Vol. 4 No. 9  Winter, 2006
Vol. 3 No. 8 Fall, 2005
Vol. 3 No. 7 Summer, 2005

Massachusetts Academy of Dermatology
N E W S
Vol. 3 Issue 8 FALL, 2005


President’s Message
by Kathryn Bowers M.D.

I want to begin my term as your President by expressing thanks and appreciation to Steve Smith for his extended service as our President for the past five years. I know when he accepted the position he did not anticipate such a lengthy stay but, nevertheless, he served us all well.

During Steve’s tenure he oversaw the major changes that have taken place in the organization including the decisions to hire professional staff and the subsequent dues increase to support that decision. He leaves an organization that is very different and functioning very well.

Our recently concluded Annual Meeting was a great success. About 60 physicians attended along with six fellows from the Harvard International Training Program program, who we were pleased to have as our guests. The program was uniformly praised both for the topics presented and the high caliber speakers. The Woodstock Inn and the surrounding activities received rave reviews and we plan to return in the future.

At the business portion of the meeting Steve Ugent, our treasurer, reported a strong financial position and brought a recommendation from the Board to reduce the dues by 20% to $200 per year; the motion was approved. This ability to reduce our dues is a direct result of hiring our professional staff (Paul Wetzel and Marty Cohn). In the last three Annual Meetings they have successfully improved the corporate pharmaceutical support of our program. This year’s revenue was three times that of four years ago.

The business session also featured a discussion of a current bill in the Legislature requiring the direct billing of the client for dermatopathology services. This newsletter includes viewpoints on each side of the issue by two of our members and I hope you will read it carefully.

At the Fall meeting the membership voted to remain neutral unless the bill should be changed to limit a dermatologist’s right to read his/her own slides for a fee.
Another major decision the Board made during the summer was to retain Marty Cohn to as our lobbyist. As he has extensive experience and interest in this field and is already hard at work on Beacon Hill on our behalf regarding several issues highlighted in the newsletter. Retaining our own lobbyist rather than relying on the Mass Medical Society’s staff is another goal we had set four years ago.
Looking forward, our next major event is the spring Business Meeting to be held at the Mass Medical Society on Wednesday, May 24th. Note this is a change in date from our earlier plan. This will be our second year to co-sponsor a State House skin cancer screening program with the Mass Melanoma Foundation.
It is an honor for me to lead the Massachusetts Academy of Dermatology and I encourage you to contact me with any ideas, questions, issues we need to address or general thoughts you may have about dermatology practice in Massachusetts.

Successful Annual Meeting Held in Woodstock

About 60 dermatologists attended the Annual Meeting in Woodstock, Vermont participating in a variety of clinical presentations, conducting Academy business and enjoying social events and leisure activities.

The clinical presentations covering a wide variety of topics and treatment issues received uniformly high evaluation by attendees who earned 12 CME credits for the meeting. The Woodstock Inn and its environs proved to be an outstanding venue enjoyed by all.

At the business meeting on Sunday morning, Dr. Kathryn Bowers of Concord was elected President, succeeding Dr. Steven Smith who served for five years. Dr. Daniel Finn of Braintree was elected vice president. Dr. Allen Berliner of Norwood was elected Director Emeritus. Dr. Phillip Ellerin of Cambridge was elected a Director-at-Large. Subsequently, Dr. Ellerin reported his schedule would not allow him to serve and the Board appointed Dr. Mark Lewis of Marblehead to fill the position Dr. Ira Skolnik was elected as our representative to the AAD Advisory Council.

Also, at the business meeting Paul Wetzel, Executive Director, reported that the MAD was protesting Harvard Pilgrim Healthcare’s recent imposition of a pre-payment review of claims using Modifier 59. A lengthy discussion was also held on the issue of direct billing for pathology services. (Note articles elsewhere in the newsletter.)
The group recognized Dr. Smith’s service as president at the Saturday evening dinner with Dr. Bowers thanking him for his exceptional tenure in successfully leading the Academy through a period of organizational change.

