Download as well - American Academy of Dermatology

10.2013
A Publication of the American Academy of Dermatology Association
Navigating Practice, Policy, and Patient Care
www.aad.org
A Matter of
PERCEPTION
How dermatologists are viewed by other physicians — and what they can do about it
24
+
04 Coding
10 Research
14 Legal Issues
22 Practice Management
40 Academy News
in this issue
from the editor
DEAR READERS,
The “lightning bolt” moment…
we’ve all had one.
t has enabled me to take many a bold step both personally and in my
work life. For example, when my kids were little I had one of those
“ah-ha” moments where I just knew that I wanted to work less than full
time. I knew right then and there that I would find a way to make it work
while still remaining very devoted to my career. It was not an easy course to
plan in those days, but with the clarity of vision that that kind of thinking
provides, plans can truly leap forward. Fourteen years ago I had another one
of those moments when I decided to leave my practice and head back to
academia at Penn. Got many a confused look, but inner clarity prevailed, and I’ve been the happier for it. However, I don’t know about you, but I have a lot of thoughts that circle in my head,
and the trickiest part is knowing which ones are going to be visionary. Ideas which seem at first
quite profound often dissipate after a few days. I instinctively don’t trust any thoughts I might
have while stuck in traffic or waiting for a very early train to get to my office. They might lead
me to forego many an event or quit my job! The surgeons among us might disagree — they may
always trust that inner voice, so this confusion may reflect more about me than anything more.
But whether we all are certain immediately or it takes a little time, I think we’ve all had those occasions where clarity serves us well and guides our paths. As I read over our articles for you this
month it occurs to me that some of you may find our pieces triggering those eureka moments.
Our feature this month on moving a practice got me thinking about “lightbulb” moments.
Who among us has not thought about this — either because our space was growing too small,
our referral patterns were changing, or personal priorities beckoned? We at DW thought it would
be of great interest to talk to people who made the decision to move forward with these plans, so
that you don’t have to re-invent the wheel. Remembering to make all of the needed arrangements
is certainly key to any such plan. While of course each situation is unique, there is much that can
be learned from others who have recently successfully accomplished the task. Remember you can
always search “moving a practice” at www.aad.org/dw when it becomes applicable to you. Guess
we’ll all need it sometime unless they cart you out of your office in a box!
Lightning moments can also trigger us to do negative things…such as giving up the practice
of dermatology. Hopefully Rachna Chaudhari’s guidance on audits will help each of us let that
thought go. She understands why we are all feeling somewhat abused given the possibility of
RAC audits, HIPAA audits, and now meaningful use audits. It’s enough to make all of us become
libertarians! Be sure to read her piece; her advice for handling these meddlesome events will be
helpful.
Similarly, Morris Stemp’s piece on health information exchanges (HIEs) will help you navigate
our next governmental hassle — the meaningful use stage 2 requirements. They are set for implementation January 2014, although some are lobbying to have this delayed. Eventually it will come,
so read on. Stemp helps us better understand what these HIEs are, how they will work, and what is
involved in participating in them. Hopefully being informed will keep us all from quitting en masse.
Lots to read and hopefully much to aid you in guiding your practices. Eureka was first shouted
by Archimedes when he figured out how to measure the mass of gold, which led to him running
naked through the streets of Syracuse. We’d love to see some video footage of any of you running
through your local streets when you’ve had your clarifying moments too — promise we’ll put that
on the DW website.
Enjoy your reading!
I
American Academy of Dermatology Association
CELEBRATING
YEARS OF EXCELLENCE IN DERMATOLOGY
VOL. 23 NO. 10 | OCTOBER 2013
PRESIDENT
PHYSICIAN EDITOR
Dirk M. Elston, MD
Abby Van Voorhees, MD
PHYSICIAN REVIEWER
Barbara Mathes, MD
EXECUTIVE DIRECTOR
Elaine Weiss, JD
DEPUTY EXECUTIVE DIRECTOR
Eileen Murray, CAE
PUBLISHER
Lara Lowery
EDITOR
Katie Domanowski
MANAGING EDITOR
Richard Nelson
ASSISTANT EDITOR
John Carruthers
DESIGN MANAGER
Ed Wantuch
EDITORIAL DESIGNER
Theresa Oloier
CONTRIBUTING WRITERS
Jennifer Allyn
Diane Donofrio Angelucci
Jan Bowers
Rachna Chaudhari
Nikki Haton
Clifford Lober, MD, JD
Alexander Miller, MD
Morris Stemp, MBA
EDITORIAL ADVISORS
Lakshi Aldredge, MSN, ANP-BC
Jeffrey Benabio, MD
Jeffrey Dover, MD
Rosalie Elenitsas, MD
John Harris, MD, PhD
Chad Hivnor, MD
Sylvia Hsu, MD
Risa Jampel, MD
Christopher Miller, MD
Christen Mowad, MD
Robert Sidbury, MD
Ravi Ubriani, MD
ADVERTISING MANAGER
Brian Searles
ADVERTISING SPECIALIST
Carrie Parratt
Printed in U.S.A. Copyright © 2013 by the
American Academy of Dermatology Association
930 E. Woodfield Rd. Schaumburg, IL 60173-4729
Phone: (847) 330-0230 Fax: (847) 330-0050
MISSION STATEMENT: Dermatology World is
published monthly by the American Academy
of Dermatology Association. Through insightful
analysis of the trends that affect them, it provides
members with a trusted, inside source for
balanced news and information about managing
their practice, understanding legislative and
regulatory issues, and incorporating clinical and
research developments into patient care.
Dermatology World® (ISSN 10602445) is
published monthly by the American Academy
of Dermatology and AAD Association, 930 E.
Woodfield Rd., Schaumburg, IL 60173-4729.
Subscription price $48.00 per year included in
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international. Periodicals Postage Paid at
Schaumburg, IL and additional mailing offices.
POSTMASTER: Send address changes to
Dermatology World®, American Academy
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ADVERTISING: For display advertising information
contact Richard Sieber at (301) 215-6710 ext. 116
or [email protected].
ABBY S. VAN VOORHEES, MD, PHYSICIAN EDITOR
DERMATOLOGY WORLD // October 2013
1
10.2013
A Publication of the American Academy of Dermatology Association
Navigating Practice, Policy, and Patient Care
features
www.aad.org
depts
01
FROM THE EDITOR
04
CRACKING THE CODE
“If we as
dermatologists are
going to have
the opportunity 24
to be a part of
some of these
A MATTER OF PERCEPTION
How dermatologists are viewed by other physicians
new medical
— and what they can do about it
care practices, it
will be important
30
for us to have a
MOVING UP, MOVING OUT
Dermatologists detail the moving process,
good reputation
from cross-town to cross-country
and respect within
our community.”
34
COVER STORY
BY JAN BOWERS
BY JOHN CARRUTHERS
DERMATOLOGISTS ON THE FRONT LINE
IN DETECTING VENOUS DISEASE
BY DIANE DONOFRIO ANGELUCCI
When modifier 59
is not enough.
08
ROUNDS
Compensation update.
10
ACTA ERUDITORUM
Can universal
decolonization reduce
MRSA infections?
14
LEGALLY SPEAKING
Dismissing a patient.
18
TECHNICALLY SPEAKING
Health information
exchanges.
22
IN PRACTICE
Preparing for a meaningful
use audit.
38
FROM THE PRESIDENT
40
ACADEMY UPDATE
Board of Directors
actions, more.
42
ACCOLADES
48
FACTS AT YOUR
FINGERTIPS
Camp Discovery
celebrates 20th
anniversary.
2 DERMATOLOGY WORLD // October 2013
www.aad.org/dw
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cracking the code
coding tips
BY ALEXANDER MILLER, MD
When
modifier 59
is not enough
CODING CORRECTLY FOR COVERED SERVICES, AVOIDING BILLING
FOR EXCLUDED SERVICES
ALEXANDER MILLER, MD, addresses important coding and documentation
questions each month in Cracking the Code. Dr. Miller, who is in private
practice in Yorba Linda, Calif., represents the American Academy of
Dermatology on the AMA-CPT® Advisory Committee.
A Medicare patient visits you for the second time in the calendar year, this time with
complaints of growing, occasionally bleeding facial lesions. You identify scattered
keratotic actinic keratoses (AKs) as well as probable basal cell carcinomas located
on the cheek and nose. You destroy five AKs with liquid nitrogen and biopsy both
suspected basal cell carcinomas. Your office then bills for two biopsies, CPT codes
11100 and 11101, and for the actinic keratoses destruction, CPT code 17000-59 and
17003-59x4.
Will you be reimbursed appropriately for your efforts?
There are several steps that must be considered in order to determine whether
any procedures are reimbursable, and if yes, then how coding should be done to
generate appropriate recognition of and payment for your work:
1. Is what is done a covered service or is it excluded from reimbursement?
2. Are the codes, when paired (billed on the same encounter), all payable?
3. If the codes are in principle payable, then which code should be the primary
code, and which should receive a modifier?
4. Which modifier(s) should be used?
Knowing what is a covered service can help avoid the frustration of billing an insurer for a service and receiving a denial of payment. Private insurers vary in their
coverage policies. Medicare, however, clearly divulges coverage criteria.
The September 2011 Medicare Learning Network transmittal, titled “Items
and Services That Are Not Covered Under the Medicare Program” (www.cms.gov/
Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/Items_and_Services_Not_Covered_Under_Medicare_BookletICN906765.
pdf ), specifies that cosmetic surgery, which is “…any surgical procedure directed at
improving the beneficiary’s appearance,” is not covered. Coverage may be further
detailed in a National Coverage Determination (NCD) and in your local Medicare
contractor’s Local Coverage Determinations (LCDs). Although dermatology-specific
4 DERMATOLOGY WORLD // October 2013
NCDs are few, there is one for actinic
keratoses (NCD 250.4), which states that
they are covered “without restrictions
based on patient or lesion characteristics.” However, the NCD guidelines also
allow the local Medicare contractors to
independently determine maximum
number of treatment visits. Consequently, one should be familiar with any
pertinent local contractor’s LCDs, and if
none is available, then with the contractor’s coverage and payment patterns.
Some Medicare contractors have
generated LCDs specifying treatment frequency coverage limits for actinic keratoses and/or coverage criteria for benign
lesion removals. The LCDs are readily
accessible on your Medicare contractor’s
website. An actinic keratosis LCD will
list secondary diagnoses that, when present and billed, exclude AK treatments
from the visit frequency limits. In such
cases, one would link the 17000-17004
destruction codes with the ICD-9-CM
for actinic keratosis as the primary code
(702.0) and a second code justifying
the visit frequency. This secondary code
may, for example, specify immunosuppression or a history of skin cancer, or
any other pertinent qualifying diagnosis
listed in the LCD. The billing staff needs
to know this in order to code properly
and for you to be paid. The physician
has to know this in order to provide the
appropriate supporting medical records
and billing information.
Consider that Medicare expects you
to know what services are never covered,
which services may have a frequency of
visits limitation of coverage, and which
are reasonable and necessary. If in doubt
about Medicare coverage of a service, or
if you suspect that the service may exceed the maximum treatment visits per
year limitation, then fill out and have the
patient complete and sign an Advanced
www.aad.org/dw
cracking the code continued
coding tips
Beneficiary Notice (ABN), available
on the websites of both your Medicare
contractor and CMS. Guidance on what
is covered and not covered, and specifics
about the ABN, appear in the May 2012
MLN article titled, “Advance Beneficiary
Notice of Noncoverage” (www.cms.gov/
Outreach-and-Education/MedicareLearning-Network-MLN/MLNProducts/
downloads/abn_booklet_icn006266.
pdf ). Significant for everyone’s billing
practices is the following quote from
the publication: “Medicare expects
you to know both current NCDs and
LCDs” (bold lettering from the original).
When is an ABN not needed? It is when
services are known to be covered and
when they are known to be statutorily
not covered.
There are four different modifiers
related to ABN use and/or potential
non-coverage of a service by Medicare.
These are appended to individual CPT
codes billed to Medicare.
• GA: Indicates that a given charge
may or may not be covered by
Medicare, and that an ABN has been
obtained and is on file.
• GX: Indicates that a service is not
covered because it is statutorily
excluded from coverage or is not a
Medicare benefit but an ABN has
been obtained as a voluntary option.
• GY: Indicates that the service provided is statutorily excluded from
coverage. (Note that in such a case
one is not required to submit any bill
to Medicare).
• GZ: Indicates that a charge is not
likely to be covered due to a lack of
medical necessity, and no ABN was
obtained. (In the case of payment
denial due to lack of medical necessity the patient would not be liable
for the bill because an ABN was not
obtained).
6 DERMATOLOGY WORLD // October 2013
Now, let’s return to the clinical
vignette at the top of this article. As this
is only the patient’s second visit in the
calendar year, treatment frequency limitations will not apply to actinic keratoses
destruction, and CPT codes 17000 and
17003x4 should be covered. As basal cell
carcinomas are clinically suspected, biopsies, CPT 11000 and 11101, are done for
medically necessary reasons and should
also be covered. However, will the use
and placement of modifier 59 described
at the beginning of this article provide for
reimbursement? Find out in next month’s
continuation article.
Example 1: A Medicare patient with
a raised, dark, stable nevus of several
decades’ duration would like it removed
because it grows an annoying thick,
long, and dark hair. You tell the patient
that the mole can be excised, and that it
is considered a cosmetic-non-reimbursable lesion. The patient insists that you
excise it but also wants you to bill Medicare to prove that it is not covered. You
agree, excise the mole, and bill Medicare
for the excision.
Answer: Incorrect. As the excision is
for enhancement of appearance, it is considered a non-covered, cosmetic procedure.
Whambo! Medicare will not pay, with an
explanation that the patient is not responsible for payment. You get nothing. What
went wrong? The claim should have been
submitted with a –GY modifier stipulating
that the service is statutorily excluded from
Medicare benefits. As the service is never
covered, you were not required to obtain a
signed ABN form. However, such a form
helps to document non-coverage. When an
ABN is obtained, the service may be billed
with a –GX modifier in addition to the –GY,
indicating that a voluntary ABN has been
obtained.
Example 2: You excise a Medicare
patient’s previously stable but now
suddenly tender, red, and bulging epidermoid cyst located on the back. You
bill for the excision along with ICD-9
diagnoses 706.2 for the cyst and 682.2
for the abscess.
Answer: Correct. Medicare and, typically, other insurers will cover treatment
of an abscessed or inflamed epidermoid
cyst. As this is a covered service, no ABN is
needed. In the billing sequence, the epidermoid cyst diagnosis should be primary, and
the abscess, secondary.
Example 3: A patient with a past history
of skin cancers visits your California
office for the seventh time in the past
12 months for destruction of actinic
keratoses. You freeze eight actinic keratoses and bill Medicare with CPT 17000
and CPT 17003x7 along with an ICD-9
diagnosis code 702.0.
Answer: Incorrect. The Medicare
Administrative Contractor for Jurisdiction
E, which includes California, Nevada,
Hawaii and Pacific Islands, maintains
an Actinic Keratosis LCD that specifically
limits coverage for AK destruction to six
visits per 12-month period. A visit frequency
beyond this limit may be justified by coding
for any of a variety of qualifying criteria,
including immunocompromise, extreme
sun damage, prior therapeutic radiation or
cancer causing drug exposure, predisposing
conditions such as albinism, and personal
history of skin cancer. In this example the
patient’s treatment would be made eligible
for reimbursement by billing with the
primary AK ICD-9 diagnosis 702.0 plus a
secondary code, V10.83, “personal history
of skin cancer.” dw
www.aad.org/dw
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rounds
Exchanges on the forefront
of state medical news
STATE NEWS ROUNDUP
STATE EXCHANGES
FEDERAL EXCHANGES
ealth insurance exchanges, the
centerpiece of the 2010 Affordable
Care Act, are set to become certified and operational at the start
of 2014. Open enrollment begins Oct.
1, 2013. The marketplaces, which allow
individuals and small businesses to compare policies before purchasing health
insurance, are handled under three models. Most states had chosen which model
they would pursue at press time.
H
FEDERAL/STATE PARTNERSHIPS
STATE EXCHANGES
These states plan to run their own exchanges.
• California passed the first exchange legislation in the country under then-Gov.
Arnold Schwarzenegger. An exchange
board was created in 2011 and the state
has received $40 million in grants
through the U.S. Department of Health
and Human Services.
• Connecticut passed state exchange legislation in 2011. The state exchange has
a board in place but is still searching for
a CEO.
• The District of Columbia has also
elected to run its own exchange. The
city plans to be an active purchaser of
insurance plans, consolidating the city’s
smaller group and individual markets
into the exchange.
• Hawaii, which has had an employer
mandate in place for almost four
decades, created the Hawaii Health Connector in 2011. The board is currently
working to consolidate the state-run
exchange with the existing employer
mandate and delineate the responsibilities of employers under the new federal
regulations.
• Idaho’s governor signed the bill creating a state exchange in March 2013, just
8 DERMATOLOGY WORLD // October 2013
•
•
•
•
months before the open enrollment date.
Maryland passed legislation in 2012
that required most insurers to offer
plans on the exchange in order to sell
other insurance products in the state.
Massachusetts, in many ways the model
for the current systemic overhaul,
already has a state exchange that is in
the process of fine-tuning to become
federally certified.
Minnesota’s exchange was the result of
a 2011 executive order, and Democratic
majorities in both houses passed legislation in support of it in 2013.
