Evaluating the Cost Burden of Alopecia Areata Treatment: A Comprehensive Review for Dermatologists.

Alopecia areata (AA) is managed with prolonged medical treatments and cosmetic therapies, whose cost can be burdensome. We sought to identify the costs of AA treatment and consolidate the available data for the practicing dermatologist by performing a PubMed search of articles indexed for MEDLINE. Ten studies including approximately 16,000 patients with AA across a range of Oxford Centre for Evidence-Based Medicine Levels of Evidence were included. Studies showed that despite the limited efficacy of many AA therapies, patients incurred substantial expenses to manage their AA.

Increasing a Dermatologist's Footprint on Instagram: An Analysis of Top Influencers Performing Nonsurgical Cosmetic Procedures.

BACKGROUND: Patients use social media to find information about cosmetic procedures, yet dermatologists historically lack a social media presence. Misleading information from nonexperts is potentially harmful. OBJECTIVE: To identify the top influencers posting about nonsurgical cosmetic procedures on Instagram, verify their credentials, and analyze their content to empower dermatologists to effectively join the online conversation, combat harmful misinformation, and preserve the expertise and influence of board-certified dermatologists. METHODS AND MATERIALS: Using the Klear marketing platform, Instagram influencers with more than 50,000 followers were identified. Influence rating, top posts, and other metrics were extracted using proprietary algorithms. RESULTS: Ninety nine influencers were identified. Of the top 10, 70% were board-certified plastic surgeons. Physicians not board-certified in a core cosmetic specialty had the highest influencer rating and number of followers. The most popular posts were of before and after photographs and personal posts. CONCLUSION: Dermatologists may be able to increase their Instagram footprint by posting frequently, especially of before and after and personal photographs, using hashtags, Instagram live and Instagram television, and Instagram stories. It is important for the dermatology community to find a way to ethically navigate social media to have a seat at the table and meet patients where they are.

Changes in Use of Radiotherapy Among Dermatologists From 2013 to 2017.

Importance: Concerns have been raised about the use of radiotherapy (RT) by dermatologists. Little is known about temporal trends in payment for RT among dermatologists. Objective: To characterize changes in RT use and payment among dermatologists treating patients enrolled in Medicare. Design, Setting, and Participants: A cross-sectional, population-based retrospective analysis of dermatologists submitting Medicare claims was conducted. Dermatologists identified in the 2013-2017 Medicare Physician and Other Supplier Public Use File, which includes information on fee-for-service payments and service use among physicians caring for Medicare beneficiaries, were included in the analysis. The study was conducted from March 18 to October 22, 2020. Main Outcomes and Measures: Numbers and types of RT, current terminology codes billed by dermatologists, number of dermatologists providing RT services, total payments and median payments per dermatologist for RT services, total services and median services per dermatologist, and number of dermatologists billing for both RT and Mohs micrographic surgery services. Results: From 2013 to 2017, dermatologists billed RT codes, which included RT planning, preparation, delivery, and management services with varying levels of complexity. The number of dermatologists using RT increased from 115 to 198 between 2013 to 2017. Total payments and total services for RT have fluctuated over time. Median payments per dermatologist and median services provided per dermatologist for RT reached their highest level in 2017 ($80 810 and 629 services). In 2013, RT delivery was the highest reimbursed RT service type (total paid, $9 121 505). By 2017, clinical treatment planning and simulation was the highest reimbursed service type (total paid, $20 288 796). Conclusions and Relevance: The findings of this cross-sectional study indicate that dermatologist use of RT continues to increase. A wide variety of RT services are billed by dermatologists. Further research is needed to ensure expanded use is safe, efficacious, and cost-effective.

Inequalities in the patterns of dermoscopy use and training across Europe: conclusions of the Eurodermoscopy pan-European survey.

BACKGROUND: Dermoscopy is a widely used technique, recommended in clinical practice guidelines worldwide for the early diagnosis of skin cancers. Intra-European disparities are reported for early detection and prognosis of skin cancers, however, no information exists about regional variation in patterns of dermoscopy use across Europe. OBJECTIVE: To evaluate the regional differences in patterns of dermoscopy use and training among European dermatologists. MATERIALS & METHODS: An online survey of European-registered dermatologists regarding dermoscopy training, practice and attitudes was established. Answers from Eastern (EE) versus Western European (WE) countries were compared and their correlation with their respective countries' gross domestic product/capita (GDPc) and total and government health expenditure/capita (THEc and GHEc) was analysed. RESULTS: We received 4,049 responses from 14 WE countries and 3,431 from 18 EE countries. A higher proportion of WE respondents reported dermoscopy use (98% vs. 77%, p<0.001) and training during residency (43% vs. 32%) or anytime (96.5% vs. 87.6%) (p<0.001) compared to EE respondents. The main obstacles in dermoscopy use were poor access to dermoscopy equipment in EE and a lack of confidence in one's skills in WE. GDPc, THEc and GHEc correlated with rate of dermoscopy use and dermoscopy training during residency (Spearman rho: 0.5-0.7, p<0.05), and inversely with availability of dermoscopy equipment. CONCLUSION: The rates and patterns of dermoscopy use vary significantly between Western and Eastern Europe, on a background of economic inequality. Regionally adapted interventions to increase access to dermoscopy equipment and training might enhance the use of this technique towards improving the early detection of skin cancers.

The Influence of Dermatologists' Use of Social Media on Attracting Patients.

