January 30
IN THIS ISSUE / January 30, 2019
- Dermatologists prescribe fewer antibiotics overall, but use increased with surgery
- CMS updates Open Payments data
- What causes allergic responses in patients with atopic dermatitis?
- YouTube videos about psoriasis biologics
- Is a new type of treatment for alopecia on the horizon?
- Palmetto GBA Jurisdiction J and M LCD #33445 affecting dermatology practices in several states
Dermatologists prescribe fewer antibiotics overall, but use increased with surgery
Dermatologists prescribe more antibiotics per provider than any other specialty with more than 7.1 million prescriptions per year. A recent study published in JAMA Dermatology shows antibiotic use to treat inflammatory skin conditions, like acne and rosacea, is decreasing. However, there has been an uptick in antibiotic prescriptions associated with dermatologic surgical procedures.
The researchers examined a commercial claims database of privately insured U.S. patients from 2008 through 2016. During that time, dermatologic antibiotic prescriptions went from 3.36 per 100 visits to 2.13 per 100 visits, which is about 500,000 fewer antibiotic prescriptions each year. Patients taking extended courses of antibiotics decreased 53%. During this same time period, prescriptions for short courses of antibiotics increased nearly 70%, which was driven particularly by prescriptions associated with a surgical procedure.
“This may be a sign that treatment guidelines have raised awareness about overuse, though it’s also noteworthy that there are biologic and other alternate treatments that give patients more options than they’ve ever had before,” said lead author John Barbieri, MD, dermatology research fellow at the University of Pennsylvania Perelman School of Medicine.
Read about how concerns of antibiotic resistance are leading to new therapeutic recommendations in Dermatology World.
Related Links:
- Acne update – Dermatology World (October 2016)
- AAD product: Simulated Patient Encounter – Medication Management
CMS updates Open Payments data
The Centers for Medicare and Medicaid Services (CMS) recently updated the Open Payments dataset to reflect changes to the data that took place since the last publication in June 2018. View the updated dataset on the Open Payments website.
CMS updates Open Payments data at least once per year to include updates from disputes and other data corrections. The refresh includes the following:
- Record updates: Changes to non-disputed records that were made on or before Nov. 15, 2018, are published.
- Disputed records: Dispute resolutions completed on or before Dec. 31, 2018, are displayed with the updated information. Records with active disputes that remained unresolved as of Dec. 31, 2018, are displayed as disputed.
- Record deletions: Records deleted before Dec. 31, 2018, were removed from the Open Payments database. Records deleted after Dec. 31, 2018, remained in the database, but will be removed during the next data publication in June 2019.
The Open Payments program represents the recent push to increase transparency in health care. While physicians are provided the opportunity to review their data and dispute it before the information goes live, some may be concerned that the reported information has the potential to be misinterpreted. Read more about the effects of data divorced from context in Dermatology World.
Related Links:
- Big data, big changes: How the age of information is changing patient care, physician payment, and much more – Dermatology World (February 2016)
- Dollars or donuts? Sunshine Act requirements bring new scrutiny to physicians’ relationships with pharmaceutical companies – Dermatology World (June 2013)
- AADA Practice Management Center: DataDerm™
What causes allergic responses in patients with atopic dermatitis?
A recent study published in JAAD sought to determine the predictors of allergic contact dermatitis and relevant allergens in atopic dermatitis (AD). A retrospective chart review was conducted for 502 adults who were patch tested to an expanded allergen series. Overall, 21.5% of the patients currently had AD and 21.7% had been diagnosed with AD in the past.
The researchers found that AD patients had significantly higher rates of positive patch test results to ingredients commonly found in personal care products and topical medications, including fragrance mix II, lanolin, bacitracin, and chlorhexidine. Additionally, polysensitization occurred more often in patients with AD than without.
Read more about the revolution in atopic dermatitis treatment in Dermatology World.
Related Links:
- Are you a rash whisperer? – Dermatology World (January 2019)
- Can IL-31 inhibition reduce atopic dermatitis itch? – Dermatology World (June 2017)
- Should systemic steroids be avoided in atopic dermatitis? – Dermatology World (July 2018)
- Is atopic dermatitis actually a systemic inflammatory disorder? – Dermatology World (May 2017)
- Academy clinical guidelines: Atopic dermatitis
YouTube and similar websites are increasingly used to obtain health information. In a study published in the International Journal of Dermatology, researchers studied the quality of information regarding psoriasis biologics on YouTube and found that health care professionals’ videos had significantly fewer views than patient testimonials.
The authors searched the term “psoriasis biologics” and reviewed the top 100 videos, 79 of which were included in the final analysis. Individual patient testimonials accounted for 39% of the videos and had the highest engagement of all video types. Health care professionals presented in 37 videos (47%), although only 38% of these were layman-directed material targeted to patients. Health care professionals’ videos had substantially fewer views than patient testimonials. This analysis indicates that people seeking health care information online are more likely to come across anecdotal information generated by non-health care professionals than evidence-based educational materials.
Read more about using social media in medicine in Dermatology World.
Related Links:
Is a new type of treatment for alopecia on the horizon?
Alopecia areata affects nearly 2% of the general population at some point in their lifetime, and according to the National Institute of Health, 7-25% of alopecia areata patients will go on to develop alopecia totalis or universalis, reported ABC News. Since 2014, several clinical trials have shown JAK inhibitors may have promising results for alopecia patients. About two-thirds of patients who took JAK inhibitors reported regrowth of their hair. Once the medication is stopped, however, the hair that grew back is likely to fall out again. (Read about how platelet rich plasma may be used to help alopecia patients.)
Additionally, JAK inhibitors may also increase a person’s risk of infections and some cancers. “I’d be very reluctant to keep someone on a broadly immunosuppressant treatment like this for five, 10, or 20 years,” said George Cotsarelis, MD, chair of the department of dermatology at the University of Pennsylvania Perelman School of Medicine. Clinicians have begun looking into topical forms of the oral JAK inhibitor medications in hopes of preventing the medication from affecting the patient’s whole body.
Treating alopecia is even more challenging because some insurance companies classify hair loss as only a cosmetic concern, making it difficult to provide patients with approved, simpler treatment options. Currently, JAK inhibitors are only FDA-approved for conditions like psoriatic and rheumatoid arthritis.
Related Links:
Palmetto GBA Jurisdiction J and M LCD #33445 affecting dermatology practices in several states
The Academy is aware of a reimbursement issue affecting Palmetto GBA Jurisdiction J and M Local Coverage Determination (LCD) # L33445- Removal of Benign and Malignant Skin Lesions. This LCD affects dermatology practices in South Carolina, North Carolina, Virginia, West Virginia, Tennessee, Georgia, and Alabama.
For additional help with coding and reimbursement issues, visit the Academy's Coding Resource Center.