Rhode Island has funded its exchange
through 2014 as a result of receiving
the nation’s first Level Two grant following an executive order to create the
exchange during the 2011 legislative
session. Level Two grants are distributed to states in recognition of their
advancement in the exchange setup
process. The grants provide funding to
the exchange through 2014.
•
•
•
Vermont, in addition to 2011 health
exchange legislation, passed a bill in
2012 that required individuals and
businesses with fewer than 50 workers to purchase coverage through the
exchange.
Washington became just the second
state to obtain a Level Two grant —
resulting in $128 million in exchange
funding — in May 2013.
Also participating in state-run exchanges: Colorado, Kentucky, Nevada, New
Mexico, New York, and Oregon.
FEDERAL EXCHANGES
The lawmakers in a number of states
have decided to leave the construction and
operation of insurance exchanges to the
federal government.
• Alabama Gov. Robert Bentley, MD, originally expressed support of a state-run
exchange, going so far as to appoint an
executive director. But after examining
costs, Dr. Bentley decided on a federal
www.aad.org/dw
news in brief
•
•
•
•
•
exchange following the 2012 election.
Alaska was the only state not to apply
for a $1 million exchange planning
grant in 2010.
Despite an executive order issued by
then-Indiana Gov. Mitch Daniels in
2011, current Gov. Mike Pence announced that Indiana would opt for a
federal exchange.
Kansas Gov. Sam Brownback sent an
Early Innovator grant back to the federal
government in 2011, and the state has
opted for a federal exchange.
In Mississippi, Gov. Phil Bryant told
insurance commissioner Mike Chaney
to abandon two years of work on a statebased exchange.
Missouri voters approved a ballot initiative in 2012 that forbid Gov. Jay Nixon
from launching an exchange without
legislative or voter approval. Nixon
•
•
•
elected not to seek approval.
Nebraska Gov. Dave Heineman, citing
the lack of operational differentiation
between federal and state exchanges,
elected to defer to the federal exchange
option.
New Hampshire’s legislature passed a bill
in 2012 to block a state-run exchange.
Also participating in federally run
exchanges: Arizona, Florida, Georgia,
Louisiana, Maine, Montana, New Jersey,
North Carolina, North Dakota, Ohio,
Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas,
Virginia, Wisconsin, and Wyoming.
•
•
•
FEDERAL/STATE PARTNERSHIPS
The following exchanges are to be run
jointly between federal and state officials.
• Arkansas began planning for a partnership in late 2011 and is planning for a
•
transition to a state-run exchange by
2016. The state was also the first to
approve the Medicaid expansion legislation in April.
Delaware planned for its own exchange,
but officials determined that low
enrollment would make the prospect
financially unfeasible.
Illinois lawmakers and Gov. Pat Quinn
were unable to agree on legislation, and
at present the state plans to run both
management and consumer assistance in
conjunction with the federal government.
Utah received permission in May to run
its existing small business insurance
program and have the federal government run the individual health insurance exchange.
Also participating in partnerships: Iowa,
Michigan, and West Virginia.
- JOHN CARRUTHERS
Two widely read salary surveys show slight growth in dermatology compensation in 2012
SURVEYS OF DERMATOLOGY COMPENSATION offer dermatologists data they can use to benchmark their practices — and often create the
foundation for outside impressions of the specialty. According to two of the best-known and widely reported compensation surveys, dermatology compensation increased slightly in 2012.
The median compensation for dermatologists grew by 5.55 percent in 2012 according to the Medical Group Management Association’s
(MGMA’s) 2013 Physician Compensation and Production Survey, based on 2012 data. The survey’s top-line data showed median compensation for dermatologists rose from $446,774 in 2011 to $471,555 in 2012. Specialists in general saw a 3.06 percent increase in median
compensation in 2012, according to MGMA. The figures for dermatology reported in the MGMA survey are based on responses from
298 dermatologists, including 38 who defined themselves as Mohs surgeons and 12 who defined themselves as dermatopathologists. Data
without Mohs or dermatopathology, reported as the median for dermatology in some outlets, showed a compensation figure of $446,061.
The American Medical Group Association’s (AMGA’s) 2013 Medical Group Compensation and Financial Survey, based on 2012 data,
showed a 3.56 percent increase in median compensation for dermatologists, from $397,370 in 2011 to $ 411,499. The AMGA figures for
dermatology are based on responses from 603 dermatologists, all of whom reported working in one of 114 groups, 107 of which had more
than 71 physicians. AMGA also reported data from 87 Mohs surgeons with a median compensation of $595,800. – RICHARD NELSON
MEDIAN COMPENSATION FOR DERMATOLOGISTS 2005-2012
2005
2006
2007
2008
2009
2010
2011
2012
MGMA
$334,277
$348,706
$365,524
$368,407
$413,657
$430,874
$446,774
$471,555
AMGA
$306,935
$316,473
$344,847
$350,267
$375,176
$386,068
$397,370
$411,499
Sources: 2013 MGMA Physician Compensation and Production Survey, AMGA 2013 Medical Group Compensation and Financial Survey
DERMATOLOGY WORLD // October 2013
9
acta eruditorum
Q&A
Can universal
decolonization
reduce MRSA
infections?
IN THIS MONTH’S ACTA ERUDITORUM COLUMN, Physician
Editor Abby S. Van Voorhees, MD, talks with Susan
S. Huang, MD, MPH about her recent New England
Journal of Medicine article, “Targeted versus Universal
Decolonization to Prevent ICU Infection.”
DR. VAN VOORHEES: How much of
a problem are methicillin-resistant
Staphylococcus aureus (MRSA) infections
in the hospital setting? What kinds of
infections are these patients at increased
risk for?
DR. HUANG: MRSA is still producing
substantial problems, both from cases that
are acquired in the community and come
into the hospital setting and from hospitalassociated infections. Even though the
nation has made great strides in reducing
hospital-associated infections, the CDC’s
most recent data, from January of this
year, suggest that Staph aureus, as the
combination of MRSA and MSSA, is still
the number one health care-associated
infection pathogen. Staph aureus is a
virulent bacterium which can affect almost
all organ systems and is still a major
pathogen to be contended with.
The types of infections that come from
the community are usually skin and softtissue infections, but can also include
superimposed pneumonia after influenza,
for example. In the hospital, the most
common things relate to hospital-acquired
pneumonia, bloodstream infections, and
skin and wound infections, including
surgical-site infections. What’s most
important is that the people who acquire
MRSA, either as a carrier or those who
become infected ,usually have a highrisk profile. They usually have serious
comorbidities, wounds or other loss of
intact skin, or devices which put them
at greater risk and they commonly have
multiple outpatient or inpatient visits for
medical care.
The other thing that I should mention
is that MRSA infections that occur in the
hospital and the post-discharge setting can
be quite serious; in general, about a quarter
of them involve the bloodstream.
DR. VAN VOORHEES: Are there patient
populations who are considered high risk?
DR. HUANG: The risk factors most
commonly noted in the literature are
10 DERMATOLOGY WORLD // October 2013
www.aad.org/dw
research in practice
diabetes, hemodialysis, wound and
skin disorders including eczema
or other chronic skin conditions
that provide a portal of entry, those
who have active cancer or are
immunosuppressed, and patients with
HIV or AIDS. There are other groups
that are also at risk, but those are the
most common and persistent risk
factors in the literature.
DR. VAN VOORHEES: Up until your
study how did ICUs typically handle
the risk of MRSA infections?
DR. HUANG: In general, a hospital’s
main arsenal of prevention is to use
contact precautions. Many ICUs screen
patients upon admission by swabbing
their noses for MRSA since the nose is
the main reservoir for MRSA. Carriers
are then placed into single rooms
with gown and glove precautions.
This means we are largely focused
on preventing spread from someone
who already has MRSA, whether it’s
an infecting or colonizing pathogen,
to someone who doesn’t. I think that’s
part of the issue as we look at the
U.S. where the prevalence of MRSA
continues to rise. Around 8 percent of
people who come to the hospital have
MRSA; this is a high proportion of
people who are carriers, and carriers
are predisposed to infection. In
recent years, a very strong interest has
emerged to do something for the 8-10
percent of hospitalized patients who
already have MRSA. That percentage
is often even higher in the ICU and in
places like nursing homes. If we can
get MRSA off the body, off the skin,
and out of the noses, we can prevent
infection. The strategy, arising in the
past decade, is to decolonize using
special soaps and nasal ointments to
eliminate the carrier state. That’s the
thrust of this study and of others that
led up to it which enabled us to do a big
randomized controlled trial.
DR. VAN VOORHEES: What does
decolonization of patients entail? Has
it been shown to reduce the risk of
MRSA acquisition?
DR. HUANG: The most common
regimen for decolonizing a patient
with MRSA consists of five to seven
days of daily bathing or showering
with chlorhexidine, which is an OTC
antiseptic combined with twice daily
prescription mupirocin ointment to
the front of both nostrils for five days.
This regimen has been demonstrated
to be effective in removing MRSA
from the body and preventing MRSA
infections. In the REDUCE MRSA
Trial, it has been shown to effectively
reduce MRSA burden and all-cause
bloodstream infection. Other studies
have found a benefit in reducing
all-cause bloodstream infections with
chlorhexidine alone, but there are
data to suggest that it may not be as
effective for MRSA as the combination
with mupirocin since the nose is the
primary reservoir of MRSA.
DR. VAN VOORHEES: Tell us about your
study. What did you find?
DR. HUANG: Our study was a threearm, cluster-randomized trial; we
randomized the hospitals, not
individual people. Each participating
hospital was assigned a specific
campaign and all of the adult ICUs in
that hospital did the same thing.
The first arm screened the noses
of patients who came into the ICU
for MRSA. This practice is common
in many hospitals and legislated
by several states. Those that had a
positive screen, a positive clinical
culture, or a history of MRSA were
placed into contact precautions as is
consistent with CDC guidance for
hospitals.
The second arm not only screened
and isolated patients, but also actively
decolonized MRSA carriers with a
five-day regimen of mupirocin twice a
day and daily no-rinse cloth baths of 2
percent chlorhexidine.
The third arm was the universal
decolonization arm. We stopped
screening, which saved those costs,
and decolonized everyone. Everyone
got a five-day regimen of mupirocin
twice a day and daily no-rinse cloth
baths of 2 percent chlorhexidine for
as long as they were in the ICU. If
they were only in the ICU three days
they got both for three days. If they
were in the ICU for three months,
the mupirocin stopped after five days
and the daily chlorhexidine baths
continued.
What we found were two major
outcomes. The first was a burden
estimate, an estimate of any source
of MRSA from a clinical culture
that a doctor would send. We chose
that as an outcome because since
we were decolonizing, we didn’t
want to see MRSA from any source,
regardless of if it was an infecting
strain or just a colonizing strain. We
were able to show that the all-cause
burden was reduced in the universal
decolonization arm by 37 percent.
Then we looked at bacteremia. We
had two subsets, bacteremia due
to MRSA, where we had a nice
trend of reduction in the targeted
decolonization group but it was not
statistically significant — we knew we
were underpowered for that outcome.
And in the other subset we looked
at bloodstream infections from all
pathogens and found that the middle
arm, the targeted decolonization arm,
was better than the routine arm, and
the universal arm was better than
both with a 44 percent reduction in
bloodstream infections.
DR. VAN VOORHEES: What costs
were associated with the universal
decolonization arm?
DERMATOLOGY WORLD // October 2013
11
acta eruditorum continued
DR. HUANG: In the trial, we used a 2
percent chlorhexidine cloth which
currently has a single manufacturer
in the U.S. We also used the trade
version of mupirocin because it’s
FDA-approved to clear MRSA.
Nevertheless, hospitals may opt to
use generic mupirocin or liquid
chlorhexidine in basin baths.
For chlorhexidine, the important
consideration is whether the
application is done properly. This
should be possible with a basin
bath, but more attention is needed
to ensure proper dilution, skin
application, and lack of rinsing.
Studies are underway to see if skin
concentrations following basin
baths are similar to the 2 percent
no-rinse cloth. If applied correctly
by massaging CHG into the skin, it
will bind skin proteins and protect
against re-colonization of bacteria
on the skin for 24 hours. So it works
nicely given as a daily bath; you can
protect patients every day. Cost will
vary depending on the exact product
used. Every hospital negotiates its
own pricing. Chlorhexidine baths are
approximately $6-7 per bath for the
cloth, and much less if you use the
liquid. It’s worth noting that liquid
will lather much better with a mesh
sponge. The mupirocin is between
$30-40 for the entire five-day course if
you use the branded version, or about
$5-7 if you use the generic.
DR. VAN VOORHEES: As dermatologists
we’d be a little concerned that some
of the patients might have found the
chlorhexidine bathing harsh on the
skin. Were rashes a problem in this
study?
DR. HUANG: We had 75,000 patients in
total over the 18-month intervention
period, divided across the three arms.
That means about 25,000 people in
the universal arm were receiving a 2
12 DERMATOLOGY WORLD // October 2013
research in practice
percent no-rinse chlorhexidine bath
every day, plus a fraction who were
MRSA-positive in the second arm.
Thus, we treated between 27,000 and
30,000 people with chlorhexidine. All
told, we had seven reports of adverse
events, all very mild, all skin-related
to the chlorhexidine, and all of them
rapidly improved after cessation of
product. Overall, this is a very low
adverse event rate. In the literature,
about 1 percent of patients have mild
skin irritation, but this was far less in
our study. The cloths we used have
emollients in them which help keep
the skin soft and prevent drying.
Some data in the literature even
suggest that chlorhexidine may be
better for the skin than soap and water
baths. However, if you use a higher
percentage of chlorhexidine say a 4
percent no-rinse solution, you will get
a higher level of irritation. Overall,
2 percent no-rinse and 4 percent
with rinse has been very safe and
well tolerated in many studies across
thousands of patients.
Dermatologists may already be
familiar with chlorhexidine because
of its longstanding use for other
medical indications. It is the gold
standard for prepping the skin prior to
placing a central line. Chlorhexidine
plus alcohol is also considered a
gold standard for skin preparation
prior to surgery. Furthermore, the
CDC recommends that people bathe
or shower with chlorhexidine three
times prior to arriving at the hospital
for elective surgery. So in the past
15 years, hundreds of thousands of
people have bathed with chlorhexidine
for up to three days prior to surgery.
That should be quite reassuring to
dermatologists and other physicians
who are concerned about tolerability
and allergy. It’s also used often in oral
care for periodontitis and gingivitis as
a mouth rinse.
DR. VAN VOORHEES: As caregivers
primarily in the outpatient setting,
dermatologists generally utilize
mupirocin intranasally for patients
with MRSA infections. Are there
implications from your work for the
patients that we see?
DR. HUANG: Yes and no. This particular
trial was focused only on ICU patients
and whether we were able to effect
a change in post-discharge time is
unknown. But we have a second trial,
Project CLEAR, which is ongoing
and is a post-discharge trial. Patients
who are discharged with a culture
positive for MRSA are randomized
to education alone or education plus
decolonization for MRSA. Hopefully
that will have direct relevance to
outpatient settings when results are
known in two years. dw
DR. HUANG is associate professor of infectious
diseases and medical director, epidemiology
and infection prevention at the University of
California Irvine School of Medicine. Her article
was published in the New England Journal of
Medicine; N Engl J Med 2013; 368:2255-2265
(June 13). doi: 10.1056/NEJMoa1207290.
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legally speaking
BY CLIFFORD WARREN LOBER, MD, JD
Dismissing
a patient
EVERY MONTH, DERMATOLOGY WORLD covers legal issues
in “Legally Speaking.” Clifford Warren Lober, MD, JD,
presents legal dilemmas in dermatology every other
month. He is a dermatologist in practice in Florida and a
partner in the law firm Lober, Brown, and Lober.
legal issues
s Bryan is about to leave his law
office for the day his receptionist
enters his office. She tells him
that Madison, a dermatologist and
longstanding client, is on the telephone
and is quite upset. Bryan answers the
telephone.
A
Bryan: Good afternoon, Madison! How
are you?
Madison: Not well. I just finished seeing
a patient who has repeatedly failed to
comply with my treatment recommendations and is now angry with me because
he is not getting better. Furthermore,
although he has been told that he needs
to make an appointment prior to coming
to my office, he shows up repeatedly
without having done so. I have discussed
this situation with him more than once
and it has apparently done no good. I am
uncomfortable dealing with him!
Bryan: Rather than struggle with a noncompliant patient whose expectations
seem unreasonable, it is in your mutual
best interest to dismiss him from your
practice. It would seem to be difficult if
not impossible for you to fulfill your legal
and ethical duties to him if you are not
comfortable in your relationship with
him, especially if either or both of you
have already developed negative feelings
toward the other.
Madison: Bryan, I really don’t like dismissing a patient from my practice.
Bryan: Of course you don’t, but it is far
better to terminate a bad doctor-patient
relationship than to allow problems to
escalate. As you have mentioned, the
patient is already upset with you.
Madison: What do I need to do to dismiss this patient?
Bryan: You should send him a certified
letter, return receipt requested, as well
as a copy by regular U.S. mail, letting
him know that after 30 days you will no
longer be his physician. He should be
14 DERMATOLOGY WORLD // October 2013
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legally speaking continued
legal issues
advised to seek further care from another
board-certified dermatologist during this
time. Furthermore, let him know that you
are available to see him by appointment
during the next 30 days if he needs to see
you. This avoids the accusation that you
abandoned him. It is also wise to advise
him in the dismissal letter of the medical
consequences, if any, of failing to followup with another dermatologist.
