Which types of dermal fillers are associated with increased complications?
A review published in Dermatologic Surgery found that 44% of adverse events involving injectable dermal fillers for soft-tissue augmentation were associated with hyaluronic acid fillers. Of 3,782 complications involving dermal fillers — reported in the FDA’s MAUDE database from 1993 to 2014 — 40% were associated with poly-L-lactic acid fillers, 15% of complications with calcium hydroxylapatite fillers, and fewer than 1% of complications with polymethylmethacrylate fillers.
Of all reported adverse events, lumps were the most frequently reported (39%), followed by infection (13%), and swelling (10%). Rare events included triggering of autoimmune reactions, visual disturbances, and stroke. According to the authors, this study underscores the importance of having the appropriate skills and training when administering dermal fillers as well as recognizing and knowing how to manage potential complications.
As more toxins receive FDA clearance, how do the new arrivals compare to industry heavyweights? Find out in Dermatology World.
DW Insights and Inquiries: Rituximab and dermatomyositis — Dr. Samitz would be proud
The gifted dermatologist clinician-educator Morris H. Samitz, MD, has been honored with an annual lectureship at the Perelman School of Medicine at the University of Pennsylvania for the past 44 years. Dr. Samitz passed away in 1993, but his legacy in medical dermatology remains with the “Samitz sign” of dermatomyositis (DM). The sign refers to “thickening, roughness, hyperkeratosis, and irregularity of the cuticle with minimal or no redness nor inflammation.” Dr. Samitz described six such cases; in an additional two cases of cuticular fraying (examined with the late dermatologic luminary Dr. Stefania Jablonska), capillaroscopic studies also demonstrated classical nailfold features of DM (large, tortuous capillaries accompanied by an overall decreased capillary density). Keep reading!
An ode to the good old days
Although I am only five years into practice, my recollection of my medical education seems to involve stories of walking uphill to campus both ways (literally — I attended the University of Buffalo), and thousands of hours in a dungy basement lecture hall, replete with monotone PowerPoint presentations and technical failures. My alma mater recently moved its medical school to a newly constructed, gorgeous, state-of-the-art facility in close proximity to the teaching hospitals. During my tour of the facility, I couldn’t help but feel a twinge of jealousy at having missed the opportunity to train at such a beautiful and technologically advanced facility. Read more from DW Young Physician Advisor Jenna O’Neill.
CMS issues final and proposed rules to increase price transparency
As directed by President Trump’s Executive Order on Improving Price and Quality Transparency in American Healthcare, the Centers for Medicare & Medicaid Services (CMS) issued two rules last Friday intended to increase price transparency. Highlights of the final and proposed rules are below.
Final rule: Price Transparency Requirements for Hospitals to Make Standard Charges Public
CMS finalized requirements for all hospitals to make available to the public their standard charges for items and services. This includes charges for individual items and services that could be provided by a hospital to a patient in connection with an inpatient admission or an outpatient department visit for which the hospital has established a standard charge. Price disclosure extends to office-based clinics that are part of a hospital system that may not be located on the hospital campus. The administration has previously stated it expects legal challenges to this rule.
The charges must be available through two methods:
Standard charges for all services must be made available in a machine-readable format. This must be online in a single digital file.
Hospitals must post online the standard charges for 300 “shoppable services” in a consumer-friendly manner. Shoppable services are those that can be scheduled in advance by a patient. Seventy of the 300 services are specified by CMS. The hospital may select the other 230 services to be listed. This information must be prominently displayed on the hospital’s website and must be easily accessible, i.e. free of charge, without registration or password, and searchable by service description, billing code, and provider.
Proposed rule: Transparency in Coverage
Price estimation
Health plans would be required to disclose the estimated patient cost for the anticipated services using a price comparison tool that would allow patients to receive an estimate for services from different providers within the network. CMS acknowledges that the estimate may be provided with incomplete information, such as claims outstanding or services that may be delivered at a higher severity level due to unforeseen circumstances or complexity. The estimate would not be binding and would not be required to account for unanticipated or unscheduled services. CMS envisions this comparison tool to be like an explanation of benefits that a patient receives post-service.
CMS is requesting feedback on the role of drug pricing in price transparency for services. Specifically, it requests clarification regarding whether plans and issuers are allowed to disclose rate information for drugs, or if the relationship between plans or issuers and pharmacy benefit managers contracts would need to be amended to allow plans and issuers to provide a sufficient level of transparency.
Price transparency
Health plans would be required to publicly disclose negotiated rates with providers, which would provide a mechanism for third parties to create price comparison tools. According to CMS, this is an attempt to highlight price differences for consumers and allow them to “judge the reasonableness of provider prices” and determine whether a different provider could provide care at a better price. CMS also believes that this price disclosure proposal would provide uninsured patients a better understanding of their potential financial obligation because they could use pricing information to identify affordable service providers or providers who offer the lowest price.
CMS justifies the public disclosure of negotiated rates because market theory would anticipate a reduction in rates when price competition is introduced. However, CMS does recognize in some markets, disclosure of competitor rates could lead to higher reimbursement rates.
Finally, CMS acknowledges that price is not the sole factor in choosing a provider and is requesting feedback on how indicators of quality can be leveraged to supplement the proposed rules. The proposed rules do not include any health care quality disclosure requirements, but CMS recognizes the role of quality disclosure in providing patients the information necessary to make value-based health care decisions.
Stay tuned to DW Weekly for greater analysis of what these rules mean for dermatologists.
Find out why physicians are out of the loop on drug prices and costs to patients in Dermatology World.
Dermatologists bridge gaps in rural care access
At the University of Mississippi, we recognize the need to act immediately to bring dermatologic care to all areas of our state, including the Mississippi Delta. That is why we launched a monthly volunteer dermatology clinic located within a Delta area high school. Each month, one of UMMC’s dermatologists travels to the region and treats patients with a variety of skin conditions and diseases. The importance of this work was evident early — a dermatologist identified melanoma in a female patient who would not have otherwise sought care or received a diagnosis. Following treatment of her skin cancer, the clinic continues to see her on a regular basis. The success has been a springboard for other specialties, as departments across UMMC are introducing ways to reach underserved Mississippians through similar initiatives or other approaches. Read more from Robert Brodell, MD.
Join the Academy’s skin cancer measure testing project
The Academy is seeking participants for its new skin cancer measure testing project. Your participation will help build better dermatology measures for clinical practice, DataDerm™, and MIPS. These outcome measures will help you see which patients with skin cancer are improving.
Participants will be asked to provide data on five quality measures on skin cancer, including process and outcome measures addressing appropriate surgical margins, post-operative complications, dysplastic nevi biopsies, biopsy site photos, and tracking of recurrence.
Virtual group election period open for MIPS 2020 performance period
The election period to form a virtual group for the 2020 MIPS performance year is now open. To form a virtual group, providers must follow an election process and email the submission to CMS between Oct. 1 and Dec. 31, 2019. Get more information about the election process in CMS’s 2020 Virtual Groups Toolkit.
A virtual group is a combination of two or more taxpayer identification numbers (TINs) assigned to:
One or more solo practitioners (who are MIPS-eligible clinicians); or
One or more groups consisting of 10 or fewer clinicians (including at least one MIPS-eligible clinician); or
Both (solo practitioners and groups of 10 or fewer clinicians) that elect to form a virtual group for a performance period for a year
The American Academy of Dermatology is a non-profit professional organization and does not endorse companies or products. Advertising helps support our mission.