Thank you Corporate Sponsors of our Annual Meeting!
Abbot Laboratories
Astellas Pharma
Biogen IDEC
Candela Laser
Centocor
Connetics
Dermik
Doak Dermatologics
Ferndale Laboratories
Galderma
Genentech
Medical Laser Technologies
Novartis Pharmaceuticals
Sanofi Aventis
Schering Plough
Stiefel Laboratories
3M Pharmaceuticals
Warner Chilcott

Legislative Matters
By Martin Cohn

Over the past few months, we have been working on four issues.

1. S2191. Originally filed by Senator Joan Menard working with Dr. Jeffrey Dover, the intent of this bill was that no person shall conduct a dermatologic procedure unless the person is a licensed physician appropriately trained to perform such procedure or unless the procedure is performed under the direction of such a licensed, trained, on-site physician. The bill targeted spas and clinics where concern over non-dermatologists performing procedures is growing. A public hearing was held and opposition materialized, particularly from nurses and plastic surgeons and others who work in spas.

Rather than letting the bill die, a compromise piece of legislation was drafted, S2191, that cleared the Joint Committee on Public Health. The redrafted measure will establish a task force within the Board of Registration in Medicine to study medical spas. It is now before the Joint Committee on Healthcare Financing and is expected to go for a vote before the end of the year. MAD will have an opportunity to submit names of dermatologists to serve on the Task Force and has recommended Dr. Dover, Dr. Richard Eisen and Dr. Mark J. Scharf. We can add two more names to the list and if you are interested in having your name submitted please contact the MAD office.

2. H2635. This bill, submitted by Representative Martha Walz, would provide for direct billing for certain pathology tests. At a public hearing held on November 2, 2005, representatives from the College of American Pathologists and the Massachusetts Pathology Society, as well as MAD member Dr. Lisa Cohen testified in support of the bill. They stated that it is unethical for a doctor to mark up a bill for services not provided by that doctor and that the practice of marking up pathology bills violates Medicare rules. A representative from the American Association of Dermatology testified in opposition to the bill. He reported that, while the AAD is opposed to egregious markups, this legislation is unnecessary because of rules by the Board of Registration, Medicare and the AMA guidelines.

MAD is carefully monitoring this legislation to ensure that no amendments are added that would reduce the scope of practice for any of our members. At this time we have taken no position on this legislation.

3. H.2689. This bill would allow pharmacists to expand their scope of practice to include disease management by allowing them to initiate, monitor, modify, or discontinue" a patients drug therapy, in accordance with a collaborative practice agreement with a supervising physician. The bill was strongly opposed by the Massachusetts Medical Society for the following reasons: (1) The bill does not require patient consent. (2) There is no requirement that the supervising physician have a relationship with the patient, thus opening the door to chain pharmacies hiring one or several physicians to "supervise" all pharmacies in a particular region. (3) There is no requirement for notification to or follow-up with the prescribing physician. (4) There is no limit on the amount or types of drugs the pharmacist can prescribe. (5) There are no limitations on the settings or conditions under which the pharmacists can prescribe. For example, inpatient or institutional based versus. community based. Although the bill was not immediately reported out by the Public Health Committee, it is likely to advance to the Committee on Health Care Financing shortly, where the Chair of that Committee, Senator Richard T. Moore (D-Uxbridge), is also a proponent of an expansive "collaborative practice" for pharmacists.

4. Sun tanning salons. We have had several conversations with Senators Menard and Resor, as well as staffers at the Committee on Public Health about tightening the laws regulating sun tanning salons. Particularly as this practice adversely impacts teenagers. MAD will be joining a coalition of organizations, including the Massachusetts Melanoma Foundation (MMF), to explore options.
If you have any questions about these issues, please contact the me at 617-962-3136.

Direct Billing for Pathology Services is Debated in Massachusetts
(Editor’s note: The debate over the practice of direct billing to the client for dermapathology services which has been taking place in many states has come to Massachusetts. Legislation filed at the State House would ban physicians from billing a patient for any service they do not directly perform. Views on both sides of this issue are offered by two Massachusetts Academy of Dermatology members.)

PRO - by Lisa M. Cohen M.D.

There is a bill in the Massachusetts state legislature that would mandate direct billing for pathology services. It ensures that the referring physicians’ interests are aligned with the interests of the patients. It will encourage doctors to choose a laboratory not based on price but on quality and service for their patients. This bill is about charging for a procedure that one performs, simple as that. If you are providing no aspect of the service, you should not be billing for it.

If you are a dermatologist who reads his or her own slides, you are entitled to bill for that service. However, there are laboratories that are offering to provide dermapathology services to the dermatologist, then bill the dermatologist a reduced fee and allow him or her to bill insurance or the patient (typically at an increased rate). Imagine if this practice were to occur in other areas of medicine. For instance, what if the primary care physician said, “I will refer all of my patients to you, if you let me bill for the dermatology office visit and procedures. I will then pay you a reduced fee to see my patients.” In another example, the dermatologist could make such arrangements with the Mohs surgeon. Suddenly, physicians would be choosing a specialist and sub-specialist based on the lowest price and not what is best for patient care.

Client billing is already illegal in 9 states, including many of our neighbors (Rhode Island, New York, New Jersey). It is illegal under Medicare and Medicaid. If a physician agrees to send all of his or her specimens to a lab because they permit client billing, the dermatologist may be committing Medicare fraud (if the Medicare specimens are sent in to be billed globally in “exchange for” the non-Medicare specimens that are being billed to the dermatologist).

Client billing is also a violation of the AMA Code of Medical Ethics, which states “No physician should bill or be paid for a service which is not performed.” “When services are provided by more than one physician, each physician should submit his or her own bill to the patient and be compensated separately, if possible. A physician should not charge a markup, commission, or profit on the services rendered by others.” The Code also states, “Medical considerations, not cost, must be paramount when the physician chooses a laboratory. The physician who disregards quality as the primary criterion or who chooses a laboratory solely because it provides low-cost laboratory services on which the patient is charged a profit, is not acting in the best interests of the patient.”

I urge the members of the MAD to support this bill. It is in the best interests of our patients, will likely reduce costs, and will ensure that physicians practice in an ethical manner, choosing a laboratory based on quality and service and not based on price.

CON - by Frederick D. Wax M.D.

There is a national problem with a challenge from pathology concerning the scope of practice of dermatology and in particular, dermatopathology. All of us, whether we perform our own dermatopathology or not need to become informed on this issue and follow its development closely. There have been several informative articles in the Journal of the American Academy of Dermatology that I recommend for your research.

Many dermatologists in Massachusetts do their own pathology, which is why we are licensed by the Commonwealth to perform dermatopathology in our offices, are inspected by the state and have a CLIA certificate. It is also why it is included in our training and in our dermatology boards. Whether you are one of these or not, we should protect this scope of practice for dermatologists to do dermatopathology. It is as important as protecting the right of dermatologists to do surgery including cosmetic surgery from plastic surgeons and other specialties. I have a concern that this bill is more than the white hat issue that it would appear to be which is to prevent fraudulent billing for pathology services. We all could support that and would applaud that. However, this bill is being implemented by pathologists at this point in time when there is a national program by pathology to limit our scope of practice and this makes me very uneasy and suspicious. This is also a concern of the American Academy of Dermatology which opposes this bill.
All that is needed for proponents to achieve a major goal would be a small substitution to change the wording in the current statute from “practitioner” to “Board Certified Pathologist or Dermatopathologist” Since the overwhelming majority of candidates for dermatopathology boards are pathologists and not dermatologists, this increase in business for dermatopathology would increase the number of job opportunities for pathologists.

The position of the Massachusetts Academy in protecting the right of all of those who wish to perform their own pathology is the correct one to protect the scope of practice of dermatology. We must be vigilant that the bill does not change its wording during the legislative process in a way that results in a restriction on the practice of dermatology.

Save the Dates!

2006 State House Sun Screening
Please note that a State House Sun Screening Day cosponsored
by MAD and MMF has been scheduled for Wednesday, March 22, 2006. We will be looking for volunteers to conduct screenings for a two hour shift. So please organize your schedule and plan to work on this program.

2006 Spring Meeting
Wednesday, May 24
Massachusetts Medical Society
Waltham, Massachusetts

2006 Annual Meeting
September 15-17
Marriott Hotel
Newport, Rhode Island
Please mark your calendars and plan to attend.

Visit our new Web site
www.massacademyofdermatology.org