August 8
IN THIS ISSUE / August 8, 2018
- August Access Hero: Cory Simpson, MD
- USP publishes proposed revisions to chapter on compounded sterile preparations
- CDC offers infection prevention guide as patient infection incidents increase
- Severity of atopic dermatitis tied to risk of cataracts among pediatric patients
- Tickborne diseases are likely to increase, warn NIH officials
Fee schedule: The good, the bad, and the ugly
On July 12, the Centers for Medicare and Medicaid Services (CMS) released one of the most significant proposed Medicare Fee Schedules in recent memory. In addition to an overall 1% payment cut in 2019 for dermatology, the rule also proposes substantial changes to reporting and payment for in-office evaluation and management (E/M) codes among other areas of significance to dermatology. While the exact impact of the rule will depend on your practice mix, starting this week, Dermatology World Weekly breaks down what the proposals might mean for dermatology and how the American Academy of Dermatology Association (AADA) is responding on the specialty’s behalf.
Related Links:
- Payment renovations: Parsing out the new Medicare payment structure – Dermatology World (September 2016)
- Medicare specialist breaks down code valuation process – Dermatology World (October 2016)
- AAD product: 2019 Coding and Billing for Dermatology manual
August Access Hero: Cory Simpson, MD
Cory Simpson, MD, staffs a monthly dermatology clinic that provides care to underserved populations who often face barriers to care. Learn how his team used teledermatology to increase access to care.
Each month, the Academy highlights members’ diverse efforts to expand access to dermatology. Submit your story at staging.aad.org/skinserious.
Related Links:
- Making teledermatology work – Dermatology World (August 2017)
- Experts detail benefits and limitations of teledermatology – Dermatology World (April 2015)
- Steps to teledermatology – Dermatology World (April 2015)
- AADA resource: Teledermatology toolkit
- Get involved: Join AccessDerm, the AAD’s philanthropic teledermatology program
- AAD product: Maintaining Compliance in Dermatology manual
USP publishes proposed revisions to chapter on compounded sterile preparations
U.S Pharmacopeia (USP) recently published its second round of proposed revisions to Chapter 797 on Pharmaceutical Compounding – Sterile Preparations. Should a state board of pharmacy adopt this chapter, physicians, including dermatologists, would be explicitly subject to the chapter’s equipment and process requirements when preparing buffered lidocaine, reconstituting botulinum toxin (when not in accordance with the manufacturer’s labeling), and diluting sterile drugs. In the revisions, USP proposes a one-hour exemption from the chapter’s requirements starting from preparation and ending with administration.
The AADA is advocating to increase this time-based exemption. In the near future, Academy members will have an opportunity to customize a template letter to USP, highlighting the need for patient access without unnecessary and unreasonable regulation.
Related Links:
- The compounding conundrum – Dermatology World (March 2018)
- Essentials of in-office compounding – Dermatology World (June 2018)
- AAD/A resource: Compounding toolkit – can you compound or prescribe it?
CDC offers infection prevention guide as patient infection incidents increase
As reports of infection outbreaks among patients have increased, the Centers for Disease Control and Prevention (CDC) urges physicians and other health care providers to review its Guide to Infection Prevention for Outpatient Settings: Minimum Expectations for Safe Care.
A national survey from 2017 found that 12% of physicians believed that syringes had been reused in their facilities. In one case from earlier this year, a Minnesota nurse practitioner was found reusing syringes, exposing 161 patients to the risk of infection, reports the Star Tribune. More than 150,000 people have been tested in the United States since 2001 for exposure to viruses like HIV and hepatitis C because of unsafe injection practices by health care providers.
Read more about how to avoid common adverse reactions and events, and how to deal with them when they happen in Dermatology World.
Related Links:
- What dermatologists can learn from quality efforts in surgery – Dermatology World (October 2016)
- Dermatologists continue to press for medispa regulation to protect patients – Dermatology World (September 2014)
- AAD product: Patient Safety in Dermatology online activity
- AAD resource: Why see a board-certified dermatologist?
- AADA state scope of practice resources
Severity of atopic dermatitis tied to risk of cataracts among pediatric patients
According to a recent study published in JAMA Ophthalmology, there is an association between atopic dermatitis severity and the risk for development of cataracts in pediatric AD patients.
The study used data from a Korean health insurance database between 2002 and 2013. Patients less than 20 years old with AD and severe AD were matched with four control groups with no AD-related insurance claims. The data show that patients in the AD groups underwent cataract surgery more often than patients in the control group, and severe AD was significantly associated with both the development of cataracts and the need for cataract surgery.
However, the study found the risk of developing cataracts was rare for pediatric patients, with or without AD, and the need for cataract surgery was even rarer. The study concludes that physicians should closely monitor cataract development in children with AD, particularly children with a severe form of the condition.
Check out the latest issue of Dermatology World to see what’s new in atopic dermatitis treatments.
Related Links:
- Should systemic steroids be avoided in atopic dermatitis? – Dermatology World (July 2018)
- Is atopic dermatitis actually a systemic inflammatory disorder? – Dermatology World (May 2017)
- For your patients: All about atopic dermatitis
- AAD product: Simulated Patient Encounter – Medication Management
Tickborne diseases are likely to increase, warn NIH officials
According to a commentary in the New England Journal of Medicine, U.S. incidence of tickborne infections has risen drastically with the reported numbers of tickborne disease more than doubling over the past 13 years. Lyme disease accounts for 82% of reported cases, although other bacteria and parasites can cause substantial health issues and even death.
The National Institutes of Health (NIH) is imploring public health officials and scientists to develop a robust understanding of the pathogenesis of infections, create improved diagnostics, and develop preventative vaccines to stem the growing threat from tickborne diseases.
The clinical manifestations of Lyme disease range from the erythema migrans rash in early disease to more severe manifestations, including neurologic disease and carditis in its early stages, and arthritis, which may occur months after the infection. The public health burden of tickborne pathogens is underestimated, the authors wrote. The Centers for Disease Control and Prevention (CDC) reports approximately 30,000 cases of Lyme disease per year, but estimates that the incidence is likely 10 times that number.
Ticks aren’t the only backyard hazard that patients, and consequently physicians, need to keep an eye out for. Read more about identifying and treating hazardous plant exposures in Dermatology World.
Related Links:
- On the front lines in Flint – Dermatology World (August 2016)
- Staying the course: Dermatologists continue building upon decades-long involvement with global treatment of HIV – Dermatology World (December 2016)
- Exploring dermatology’s role in identifying and treating public health trends – Dermatology World (July 2018)
- For your patients: Signs of Lyme disease that appear on your skin
- AAD product: Digital Dermatology Patient Pamphlets
