The costs of prior authorizations in a dermatology department
In a recent study published in JAMA Dermatology, a cross-sectional study was performed at the University of Utah Department of Dermatology, which spans 11 clinical locations. The staff — comprised of two full-time and eight part-time prior authorization (PA) staff — itemized all PA-related encounters over a 30-day period in September 2016.
During that period, 626 PAs were generated from 9,512 patient encounters. Staff spent 169.7 hours directly handling PAs, which cost a median of $6.72 per PA. Biologic PAs cost a median of $15.80 each and took as long as 31 business days to complete. The costliest PA equaled 106% of the associated visit’s Medicare reimbursement rate. Approval rates were 99.6% for procedures, 78.9% for biologics, and 58.2% for other medications. After appeal, 21.7% of the previously denied PAs were subsequently approved.
Not only are PAs costly to dermatology practice, but their value appears limited for some requests, the authors concluded.
DermWorld Insights and Inquiries: Targeted anti-complement therapy may prove to be a complementary treatment for bullous pemphigoid
It is not my imagination — I have been seeing more cases of bullous pemphigoid (BP) than ever. This is likely a function of an aging population in concert with an increase of drug-induced cases, notably with dipeptidyl peptidase-IV inhibitors and anti-PD-1/PD-L1agents. Treating BP is always a challenge — although corticosteroids (topical and systemic) are the bedrock of therapy, we do everything possible to administer steroid-sparing medications to avoid the litany of adverse steroid reactions. Keep reading!
Derm Coding Consult: CMS modifies the 60-day limit for locum tenens during COVID-19
CMS recently clarified the 60-day limit for substitute billing arrangements, previously known as locum tenens, during the COVID-19 public health emergency.
CMS is allowing dermatologists to use the same substitute physician (locum tenens) for the entire time they are unavailable during the COVID-19 public health emergency plus an additional 60 calendar days after the public health emergency expires.Learn more about CMS’ clarification for substitute billing arrangements.
California Governor signs nurse practitioner independent practice law
Last week, California Gov. Gavin Newsom signed legislation (AB 890) authorizing nurse practitioners (NPs) to practice independently after three years of practice, effective January 2023. This legislation would threaten patient safety by allowing NPs to diagnose and treat patients without physician oversight, thereby practicing medicine. The AADA worked closely with the California Society of Dermatology and Dermatologic Surgery (CalDerm), American Medical Association, California Medical Association, and the house of medicine to oppose the legislation. The AADA’s advocacy efforts included written comment letters, social media efforts, and a total of six grassroots alerts sent so far this year.
Non-physician clinicians are increasingly being incorporated into dermatology practices nationwide. One of the AADA’s top priorities is to advocate for a physician-led, team-based approach to care that ensures both the safety and best outcomes for each patient. With this bill signed into law, the Academy will turn its efforts toward the rule-making process, where we’ll provide input into how this policy will be enforced.
A recent JAAD study examined whether the skin could act as a potential host of COVID-19. A total of 3,128 patients with laboratory-confirmed COVID-19 were included in the analysis. The researchers performed single-cell rna-sq with keratinocytes from normal human skin. The data showed that angiotensin-converting enzyme2 (ACE2), the viral host cellular receptor, was highly and specifically expressed in the granulosum of the skin while transmembrane serine proteases (TMPRSSs) were relatively scattered in all keratinocytes, melanocytes, duct, Schwann, and neurocyte cells.
The co-expression of ACE2 and TMPRSSs was particularly found in the granulosum. Nucleocapsid protein was expressed in the cytoplasm of the epidermis from COVID-19 patients but was not detected in normal skin tissue. This data suggests that the skin may be a potential host of COVID-19, although further studies must be done.
Applications for $20 billion in new funding for physicians and other providers on the frontlines of the COVID-19 pandemic opened this week.
Under this Phase 3 General Distribution allocation, physicians who have already received Provider Relief Fund payments of 2% of annual revenue from patient care, may submit more information and apply for additional funding that considers financial losses and changes in operating expenses caused by the coronavirus.
Previously ineligible providers, such as those who began practicing in 2020 will also be invited to apply along with an expanded group of behavioral health providers. The application portal will be open through Friday, Nov. 6, 2020. Practices are encouraged to apply early. Learn more at AAD.org.
Additionally, the Secretary of HHS recently extended the public health emergency, allowing all of the waivers and special rules tied to the public health emergency declaration and the President’s declaration of a national emergency to continue for an additional 90 days. The new date of potential expiration or extension is set for Jan. 21, 2021.
Academy seeks assistant secretary-treasurer nominees
Applications and nominations are now being solicited for the position of assistant secretary-treasurer for the American Academy of Dermatology and AAD Association for the term beginning March 2022.
Members interested in serving the Academy in this position should have significant administrative and financial management experience. The position of assistant secretary-treasurer requires a considerable time commitment. Applicants must be able to serve for six years: three years as assistant secretary-treasurer and three additional years as secretary-treasurer.
Learn more about the position and apply at staging.aad.org/AST. Applications are due Jan. 4, 2021. Questions may be directed to Cyndi Del Boccio in the AAD Executive Office at (847) 240-1041 or cdelboccio@aad.org.
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