BACKGROUND: Many dermatologists consider social media to be a useful tool for building their practices and personal brands. However, limited data exists on patients’ perceptions of the value of social media in dermatology. OBJECTIVE: To examine how social media influences patients when choosing a dermatologist and which aspects of dermatologists’ sites offer the most benefit to patients. METHODS: A cross-sectional study was completed by sampling a diverse online population using a 10-question survey. RESULTS: The survey was sent to 1,481 individuals; of the 57.5% who qualified, 98.5% completed the survey (N=715). Of the qualified respondents, 58% were female and 42% were male. Twenty five percent were 18-29 years, 24% were 30-44 years, 33% were 45-60 years, and 19% were over 60 years. Fifty-seven percent reported that social media is only slightly important or not at all important when selecting a dermatologist. According to respondents, patient reviews (68%), years of experience (61%), and medical information written by the dermatologist (59%) were the most important aspects of dermatologists’ social media sites. Cosmetic patients (P<0.0001), younger patients (P<0.0001), and participants with fewer years of education (P=0.0006) valued social media significantly more when selecting a dermatologist compared to their counterpart populations. LIMITATIONS: Selection bias is possible given the survey was distributed only to SurveyMonkey® users. CONCLUSION: Given the majority of patients reported that social media is not important or only slightly important, dermatologists should consider means other than social media to attract new patients to their practices. For dermatologists who use social media, they should highlight patient reviews, experience level, and original medical content. J Drugs Dermatol. 2020;19(5):   doi:10.36849/JDD.2020.4849.

The evolution of private equity in dermatology.

The first known entry of private equity (PE) in the clinical dermatology space was over a decade ago. There are now in excess of 30 PE-backed dermatology groups (PEGs) with a vision for dermatology. Many use the management services organization, which allows PE firms to circumvent corporate practice of medicine laws, align cooperative physicians, and set the foundation for PEG evolution. PEGs may have different characteristics depending on their stage of evolution; however, as they mature through the stages, they become increasingly similar to each other. This contribution will discuss the stages of PEG evolution in detail. Dermatologists should be aware of these stages so that they can understand a PEG's past and anticipate a PEG's future.

What do Australian dermatologists expect to be paid for store-and-forward teledermoscopy? A preliminary investigation.

INTRODUCTION: Determining appropriate remuneration for teledermoscopy service is important because inadequate remuneration can be a barrier to practitioner uptake and participation. This study explores dermatologist remuneration expectations for a single lesion store-and-forward teledermoscopy consultation. METHODS: Fourteen dermatologists participated in telephone interviews during May-June 2017. Questions regarding remuneration focused on a clinical scenario involving teledermoscopy of a single lesion suspected to be skin cancer. The initial scenario was an existing patient, with a provisional diagnosis of benign neoplasm from the images, to be followed-up with routine skin checks, taking three minutes to review. Participants indicated their remuneration expectation by selecting from an ascending array of pre-determined remuneration ranges. The question was repeated a further four times with one aspect of the scenario changed each time; consultation length, source (patient or general practitioner), required follow-up, and a new rather than existing patient. Participants were also asked how appropriate they thought teledermoscopy was for the scenario, and whether they would choose to undertake the consultation presented. RESULTS: Nine dermatologists selected the AU$61-90 or AU$91-120 remuneration ranges for the initial scenario. When given the opportunity to comment on teledermoscopy service provision in Australia, respondents reflected that it was a valuable, advanced dermatology service, but they would prefer face-to-face consultation with patients where possible to allow for a full body examination. DISCUSSION: Dermatologists expect to be remunerated in the range of AU$61-120 for a single lesion store-and-forward teledermoscopy consultation when face-to-face examination is not possible.

Industry payments to dermatologists: updates from the 2016 open payment data.

Payments made to dermatologists by pharmaceutical and medical device manufacturing companies have become better understood following the advent of the Open Payments program. The purpose of this study was to analyze payments made to dermatologists in 2016 and evaluate trends in the payments from the previously published 2014 data.

Mohs Micrographic Surgery Volume and Payment Patterns Among Dermatologists in the Medicare Population, 2013.

OBJECTIVES: Mohs micrographic surgery (MMS) has expanded markedly in recent years but there is limited information on volume, practice patterns or reimbursement. This study characterizes MMS utilization in the Medicare population. MATERIALS AND METHODS: We analyzed the Medicare Provider Utilization and Payment Data: Physician and Other Supplier Public Use File Calendar Year 2013 data set for provider service volume and reimbursement for dermatologists who did and did not perform MMS procedures. RESULTS: Total Medicare-funded MMS procedures increased 25% from 2009 (558,447) to 2013 (700,262). Dermatologists who performed MMS had significantly more average services per provider (5419.4 vs. 3627.1, r=0.16, P<0.0001), were reimbursed significantly more in average total procedure-related compensation ($475,883.64 vs. $144,564.74, r=0.49, P<0.0001) than dermatologists who did not perform MMS, and made up 71.3% of the top decile of dermatologists ranked by total reimbursement received from Medicare. Total MMS service volume and reimbursement was concentrated among a subset of providers. Among MMS providers, a higher volume of MMS procedures was correlated with a greater likelihood of performing procedures on lesions located on the trunk, arms or legs (r=0.27, P<0.001). CONCLUSIONS: In 2013 reimbursement for MMS comprised almost 19% of the amount reimbursed by Medicare Part B Fee For Service to dermatologists and greater than half a percent of the total amount reimbursed to all physicians participating in the program. Further studies incorporating clinical and outcomes data are needed to evaluate appropriate utilization of this procedure.

Task Shifting in Dermatology: A Call to Action.

Clinical Question: Can task shifting be used to improve the delivery of dermatologic care in resource-poor settings worldwide? Bottom Line: Task shifting is a means of redistributing available resources, whereby highly trained individuals train an available workforce to provide necessary care in low-resource settings. Limited evidence exists for task shifting in dermatology; however, studies from psychiatry demonstrate its efficacy. In the field of dermatology there is a need for high-quality evidence including randomized clinical trials to validate the implementation of task shifting in low-resource settings globally.