Wednesday, March 20, 2019

Best Professional Advice #PACPearls

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 correctly save a draft and sleep on it. This can help to avoid miscommunications and make sure that your emails come across professionally.”
- Jeanette Black, MD

“You have more time than you think you have! Make the best decision for you now and realize that you have no idea what twists and turns are ahead.  Work hard, do your best and be open to your future! “
- Pearl Grimes, MD

Tuesday, February 26, 2019

WDS Member Spotlight: Drs. Susan and Allison Weinkle


WDS Editorial Highlight


Dr. Susan Weinkle has been past president of the WDS, ASDS, Florida Society of Dermatologic Surgery and was the first woman to receive the FSDDS surgeon of the year.  Most recently, in 2017 she received the WDS Legacy honor as well as the ASDS Stegman award.  She is actively involved in our profession and is a willing and enthusiastic mentor to all.  She recognizes the WDS as being supportive of her career with many wonderful mentors along the way.

One of her greatest achievements, though, is having her daughter, Allison Weinkle, decide to follow in her footsteps.  As Susan has said, at 16 years old, Allison wanted to be nothing like me … now she’s a “mini me!”   Allison is a PGY-3 second year dermatology resident at the University of South Florida and pursuing a Mohs Fellowship after her residency and will soon join her mother in her private practice in Bradenton, Florida.  I took some time out to speak with Susan and Allison so the WDS newsletter could feature this dynamic mother/ daughter duo.

There are other WDS member mother/daughter dermatology teams out there and it might be fun to feature a new one every few months.  For our first mother/daughter feature, we asked Susan and Allison ten questions each (and they didn’t know each other’s answers!)

1. What made you decide to become a dermatologist?

Susan:  I wanted to be a cardiac surgeon but back when I was training the surgeons weren’t so nice!  Dermatology was just becoming a surgical specialty and I thought it would be a great opportunity for me to specialize in surgical procedures.

Allison:  Although I never imagined as a teenager I would follow in my mom’s footsteps,  I knew I loved science and my short time in college on the lab bench helped me realize I wanted to directly care for patient’s hands on. In medical school, I saw all I loved about medicine could be realized in dermatology. Continuity of patient care where you really develop relationships with patients, hands on surgical procedures occasionally allowing the doctor to actually “fix things” which I find very rewarding, visual and palpable findings and the possibility to expand into the world of cosmetics.

2. What is the best and worst thing about our profession?

Susan:  The best is our patients get better, but they also have many different issues which make them stay with us for a lifetime. The worst is that in solo private we can become very isolated.  It is good to be involved with local and national organizations in order to avoid this isolation and burn out. 

Allison:  The best is the ability to have long- term relationships with a broad range of patients and truly have an impact on their quality of life.
The worst is I personally find the pressure to see more and more patients in less and less time a potential problem in our profession that can compromise patient care and physician well- being.


3. What are the best words of advice you’ve been given?

Susan:  Wilma Bergfeld once stressed the importance of work/life balance to me and I will never forget it.  She said Susan, you can’t do and be everything.  It is a balance. 

Allison:  If you love your job, you’ll never work a day in your life!


4.  What is the one device or product you can’t live without?

Susan:  My hyfrecator (for bleeding Mohs patients) and definitely fillers!!  (That’s two but she does Mohs in the morning and Cosmetics in the afternoon so she needs two things!)

Allison:  My hands! I want to learn as many surgeries and procedures I can perform with my hands as possible. Devices get upgraded bi-annually it seems like, but the investment you put in hands on learning stays with you and can’t be replaced.


5. What is your favorite quote?

Susan:  Hard work beats talent every time, especially when talent doesn’t work hard.  

Allison:  Work hard, play hard… not sure if one person said it, but my family lives by it.


6. What book are you reading now?

Susan:  The Outlander series final book by Diana Gabaldon.

Allison:  Um….Bolognia…I’m a resident!


7. What is the one luxury item you would take on a desert island?

Susan:  I would need shampoo.  I can’t stand dirty hair!  But a luxury item would be my new Birkin Bag I just bought in Paris!  I had to walk through three blocks of armed guards to get to the store to purchase it!!

