Treating patients during the COVID-19 pandemic? Here’s how to minimize your malpractice liability risk.
As the number of COVID-19 cases begins to decline, many states have started to lift stay-at-home orders and have allowed businesses and communities to reopen. With this, many health care facilities and offices, including dermatology practices, are reopening or extending services to include non-emergent, elective services for the first time since the beginning of the pandemic.
Although some areas of the country have seen a leveling off in the number of cases, the COVID-19 pandemic and the threat of infection still exist. The COVID-19 public health emergency has introduced new issues regarding malpractice liability risks and employer responsibilities. This article provides an overview of the legal and operational issues that dermatologists should consider when reopening to help protect patients, employees, and themselves. Read more from this sneak peek of the August Dermatology World.
DW Insights and Inquiries: Researching therapeutic reformation of the capillary malformation — Arteriovenous malformation syndrome
Small cutaneous lesions may have profound systemic implications. Astute dermatologists will recognize these lesions and assess patients accordingly, often to the surprise of referring physicians and patients alike.
The capillary malformation — arteriovenous malformation (CM-AVM) syndrome — was first recognized by Eerola et al in 2003, where RASA1 mutations were detected. In addition to CM, either AVMs, arteriovenous fistulae (AVF), or Parkes-Weber syndrome (port wine stains with underlying multiple micro-AVFs, in association with soft tissue and skeletal hypertrophy) was documented in all families with a mutation.
Although most cases are recognized in childhood, occasional late presentations have been reported, such as the case of a 31-year-old pregnant woman with hydrops fetalis, referred to dermatology for multiple skin lesions. Keep reading!
AADA successfully advocates against unfair Medicare prior authorization policy
The AADA has successfully advocated for a reversal of Medicare policy that would have required prior authorization for CPT code 21235, Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft). The policy would have been applicable to hospital outpatient settings and would have affected academic medical centers nationwide, particularly when an ear cartilage graft would be needed during Mohs surgeries for Medicare patients. The policy was slated to go into effect July 1.
The American Academy of Dermatology Association met with CMS staff to educate them about the unintended consequences of this policy, namely, that it would be clinically inappropriate to halt the procedure to commence a prior approval request and await decision, leaving a patient with an incomplete repair. CMS agreed with the AADA’s concerns and agreed to carve out 21235 from the prior authorization policy. CMS has indicated that a correction to the policy has been made, effective immediately.
The Academy has created a customizable, clinically specific tool to allow practices to easily download prior authorization appeal letters for select dermatologic drugs and diseases. Try the AADA's prior authorization drug denial template tool.
Derm Coding Consult: New interactive evaluation and management tool available
The AADA has launched an interactive evaluation and management (E/M) coding tool that helps members navigate the E/M level determination process based on a few key questions.
The E/M tool is available to all AAD members and was created and developed using the fundamental tenets of E/M coding, using the selection of key components and contributory factors that identify the complexity of care provided during a patient encounter.
By answering a few simple questions, dermatologists can arrive at a level of E/M service. Throughout the interactive experience, tips are accessible for dermatologists and provide guidance to help understand the more complex concepts of each component. The final output screen provides a detail of each key component or time indicating how the level of service was determined.
Additionally, during the COVID-19 public health emergency, the E/M tool allows for the level of service to be determined based on medical decision making (MDM) or time. A new iteration of this tool will be available later this year to prepare members for the E/M changes in 2021.
Try out the new coding tool.
Learn more about the upcoming Medicare changes that could affect you and your practice in Dermatology World.
How does race impact time to treatment for melanoma?
According to a recently published study in JAAD, black patients are more likely to experience a longer delay from diagnosis to surgery versus white patients with melanoma. The study authors used data from the National Cancer Database from 2004 to 2015 to identify 233,982 melanoma patients and assess racial differences from time to diagnosis to definitive surgical resection of the primary tumor (TTDS).
Of the melanoma patients, 0.52% were black. Compared with white patients, black patients had increased average TTDS — 23.4 days versus 11.7 days. For stage I to III melanoma, black patients had longer TTDS and time to immunotherapy, although there were no significant differences for stage IV melanoma and time to chemotherapy.