Madison: What if he refuses to accept the
certified letter?
Bryan: Keep it as part of his medical record.
The fact he refused the letter is further
evidence of his non-compliance. You do
not need to open the letter if it is returned.
After all, you know exactly what’s in the
envelope since you sent it to him!
Madison: Do I have to give a complete
explanation for dismissing him?
Bryan: No. You do not have to review in explicit detail the events leading to your decision to dismiss him. The intent of a letter
dismissing the patient from your practice
is not to give him a reason to argue with
you, but rather to cleanly and legally terminate the relationship. A general statement
indicating that under the present circumstances you do not feel that it is in his best
interest for you to continue to provide his
medical care is usually sufficient.
You should also be aware that in a few
states the Board of Medicine has a form
letter available on the Internet that you
may use when dismissing a patient.
Madison: Should I give him the name of
another colleague?
Bryan: Absolutely not. It is better to refer
him to his primary care physician, the
county medical society, a local hospital,
or to a similar referral facility. You want
to make him responsible for selecting the
physician who will subsequently treat him.
Besides, do really want to send a patient
you are dismissing from your practice to a
specific colleague?
16 DERMATOLOGY WORLD // October 2013
Madison: Should I enclose a copy of his
medical records with the dismissal letter?
Bryan: This is usually not required by state
law. In my opinion, however, it is wise to
do so to eliminate the need for either the
patient or a subsequent treating physician to have to contact you to request the
same. When you enclose medical records
you should indicate in the dismissal letter
that you are doing so to facilitate his future
medical care.
Madison: What should I do if he needs to
see me in the next 30 days?
Bryan: He should be given an appointment just like any other patient. If he has a
true medical emergency you should either
attempt to see him immediately or refer
him to the emergency room. It is critical,
however, that if he comes to your office
you do not see him alone. Remember, this
is a patient who you are in the process of
formally dismissing from your practice.
He will most likely not be in a good mood
or regard you kindly, to say the least. Having your nurse or another person present
at all times you are with him will lessen
the likelihood that he will claim you said or
did something inappropriate.
Madison: What if he makes an appointment and comes to the office or calls to
discuss the reason I am dismissing him?
What should I do if he apologizes and
wants to continue being my patient?
Bryan: You do not want to end up debating
the patient. You should strive to end the
relationship cleanly. Emphasize that your
decision to dismiss him is in your mutual
best interest and is final. Although I am
aware that other attorneys may view this
situation differently, I strongly advise you
not to accept someone back into your
practice once you have sent a dismissal
letter. People in this situation are often
resentful, hostile, and may even be physically dangerous. If he feels that you have
done anything objectionable after you have
taken him back into your practice he may
not hesitate to complain to the Board of
Medicine, make defamatory comments
on the Internet concerning you or your
practice, or even consider filing a lawsuit
against you. After all, you are the one who,
from his point of view, had the audacity
to dismiss him from your practice. Why
would you allow such a situation to occur?
Madison: Bryan, I understand and will
take your advice. Thank you!
KEY POINTS
1. When dismissing a patient, send a
certified letter, return receipt requested, as well as a copy by U.S. mail,
advising that you will no longer be
providing his or her medical care 30
days after receipt of the letter.
2. Refer the patient to his or her primary
care physician, local hospital, or the
county medical society to locate another board-certified dermatologist.
3. Although not usually legally required,
consider enclosing a copy of the relevant medical records to facilitate the
patient’s subsequent medical care.
4. State the consequences, if any, of the
patient’s failure to follow-up with
another board-certified dermatologist.
5. Should you see the patient within
30 days of his or her receipt of the
dismissal letter, have your nurse or
someone else present in the room
with you to lessen the likelihood that
the patient can claim you said or did
something inappropriate.
If you have any suggestions for topics to
be discussed in this column, please e-mail
them to me at [email protected]. See the
February 2013 issue of Dermatology World
for disclaimers. dw
www.aad.org/dw
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technically speaking
BY MORRIS W. STEMP, CPA, MBA, CPHIMS
Health information
exchanges
HOW THEY WORK, HOW DERMATOLOGISTS CAN CONNECT
TO THEM AND START EXCHANGING INFORMATION WITH
OTHER PRACTICES/HOSPITALS
EVERY MONTH, DERMATOLOGY WORLD covers technology issues
in “Technically Speaking.” This month’s author, Morris W. Stemp,
is the CEO of Stemp Systems Group, a Health IT solutions
provider in New York City. Stemp earned the designation
of Certified Professional in Health care Information and
Management Systems (CPHIMS) in 2010, joining an elite group of
only 1,500 professionals worldwide to earn this certification.
18 DERMATOLOGY WORLD // October 2013
ne of the key objectives of the
government’s push for electronic health records (EHR) and
their meaningful use (MU) is to
facilitate the easy exchange of patient
medical records and health information. How much more effective and
less expensive might it be to care for an
emergency room patient if the hospital
could easily access the patient’s medical
records from his primary care provider
(PCP) and specialists? Would this sharing enable the hospital to more quickly
respond to the patient’s symptoms or
perform fewer tests? In an ambulatory
setting, could a specialist focus limited
appointment time caring for the patient
rather than taking a patient history,
recording allergies, and duplicating
tests that are already recorded inside the
EHR system of the patient’s PCP?
The government, in its push to
encourage doctors to start using health
information exchange (HIE), has
mandated as part of MU Stage 2 the
following requirements related to HIE.
Eligible providers (EP) must “(a) conduct one or more successful electronic
exchanges of a summary of care records
with a recipient using technology that
was designed by a different EHR developer than the sender’s, or (b) conduct
one or more successful tests with the
CMS-designated test EHR during the
EHR reporting period.”
(As of this writing, MU Stage 2 is
set to become effective on Jan. 1, 2014.
But there are various groups pushing
for a delay of its implementation.)
While on the topic of the electronic
exchange requirements in MU Stage
2, it is important to note that exchanging information with another EHR is
not the only electronic data exchange
requirement mandated under Stage 2.
These additional requirements include:
• Use secure and encrypted messaging to communicate with at least 5
percent of patients.
O
www.aad.org/dw
tech tips
•
Provide patients with the ability to
view, download, and transmit their
health information within four days
of a patient visit and encourage at
least 5 percent of patients to use this
ability.
• Provide a summary of care record
electronically to other providers to
whom patients are referred.
• Send electronic data to immunization, cancer, and other registries.
Finally, as an additional motivator,
in April 2013 the Department of Health
and Human Services started to consider
requiring electronic Health Information
Exchange (HIE) as a condition of participation in Medicare.
Naturally, eligible providers, including dermatologists, are anxious to
find out how they can take part in this
exchange, not only to meet all the new
government requirements but also to
simplify the exchange of information
with other providers, reduce medical
errors, minimize costs, and improve the
overall quality of patient care.
GETTING STARTED WITH HEALTH
INFORMATION EXCHANGE
HIE requirements can be satisfied by
exchanging data through a number of
exchange environments, including:
• Exchanges set up by specific EHR
vendors,
• Private exchanges set up between
providers and hospital groups, or
• Regional health exchanges set up by
a local or state government.
VENDOR EXCHANGE
Some vendors have integrated electronic
health information exchange directly
into their EHR software. eClinicalWorks (eCW), for example, has built a
peer-to-peer network called P2POpen
which allows secure communication
between providers in their P2POpen
network regardless of the EHR system
used. Users of eCW invite providers
into their network to collaborate with
them. Providers are located using a
master search list, and faxed or emailed
invitations can be sent to any provider
regardless of geographical location. If
that provider is not already on the P2P
network, the message invites him to
join and includes a link to the eCW
P2P Portal. According to eCW, “P2P
facilitates referrals, streamlines scheduling appointments for patients with the
other providers, and enables providers
to transmit patient records with attachments, including progress notes, lab results, medical summaries, and scanned
patient documents.”
PRIVATE EXCHANGE
A private HIE is coordinated by a health
care organization such as a hospital system or ACO, through private funding,
to connect constituents in the area and
align to its business goals. A provider
generally needs to be affiliated with the
organization to participate in the private
exchange, and in many cases, needs to
use the EHR designated by the hospital.
One example of a private HIE is the
eHealth Connection sponsored by the
Inspira Health Network in New Jersey.
Inspira Health Network is a community
health system comprised of three hospitals with more than 5,000 employees
and 800 affiliated physicians. According to Inspira’s website, the “eHealth
Connection is a network that links all
Inspira facilities and its physicians, allowing participating providers the ability
to exchange health information.” Inspira
further describes the function of the
HIE as follows: “HIE allows the sharing of your health information among
participating doctors’ offices, hospitals,
labs, radiology centers, and other health
care providers through secure, electronic means. The purpose is to provide
participating caregivers the most recent
health information available. This health
information may include lab test results,
radiology reports, medications, hospitalization summaries, allergies, and other
clinical information vital to your care.
Certain demographic information used
to identify the individual such as name,
date of birth, address, insurance may
also be shared.”
PUBLIC HIE
The government has loftier goals than
the limited vendor or hospital networks.
It seeks the exchange of information
between all providers across the nation.
To accomplish this public HIE, the
government has funded Regional Health
Information Organizations (RHIOs)
and charged them with establishing
HIEs for their designated regions
within their states. The ultimate goal
is a nationwide health information
network (NHIN) which plans to connect
all health care information providers,
including HIEs, health plans, providers,
and federal agencies through a national
health exchange. (I previously addressed
this topic in June 2012; see sidebar at
www.aad.org/dw/monthly/2012/june/
interoperability-of-ehr-with-other-practices-and-hospitals.)
To enable HIE and improve health
care in its region, a RHIO can enable
secure sharing of medical records in one
of two ways. In the centralized model,
the RHIO uploads and collects all the
medical records from all of its participants and stores this massive amount
of data on its own servers in its own
infrastructure. In the federated model,
the RHIO provides the infrastructure
to facilitate the access requested by one
provider to medical records stored in the
systems maintained by other providers
and supported on those other providers’
infrastructures. In this model, the HIE
does not collect, hold, or maintain any
medical records within the RHIO’s systems. There are pros and cons to each
of these methods in terms of privacy
concerns, costs, and speed of access.
DERMATOLOGY WORLD // October 2013
19
technically speaking continued
tech tips
RHIOs require patient consent before patient information may be shared.
Some RHIOs have an opt-in format
which requires that patients sign an
agreement to permit their information
to be shared. Others assume that patients give their consent unless a patient
specifically opts-out.
In order to participate in a RHIO, a
provider may be required to pay one or
more fees including a one-time integration fee, a one-time implementation/
setup fee, an annual fee for basic services, and an implementation and/or annual fee for optional premium services.
Some fees are based on the number of
providers and some are charged on a
per-practice basis. The actual fee may
be dependent on the size of a practice
or the type of health system or organization. In some cases, the fees may be
subsidized by a government agency or
possibly a hospital system. In order for
the provider to participate electronically
using his EHR, the EHR must be certified for MU Stage 2 which means that
the EHR has been tested to support the
interoperability standards required to
share data through an HIE.
In NYC, for one to five providers, the
fees can range as follows:
• Integration fees from zero to $500
per practice
• Implementation fees from zero to
$3,500 per practice
• Annual fee for basic services from
$240 per provider to $1,000 per
practice
• Premium services fees of $1,000 for
implementation plus $250 for annual support
Some of the services provided by an
HIE include:
• Patient record lookup to access the
patient’s medical data.
• Real-time notification of a patient’s
medical status or update to the patient’s provider sent through a secure
email or text message. For example,
20 DERMATOLOGY WORLD // October 2013
•
•
•
•
•
a provider can be alerted via a text
message that a patient was admitted
to the hospital.
Consent management.
Direct exchange (via secure email) of
medical records for a given patient:
o To a receiving physician upon
discharge from a hospital,
o To a specialist from a primary
doctor, and
o To a practice from a lab.
Analytics across multiple sources of
clinical and administrative data.
Quality reporting and public health
reporting.
Patient portal (for patients to access
their medical records as required by
MU).
HOW ONE HIE GETS SHARING DONE
To understand exactly how HIE works
within a RHIO, I spoke with Jason
Thaw, a senior account manager at
Healthix, a RHIO located in downstate
New York where I live and the largest RHIO in New York State. Healthix
connects over 250 hospitals, clinician
practices, nursing homes, radiology centers, diagnostic labs, and other providers
with information about more than seven
million patients.
When joining Healthix, providers
notify their EHR vendor so that the vendor can work with the HIE to develop
the interface and set up any additional
services requested by the provider.
Healthix offers a single sign-on which
works directly within the EHR system
and enables providers to access the
RHIO through a tab on their EHR.
Healthix services include patient
data search, consent management,
secure email, and real-time event
notifications. To search for patient data,
providers access the patient’s record and
then click on the Healthix tab to search
the HIE for other medical records associated with that patient. All data is
real-time and results typically display
within seconds. Therefore, as soon as
a lab result is available, even if the lab
test was not ordered by the provider,
Healthix can retrieve it, send an alert
notification to the provider, and display
the results the next time any provider
(with consent) queries this patient.
New York is an opt-in state. When
a patient goes to the doctor, she signs a
consent form allowing or denying that
doctor to view any of her medical records
from any other facility connected to the
RHIO. The consent does not relate to
sharing of the medical records, but to
who is permitted to access the records.
Healthix follows a federated model
and does not create a central repository of clinical information. Instead, it
routes encrypted electronic transactions
among participating institutions so that
they may exchange patient clinical data
which resides in systems behind the
firewalls of the acquiring organizations.
Healthix maintains a central registry
which identifies which patients have
information and where it can be found.
CONCLUSION
The function of HIE is to facilitate
secure and efficient sharing of patient
medical records between providers
caring for the same patient. The goal is
to reduce the cost of providing medical
care and improve the quality of patient
care by eliminating duplicate diagnostic
testing and making records available
when and where they are needed. But
the system can only work if all the
providers in a given community join
the system. Once MU Stage 2 takes
effect, more practices will join and, over
time, membership fees are expected to
drop. Start researching the HIE options
and services in your communities by
contacting the local regional extension
center. Within the next few years, HIE
participation will be a requirement. Now
is the time to get onboard to be ahead of
the curve. dw
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answers in practice
BY RACHNA CHAUDHARI
Preparing for
a meaningful
use audit
EACH MONTH DERMATOLOGY WORLD tackles issues “in Practice” for
dermatologists. This month Rachna Chaudhari, the Academy’s practice
management manager, offers tips on an area she commonly receives
questions about from members.
22 DERMATOLOGY WORLD // October 2013
ermatologists are entering a new
landscape of ever-increasing audits.
They are being hit with Recovery
Audit Contractor (RAC) audits for
their Medicare billings, HIPAA audits for
their protection of their medical records,
and numerous other audits affecting
their business practices. The Electronic
Health Record (EHR) Incentive Program
only adds to this mix of audits with the
recent implementation of meaningful
use audits. The Centers for Medicare
and Medicaid Services (CMS) has begun
pre- and post-payment audits on at least
5 percent of physicians attesting for
meaningful use, and the agency is legally
able to audit for up to six years after a
physician attests.
CMS has stated that all meaningful use audits are performed either by
random selection or based on anomalous
data, such as inconsistent denominators
for measures. Atlanta West Dermatology,
located in Georgia, was targeted at random for a meaningful use pre-payment
audit. Holley Garrett, CPM, CPC, CDC,
the practice’s administrator, was first
notified of the audit in April. “CMS notified our practice of the audit by sending
a formal audit letter from the law firm of
Figliozzi and Company to the email address we supplied when we attested for
meaningful use,” she said. (An example
of a formal audit letter is found at www.
cms.gov/Regulations-and-Guidance/
Legislation/EHRIncentivePrograms/
Downloads/SampleAuditLetter.pdf.) “If
the email address you entered during
attestation is not accurate, your practice
will not be notified by any other method
and CMS will automatically recoup the
meaningful use payment if no response
is given within three weeks. So it is important to ensure that the email address
you enter during attestation is one which
is regularly checked and doesn’t filter out
CMS emails,” she warned.
D
www.aad.org/dw
management insights
Once a practice is notified of an
impending audit, it is prudent to
assign a staff member to oversee the
process. CMS will require additional
documentation for each meaningful
use measure as well as supporting
documentation for each numerator
and denominator value. The auditor
will expect to receive the formal
meaningful use report generated
by the EHR system in addition
to screenshots validating specific
measures. Garrett noted that “the
screenshots must show the physician’s name, EHR vendor’s logo and/
or product name to verify certification, as well as a date stamp to show
the measure occurred during the
EHR reporting period.” Her practice
also had to send a letter from the
EHR vendor stating that the system
was certified for the full year during
which the meaningful use measures
were reported. CMS has posted guidance on additional documentation
and examples of screenshots at www.
cms.gov/Regulations-and-Guidance/
Legislation/EHRIncentivePrograms/
Downloads/EHR_SupportingDocumentation_Audits.pdf.
The auditing agency will expect
to receive all supporting documentation via a portal on its website or via
first class mail. It is the practice’s
responsibility to ensure the materials are in a readable format, and the
auditor does not give an expected
response time, according to Garrett. Her auditor did not respond
until one month after her initial
submission and the whole process
took almost four months before she
received notice that she had passed.
It took another 30 – 60 days for the
practice to actually receive payment.
She also had to send in additional
MAINTAINING AND DOCUMENTING COMPLIANCE
Take the following steps to insure you are remaining compliant with all
aspects of the meaningful use program.
• Obtain a letter from your EHR vendor stating which product you
have, the certification ID, and the dates it was installed in your office.