Allison:  Fishing pole, I’m all about survival and have got a bit of my dad in me. Water, food, shelter = happiness. Second would be a sun protective shirt/hat!


8. Where were you born and raised?

Susan:  Hackensack, New Jersey.   My father was an FBI agent who travelled with J. Edger Hoover. 

Allison:  I was born and raised in Bradenton, Florida where my mom has been in practice for over 30 years.


9. What are 5 adjectives/words you would use to describe our profession:

Susan:  personally rewarding, professionally rewarding, fun, exciting, challenging

Allison:  exciting, challenging, collaborative, intellectual, and… glamorous


10. What career would you have chosen if you wouldn’t have become a dermatologist?

Susan:  A fashion designer

Allison:  A ski instructor or outdoor guide. I love the outdoors and hope to explore more of it throughout my life.


Thank you Susan and Allison for taking the time to be interviewed for the WDS Member Spotlight!



Wednesday, February 20, 2019

Recommended Practice Management Sessions at the AAD #PACPearls

PAC Pearls by the Women’s Dermatologic Society

The Practice Advisory Committee (PAC) wants to remind AAD members of the opportunity to improve practice management by attending these recommended sessions at the 2019 AAD Annual Meeting. For more information, view a full list of available sessions.


Friday, March 1, 2019
F004 - The Future of Dermatology: What Changes Are Coming and How Can We Prepare?
S015 - Bureaucracy, Compliance, and Burnout: What it Means to Dermatologists
F040 - DataDerm and Quality Reporting for Public & Private Payors
U022 - Practical Practice Enhancements: Applying Evidence Based Strategies

Saturday, March 2, 2019
F048 - Coding and Office Management
D004 - Predicting the Future: AI, Machine Learning and Dermatology

Sunday, March 3, 2019
D005 - How to Create an Unforgettably Positive Patient Experience
F092 - Invention and Entrepreneurialism in Dermatology: Stories of Success and Reality Check
F103 - Documentation and Coding: Getting Paid and Passing Audits

Monday, March 4, 2019
C021 - Coding and Documentation
C025 - Advanced Practice Management
S059 - Teledermatology Working for You: Customizing Use in the Changing Healthcare Environment
F130 - Value in Healthcare: Improving Outcomes and Decreasing Waste



Friday, March 1, 2019  

Time
9:00 AM – 11:00 AM
CME Credits
2.00
Directors/Co-Directors
Sabra Sullivan, MD, PhD, FAAD
Marta Jane Van Beek, MD, MPH, FAAD
Speakers
Brett M. Coldiron, MD, FAAD
Howard Wooding Rogers, MD, FAAD
Seemal R. Desai, MD, FAAD

Time
1:00 PM – 4:00 PM
CME Credits
3.00
Directors/Co-Directors
J. Matthew Knight, MD, FAAD
Speakers
Andrea Tesvich Murina, MD, FAAD
Elizabeth A. Swanson, MD, FAAD
Mark D. Kaufmann, MD, FAAD
Neal D. Bhatia, MD, FAAD


Time
3:30 PM – 5:30 PM
CME Credits
2.00
Directors/Co-Directors
Robert Swerlick, MD, FAAD
Speakers
Alice B. Gottlieb, MD, PhD, FAAD
Marta Jane Van Beek, MD, MPH, FAAD
Suephy C. Chen, MD, FAAD

Time
4:30 PM – 5:30 PM
CME Credits
1.00
Directors/Co-Directors
Vinod Nambudiri, MD, MBA, FAAD
Speakers
Alice Joan Watson, MD, MPH, FAAD
Fei-Shiuann Clarissa Yang, MD, FAAD





Saturday, March 2, 2019  

Time
9:00 AM – 11:00 AM
CME Credits
2.00
Directors/Co-Directors
Alexander Miller, MD, FAAD
Speakers
Howard Wooding Rogers, MD, FAAD
Joseph S. Eastern, MD, FAAD
Mark D. Kaufmann, MD, FAAD
Scott M. Dinehart, MD, FAAD



Time
3:30 PM – 5:30 PM
CME Credits
2.00
Directors/Co-Directors
Jeffrey A. V. Benabio, MD, FAAD
Speakers
Adewole Shomari Adamson, MD, MPP, FAAD
Allan C. Halpern, MD, FAAD
Roger Ho, MD, FAAD