Black patients had more than twice the odds of having TTDS between 41 and 60 days, more than three times the odds of having TTDS between 61 and 90 days, and more than five times the odds of having TTDS >90 days, when controlling for sociodemographic information and stratifying by insurance type.
As physician bias creates care disparities, what can dermatologists do to balance the scales? Find out in Dermatology World.
Reflections from a dermatologist on a COVID-19 medical ward
DW Weekly talked to John G. Zampella, MD, from the Ronald O. Perelman Department of Dermatology at the New York University School of Medicine, about his experiences on the front lines of the COVID-19 pandemic.
DW Weekly: How did you get involved treating COVID-19 patients?
Dr. Zampella: New York City was the epicenter of the coronavirus pandemic in the United States and the hospitals were overwhelmed. The email arrived late on a Wednesday. The covid-army — an email account set up by NYU Langone Health to disseminate information related to coronavirus — was requesting volunteers of the full-time faculty to leave the outpatient world and help on the wards. I saw the memes urging people to stay home unless they wanted to be intubated by a dermatologist — I chuckled, but secretly wondered if I could still intubate someone. As I thought about the state of the pandemic and the urgent need for health care professionals, several questions were going through my head. What were the obligations of a dermatologist during a pandemic? Would I expose myself and endanger my family? Did I remember enough internal medicine to treat patients on the wards? I contemplated, debated, and finally decided: I would enlist in the covid-army.
DW Weekly: You said you contemplated and debated before deciding to join the COVID-19 army. What was going through your head at that time?
Dr. Zampella: Before deciding to enlist, I was torn by competing senses of duty. On the one hand, as physicians we take up the mantel to help the afflicted when we say the words from the Hippocratic oath, “[I will] use treatment to help the sick according to my ability and judgment.” On the other hand, my family’s well-being was my highest priority and given the high risk among health care workers, I didn’t want to bring home a potentially deadly virus. The decision was challenging, and the heart-wrenching stories of family members giving coronavirus to parents or spouses who later passed away did not allay my fears. Nevertheless, working to reunite families who had loved ones affected by this disease seemed to be the least I could do. I was resolved to take every available precaution to protect myself and my family while still trying to do my part for families affected by coronavirus. Keep reading!
CMS issues final rule on advancing interoperability, patient access to health data
The Centers for Medicare & Medicaid Services (CMS) issued a final rule requiring all CMS-regulated payers (Medicare, Medicaid, Medicare Advantage, etc.) to make certain clinical, claims, and coverage information available to patients through an open application interface (API) beginning Jan. 1, 2021. The CMS rule governs new data-sharing standards to give patients access to their health data, impose interoperability requirements on payers, and encourage providers to adopt and implement information exchanges.
What does this mean for dermatologists? In fall of 2020, dermatologists as well as their physician assistants and nurse practitioners must submit an attestation response to statements on the Merit-based Incentive Payment System’s (MIPS) Promoting Interoperability performance category by answering “yes” to the following categories:
The prevention of information blocking attestation
The ONC direct review attestation
The security risk analysis measure
Physicians who submit these attestations (or have received an exemption) will avoid being listed as not having attested on the Physician Compare website. More details about this will be forthcoming in the proposed fee schedule. Additionally, physicians and their non-physician clinicians must update their digital contact information on the National Plan and Provider Enumeration System (NPPES). CMS will issue further deadline details later this year.
As the API interface is broadly implemented, dermatologists should monitor their EHR vendors’ progress so that they have a better sense of when the vendor will test or have the API ready to meet the Office of the National Coordinator for Health Information Technology (ONC) deadlines starting in 2021. Learn more about the CMS final rule.
Academy Advisory Board invites members to submit policy resolutions
Do you have an issue of interest or area of concern? Now is your opportunity to submit a resolution from which an official Academy position might arise. Even if you do not have experience drafting resolutions, we encourage you to contact AADA staff Beth Laws or Cierra Martin, or members of the Advisory Board Executive Committee with ideas, and they will help guide you through the submission process.
To ensure consideration, all resolutions must be submitted by June 24. The author and/or their AB representative must update their conflict of interest disclosure and submit a statement of support with their resolution for consideration by the full Advisory Board. The statement should state the reasons why the Advisory Board should adopt the resolution. The full Advisory Board will consider the submitted comments and resolutions and vote this summer.
Established Academy position statements can be found on the Academy’s website.
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