• Periodically check the email you provided during the attestation
process for any auditing communication.
• Print a copy of your meaningful use report along with the physician’s
name, EHR vendor product name, and date stamp. Review it for any
errors.
• Document non-percentage-based measures with screenshots
showing the action occurring along with a date stamp, physician’s
name, and EHR vendor logo.
• Document percentage-based measures with a report showing each
relevant numerator and denominator along with a date stamp,
physician’s name, and EHR vendor logo.
• Prepare a written explanation for each measure your physician is
excluded from along with a report showing a zero denominator if
applicable.
• Prepare copies of all relevant security risk analysis documents
including business associate agreements, policies, and procedures.
documentation when the auditor
requested more information on
specific measures. “It is important
to realize that the auditor is not
familiar with our way of practice.
Don’t assume they know more about
meaningful use than you,” she said.
She noted that her practice had to
send in additional letters from the
physician explaining why she was
claiming an exclusion for specific
measures, clarification of various
ICD-9 codes, and copies of all of the
practice’s HIPAA training materials as well as business associate
agreements to show the practice was
meeting the security risk analysis
measure. For additional help on
preparing documentation for a
meaningful use audit, your practice
can also contact your HIT regional
extension center at www.healthit.
gov/providers-professionals/regional-extension-centers-recs#listing.
Fortunately, Garrett’s practice
was successful in passing its audit;
however, it took a significant amount
of time and work for her to gather all
of the relevant documentation. She
advises that practices ensure that
they are backing up their attestation
with relevant documentation in the
form of screen shots or explanatory
statements and pay close attention
to the security risk analysis measure.
As the meaningful use program is
only expected to grow exponentially
over the next several years, these
types of audits will only increase and
cause further regulatory pressures
on practices. dw
DERMATOLOGY WORLD // October 2013
23
A Matter of
PERCEPTION
How dermatologists are viewed by other physicians — and what they can do about it
24 DERMATOLOGY WORLD // October 2013
www.aad.org/dw
BY JAN BOWERS, CONTRIBUTING WRITER
W
hat do other physicians think of dermatologists? Are their perceptions off the mark,
or is there a grain of truth there? And why should dermatologists care?
The AAD tackled the first question in 2011 when it commissioned a research firm to query
senior staff and elected physician leaders at 13 medical associations. The researchers
asked a broad range of open-ended questions touching on perceptions regarding different
aspects of how dermatologists practice (e.g., whether they treat serious conditions or
diseases), how they interact with colleagues, their contributions to patient care and
medical research, and whether they give back to society.
The results of the interviews revealed that dermatologists are perceived as valuable
colleagues who make significant contributions in the prevention and treatment of skin
cancer and controlling chronic disease. Among the negative perceptions, five key concerns
emerged: access to dermatologists is limited, both for hospital inpatient consults and
outpatient referrals; dermatologists are hesitant or unwilling to treat routine medical
conditions, favoring surgical cases; dermatologists are unwilling to accept insurance;
dermatologists are shifting their focus to cosmetic-related services; and, dermatologists
do not tend to be visible or engaged in their local communities and medical societies. >>
DERMATOLOGY WORLD // October 2013
25
A Matter of
PERCEPTION
The AAD convened an ad hoc task force
to address the perception issues raised by the
interviews and explore solutions that can be
undertaken by the Academy and by individual
dermatologists. Dermatologists’ reputation among
their colleagues matters a great deal, said the task
force chair, because the health care environment of
the future may likely include new models of team
care with primary care physicians as gatekeepers.
“If we as dermatologists are going to have the
opportunity to be a part of some of these new
medical care practices, it will be important for us
as a group and, more importantly, as individuals
to have a good reputation and respect within our
community,” said Lisa A. Garner, MD, vice president
of the AAD, clinical professor of dermatology at the
University of Texas Southwestern Medical School,
and chair of the task force. That sentiment was
echoed by task force member Brent R. Moody, MD,
a dermatologist in private practice in Nashville, who
noted that other physicians “may not understand
who we are and the value of what we do. It’s up to us
to stay engaged and show them. I’m concerned about
dermatologists being marginalized, and perhaps not
being afforded the opportunity to be integral players
in any future delivery models.”
HOSPITAL CONSULTS
Although all the task force members contacted
said they do inpatient consults, it nevertheless is
“a significant issue,” Dr. Garner said. “There are
certainly many areas, even some urban areas, where
there are hospitals that can’t get a dermatologist to
see an inpatient.”
One factor underlying some dermatologists’
reluctance to do inpatient consults is the logistical
barriers that can make it frustrating and timeconsuming. “It’s difficult now because every hospital
has its own EHR system, which you might not
be trained on,” said task force member Barbara
M. Mathes, MD, clinical associate professor of
dermatology at the Perelman School of Medicine at
the University of Pennsylvania. “Many institutions
require that you log in onsite every so often to
change your password; you can’t do it from an
outside computer. These are not intended to
be obstacles, but they are for a dermatologist
who goes to the hospital infrequently, and some
dermatologists think it’s just not worth the hassle.”
The task force is exploring ways to work with
organizations, such as the American Hospital
Association, that might encourage hospitals to make
it easier for consulting physicians to navigate the
STRATEGIES TO IMPROVE ACCESS TO THE
DERMATOLOGIST’S OFFICE
A key concern among dermatologists’ physician colleagues is the difficulty they face in getting their
patients in to see a dermatologist, particularly urgent or emergent cases. Two members of the AAD’s
ad hoc task force addressing the perceptions of dermatology by others in the house of medicine have
suggested steps that dermatologists can take now to alleviate the problem.
Suzanne M. Connolly, MD, emeritus professor of dermatology at Mayo Clinic in Scottsdale, Ariz., noted
that dermatologists can:
• Keep some slots open, preferably at the beginning or end of the morning and afternoon session.
Don’t fill them until 24 hours ahead, reserving one or two until eight hours ahead.
• If you know a staff shortage will be occurring, set aside a few slots in addition to those normally
reserved.
• For established patients who call in concerned about one “spot,” arrange to see these patients early
in the morning, before other patients.
• Utilize teledermatology within the institution to facilitate triaging patients who are more urgent.
• Group patients who share a condition (such as sore mouth or dermatitis) for general education
regarding the disorder and its management and workup. You will still need to see these patients
individually for history, exam, and finally summary session, but group education may free up some slots.
26 DERMATOLOGY WORLD // October 2013
www.aad.org/dw
EHR requirements, Dr. Garner said.
In the meantime, she maintained, “an individual
dermatologist can try to negotiate with their hospital.
They like to tell us that these things are set in stone,
but they’re often not.” In Nashville, “hospitals
understand the logistical problems, and they make
it really easy for me,” Dr. Moody said. “In general, if
dermatologists are willing to do consults, the medical
staff will appreciate that and accommodate their
needs.”
Another reason for not doing inpatient consults
is low reimbursement, Dr. Mathes said. Compound
this with logistical and inconvenience factors (few
dermatologists have offices in hospitals, making
it difficult to see consults during a short break in
one’s schedule), and the possibility that the patient’s
problem is not urgent and could be managed in
the office, she said, and one can understand why
dermatologists may not consider hospital consults a
priority.
ACCEPTING REFERRALS
Getting patients access to a dermatologist’s office “is
probably one of the biggest issues for other health
care providers when they think of dermatology,” Dr.
Mathes said. “There is a distribution issue. Some
parts of the country are underserved; even within
the same city, there are clusters of dermatologists
in some areas and few or no dermatologists in
other areas.” This is a challenge, she said, as is the
problem of large geographic areas that are wholly
without a dermatologist.
One approach to alleviating the problem is
educating primary care physicians to evaluate
dermatologic conditions “so that only patients who
really need the dermatologist to diagnose or manage
their care are referred to a dermatologist,” Dr. Mathes
said. “I teach dermatology at the annual meeting
of the American College of Physicians — I’ve been
doing it probably more than 20 years — and typically
it’s about very common skin conditions that they see,
ways they can manage those conditions appropriately,
and which are the critical conditions that must go to a
dermatologist.” With more appropriate referrals, she
said, “dermatologists are more likely to say, ‘I’m happy
to do that.’”
Teledermatology is another tool that
dermatologists can use to address both the inpatient
and outpatient sides of the access issue. “Penn
dermatologists pioneered a program (led by Dr.
Carrie Kovarik) using the Academy’s [AccessDerm]
program in areas of Philadelphia where no
Leonard J. Swinyer, MD, a dermatologist in private practice in Salt Lake City, described four different
types of “hold” appointments, noting that “whether or not we put any or all of these into an individual
provider’s schedule depends on how far out they are scheduling and how busy they are.”
• Emergency appointments are meant to be filled on the day of the appointment only, and are
reserved for patients who must be seen the same day. Generally, one is in the later morning and one
is in the afternoon; if they’re not filled by 9 a.m., they’re released for general scheduling.
• Consult appointments are given to patients whose physician offices call directly for appointments.
There is usually one per day on the schedule; they are released to general scheduling if they’re not
filled a week before the appointment date.
• “Hold” appointments are for the use of the front desk receptionists who are scheduling patients as
they leave. There are usually three or four on the schedules of the busiest providers; they allow the
provider to see a patient in two to three weeks when the regular schedule is four to six weeks out.
• Surgical appointments are 45- to 60-minute slots set aside for surgical procedures. The practice
normally blocks out one or two per day to ensure that excisions can be accommodated. If they’re not
filled a week before the appointment date, they are released for general scheduling.
DERMATOLOGY WORLD /// October 2
2013
013
27
A Matter of
PERCEPTION
dermatologists are on staff, and in community
health centers where it’s unlikely they’ll have
dermatologists seeing patients,” Dr. Mathes said.
“There are obstacles — issues related to state
regulations and compensation; I think there are
only a few states that allow you to bill patients for
doing medicine in this way. But I don’t think any
of the obstacles are insurmountable.” Indeed, the
Academy has appointed an ad hoc task force on
telemedicine to address these issues and the Board
approved a pilot project at its August meeting that
simple step of keeping the primary care physician
informed “increases the presence of dermatology,
which is always a benefit in building a practice; it
says you’re responsive and communicative, which is
only beneficial in terms of personal and professional
relationships; and I think it says that we want to be
part of the bigger house of medicine.”
CONFRONTING THE MYTHS
While access is clearly an issue that is broadly
recognized and already being addressed by
dermatology,
perceptions of
dermatologists
It will require all of dermatology
relating to insurance
to improve our perception.
and specialization in
It starts with the individual,
surgical procedures
or cosmetic
but then it has to grow.
treatment may
reflect a complex set
of circumstances that vary according to region. “The
will help demonstrate how teledermatology can
majority of dermatologists participate in Medicare,
increase dermatologists’ ability to provide inpatient
but we hear all the time that dermatologists
consultations.
don’t take Medicare,” Dr. Mathes said. “Rarely do
The task force on perception has been
physicians in any specialty get paid the amount
brainstorming strategies that very busy practices
billed to the insurer. If you’re in an area covered by
can use to enable dermatologists to accept more
insurers that pay notoriously low reimbursements,
referrals from other physicians, Dr. Garner said
you may not be participating with those insurers.
(see sidebar, p. 26). But one approach the task
And frankly, other docs in your community probably
force sees as “problematic” is that some practices
are not participating either.” Forging relationships
put emergency referral appointments on the
with primary care providers, and occasionally
schedules of nurse practitioners or physician
reducing or waiving the fee for their low-income
assistants without oversight or evaluation by the
patients in need of care, can go a long way toward
dermatologist, she noted. “When you’re referred
improving the misperception, Dr. Mathes said,
an emergency patient from another physician, we
adding that “we have to demonstrate, make the case,
believe it can appear to show indifference if the
that we are better than the myths about us.”
patient is put on the PA or NP schedule and not
The notion that dermatologists are hesitant
seen by the dermatologist,” Dr. Garner said. “The
or unwilling to treat non-surgical cases is another
referring physician might well say, ‘Hey, that’s not
misperception, Dr. Mathes said. “There certainly are
what I was asking for.’”
some non-Mohs dermatologic surgeons who only
When a dermatologist does see a referral,
want to excise or do other procedures, but I don’t
it’s not just best for the patient but also good
think that’s common. Now, if there are a limited
business and good manners to follow up with
number of derms in your community, and you refer
the referring physician, said several task force
all the [medical dermatology] cases to your PA, then
members. “One of our challenges is to make sure
the perception may be correct in that particular
we’re communicating,” said Julie Hodge, MD, a
case. But I don’t think that is universal across
solo practitioner and assistant clinical professor at
University of California – Irvine School of Medicine. dermatology.” On the other hand, Dr. Schlosser
noted, “the reimbursement system today favors
“Every time a patient tells me who their primary
procedural intervention, and that’s not unique to
care physician is, and certainly every time I treat a
dermatology. In the end, people do have to sustain a
referral, I send the primary or referring physician
living and make it viable for their staff.” In addition,
a note about what I’ve done,” Dr. Hodge added.
“in some areas they’re so busy fighting the epidemic
Bethanee J. Schlosser, MD, PhD, assistant professor
of skin cancer, it doesn’t leave a lot of room for other
of dermatology at Northwestern University’s
things. And the aging population is only going to
Feinberg School of Medicine and chair of the AAD’s
contribute to that further.”
Young Physicians Committee, insists that the
The Academy’s own practice survey data
28 DERMATOLOGY WORLD // October 2013
www.aad.org/dw
contradicts the stubborn myth of dermatologists’
focus on cosmetic treatment. In 2009 and 2012,
time spent on patient care broke down as 67 percent
medical, 25 percent non-cosmetic surgical, and
8 percent cosmetic. “One of our problems is the
only time you see dermatology ads, they’re all for
cosmetic procedures, and there’s often a medi-spa
associated with the practice and the advertisement,”
Dr. Garner said. “That’s what people see, so they
begin to believe that all dermatology practices
are only interested in cosmetic dermatology
patients. I’m not quite sure what to do about that
misperception.” Dr. Hodge said her own experience
reinforced that interpretation, and prompted her
to change her website. “I was surprised I was
perceived that way, because I do 70 percent medical
dermatology, and I always have,” she noted. “But
then I looked at the things I had done marketingwise, and it was in that [cosmetic] arena. I like to do
some [cosmetic procedures], but I also realize they
are important to the bottom line because they allow
me to do the other things and not worry about it.”
She doesn’t see a clear separation between medical
and cosmetic dermatology, she added, because
“anyone who has a skin problem has a cosmetic
problem. And I’ve always seen that as the case, and
I feel it’s my responsibility to take care of everybody.
I don’t have different slots for medical and cosmetic
patients or different waiting rooms. I try to address
the medical and cosmetic needs of all my patients. I
don’t want anyone to feel like a second class citizen.
Dermatologists are lucky to be in a position to
balance a mix of patient problems and procedures.
This is what I love about being a dermatologist.”
Dr. Mathes again emphasized the importance
of maintaining strong relationships within the
medical community: “We need to make clear to our
colleagues in medicine, as well as to the community,
that patients coming in for cosmetic medicine may
also be getting a dermatologic evaluation for other
things, particularly skin cancer. It’s an education
thing, but also a relationship issue.”
ENGAGEMENT THE KEY
The theme that underlies both the misperceptions
of dermatologists and the path to correcting them,
said the task force members, is engagement — with
the hospital staff, with individual primary care
physicians, with the community, and with local
and state medical societies. At the leadership level,
Dr. Garner said, the task force is “trying to interact
with larger national primary care organizations to
find out what they see as their greatest needs that
we could address. What does their leadership see
as a way to improve our interaction, how can we
do a better job at providing what their members
need from dermatology? We don’t really know what
that is.” Dr. Mathes emphasized the importance
of interaction among specialties, noting that
“everyone wants to hear dermatologists talk. We
should encourage our members to speak at local,
regional, and national meetings. But we should also
invite them into our house so that we have mutual
respect for each other. I think if this is done on the
leadership level, it will demonstrate the importance
and the commitment we have as a specialty society.”
One area of focus should be the hospital, Dr.
Moody said. “Part of our problem is our success
in treating patients in the outpatient setting,” he
explained. “This is wonderful for patients, and
cost-effective, but the downside is lack of visibility
in the hospitals. The dermatologist who is engaged
in some type of hospital activity, such as taking a
committee assignment, is helping to counteract
some of those negative perceptions people have of
us being disengaged or unavailable or uninterested.”
The Young Physicians Committee is actively
“trying to encourage broader participation by
dermatologists in the house of medicine,” Dr.
Schlosser said. “Sitting on various hospital
committees, participating not just in state and
local dermatology societies but also state and
county medical societies. By doing that you are
automatically saying that dermatology cares about
more than just itself. And, from a self-preservation
standpoint, if we’re not sitting at the table, we
will not have a voice in decisions about licensure
requirements, certification, scope of practice
issues — people will be making those decisions
for us.” The youngest member of the task force,
Karolyn Wanat, MD, who recently completed a
dermatopathology fellowship at the University
of Pennsylvania and joined the faculty at the
University of Iowa as a clinical assistant professor,
remarked that “creating a culture” of engagement
among dermatology residents involves promoting
volunteerism and activism, and “establishing
relationships with primary care physicians in the
area so that they can help get patients in when they
need to. It will require all of dermatology to help
improve that perception. I think it starts with the
individual, but then it has to continue to grow so
that others are aware of what we can accomplish
together as dermatologists.” dw
DERMATOLOGY WORLD // October 2013
29
MOVING UP,
MOVING OUT
Dermatologists detail the moving process,
from cross-town to cross-country
30 DERMATOLOGY WORLD // October 2013
www.aad.org/dw
BY JOHN CARRUTHERS, ASSISTANT EDITOR
T
he process of moving a practice, whether it’s down
the road or to a different time zone, brings with it
opportunities and challenges which can run down
even the most enthusiastic practice owner. By planning well
in advance, gleaning the lessons of colleagues’ experiences,
and resolving to make oneself adaptable, practitioners can
greatly ease one of the more intimidating events of one’s
medical career.
THE ‘LIGHTNING BOLT’ MOMENT
For every dermatologist who moves their practice, there’s
an identifiable moment where the “should I?” of moving
becomes “how do I?” according to dermatologist Neal
Bhatia, MD, who in 2010 left his Milwaukee practice for
private practice in California and a position as interim
program director of the division of dermatology at Harbor
UCLA Medical Center. >>
DERMATOLOGY WORLD // October 2013
31
MOVING UP,
MOVING OUT
“For me, there were a number of personal factors
that went into the move, as well as the fact that a group
of physicians I was affiliated with was sold to a hospital
system, which can be a disaster for a dermatologist,” he
said. “Between that and wanting to move closer to family, I
made the decision fairly quickly. The minute you make that
decision, it’s important to start making preparations. In my
case, it was six months in advance.”
Other physicians are driven to relocate because of
expiring contracts or leases, or economic conditions
that make staying in place untenable. Fort Smith, Ark.,
dermatologist Sandy Johnson, MD, found that her office was
becoming too small for the growing practice.
“Before our move, we were renting, and we had the
ability to purchase and grow,” Dr. Johnson said. “Our first
plan was to purchase the clinic that we had been renting,
but it turned out not to be a viable option. So that original
plan was replaced by almost three years of looking for land,
drawing up and modifying plans, and then carrying out the
12-month construction process.”
MANAGING THE LOGISTICS
As a physician with responsibilities to one’s patients,
the moving process can be somewhat complicated. For
Washington, D.C., dermatologist Andrew Lazar, MD, who
has moved from practicing in Illinois to California to his
new D.C. home since 2010, the very first step each time was
a call to set in motion the process of becoming licensed in
the new state.
“The moment you know where you’re going, you need
to start the process as soon as you can, because it takes
a long time to get a license,” Dr. Lazar said. “The sooner
you get things started, the sooner you can be working. No
matter what, get that process started as soon as you make a
commitment as to where you’re going to go.”
To ease the process, Dr. Lazar recommends employing
a service that will handle the paperwork and red tape of
licensure. The cost involved, he said, is offset by the lack of
bureaucratic headaches.
“There are a number of organizations that will actually
do the busywork for you. They charge you about $600
per license to do the work. It’s not a small amount, but at
the same time, I’m not calling the registrar of the medical
school to make sure a form was sent or calling the head of
residency to make sure it’s sent on the right stationery,”
Dr. Lazar said. “During the last move, I was told by the
person who is working on my applications that one of these
licensing agencies has requested copies of where I trained
and did my residency four different times. It was sent four
times through the service, but they didn’t have a record of
receiving it. It was worthwhile for me not to have to deal
with that.”
In addition, Dr. Bhatia recommends that young
physicians in residency look ahead to future licensing
situations, obtaining licenses for their states of training
and home states, in addition to where they plan to practice
initially.
“The best advice that I can give anyone in residency is to
get the license of the two states that you think you may move
32 DERMATOLOGY WORLD // October 2013
LEAVE A NOTE
The list of parties that must be notified of a practice
move, even a short move, is quite substantial. Before the
boxes are on their way to the new office, be sure to tell:
Patients
Referral colleagues
Contractors and vendors
(janitorial, biohazard pickup,
information technology)
Medicare and other insurers
State medical board
Medical associations,
including the AAD
The U.S. Postal Service
to in your lifetime,” Dr. Bhatia said. “Even if you don’t keep
them up, you can re-enroll when you move there because
you already have your foot in the door. I was able to get set
up in California much more quickly this way because I’d
applied for a license there during residency.”
After licensure is dealt with, there remains the issue
of malpractice tail insurance. Typically, insurers will
offer either a one-time payment option or a slightly more
expensive multi-year pay period. Academic institutions, Dr.
Lazar said, will sometimes cover the insurance themselves,
depending on the length of one’s employment. Large
groups, he said, can also be persuaded to cover the payment
as part of their expenses.
“Doctors never think about the fact that you can negotiate
give and take between a group or institution. There’s a lot
of give and take depending on the size of the organization
you’re dealing with,” Dr. Lazar said. “Most of us aren’t used
www.aad.org/dw
to that. We don’t think about the business aspects of it, and
it’s important to realize it.”
Enrolled Medicare providers must also report changes
in address to their contractor to ensure the least possible
disruption in payment. While earlier is better, according
to Dr. Lazar, under the law, one must report the move
within 90 days. Whether a doctor is moving or becoming a
Medicare provider for the first time, he or she should visit
www.cms.gov/MedicareProviderSupEnroll to learn about the
requirements and/or update his or her entry in Medicare’s
Provider Enrollment, Chain and Ownership System
(PECOS).
If one is splitting a dermatology practice from a group,
Dr. Bhatia said, it’s important to address the accounts
receivable situation as quickly as possible. The nature of the
split, he said, often dictates the financial arrangement.
“Some groups will offer you either sustained payoffs over
time or you can take an immediate lesser buyout, as you
would from the lottery, rather than the long-term payout of
what is truly owed you,” Dr. Bhatia said. “If it’s an amicable
split, a lot of people will take the longer payout. If not, most
people will take the immediate buyout. There’s an upside
and a downside to both, depending on your situation.”
GETTING THE WORD OUT AND STARTING ANEW
The process of informing and transitioning patients, Dr.
Bhatia said, is a multi-step one. Once he had informed his
affiliated physician group (90 days before he intended to
move), Dr. Bhatia began to plan for his patients’ futures,
taking on fewer and fewer new patients and beginning to
send follow-up cases to colleagues in the area.
“As 90 days turns into 60 days, you’re starting to make
patients aware that you’re going to be gone or that you’re
going to be seeing them for the last time, which can be very
sentimental,” he said. “From there, you’re also making sure
that those patients with melanoma or high-risk therapies are
getting their future care addressed sooner rather than later.
You don’t want them falling through the cracks.”
Depending on the state that one is leaving, there are a
number of varying responsibilities upon the physician to
ensure they have done their best to notify patients.
“When I was in Illinois, I talked to the state medical
society and found out what the legal obligations were
to close your practice. There, you had to post a notice in
the newspaper a certain amount of time in advance,” Dr.
Lazar said. “In dermatology, you don’t have many true
emergencies. In the case that you do, whoever took over the
practice or who you referred the patient to would get the
phone call.”
Some physicians make efforts to notify each patient
individually, but according to Dr. Lazar, doing so can incur
substantial cost.
“In dermatology you might have 40,000 active charts
in your practice. To try to contact all of those people is an
exceptionally difficult and exceptionally expensive process.
It’s going to cost you about a dollar per contact.”
Instead, Dr. Lazar posted the legal notice in the paper,
then made arrangements with the physicians taking over
his two practices to take over the phone numbers of the
practice and notify each patient as they called. The charts
remained where they were, he said, which greatly improved
the continuity of care.
Even for cross-town moves, Dr. Johnson said, a select
number of patients may miss all the signs and notifications.
“We’ve been in our new location for two-and-a-half
years. When we moved, we took out ads in the paper,
bought a billboard near the old location for a few months,
mailed notices, and sent out messages with our automated
messaging machine,” she said. “We still have patients going
to the old location. It’s important to promote the move not
only months ahead, but for some time afterward.”
In addition to patients, Dr. Johnson said, insurers may
require more than one notification, or at least a follow-up
to make sure that the payment transfer proceeds smoothly.
More than one payer, she said, had trouble with the change
of address that resulted in a two-month delay in payment.
Contract language may prevent some physicians from
informing the patients about anything but the fact that
they’re moving. Birmingham, Ala., dermatologist Elizabeth
Martin, MD, negotiated with the clinic system she was
leaving — for a location literally across the street — on
the method she would use to notify patients of her move.
Eventually, she sent each patient a postcard with a map of
the new location in relation to the old one.
“While they weren’t too happy about me leaving, it was
a fairly amicable breakup,” Dr. Martin said. “We agreed
mutually upon the wording on the card.”
Some physicians have an even more difficult time. In
a recent Leadership Institute session she was leading at
the Summer Academy Meeting in New York, Dr. Martin
answered an attendee’s inquiries about notifying patients
of his impending move under the strictest of contractual
tethers. The dermatologist, she said, was allowed to tell
patients he was moving, but nothing more than that.
“That’s a difficult situation for a dermatologist, not being
allowed to contact any patients,” Dr. Martin said. “We got a
discussion going, and the general recommendations were to
make sure his information was up to date and easy to find
via Google, and tell patients that they could search for him
after the move.”
Even if one leaves the practice in another dermatologist’s
hands, Dr. Bhatia said, it’s typically good business to make
oneself available for the new practice owner and patients for
a short period of time following the move.
“You want to maintain as much good faith as you can so
that you can leave on a positive note,” he said. “Ultimately,
you want to leave a good legacy.” dw
GETTING UP TO DATE
Moving your practice? Update your information with the
Academy at www.aad.org/Account/Profile, or through
the Member Resource Center at (866) 503-7546.
DERMATOLOGY WORLD // October 2013
33
Dermatologists on the front line
in
detecting venous disease
34 DERMATOLOGY WORLD // October 2013
www.aad.org/dw
BY DIANE DONOFRIO ANGELUCCI, CONTRIBUTING WRITER
A
ccording to the Vascular Disease Foundation, six million
people in the United States have skin changes associated
with chronic venous insufficiency.
Although venous disease is often addressed by a range of medical
specialists, because of these skin changes, dermatologists are
often on the front line in detecting this condition.
Elevated blood pressure in the superficial venous system that
occurs during walking, which results from a clot or other venous
system destruction with valve breakdown, can result in leaky
veins, said David Margolis, MD, professor of dermatology and
epidemiology at the University of Pennsylvania. Therefore,
varicose veins, edema, dermatitis, ulcers, and blood staining of
the skin can occur.
“Dermatologists are often trained to take care of wounds so they
understand the concepts of good wound care, sometimes better
than others,” Dr. Margolis said. However, an integrated approach
— drawing on the expertise of vascular surgeons, podiatrists, and
other specialists — remains important.>>
DERMATOLOGY WORLD // October 2013
35
Dermatologists on the front line
in
detecting venous disease
DIAGNOSING VENOUS DISEASE
WEIGHING TREATMENT OPTIONS
A careful patient history and examination reveal critical
details. Often surfacing in women in their 40s and men
in their 60s and 70s, venous insufficiency occurs more
commonly in the Western world. Risk factors include
family history, a history of deep vein thrombosis, obesity,
and multiple pregnancies, among others. Those required
to stand for lengthy periods at work may also be more
prone to this condition if they are predisposed.
“We do more full-skin exams than any other specialty,”
said Girish (Gilly) Munavalli, MD, MHS, medical
director of Dermatology, Laser, and Vein Specialists of
the Carolinas, PLLC, in Charlotte, N.C., and assistant
professor in the Wake Forest University department of
dermatology, giving dermatologists a unique opportunity
to evaluate the vascular status of their patients.
On physical examination, clinicians should search
for signs such as bulging veins, stasis dermatitis, skin
breakdown, and swelling. “Anything that you see should
prompt you to just to ask a couple of simple questions,
like, ‘Do you have a family history of varicose veins?’ or
‘Do your legs bother you? Are they achy?’” Dr. Munavalli
said.
When spider veins appear on the calf, it’s important to
examine the back of the patient’s legs. “If you don’t look at
the back of the knee or thighs, you’re not going to realize
that they have a varicose vein there that’s contributing to
the spider veins lower down,” said Margaret Weiss, MD,
of the Maryland Laser, Skin, and Vein Institute in Hunt
Valley, Md.
“When groups of spider veins and associated blue
veins are on the medial side of the leg, there’s a high
probability, probably 80 to 90 percent chance, that they’re
coming from a leak in the great saphenous vein,” said
Robert Weiss, MD, director of the Maryland Laser, Skin,
and Vein Institute. However, he continued, if they’re on
the lateral part of the leg, they can usually be attributed to
the lateral subdermal venous system.
Diabetes, hypertension, and other conditions can
mask the signs of venous disease in the lower legs,
Dr. Munavalli said, because they cause lower leg skin
changes and potentially leg swelling. Lymphedema can
demonstrate similar characteristics, such as edema, skin
changes, heaviness, and pain, he explained. “Venous
disease onset is insidious and can also manifest with
episodic swelling of the legs and stasis dermatitis around
the areas of bulging veins,” he said.
Duplex ultrasound is an essential tool in diagnosis.
“Most dermatologists don’t have this tool in their offices,
so you really need to develop a referral relationship with
a vein center or another colleague who does a lot of
superficial venous ultrasounds,” Dr. Munavalli said, such
as a vascular surgeon. Duplex ultrasound “is non-invasive,
quick, and gives information on abnormal flow in the
veins,” he said. It can also measure the abnormally large
veins that result from longstanding distension.
A decade ago, patients with vein damage often needed vein
stripping; however, outpatient treatments have emerged
that reduce the need for more invasive procedures.
Dr. Robert Weiss and Mitchel Goldman, MD, were
key developers of endovenous ablation technology, which
destroys the vein so it eventually will become reabsorbed.
“That really revolutionized the treatment of leg veins,
and because so many people now have access to that, we
predict that the number of people with leg ulcers from
chronic venous insufficiency is going to go way down and
it’s actually going to reduce our health care costs,” Dr.
Robert Weiss said. He explained that patients often delayed
seeking the stripping procedure, but endovenous ablation,
using diode or Nd-YAG lasers, is performed with a single
puncture.
Major leg veins with leaky valves typically are treated with
endovenous ablation (laser or radiofrequency), Dr. Margaret
Weiss explained. “After that major leakage is shut down, then
one can generally treat remaining varicose veins either with
sclerotherapy or sometimes with ambulatory phlebectomy,”
she said. “Many times telangiectasias don’t have significant
underlying reflux and they can either most commonly get
treated with sclerotherapy or they can be treated sometimes
with lasers.”
Another advance in the treatment of abnormal veins,
the sclerosant polidocanol (Asclera), was cleared by the
U.S. Food and Drug Administration in 2010 to treat spider
veins and small varicose veins. “Now that it’s available, it
actually is a great benefit to patients,” Dr. Robert Weiss
said — physicians who previously used polidocanol had to
obtain it from compounding pharmacies, but today they
can use a true pharmaceutical grade version. Peterson and
colleagues reported a study comparing polidocanol and
hypertonic saline sclerotherapy in the August 2012 issue
of Dermatologic Surgery. In this study (funded by Merz
Aesthetics, which distributes Asclera in the U.S.), both
agents were effective, but patients experienced less pain
with the new formulation.
“Foam sclerotherapy has been a big advance,” Dr.
Robert Weiss added. (Injecting the sclerosant as foam
rather than a liquid allows it to make contact with a higher
percentage of the inside of the vein.) However, he noted,
the FDA differentiates between injecting a sclerosant as a
liquid or a foam, so foam treatment is currently off label.
“What [foam] allows you to do is to treat more precisely
because you can see where the foam displaces the blood,”
he said. “You can do it just as far as you want and then
stop. The other big advantage is that, because these are all
microbubbles, on the surface of each microbubble you have
the full concentration of the solution without being diluted
by blood, so it makes it a more effective sclerosing agent
and more precise.”
New sclerosants are working their way through the
pipeline, according to Dr. Munavalli, who directed a forum
on treatment of varicose and telangiectatic veins at the
36 DERMATOLOGY WORLD // October 2013
www.aad.org/dw
American Academy of Dermatology’s 2013 Annual Meeting.
“Some of the things coming down the line are new, more
potent sclerotherapy agents that are better able to destroy
the vein without spreading outside of that area,” he said.
TREATMENT SIDE EFFECTS
Major adverse events from sclerotherapy are solution
dependent, Dr. Robert Weiss said. “You can get a little skin
breakdown or ulceration where the solution was injected.
It’s highly unlikely, though, with the newer solutions,”
he said. Because he believes hypertonic saline carries the
highest risk of skin breakdown, he tends to avoid it.
For patients with widespread networks of problem
veins, Dr. Margaret Weiss encourages testing with varying
concentrations of solutions and foam vs. non-foaming
agents to determine whether a patient is susceptible to
hyperpigmentation or matting.
“Matching the concentration of the sclerosing solution
to the size of the vessel is really important,” Dr. Margaret
Weiss said. “In other words, you want to use the minimum
concentration of sclerosant for a particular size vessel and
then have the patient wear compression stockings after
the treatment for anywhere from one to three weeks.”
Post-treatment compression helps reduce the risk of
hyperpigmentation. Meticulous attention to technique
is also essential so the solution does not leak into the
surrounding skin, resulting in ulceration, she explained.
Dr. Margaret Weiss also advised using the smallest
amount of solution needed. “The risk of a deep blood clot is
fortunately extremely low with sclerotherapy and using the
appropriate amount of solution and compression stockings,
having the patients…ambulatory after their treatment, that’s
helpful in reducing that risk,” she said.
FACILITATING WOUND HEALING
Venous disease can lead to ulcers. Because it is not the
only cause, though, clinicians should start the woundhealing process by ruling out other potential causes of
ulceration. “Sometimes there are mimickers of venous
ulcers; anything from cancer to inflammatory conditions
can sometimes look like a venous ulcer,” said Robert S.
Kirsner, MD, PhD, professor, vice chairman, and Stiefel
Laboratories Chair in the department of dermatology
and cutaneous surgery, and chief of dermatology at the
University of Miami Hospital School of Medicine.
In addition to performing a physical examination and
vascular or arterial studies, clinicians may also perform
biopsies to exclude other wound causes if a wound is not
improving.
Primary wound dressings usually help keep the
wounds moist, and some ulcers may need debridement —
especially when chronic ulcers have devitalized tissue, Dr.
Margolis said.
Dr. Kirsner explained that compression wraps are the
mainstay of treatment for venous ulcers. “The problem is
that it is a difficult treatment for patients because they are
meant to be left on so it does affect their lifestyle,” he said.
To achieve optimal results with compression wraps, it’s
important to choose the correct wrap and ensure it will not
create problems; for example, if elastic full-strength wraps
are used in patients with inadequate arterial flow, skin
necrosis could occur, Dr. Kirsner said.
Two types of compression wraps exist: inelastic and
elastic. Inelastic wraps harden, providing compression
when the patient walks, whereas elastic wraps constantly
squeeze the leg. “So typically elastic compression is better
than inelastic compression, and systematic reviews have
confirmed that multilayered compression bandages are
better than a single layer of compression,” Dr. Kirsner
said.
“For the average-sized wound (<10 cm2), about a 30 to
40 percent size reduction in a month is a good indicator
of whether or not the wound is going to have a chance
to go on to heal,” Dr. Kirsner continued. If the wound
hasn’t reduced in size by one month of treatment, the
clinician should consider adding one of several available
adjunctive therapies that have been successfully used with
compression wraps to speed healing. “There have been
studies with aspirin and with pentoxifylline given orally
that will speed the healing of venous ulcers when used with
compression wraps,” Dr. Kirsner said. Jull and colleagues
reported on pentoxifylline in treating venous ulcers in
the 2012 Cochrane Database of Systematic Reviews. “There
are also biologic and synthetic extracellular matrices or
acellular constructs that have been shown in studies to
speed the healing,” Dr. Kirsner said. Kelechi and colleagues
investigated the use of a poly-N-acetyl glucosamine
nanofiber-derived wound-healing technology in a pilot
study reported in the June 2012 issue of the Journal of
the American Academy of Dermatology, and Mostow and
colleagues reported on a biomaterial derived from porcine
small-intestine submucosa in the May 2005 issue of
the Journal of Vascular Surgery. In addition, Dr. Kirsner
explained, bilayered engineered cellular constructs grown
in the laboratory have level 1 evidence to support their use.
REDUCING VENOUS ULCERS
Dr. Margaret Weiss hopes venous ulcers eventually become
a thing of the past. If venous insufficiency is treated
before changes such as dermatitis, chronic edema, and
skin breakdown occur, clinicians can help prevent these
consequences, “so they wouldn’t get a wound that needed
to heal,” she said.
Editor’s note: Dr. Margaret Weiss has no financial interests
related to her comments. Dr. Kirsner is a consultant for 3M,
Healthpoint Biotherapeutics, and Organogenesis. Dr. Margolis
has served as a consultant for Healthpoint Biotherapeutics,
Organogenesis, and Shire Regenerative Medicine; he also has
served on an advisory board for Celleration. Dr. Munavalli
has been an investigator for BTG (makers of Varisolve) and
CoolTouch, a laser used to perform endovenous ablation, and
is medical director of Merz Aesthetics, which produces Asclera.
Dr. Robert Weiss previously served as a speaker for Merz
Aesthetics. dw
DERMATOLOGY WORLD // October 2013
37
from the president
BY DIRK ELSTON, MD
Volunteerism
can improve
perspectives
t’s an interesting time to be a dermatologist. In the last few months you’ve
heard a lot, from me and from others, that may alarm you — and if you
haven’t, I encourage you to get online and read about some of the pressing issues that face our specialty. Member to Member, our official biweekly
e-newsletter, is running a series about them; check it out every other Friday
and online at www.aad.org/members/publications/member-to-member. You’ve
also been reading about these issues in Dermatology World; last month’s cover
story (available online at www.aad.org/dw/monthly/2013/september/shiftingsands, if you missed it) explored the changing reimbursement landscape,
while this month’s addresses concerns about how our profession is perceived
by our colleagues in medicine. More about that in a moment.
First, though, think about why you chose to become a dermatologist. Was
it so you could obsess about how much Medicare would pay for a particular
procedure? Was it so you could become expert at medication preauthorization?
Or did you, like me, become a physician to make a difference in people’s lives?
As dermatologists, we have the daily satisfactions of providing immediate relief
to patients, of being able to deliver results they can see and appreciate, and each
melanoma identified early is a life saved.
We make a difference each day when we go to work, whether we’re advising
a patient with refractory urticaria, excising a skin cancer, identifying a contact
allergen, or diagnosing melanoma on a biopsy slide. But it’s easy to get so
caught up in the headaches of running a practice that we forget how important
our day-to-day work is to each patient. Step back for just a moment and examine how many lives you impact each day. It’s a good feeling. Practicing efficient,
cost-effective medicine can help preserve patient access to our specialty at a
time when every specialty has to prove its value.
There are other ways of making a difference that also reinforce our identity
as physicians and healers — small acts of kindness that can have a huge impact.
Helping to guide a patient with limited resources toward the most cost-effective
treatment may determine what they can afford to eat for the next month. Tak-
I
38 DERMATOLOGY WORLD // October 2013
ing a moment to listen and allay the fear and
anxiety that surrounds a cancer diagnosis. Expressing empathy for the stress of a child with
refractory eczema who can’t sleep at night.
People who take advantage of the many small
opportunities to impact people’s lives are happier at work; and those who are happy at work
are more highly regarded by their patients. It’s
an upward spiral.
Volunteerism is another great way to make
a difference in the community. Whether it is
medical work, Camp Discovery, or coaching
little league, volunteering makes a difference
in your own life as well as the lives of those
you help. One of my greatest joys is volunteer
teaching, and acting as a volunteer attending.
In addition to providing care to an underserved population, it helps me connect to a
new generation of physicians full of eagerness
and excitement about dermatology. Their enthusiasm rubs off. Finding a meaningful way
to contribute gives one a better perspective on
what it all means. Many volunteer activities
provide an opportunity to reconnect with
old friends while accomplishing something
worthwhile. It energizes you and the positive
energy filters back into your own practice. But
don’t take my word for it. I invited some of our
colleagues to explain why they volunteer; see
what they said on the next page.
Returning to the perception question
addressed on this month’s cover: When we
engage in activities that nourish our souls, we
radiate a more positive image to our patients,
our colleagues, and our families. Our good
works don’t just change our perspectives —
they can also help change the perspectives
of those around us. In a time when those
perspectives matter more and more, that is no
small added bonus.
Wondering how to get started, or looking
for something new? The Academy has plenty
of options for you; visit www.aad.org/members/volunteer-and-mentor-opportunities to
learn more.
www.aad.org/dw
academy perspective
WHY DO DERMATOLOGISTS VOLUNTEER?
“Volunteering at Camp Discovery vaccinates me. It reminds me that patients with skin diseases are real suffering people. It
renews my commitment to really care about my patients and try harder to really help them.”
“It’s easy to give money, but it’s more rewarding to me to give time and love.”
– Mark Dahl, MD
“The Academy’s teledermatology program, AccessDerm, is a convenient and rewarding way to serve America’s vulnerable
citizens.”
–William James, MD
“Volunteering my time to run the dermatology service in Botswana has been one of the most rewarding aspects of my
career. Not only do I get to provide care to a population with great need, but I also mentor young residents in their rotation
there through the AAD Resident International Grant. The participating residents often describe this rotation as an incredibly
enriching experience that has a profound effect on their dermatology careers and lives in general. It is my hope that I am able
to even slightly influence this next generation to continue and expand a culture of volunteerism within our specialty.”
– Carrie Kovarik, MD
“Camp Discovery offers physician volunteers many ways to interact with and influence the lives of children with chronic skin
disorders. In addition to helping with the campers’ medical needs, dermatologists have helped with arts and crafts activities,
led bike hikes, taught harmonica lessons, or simply served as a friend and surrogate parent. The rewards of service are
countless and most of us have found our own lives to be enriched far more than we can ever hope to give back to camp.”
– Howard Pride, MD
“For me volunteerism is a natural part of medical practice and something that gives one great satisfaction...I feel very blessed
that I am able to do so and help communities with the training I have been lucky to receive as a dermatologist. Another great
part about volunteering is getting medical students, residents, and fellow colleagues involved to serve and get involved with
community service.”
– Aisha Sethi, MD
“Dermatologists and other physicians are some of the most fortunate people in the world. It is a privilege and honor to do the
work we do. I think giving something back is a duty we all have.”
– Paul Storrs, MD
“I have volunteered at Camp Discovery for 14 years. It has definitely made me a better pediatric dermatologist. Having
performed daily skin care on children with severe ichthyoses, atopic dermatitis, and epidermolysis bullosa, I have practical
skills that you do not get from seeing patients in clinic. But what the experience best provides is an insight and empathy into
what the daily lives of these children are like, their struggles with pain and the amount of time involved to care for their skin.
But the best part is seeing the joy and happiness of the kids, just being kids. It is the smiles, laughter, and giggles that make
Camp such a special place.
I have volunteered internationally as well, having been to Tanzania at the Regional Dermatology Training Center and also
in Iquitos, Peru with Penn State’s Global Health Scholars Program. It is a completely different experience than Camp.
Volunteering abroad is a means of giving back and to see the world beyond the walls of an academic medical center. I am
extremely blessed to live in a resource rich country with excellent training. Teaching abroad, seeing and helping patients with
the greatest need with limited resources, is a grounding and humbling experience.”
– Andrea Zaenglein, MD dw
DERMATOLOGY WORLD // October 2013
39
academy update
AAD, AADA Boards adopt
position statements, set
priorities at August meeting
he Board of Directors of the American Academy of Dermatology Association adopted a new position statement at its Aug. 3 meeting
that positions the organization as “proactive in addressing the physician shortage in this country.” The statement, on graduate medical
education, calls for Congress to “remove the freeze on Medicare-supported residency positions that has been in effect since 1997” and
for an increase in slots of 15 percent overall, with half of the new residency slots allocated to specialty training, including dermatology. The
AADA Board also approved revisions to its position statement on generic therapeutic and biosimilar substitution that call for adverse event
tracking for generics and biosimilars as well as notification to the physician prior to dispensing. Both position statements are available
online at www.aad.org/Forms/Policies/ps.aspx.
The American Academy of Dermatology Board approved the creation of a new Professionalism Award, to be awarded as-warranted,
that will be “presented to a medical professional or organization in recognition of the recipient’s exemplifying the highest standards of professionalism over a career or substantial period of time.” Details about the award and how to submit a nomination will be available at www.
aad.org/members/awards-grants-scholarships.
The AAD Board also approved the use of rotating taglines on AAD.org. In addition to the Academy’s “Excellence in Dermatology”
tagline, visitors to the website will see taglines referring to excellence in areas including medical dermatology, dermatologic surgery, and
dermatopathology, and each area will be highlighted on the home page slideshow.
The Board also approved a pilot project to demonstrate the value of teledermatology in improving the ability of dermatologists to provide inpatient consultations for patients with dermatologic complaints. More information will be available as the project is developed and
rolled out. – RICHARD NELSON
T
Harold O. Perry, MD,
former AAD president, mourned
Nominations sought for
Master Dermatologist Award
HAROLD O. PERRY, MD, who served as AAD president in
1981 and as vice president in 1976, died on Aug. 9. He was 91
years old.
Dr. Perry completed his medical degree at the University
of Minnesota in 1946, then served in the U.S. Naval Medical Corps from 1947 to 1949. He completed his dermatology
residency at the Mayo Clinic in Rochester, Minn., in 1952, and
later served there as professor of dermatology and chairman
of the medical school’s department of dermatology.
In addition to serving as president of the AAD, Dr. Perry
was president of the Minnesota Dermatological Society in
1965, the Noah Worcester Dermatological Society in 1967-68,
the American Dermatological Association in 1990, and the
American Board of Dermatology in 1990.
Dr. Perry was named an Honorary Member of the Academy in 1984. The next year he was chosen as a recipient of
the Academy’s Master of Dermatology award. In 1998 he received the organization’s highest honor, the Gold Medal. The
Academy’s Board unanimously approved the acquisition of its
first headquarters in 1981, a decision Dr. Perry later called his
greatest achievement as president. – RICHARD NELSON
THE ACADEMY’S HISTORY COMMITTEE seeks nominations
for the AAD Master Dermatologist Award. The Award recognizes an Academy member who throughout the span of his or
her career has made significant contributions to the specialty
of dermatology as well as to the leadership and/or educational
programs of the American Academy of Dermatology. The selected individual will be presented with the Master Dermatologist Award at the 73rd Annual Meeting in San Francisco, March
20-24, 2015.
Recipients should possess a national or international presence and a well-recognized expertise. The recipient should be a
longstanding Academy member.
Requests for nominations are solicited annually from the
Academy membership at large, via Dermatology World, as well
as from the members of the Board of Directors and the Academy’s History Committee. The recipient will be selected by the
History Committee and presented to the Board of Directors for
approval.
Requests for nominations must be submitted online at
www.aad.org/MasterDermatologist. For more information
contact Nikki Haton at [email protected]. – NIKKI HATON
40 DERMATOLOGY WORLD // October 2013
www.aad.org/dw
CELEBRATING
1938-2013
EXCELLENCE IN DERMATOLOGY
Special Thanks
You make it possible!
PRESIDENT’S CABINET SOCIETY
($25,000+)
Phillip Frost, MD, FAAD
PRESIDENT’S ADVOCATES SOCIETY
($10,000+)
Murad Family Foundation
PRESIDENT’S CIRCLE
($5,000+)
Individuals
Murad Alam, MD, FAAD
Johnnie and Rex Amonette
Humberto C. Antunes
Andrew K. Bean, MD, FAAD
Brett M. Coldiron, MD, FAAD
C. William Hanke, MD, FAAD
Hiroshi Ikeno, MD
Henry W. Lim, MD, FAAD
Suzanne Olbricht, MD, FAAD
David M. Pariser, MD, FAAD
Daniel M. Siegel, MD, MS, FAAD
A. David Soleymani, MD, FAAD
Stephen and Lisa Stone
Dr. John S. and Mrs. Susan T. Strauss
Organizations
National Rehab Equipment, Inc.
Vicky and Sam Hunt Foundation
LEADERSHIP CIRCLE
($2,500+)
Individuals
Richard G. Asarch, MD, FAAD
Thomas C. Chin, MD
Robert D. Durst, Jr., MD, FAAD
John H. Exner, MD, FAAD
Lisa A. Garner, MD, FAAD
Bruce D. Glassman, MD, FAAD
Mrs. Paul Hirsch (Harriette)
Eileen M. Murray, MBA, CFRE, CAE
Ryan S. Owsley, MD, FAAD
Thomas E. Rohrer, MD, FAAD
Bruce H. Thiers, MD, FAAD
Eugene J. Van Scott, MD, FAAD
Organizations
Noah Worcester Dermatological Society
CORNERSTONE
($1,000+)
Individuals
Nancy Ali
Linda L. Alston, MD, FAAD
Jean L. Bolognia, MD, FAAD
Noel T. Chiu, MD, FAAD
Stephen W. Clark
Clay J. Cockerell, MD, FAAD
Terrence A. Cronin, Jr., MD, FAAD
Mark V. Dahl, MD, FAAD
James Q. Del Rosso, DO
Richard L. Dobson, MD, FAAD
Jeffrey S. Dover, MD, FAAD
Lynn A. Drake, MD, FAAD
Boni E. Elewski, MD, FAAD
Dirk M. Elston, MD, FAAD
James O. Ertle, MD, FAAD
Frederick S. Fish, III, MD, FAAD
Van Fletcher, MD, FAAD
Ilona J. Frieden, MD, FAAD
Charles E. Gambla, MD, FAAD
John K. Geisse, MD, FAAD
Mrs. Helen Gruber
Marshall A. Guill, III, MD, FAAD
Charles L. Heaton, MD, FAAD
George J. Hruza, MD, FAAD
Dr. and Mrs. William D. James
Gail A. Kleman, MD, FAAD
E. Michael Kramer, MD, FAAD
Paul H. Kravitz, MD, FAAD
Adarsh A. Kumar, MD, FAAD
Mark Lebwohl, MD, FAAD
Francis C. Lee, MD, FAAD
Donald P. Lookingbill, MD, FAAD
Elizabeth S. Martin, MD, FAAD
Mahaveer C. Mehta, MD
Alexander Miller, MD, FAAD
Larry E. Millikan, MD, FAAD
Ronald L. Moy, MD, FAAD
Elise Olsen, MD, FAAD
Ronald P. Rapini, MD, FAAD
Kelley P. Redbord, MD, FAAD
Phoebe Rich, MD, FAAD
Franziska Ringpfeil, MD, FAAD
Dr. Marcia Robbins-Wilf
Richard A. Romaine, MD, FAAD
Dr. Herman & Mrs. Rozelle Schultz
Keith E. Schulze, MD, FAAD
Kathryn Schwarzenberger, MD, FAAD
Mary C. Spellman, MD, FAAD
John Strasswimmer, MD, PhD, FAAD
Eugene W. Sweeney, MD, FAAD
J. Michael Taylor, MD
Mark D. Thieberg, MD, FAAD
Douglas A. Thomas, MD, FAAD
Carl R. Thornfeldt, MD, FAAD
*Includes contributions through August 20, 2013. The Academy apologizes for any errors or omissions.
