to run their offices as efficiently as possible.

Sometimes their priorities will be internal changes patients may never see.

Beth A. Honl, M.D., in Fargo, N.D., plans to make the switch to electronic medical records.

"I'm running out of space, so it's more of a financial decision than anything. Not owning my own building, my space is limited. As a renter, what I utilize, I have to utilize well. When you start running out of space with medical records and have to find places to store them, that starts costing a lot of money per square footage,"she says.

A practitioner for eight years, Dr. Honl knows that will be her focus for the coming year.

"That's a pretty big issue and will take some time to accomplish. We're pretty close to deciding on something, but it's picking a system that works for your type of practice. You look for something that will also streamline some of the paperwork for billing. Submitting cleaner bills should result in fewer denials, too; because it's a paperless transaction should improve things," she tells Dermatology Times.

For some dermatologists whose practices are heavily medical, assessing the effect of Medicare reimbursement rule changes, and making adjustments to cope with those changes, promises keep next year interesting.

Splitting Mohs

Brian G. Sandler, M.D., in Shelby Township, Mich., says he's ready to split Mohs surgery into a two-day procedure.

"Ophthalmologists don't do two cataracts the same day; orthopedic surgeons don't do two knees or two shoulders.

"Because of changes in the Medicare multiple surgical reduction rule, we're going to see if patients will be amenable to having their Mohs surgery performed one day, and then return the following day for the repair. We want to see if we can't do something to keep our reimbursement without putting too much of a strain on the patient. That change is going to hit hard for anyone specializing in Mohs surgery," he says.

Surviving losses, pay cuts

Dr. Sandler knows he will also be dealing with patients who have lost their insurance because of job layoffs.

"Our staff is trying to be more diligent in pre-certifying patients and explaining that it isn't business as usual. If their new insurance has a $5,000 deductible, they are liable for it. We are actually seeing patients pay out-of-pocket, and I expect to see that more often," Dr. Sandler says.

In Celebration, Fla., Dean R. Goodless, M.D., describes himself as "bearish" on dermatology.

"My New Year's resolution is to survive the Medicare pay cut - and to a find way to make up for the lost revenue," he says.

With a practice that runs about 80 percent medical and surgical dermatology and 20 percent cosmetic, Dr. Goodless can see that shifting.

"In anticipation of the threatened cuts, we will accommodate our existing Medicare patients and our patients who transition to Medicare, but we are not signing up new Medicare patients until we see what Congress will do with this pay cut.