Sunday, March 3, 2019  



Time
1:00 PM – 3:00 PM
CME Credits
2.00
Directors/Co-Directors
Charles N. Ellis, MD, FAAD
Speakers
Steven Kenneth Shama, MD, MPH, FAAD
Victor James Marks, MD, FAAD


Time
1:00 PM – 3:00 PM
CME Credits
2.00
Directors/Co-Directors
Eric F. Bernstein, MD, FAAD


Time
3:30 PM – 5:30 PM
CME Credits
2.00
Directors/Co-Directors
Howard Wooding Rogers, MD, FAAD
Speakers
Mollie A. MacCormack, MD, FAAD
Murad Alam, MD, FAAD
Scott M. Dinehart, MD, FAAD








Monday, March 4, 2019  


Time
9:00 AM – 12:00 PM
CME Credits
3.00
Directors/Co-Directors
Murad Alam, MD, FAAD
Speakers
Alexander Miller, MD, FAAD
Ann F. Haas, MD, FAAD
Brent R. Moody, MD, FAAD
Howard Wooding Rogers, MD, FAAD
Mollie A. MacCormack, MD, FAAD



Time
1:00 PM – 4:00 PM
CME Credits
3.00
Directors/Co-Directors
Ninad C. Pendharkar, MD, MBA, FAAD
Speakers
Angela K. Walker, MD, FAAD
Caroline C. Kim, MD, FAAD
Christie Gail Regula, MD, FAAD
Dirk Michael Elston, MD, FAAD
Joseph S. Eastern, MD, FAAD



Time
3:30 PM – 5:30 PM
CME Credits
2.00
Directors/Co-Directors
Joslyn S. Kirby, MD, FAAD
Speakers
Adewole Shomari Adamson, MD, MPP, FAAD
Arash Mostaghimi, MD, MPH, FAAD


Time
1:00 PM – 4:00 PM
CME Credits
3.00
Directors/Co-Directors
Karen E. Edison, MD, FAAD
Speakers
Dennis H. Oh, MD, PhD, FAAD
George Han, MD, PhD, FAAD
Jasmine Campbell Hollinger, MD, FAAD
Jun Lu, MD, FAAD
Roy Mitchell Colven, MD, FAAD


Wednesday, February 13, 2019

New IJWD Special Issue on Dermatologic and Cosmetic Surgery

The February Special Issue of the International Journal of Women's Dermatology (IJWD) on Dermatologic and Cosmetic Surgery is now available online. Read the current issue, access the new Women's Health Highlight articles, and download the new Patient Page resources on the new IJWD website at www.wdsijwd.org.




WOMEN'S HEALTH HIGHLIGHT 


Nonmelanoma skin cancer in women
H. Heaton, N. Lawrence

The relationship between menopausal hormone therapy and keratinocyte carcinoma: A review 
R. Suresh, A. Twigg, J.E. Murase




PATIENT PAGE


The Patient Page is a concise, informative sheet that Health Care Providers can download, print and provide to their patients to prompt them to ask relevant questions and begin focused doctor/patient dialog. 

Nonmelanoma Skin Cancer In Women
Authors: Jodie Raffi, Raagini Suresh, and George Kroumpouzos

The most common form of cancer is becoming more prevalent in women; causative factors have been further investigated.






FEBRUARY 2019 IJWD FULL TABLE OF CONTENTS



Dermatology & Cosmetic Surgery
Murad Alam

Nonmelanoma skin cancer in women
H. Heaton, N. Lawrence

The relationship between menopausal hormone therapy and keratinocyte carcinoma: A review 
R. Suresh, A. Twigg, J.E. Murase

Physical activity of early stage melanoma survivors
J.K. Robinson

The female pioneers in Mohs micrographic surgery
N. Papac, L. Collins

Beyond the physician’s perspective: A review of patient-reported outcomes in dermatologic surgery and cosmetic dermatology
S. Mori, E.H. Lee

How to succeed in dermatologic surgery
A. Wysong, E. McBurney

New oral and topical approaches for the treatment of melasma
P.E. Grimes, S. Ijaz, R. Nashawati, D. Kwak

Current and emerging treatment strategies for hair loss in women of color
U.R. Okereke, A. Simmons, V.D. Callender

Platelet-rich plasma for androgenetic alopecia: A review of the literature and proposed treatment protocol
J. Stevens, S. Khetarpal

An approach to structural facial rejuvenation with fillers in women
R. Fitzgerald, J. Carqueville, P.T. Yang

Treatment for cellulite
Neil Sadick

Cutaneous complications associated with breast augmentation: A review
S. Chopra, D. Marucci

Thursday, January 17, 2019

Recommended Dermatology Meetings #PACPearls




Dermatology conferences and meetings offer great resources to network, learn from industry experts, and bring back useful information which can be used in your everyday practice. The WDS Practice Advisory Committee (PAC) has put together a list of their recommended meetings to attend related to business and practice management for both dermatologists and office managers.

AAD - American Academy of DermatologyI love the "Hands On" courses at the AAD! These are a fantastic way to update existing skills and learn new skills one-on-one from experts around the country and world.

- Molly Hinshaw, MD


ADAM - Association of Dermatology Administrators and Managers Annual MeetingOur office manager feels ADAM, Association of Dermatology Administrators and Managers Annual Meeting, is the most comprehensive and efficient way to learn about changes that happen each year. This meeting happens in conjunction with the AAD.

It is better than attending general dermatology meetings because the meeting focuses on only the manager role. Often other meetings include medical, surgical, or other clinical highlights that do not pertain to the office manager or business. Other management courses are often broad overviews, and this meeting is very focused and detailed. It includes more than just the basic information.

ADAM discusses everyday problems and resolutions that managers can benefit from. Interaction and networking with other practice managers is invaluable. ADAM has a fantastic annual survey that gives insight into trends in dermatology and is not weighted by a company selling anything.

- Sarah Jackson, MD and Deirdre Hooper, MD

ASDS - American Society for Dermatologic SurgeryThe ASDS annual meeting features diverse learning topics covering skin care, new techniques, new technologies as well as providing a great forum to connect with colleagues practicing procedural and aesthetic dermatology. I particularly enjoy the Unplugged session that takes place before the official start of the conference - there I learn about unique practices, pearls and perspectives on products, devices and approaches.
- Monica Li, MD, FRCPC, FAAD

ASLMS - American Society for Laser Medicine and SurgeryThe ASLMS Annual Conference is great for both for dermatologists with experience in lasers and those looking to expand their practice with laser medicine. As technology with medical lasers and energy-based devices are rapidly expanding, this conference offers insights into cutting edge evidence-based research and real-life experiences from some of the best laser experts in the country. If you are looking to purchase a new device or grow your expertise in using devices that you already have access to this conference is a must!
- Jeanette M. Black, MD



Tuesday, December 18, 2018

CMS Final Rule and Telederm #PACPearls

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 within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion.

*PLEASE NOTE: These two G codes are considered communication technology codes, and NOT considered “Medicare Telehealth services.” That being the case, they are NOT subject to geographic restrictions, and are NOT billed using E/M codes with modifiers.


G2010 is essentially “store-and-forward” telederm and it requires follow-up with the patient within 24 hours of receipt. G2012 is essentially a 5-10 minute medical discussion using a “communication technology-based service.” This may require further clarification, but so far, CMS has stated that the code allows “audio-only real-time telephone interactions in addition to synchronous, two-way audio interactions that are enhanced with video or other kinds of data transmission.”

A couple of take-homes
First, these are only available to use on established patients, not on new patients. These codes are both predicated on not having seen the patient in the last 7 days, and not setting up an “in-person” appointment with them within the following 24 hours or “soonest possible appointment.”

Also, “beneficiary consent” is required prior to providing a remote service, and this must be noted in the medical record for each service (the consent itself can be verbal consent, but it must be documented that it was obtained). This consent should include knowledge that you will be billing Medicare for this remote visit.

Based on what was published in the CMS Final Rule, G2010 will reimburse $12.61, and G2012 $14.78. These amounts are national average.

New Skin Biopsy Codes
Just a reminder, we also will have six new skin biopsy codes going into effect on January 1, 2019. Review these changes in the August 2018 PAC Pearls.