John M. Tieman, MD, FAAD
Rebecca C. Tung, MD, FAAD
Elaine Weiss
Organizations
American Osteopathic College
of Dermatology
Broward County Dermatology Society
Journal of Dermatology for
Physician Assistants
Maritz Travel Company
Minnesota Dermatological Society
Northwest Dermatology, S.C.
Tucson Dermatology Society
PATRON
($250+)
Individuals
Anonymous
Glynis R. Ablon, MD, FAAD
Ana Abreu-Velez, MD, PhD
Edwin M. Ahrens, MD, FAAD
Khalil Al-Arrayed, MD
G. Havard Albright, MD, FAAD
Judy R. Anderson, MD, FAAD
Richard J. Antaya, MD, FAAD
Robert B. Ash, MD, FAAD
Peter L. Babinski, MD, PhD
Brian N. Bailey, MD, PhD, FAAD
Patricia A. Baldwin
Mark R. Balle, MD, FAAD
Channing Barnett, MD, FAAD
Jay G. Barnett, MD, FAAD
David J. Barnette, Jr., MD, FAAD
John and Mary Barrow
Rodney S. W. Basler, MD, FAAD
Brenda J. Berberian, MD, FAAD
James R. Bergeron, MD, FAAD
Eric Z. Berkowitz, MD, FAAD
Brian Berman, MD, PhD, FAAD
Diane M. Bernardi, MD, FAAD
Frank W. Berry, Jr., MD, FAAD
Michael A. Bharier, MD, FAAD
Neal D. Bhatia, MD, FAAD
Retna A. Billano, MD, FAAD
Kay Bishop, MD, FAAD
J. Greg Brady, DO, FAAD
Mitchell L. Bressack, MD, FAAD
Sharon E. Bridgeman-Shah,
MD, FAAD
Fredric S. Brown, MD, FAAD
Philip Bruder, MD, FAAD
Keith R. Bruno, MD, FAAD
M. Francine Bruyneel, MD, FAAD
Vivian W. Bucay, MD, FAAD
Howard A. Bueller, MD, FAAD
Irene Buno, MD, FAAD
Melissa Burnett, MD, FAAD
PATRON (cont.)
($250+)
Individuals
Thomas L. Busick, MD, FAAD
Andrew S. Calciano, MD, FAAD
Jeffrey P. Callen, MD, FAAD
Maria J. Canizares, MD, FAAD
Carolyn Carroll, MD and James
Carroll, MD
Marc R. Carruth, MD, FAAD
John C. Chapman, MD
William G. Chapman, MD, FAAD
Robert L. Chappell, Jr., MD, FAAD
Micsunica-Elvira Chiritescu,
MD, FAAD
Yoon K. Cohen, DO
William R. Coleman, MD, FAAD
Scott A. B. Collins, MD, FAAD
Gregory J. Colman, MD, FAAD
Leo A. Conger, MD, FAAD
Beatriz Coquilla-Canete,
MD, FAAD
Timothy G. Cornitius, MD, FAAD
Jill S. Crollick, MD, FAAD
C. Ralph Daniel, MD, FAAD
Michael J. Dannenberg, MD,
FAAD
Mark Dawkins, MD, FAAD
Kiran Dhar, MD, MBBS
Sunil S. Dhawan, MD, FAAD
Daniel B. Dietzman, MD, FAAD
Glenn A. Dobecki, MD, FAAD
Christopher K. Dolan, MD
Jean-Pierre D. Donahue,
MD, FAAD
Jeanine B. Downie, MD, FAAD
Zoe D. Draelos, MD, FAAD
John C. Dumler, Jr., MD, FAAD
Selig Eisenberg, MD, FAAD
Patti K. M. Endo, MD, FAAD
Josie Eschweiler
Dennis L. Feinberg, MD, FAAD
Dr. Kevin Fickenscher
Scott L. Flugman, MD, FAAD
Alexander A. Fondak, MD, FAAD
Julie S. Francis, MD, FAAD
Kathryn E. Frew, MD, FAAD
David H. Friedman, MD, FAAD
Louise Friend, MD, FAAD
Lynne K. Furlong, MD, FAAD
William W. Galloway, MD, FAAD
Mark D. Gaughan, MD, FAAD
Richard H. Gentry, MD, FAAD
Stephen D. Gibbs, MD, FAAD
Erin Gilbert, MD, PhD, FAAD
Anita C. Gilliam, MD, PhD, FAAD
Sharon A. Glick, MD, FAAD
Leonard H. Goldberg, MD, FAAD
Max Gratrix, MD, FAAD
Bernard Gregoire-Krikorian, MD
Ronald E. Grimwood, MD, FAAD
Alexander S. Gross, MD, FAAD
George K. Haines, III
Marta T. Hampton, MD, FAAD
Elissa Harrell
David R. Harris, MD, FAAD
Keith R. Harris, MD
Curtis W. Hawkins, MD, FAAD
Richard R. Henderson, MD, FAAD
James J. Herrmann, MD, FAAD
Richard J. Herschaft, MD, FAAD
Craig S. Hersh, MD, FAAD
Janet G. Hickman, MD, FAAD
Molly A. Hinshaw, MD, FAAD
Thomas Hirota, DO, FAAD
Julie A. Hodge, MD, MPH, FAAD
Jean M. Holland, MD, FAAD
Kristen P. Hook, MD, FAAD
Douglas B. Horan, MD, FAAD
Martin S. Horn, MD, FAAD
Hiba A. Injibar, MD
Farouk Iqbal, MD
David B. Jackson, MD, FAAD
J. Mark Jackson, MD, FAAD
Robert L. Jackson, MD, FAAD
Brian T. Johnson, MD, FAAD
Lawrence L. Johnson, MD
Robert H. Johr, MD, FAAD
David A. Jones, MD, PhD, FAAD
Amy Y. Jordan, MD, FAAD
Nicole P. Kageyama, MD, FAAD
Lisa Kates, MD, FAAD
Stephen I. Katz, MD, PhD, FAAD
Donald Kay, MD, FAAD
Michael G. Keeran, MD, FAAD
William S. Ketcham, MD, FAAD
Louis S. Kish, MD, FAAD
Joseph L. Kloss, MD, FAAD
Donna J. Ko, MD, FAAD
Kenneth A. Kobayashi, MD, FAAD
Dr. and Mrs. Richard A. Krathen
Eric W. Kraus, MD, FAAD
Hans-Wilhelm Kreysel, MD
Geraldine Kurz, MD, FAAD
Pearl C. Kwong, MD, FAAD
Mark A. Lake, MD, FAAD
Nikolajs A. Lapins, MD, FAAD
Andrew P. Lazar, MD, FAAD
Gary C. Lee, MD, PhD, FAAD
Jack L. Lesher, Jr., MD, FAAD
Pamela A. Leve, MD, FAAD
James J. Leyden, MD, FAAD
Charles E. Linden, MD, FAAD
Jane H. Lisko, MD, FAAD
John C. Long, Jr., MD, FAAD
Sherri A. Long, MD, FAAD
Eve J. Lowenstein, MD, PhD,
FAAD
Lee R. Lumpkin, III, MD, FAAD
Paul B. Lundstrom, MD, FAAD
Marian L. MacDonald, MD, FAAD
Susan J. Mahler, MD, FAAD
Michael J. Majors, MD, FAAD
1938 LEGACY SOCIETY
The Academy extends its deep gratitude to the following members of the 1938 Legacy
Society who have chosen to help ensure the good work of the Academy continues well
into the future through a gift to the AAD in their wills, trusts or estate plans:
Anonymous
Rex and Johnnie Amonette
John U. Buchman, MD, FAAD
Dr. Gene and Ann Burrish Family Endowment
C. Ralph Daniel, MD, FAAD
Hobart C. Parkhurst, MD*
Steven and Jeannie Shama
Stephen and Lisa Stone
Hiram and Richard Sturm Charitable Remainder Trust
George A. Waldriff, MD*
*deceased
Bruce D. Mallatt, MD, FAAD
Stephen H. Mandy, MD, FAAD
Jeffrey L. Marx, MD, FAAD
Barbara M. Mathes, MD, FAAD
Charles J. McDonald, MD, FAAD
Karen McKoy, MD, MPH, FAAD
Alexandria Meccia, MD, FAAD
Wilhelm N. Meigel, MD
John W. Melski, MD, FAAD
Jeffrey L. Messenger, MD, FAAD
Charles C. Meurehg, MD
D. Scott Miller, MD, FAAD
Elaine K. Miller, DO
Oliver F. Miller, III, MD, FAAD
Richard L. Miller, MD, FAAD
Stanley J. Miller, MD, FAAD
Harold J. Milstein, MD, FAAD
Mr. and Mrs. Elliott Milstein
Pamela Morganroth, MD
George J. Murakawa, MD, FAAD
Michael A. Myers, MD, FAAD
Jeffrey S. Newman, MD,
PhD, FAAD
Dennis E. Newton, III, MD, FAAD
Xuan H. Nguyen, MD, FAAD
Masayuki Nishimura, MD
Catherine M. OGawa, MD, FAAD
William B. O’Grady, MD, FAAD
Thomas G. Olsen, MD, FAAD
Emily F. Omura, MD, FAAD
Andrew L. Ondo, MD, FAAD
Robert L. Orme, MD, FAAD
Amit G. Pandya, MD, FAAD
Anastasios A. Pappas, MD, FAAD
Herbert M. Parnes, MD, FAAD
Sylvia L. Parra, MD, FAAD
Roger W. Pearson, MD, FAAD
Jennifer W. Pennoyer, MD, FAAD
Sandra Perez
Lindall and Jane Ann Perry
Susan B. Perry, MD, FAAD
Angela R. Peterman, MD, FAAD
Kurt F. Pickus, MD, FAAD
Christine Poblete-Lopez,
MD, FAAD
Mark D. Popkin, MD, FAAD
Robert M. Portman and Annette
F. Simon
Adam S. Pritzker, MD, FAAD
Daniel C. Rabb, MD, FAAD
Scott C. Rackett, MD, FAAD
Ronnie D. Rasberry, MD, FAAD
Eric O. Rasmussen, MD, FAAD
Steven E. Rasmussen, MD, FAAD
Jason S. Reichenberg, MD, FAAD
Berna Remzi, MD
Gregory C. Richterich, MD, FAAD
Jennifer M. Ridge, MD, FAAD
Elisa M. Roberts, MD, FAAD
Bernard N. Robinowitz, MD, FAAD
Roy S. Rogers, III, MD, FAAD
Natalie S. Roholt, MD, FAAD
Karen F. Rothman, MD, FAAD
Ruth G. Rothman, MD, FAAD
Hakeem Sam, MD, FAAD
Sarah K. Short Sarbacker, MD,
FAAD
William F. Sausker, MD, FAAD
Kathleen Y. Sawada, MD, FAAD
Aradhna Saxena, MD, FAAD
William H. Saye, Jr., MD, FAAD
Rhonda R. Schneider, MD, FAAD
Joseph J. Schwartz, MD, FAAD
Patricia L. Seal, MD, FAAD
Philip E. Shapiro, MD, FAAD
Karen A. Sherwood, MD, FAAD
Daniel Shurman, MD, FAAD
Mr. and Mrs. Alvin Siegel
*Includes contributions through August 20, 2013. The Academy apologizes for any errors or omissions.
Michael H. Simpson, MD, FAAD
Anjali H. Singh, MD, FAAD
Judith A. Small, MD, FAAD
Kristin W. Smallwood, MD, FAAD
Cindy F. Smith, MD, FAAD
Molly K. Smith, MD, FAAD
Robert M. Soderstrom, MD, FAAD
David A. South, MD, FAAD
Richard L. Spielvogel, MD, FAAD
Susan E. Stinehelfer, MD, FAAD
Richard M. Storm, MD, FAAD
Amy F. Taub, MD, FAAD
Mr. and Mrs. David Thomas
Oscar W. Thompson, III,
MD, FAAD
Charles S. Thurston, MD, FAAD
Kenneth J. Tomecki, MD, FAAD
Charles B. Toner, MD, FAAD
Ella L. Toombs, MD, FAAD
Mary B. Toporcer, MD, FAAD
Abel Torres, MD, JD, FAAD
Dwight R. Tribelhorn, MD, FAAD
Erwin Tschachler, MD
Maria L. C. Turner, MD, FAAD
Sheryll L. Vanderhooft, MD, FAAD
Jennifer L. Vesper, MD, FAAD
Kent D. Walker, MD, FAAD
Patrick Walsh, MD, FAAD
Michael R. Warner, MD, FAAD
Kalman L. Watsky, MD, FAAD
John A. Watson, MD, FAAD
Stephen B. Webster, MD, FAAD
Mark B. Weinstein, MD, FAAD
Jonathan S. Weiss, MD, FAAD
Christine Welsh and Douglas
S. Mitchell
John R. West, MD, FAAD
Kevin L. Whaley, MD, FAAD
David A. Whiting, MD, FAAD
Lori-Ann R. Wilcox, MD, FAAD
Judith V. Williams, MD, FAAD
Cassandra L. Wilson
Dorota M. Wilson, MD, FAAD
Peter L. Winters, MD, FAAD
George B. Winton, MD, FAAD
Allan S. Wirtzer, MD, FAAD
Dr. Barbara A. Wolf
George R. Woodbury, Jr., MD,
FAAD
Richard D. Wortzel, MD, PhD,
FAAD
Patricia P. Wyhinny, MD, FAAD
Masaru Yasuda, MD, PhD
Ruth A. Yates, MD, FAAD
Inia I. Yevich-Tunstall, MD, FAAD
Lori and Bill Youngdahl
Eva L. Youshock, MD, FAAD
David D. Yuh, MD
Joseph J. Zaladonis, Jr., MD,
FAAD
James A. Zalla, MD, FAAD
Nathalie C. Zeitouni, MD, FAAD
Bella Zubkov, MD, FAAD
Organizations
Associates in Dermatology, PLLC
Dermatology Consultants
of Sacramento
KAO USA Inc.
L.E.K. Consulting LLC
LFE Capital, LLC
Main Line Dermatology, Inc.
MassMutual Financial Group
San Antonio Dermatological
Society
Tilly & Salvy’s Bacon Street
Farm, LLC
American Academy of Dermatology
In recognition of the Academy’s 75th anniversary, we would like to thank those donors whose cumulative gifts have
exceeded $50,000. Their continued generosity has ensured the success of Academy programs and services that
have enriched the lives of children and adults, made a difference in local communities, and advanced the specialty.
CELEBRATING
1938-2013
Johnnie and Rex Amonette
Gene F. Burrish, MD, FAAD
Lloyd and Margit Cotsen
Phillip Frost, MD, FAAD
EXCELLENCE IN DERMATOLOGY
C. William Hanke, MD, FAAD
Terence J. Harrist, MD
David M. Pariser, MD, FAAD
Steven and Jeannie Shama
Stephen and Lisa Stone
Dr. John S. and Mrs. Susan T. Strauss
Hiram M. Sturm, MD, FAAD and
Richard L. Sturm, MD, FAAD
Reflecting the Academy’s records since 2005 and including data from years previous where available.
A special thank you to all AAD members who gave in celebration of the Academy’s 75th Anniversary.
Anonymous (2)
Wadid Abadir, MD, FAAD
Kelly L. Abate, MD, FAAD
Cynthia A. Abbott, MD, FAAD
Magdy Z. Abdallah, MD
William Abildgaard, MD, FAAD
Roxanne J. Abitbol, MD, FAAD
William Abramovits, MD, FAAD
Arthur J. Abrams, MD, FAAD
Ricardo E. Achenbach, MD
David C. Adams, MD, FAAD
Max F. Adler, MD, FAAD
Lymarie I. Aguila Gonzalez, MD, FAAD
Simin Ahari, MD
Kamel Ait Mehdi, MD
Russell S. Akin, MD, FAAD
Mohammed Al Abadie, MBBS, PhD
Wesam K. Al Arayedh, MD, FAAD
Maldaa G. Al Daoudi, MD
Khalid A. Al Hawsawi, MD
Massefa J. Al- Mazrouei, MD
Suleiman M. Al Muzainy, MD
Muneerah A. Al Otaibi, MD
Kenneth W. Alanen, MD
Kim M. Albridge, MD, FAAD
Ross A. Alexander, MD, FAAD
Abraham B. Alfaro, MD
Ronald J. Algra, MD, FAAD
Ahmad A. Al-Haddad, MD
Ahmed M. Alissa, MD, MBBS
David M. Allen, MD, FAAD
Osama A. O. Al-Majali, MD
Andrea D. Almeida, MD
Fernando A. Almeida, MD
Amna S. Al-Muhairi, MBBS
Nawaf Al-Mutairi, MD
Sahar H. Al-Natour, MD
Rokiyah A. Alokla, MD
Yasser A. Alqubaisy, MD
Abdul-Aziz N. Al-Sadhan, MD, FAAD
Qasem A. Al-Saleh, MD
Jeffrey S. Altman, MD, FAAD
Joao A. Amaro, MD
Aleodor A. Andea, MD
R. Makala Anders, MD, FAAD
Bo L. Andersen, MD
Lisa L. Anderson, MD, FAAD
Reagan Anderson, DO
Pierre Andre, MD
Lucio Andreassi, MD
Gina C. Ang, MD, FAAD
Edith G. Anidjar, MD
Natalia Anikin, MD
Takashi Aoyagi, MD
Mariano Ara, MD
Jiro Arata, MD
Irene Araya, MD
Azucena L. Arguelles, MD
Jerry N. Ariail, MD, FAAD
David R. Arrowsmith, MD, FAAD
Robin Ashinoff, MD, FAAD
Susan L. Ashworth, MD, FAAD
Luna Azulay-Abulafia, MD
Mohamed A. Azzouz, MD
Dennis E. Babel, PhD
Kamel Baccouche, MD
Ove B. Back, MD, PhD
Lynn A. Baden, MD, FAAD
Robert S. Bader, MD, FAAD
George C. Baker, MD, FAAD
Arthur K. Balin, MD, PhD, FAAD
Murtuza S. Bandukwala, MD, MBBS
Angela M. Barbosa, MD
Frank Baron, MD, FAAD
Ronald J. Barr, MD, FAAD
Enio R. M. Barreto, MD
Jane S. Barry, MD, MBBCh
C. Enrique Batres, MD, FAAD
Carla J. Bauman, MD, FAAD
Wayne E. Bauman, MD, FAAD
Garrett T. Bayrd, MD, FAAD
Samuel F. Bean, MD, FAAD
Graeme L. Beardmore, MD
Stephen J. Beck, MD, FAAD
Burton S. Belknap, MD, FAAD
M.I. Benavides, MD
Jaye E. Benjamin, MD, FAAD
Lori S. Benjes, MD, FAAD
Bruce Bennin, MD, FAAD
Viviana L. Berben, MD
Daniel Berg, MD, FAAD
Bernard W. Berger, MD, FAAD
Beatrice J. Berkes, MD, FAAD
Michael E. Berman, MD, FAAD
Eric F. Bernstein, MD, FAAD
Roland S. Beverly, III, MD, FAAD
Kelly M. Bickle, MD, FAAD
Paul L. Bigliardi, MD
Susan E. Binder, MD, FAAD
Craig S. Birkby, MD, FAAD
Zuhair Z. Bisharat, MD
Tanja G. Bohl, MD
Gary G. Bolton, MD, FAAD
Paola Bonaccorsi, MD, FAAD
Sally A. Booth, MD, FAAD
Lindie K. Borton, MD, FAAD
Ahmed Bourra, MD
Navid Bouzari, MD, FAAD
Bert J. Boyden, MD
Teresa P. Brandt, MD, FAAD
Ryan K. Brashear, MD, FAAD
Valeria Brazzelli, MD
Mathijs Brentjens, MD, FAAD
Vero Brentjens, MD
Manuel R. Briones, MD
Stacey F. Brisman, MD, FAAD
Leon E. Brown, MD, FAAD
William C. Brunner, MD, FAAD
Daniel Buchen, MD, FAAD
Lisa M. Bukaty, MD, FAAD
Stella M. Bulengo, MD, FAAD
A. Thomas Bundy, MD, FAAD
Patricia A. Burden, MD, FAAD
Walter H. C. Burgdorf, MD
Steven M. Burnett, MD, FAAD
Jerome W. Buzas, MD, FAAD
David R. Byrd, MD, FAAD
Julie A. Byrd, MD, FAAD
Roger C. Byrd, DO
Allen A. Cabrera, MD
Hugo N. Cabrera, MD
Adriana P. Calebotta, MD
Elizabeth F. Callahan, MD, FAAD
Martha H. Campo, MD
Stanley L. Capper, MD, FAAD
John A. Carucci, MD, PhD, FAAD
Vilma Celle, MD
Saileesh Chalasani, MD, MBBS
Marc D. Chalet, MD, FAAD
Anna Lissa R. Chan, MD
Henry H. Chan, MD
Rachel Chandler, MD, FAAD
Roxana L. Chapman, DO, FAAD
Ernest N. Charlesworth, MD, FAAD
Arianne Chavez-Frazier, MD, FAAD
Wendy H. Chern, PhD
Kenneth J. Cherney, MD, FAAD
Alexander Chiaramonti, MD, FAAD
Young S. Cho, MD
Adrienne Choksi, MD, FAAD
Vera A. Chotzen, MD, FAAD
Anindya Choudhury, MBBS
Silvia A. M. Choy, MD
Holly L. F. Christman, MD, FAAD
Douglas W. Chun, MD, FAAD
Hae-Shin Chung, MD
John Y. Chung, MD, FAAD
Wonsoon Chung, MD
David Ciocon, MD, FAAD
Cassandra Claman, MD, FAAD
Don L. Clarke, MD
Philip J. Clarke, MD
Henry W. Clever, MD, FAAD
Julita Cofre-Beca, MD
Bernard Cohen, MD, FAAD
Howard B. Cohen, MD, FAAD
Mark A. Cohen, MD, FAAD
Emilia N. Cohen Sabban, MD
Susannah L. Collier, MD, FAAD
Ana L. Colon De Jimenez, MD, FAAD
Kathleen M. Colorado, MD, FAAD
Nneka I. Comfere, MD, FAAD
M. Kari Connolly, MD, FAAD
Thomas W. Cooper, MD, FAAD
Roger C. Cornell, MD, FAAD
Amparo M. Correa, MD
Billie F. Cosgrove, MD, FAAD
Silvia E. Costantini, MD
William F. Cosulich, MD, FAAD
Peter G. Craig, MBBS
Judy Y. Cuaso, MD, FAAD
Cesar C. Cuono, MD
Ashley R. Curtis, MD, FAAD
Verne E. Cutler, MD, FAAD
Ana S. B. Da Silva, MD
Milena Danies, MD
Francis J. Dann, MD, FAAD
Windell C. Davis-Boutte, MD, FAAD
Janice L. DaVolio, MD, FAAD
Clarence de Belilovsky, MD
G.A. De La Bretonne, Jr., MD, FAAD
Raul S. De La Torre-Suarez, MD
Saskia de Mare, MD, PhD
Fernanda C. De Menezes, MD
Francisco J. De Ovando, MD
Tami S. DeAraujo, MD, FAAD
Kwame S. Denianke, MD, FAAD
W. Landon Dennison, Jr., MD, FAAD
Amalie S. Derdeyn, MD, FAAD
Sandipan Dhar, MD, MBBS
Anna Di Nardo, MD, PhD
David F. Dieteman, MD, FAAD
Elaine Digrande, MD, FAAD
Salvatore J. DiGrandi, MD, FAAD
Gina M. Dillig, MD, FAAD
Jack F. Ditty, Jr., MD, FAAD
*Includes contributions through August 20, 2013. The Academy apologizes for any errors or omissions.
William L. Dobes, Jr., MD, FAAD
Mary M. Dobson, MD, FAAD
Christopher K. Dolan, MD
Elizabeth T. Dolan, MD, FAAD
Olivia M. Dolan, MD
Matthew Doppelt, DO
Kenneth E. Dorsey, MD, FAAD
Amaranila L. Drijono, MD
D. Anastasia Drohan, MD
Benjamin A. Dubin, MD, FAAD
Miroslawa A. Dulczewska-Miller, MD, PhD
Paul T. Dunn, MD, FAAD
Marsha L. DuPree, MD, FAAD
Patricia A. Duprey, MD, FAAD
John A. Ebner, DO, FAAD
Libby Edwards, MD, FAAD
Eric P. Ehrsam, MD
Molly G. Eisner, MD, FAAD
Jan J. Eklind, MD
Ann L. Eldridge, MD
Jeffrey I. Ellis, MD, FAAD
Mauro Y. Enokihara, MD
Sezer Erboz, MD
Corinne L. Erickson, MD, FAAD
Serban A. Esca, MD
Begoña Escutia-Munoz, MD
Karel Ettler, MD, PhD
Robin D. Evans, MD, FAAD
Ann E. Evers, MD
William R. Faber, MD, PhD
Brian G. Fabian, MD, FAAD
Sharon I. Fairbee, MD, FAAD
Erlinda S. Fang, MD, FAAD
Assem M. Farag, MD
Harold F. Farber, MD, FAAD
Lenora I. Felderman, MD, FAAD
Michael J. Fellner, MD, FAAD
Pascal G. Ferzli, MD, FAAD
Cheryl N. Fialkoff, MD, FAAD
Caio H. Figueiredo Matos, MD
Lorraine G. Finelli, DO
Taraneh S. Firoozi, MD, FAAD
Steven J. Fishman, MD, FAAD
Shawna A. Flanagan, MD, FAAD
Erik K. Foged, MD
Isabella C. Forneiro, MD
Samuel L. Fort, MD, FAAD
Marie A. Francoeur, MD, FAAD
Thomas J. Franz, MD
Robert A. Frazier, Jr., MD
Fatima P. Freitas, MD
Adam J. Friedman, MD, FAAD
Jennifer Fu, MD, FAAD
Juian-juian L. Fu, MD, PhD, FAAD
Jan F. Fuerst, MD, FAAD
Wataru Fujimoto, MD
Bruce W. Fuller, MD, PhD, FAAD
Claire Fuller, MD
Robert P. Fuller, MD, FAAD
Fukumi Furukawa, MD, PhD
Jalong Gaan, MD, PhD, FAAD
Margaret G. Gaffney, MD, FAAD
Lauren B. A. Gandhi, MD, FAAD
Enrique F. Garcia-Perez, MD
Jennifer Gardner, MD, FAAD
Joe F. Garner, II, MD, FAAD
John A. Garofalo, MD, FAAD
Jacquelyn B. Garrett, MD, FAAD
Mahmoud A. Ghannoum, PhD
Laura Gheuca-Solovastru, MD, PhD
Reza F. Ghohestani, MD, PhD
Seyed A. Ghotbi, MD, FAAD
Richard B. Gibbs, MD, FAAD
Maria Pino Gil Mateo, MD
Alejandro Ginzburg, MD
Ada R. Girnita, MD, PhD
Julie A. Gladsjo, MD, PhD, FAAD
Leslie A. Glass, MD, FAAD
George M. Glassman, MD
Lynn A. B. Glesne, MD, FAAD
Brad P. Glick, DO, MPH
Leonard H. Goldberg, MD, FAAD
David Goldman, MD, FAAD
Peter M. Goldman, MD, FAAD
Sandy R. Goldman, DO
Jeffrey B. Goldstein, MD, FAAD
Abdel-Salam M. Gomah, MD
Antonio C. B. Gomes, MD
Evelyn R. Gonzaga, MD
Elba I. Gonzalez, MD
Gregory J. Goodman, MD
Manuel M. Gordon, MD
Srikumar Goturu, MD, MBBS
Jeannette O. Graf, MD, FAAD
Hege Grande Sarpa, MD, FAAD
Jane M. Grant-Kels, MD, FAAD
Max Gratrix, MD, FAAD
Julia E. Graves, MD, FAAD
Vaughan C. Graves, MD
Jose C. Greco, MD
Michele Green, MD, FAAD
Jorge A. Gregoris, MD
Daniela G. Greiner, MD
Dana J. Grenier, MD, FAAD
Nicole L. Grenier, MD, FAAD
Carin H. Gribetz, MD, FAAD
Darrell Griffin, MD, FAAD
Molly E. Griffin, MD, FAAD
Wakitha Griffin, MD, FAAD
Christopher E. M. Griffiths, MD
Kenneth G. Gross, MD, FAAD
Jose Grossi, NETO, MD
Kenneth Grossman, MD, FAAD
Victoria E. Guerra, MD, FAAD
Antonio Guglielmetti, MD
Wayne P. Gulliver, MD, FAAD
Akiyo Gushi, MD
Miriam J. Gutierrez, MD
Cynthia A. Guzzo, MD, FAAD
Isabella K. Gyening, MD, FAAD
May Haddad Tabet, MD
Svitlana O. Halnykina, MD
John R. Hamill, Jr., MD, PA, FAAD
Akinori Haratake, PhD
Philip R. Hardin, MD, FAAD
Marie N. Hardy, MD, FAAD
Lucila Haro, MD
Kenneth E. Harper, MD, FAAD
Roland Hart, MD, FAAD
Don C. Harting, MD, FAAD
John L. M. Hawk, MD
Roderick J. Hay, MD
Jessica A. Healy, MD, FAAD
Dean W. Hearne, MD, FAAD
Scott B. Hearth, MD, FAAD
Adelaide A. Hebert, MD, FAAD
Jeffrey J. Heller, DO, FAAD
Philip D. Hellreich, MD, FAAD
Mohamed M. Helmy, MD
Clara H. Henry, MD, FAAD
David R. Hensley, MD, FAAD
Asoka K. Herat, MBBS
Gloria E. Hernandez Ruiz, MD
James H. Herndon, Jr., MD, FAAD
Melba C. Herrera, MD
Ronny Herskovits, MD, FAAD
Kjell S. Hersle, MD
Adam B. Hessel, MD, FAAD
Eric J. Hester, MD, FAAD
Maria Hicks, MD, FAAD
Clayton T. Hinshaw, MD, FAAD
Thomas Hirota, DO, FAAD
Akita Hirotaka, MD
Barbara M. Hisler, MD, FAAD
Jeanne M. Hoag, MD, FAAD
Ilonka V. Hoell, MD
Katherine Z. Holcomb, MD, FAAD
Michele A. Holder, MD, FAAD
Rona Beth R. Holmes, MD, FAAD
Golara Honari, MD, FAAD
Juan F. Honeyman, MD
Douglas B. Horan, MD, FAAD
Stephen D. Houston, MD, FAAD
Sharon L. Hrabovsky, MD, FAAD
Tony M. Hsu, MD, FAAD
Po-Han Huang, MD
Paula W. Huber, MD, FAAD
Arthur Huen, MD, PhD, FAAD
David M. Huntley, MD, FAAD
Diana S. Hurwitz, MD, FAAD
Tarek M. Y. Ibrahim, MD
Masamitsu Ichihashi, MD
Simone A. Ince, MD, FAAD
Hiba A. Injibar, MD
Cleide E. Ishida, MD
John F. Ives, MD
Diane M. Jackson-Richards, MD, FAAD
David F. Jaffe, MD, FAAD
Farhana Jan, MD, FAAD
Anthony M. Janiga, MD, FAAD
Ingrid M. Jarvis, MD, FAAD
Burton Jay, MD
Jan Jekler, MD, PhD
Kraig K. Jenson, MD, FAAD
Beth A. Jester, MD, FAAD
Ryan P. Johnson, MD, FAAD
Todd A. Johnson, MD, FAAD
Hillary Johnson-Jahangir, MD, PhD, FAAD
Elena L. Jones, MD, FAAD
Robert W. Jones, MD, FAAD
Robert E. Jordon, MD, FAAD
Merlina Joseph, MD
Ronald S. Jurzyk, MD, FAAD
Lenore S. Kakita, MD, FAAD
Celia L. P. V. Kalil, MD
Ryoichi Kamide, MD
Sara M. Kantrow, MD, FAAD
Wynn H. Kao, MD, FAAD
David L. Kaplan, MD, FAAD
Djordjije M. Karadaglic, MD, PhD
Jane F. Kardashian, MD, FAAD
Maria Kardasi, MD
Richard C. Kasper, MD
Stacy Katchman, MD, FAAD
Junko Katoh, MD
Brian J. Katz, MD, FAAD
Ilan Katz, MD
Brent C. Kelly, MD, FAAD
Cameron T. C. Kennedy, MD
Katherine R. Kerchner, MD, FAAD
Bonnie J. Kerr, MD, FAAD
Nedhal A. R. Khalifa, MD
Dmitry Khasak, MD, FAAD
Jane G. Khoury, MD, FAAD
James D. S. Kim, MD
Tae-Yoon Kim, MD
Traci L. Kimbrough, MD, FAAD
Rebecca B. Kissel, MD, FAAD
Tobi B. Klar, MD, FAAD
Arthur D. Klein, III, MD, FAAD
Lorrie J. Klein, MD, FAAD
Helen E. Knaggs, PhD
Janet L. Knight, MD, FAAD
Kenneth A. Kobayashi, MD, FAAD
Kimberly A. Kolar, MD, FAAD
Denise A. Kolbet, MD, FAAD
Serge N. Kolev, MD
Steven Kossard, MD
Charles R. Kovaleski, MD, FAAD
Takehito Kozuka, MD
Bernice R. Krafchik, MD, FAAD
Marit K. Kreidel, MD, FAAD
Sonja M. Krejci, MD, FAAD
George Kroumpouzos, MD, PhD, FAAD
George H. Kuffner, MD, FAAD
Kenneth R. Kulp, MD, FAAD
George I. Kurita, MD, FAAD
Pearl C. Kwong, MD, FAAD
Mario E. Lacouture, MD, FAAD
Sheri J. Lagin, MD, FAAD
James G. Lahti, MD, FAAD
Mimi Lam, MD, FAAD
Joshua E. Lane, MD, FAAD
Tanda N. Lane, MD, FAAD
Jon Langeland, MD
Andrzej W. Langner, MD
Olle J. W. Larko, MD, PhD
Maria F. Lasa, MD, PhD
David A. Laub, MD, FAAD
Michel Le Maitre, MD
William Lear, MD, FAAD
Chang W. Lee, MD
Joo B. Lee, MD
Linda H. Lee, MD, PhD, FAAD
Margaret S. Lee, MD, PhD, FAAD
Michael M. Lee, MD, PhD
Peter K. