Women's Dermatologic Society

The WDS Practice Advisory Committee (PAC) shares dermatology photography tips including how to take quality photos and save time, before and after photography, dermoscopy and more. Dermoscopic Photography I find it very helpful to monitor pigmented lesions for changes using dermoscopic photography. In order to do this quickly, I have a phone case that is magnetized to hold my dermatoscope in place. Both my dermatoscope and the case are from DermLite. Using an app for EPIC, my photographs can be directly uploaded into the patient's chart for future use. I find this system to be very quick and efficient.  Taking dermoscopic photographs of things that I biopsy has also improved my own knowledge. I review photographs when dermpath comes back to see if there are any features that I can learn from for a particular diagnosis. For anyone who teaches residents, having a library of dermoscopic images can also improve residency training. - Lori Fiessinger, ...

By Dr. Mark Kaufmann The bar has been raised. The amount of MIPS points required to be exempted from the 7% penalty in 2021 (for performance year 2019), is DOUBLE what it was last year. Instead of 15 MIPS points, you now need to get 30 MIPS points. With a little more effort, there is still a way to avoid the MIPS penalty in 2019, and while it’s still possible to do this without using a registry OR an EHR, both of them would make it a lot easier. Here’s how to get it done: If you are a small (fewer than 15 clinicians) practice, each clinician needs to complete five measures on at least one patient. I still recommend that each clinician complete five measures on more than one patient. Any combination of measures will do, and five will give you 15.75 points. In order to get up to 30 MIPS points, you will also need to do a High Weighted Improvement Activity (IA). You can choose any of the high weighted IAs from the 2019 Improvement Activities List , and if you want to do it wit...

The WDS Practice Advisory Committee (PAC) shares tips and advice for optimizing consent forms for surgical and cosmetic procedures in dermatology. Include Patient Discussions in Office Notes Don’t forget that a form may not always protect you. It is just as important, if not more, to include the discussion you had with the patient in your office note. The patient can always claim that they didn’t read a form that was put in front of them. - Mark Kaufmann, MD Focus on Patient Dialogue More important than a signed consent form, is a dialogue with the patient to convey the risks, benefits and alternatives of a procedure or intervention, and determining that the patient understands the dialogue as it is pertinent to them. Also, consider having a witness print their name and sign as well as the patient on the consent form. - Monica Li, MD, FRCPC, FAAD Increase Patient Compliance after a New Procedure Give patients a follow up call the day after a new proced...

The WDS Practice Advisory Committee (PAC) shares ways to go the extra mile to ensure patient satisfaction. Patient Appreciation Day We organize a ‘Patient Appreciation Day’ once a year where existing patients have access to exclusive treatment packages, discounts on non-physician services and discounts on skin care products. The event is in open house format - patients are served snacks and juice, and can tour the clinic further. Our patients LOVE the annual event! - Monica Li, MD, FRCPC, FAAD Neutralize the Hangry Patient On busy clinic days when we get behind schedule, we offer snacks and soft drinks in addition to our standard coffee and water service. - Elizabeth Long, MD Acknowledge Life’s Joys and Sorrows We keep a stash of custom thank you cards on hand to swiftly thank those who bring us gifts of food, tokens of friendship, or souvenirs from exciting travels abroad. We also reach out with condolence cards when we hear of the death of a patie...

The WDS Practice Advisory Committee (PAC) shares their best piece of professional advice to help you succeed in every stage of your career. "If it comes down to your ethics versus a job, choose ethics. You can always find another job.” - Mark Kaufmann, MD “There is never a right time to start a practice. There will always be competing interests and commitments, regardless of the stage in life. Things will fall into place with time and effort, if having a practice is what you want. Just go for it.” - Monica Li, MD, FRCPC, FAAD “When working toward a goal be highly selective in how you spend your most valuable resource: time. If a task does not require your skill set then delegate it or decide it will not get done at least for now.” - Molly Hinshaw, MD “When writing work related emails don't be reactive or quick to hit the send button. If you have any hesitation about how to respond to a situation at work or aren't sure how to word an email correc...

By Dr. Mark Kaufmann There’s been a lot of talk about CMS approving Telederm for reimbursement. I am going to lay out what we know so far. Below are the two G codes that will be available to us starting January 1, 2019. G2010 - Remote evaluation of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours (or soonest available appointment). G2012 - Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure with...

The Practice Advisory Committee has put together a list of pearls to help manage angry patients. Anger in some situations is a secondary emotion. I try to identify and address the primary emotion instead of the anger. For example, fear and anxiety are two primary emotions that can result in anger. Reassuring the patient by addressing their fear and anxiety helps dissipate the anger. - Molly Hinshaw, MD Listen, 90% of the time an angry patient just wants to be heard. And often they have a valid point. I always say I hear you, let me take care of your skin, and then I’m going to make sure that your problem gets taken care of. And if it’s my fault, for example running late, I apologize and move on. - Deirdre Hooper, MD Listen with empathy. Let the patient express what they would like to say and acknowledge their frustration to deescalate the situation as much as possible. Even several minutes of letting the patient talk without interruption can really he...

The Practice Advisory Committee has put together a list of pearls to avoid burnout in your practice. Focus on Your Strengths You should spend your day doing what you were trained to do, and minimize the time you spend on regulatory and administrative tasks.  - Dr. Mark Kaufmann, MD Get the Support You Need We hired a coder/biller who reviews our notes after we are finished. She verifies that what we have recorded in the note meets the level of service that we have billed. This has saved me hours of tediously going through notes to make sure I have coded correctly. This has increased my job satisfaction tremendously. Well worth it! - Dr. Sarah Jackson, MD Expand Your Passions Find a passion (or a hobby) outside of medicine. My outside interests in art and design have led me to engage more in my community, travel, and improve the visual state of both my home and office. A happy visual space makes for a place I want to be in. - Dr. Elizabeth...

By Dr. Mark Kaufmann On July 12, 2018 CMS published their proposed rule on the Medicare Physician Fee Schedule. This 1,440 page document is filled with some very broad ranging proposals. These proposals include a blended E/M code system (one E/M code to replace 99202-99205, and 99212-99215), a 50% cut in E/Ms billed with a modifier -25, and another call for comments on whether global period visits are happening, just to name a few. While many of these changes could have wide ranging effects on all of our practices, today’s pearl will deal with the one change that will definitely happen on January 1, 2019- 6 new skin biopsy codes to replace the 2 that we are used to using. Current CPT codes 11100 and 11101 will be deleted from the CPT book AND will be denied payment if used on or after January 1, 2019. Replacing them will be 6 NEW codes- 3 base codes and 3 “additional biopsy" codes. The three new categories will be “Tangential Biopsy of Skin" (think Shave Biopsy)...

The Practice Advisory Committee has put together a list of pearls to keep in mind your first year out of residency. Pearls from Dr. Sarah Jackson  Many of us had no formal business training, yet we run successful businesses now. If you are starting your own practice, you must seek out the advice of experts, just as you would for a tough medical case. Throw yourself into learning about business, and utilize courses, mentors, and experts outside of our specialty. You will reap the rewards throughout your days of private practice! Pearls from Dr. Monica Li  Do not let patients pressure you into providing an intervention that you are not comfortable with. When in doubt, go back to the basics and be systematic. Always be nice to your support staff - they can be so helpful in ways known and unknown to you! Pearls from Dr. Elizabeth Long  Learn from failure. When patients express dissatisfaction from a treatment, a drug price, an interaction with staff, etc....

Similar to last year, I have come up with a way to avoid the MIPS penalty in 2018 without having to use a registry  OR even  have an EHR. It’s not as easy as last year, but still reasonable (if you can call anything having to do with a government program reasonable)… So here it goes: Here is what I have come up with for avoiding the MIPS penalty in 2020- with assumption being that you are on paper, DON’T have DataDerm (or another registry), and are in a group of fewer than 15 clinicians. You need to get 15 MIPS points to avoid the penalty.  (Last year it was 3 points.) Any practice with fewer than 15 practitioners- automatically gets a Small Practice Bonus=  5 points So, you really only need to get 10 more points to avoid the penalty. Only way to get points- given above assumptions- is to submit quality measures via claims. So, you will need  4 quality measures (one time, on one patient)  to get  12 more points  and avoid th...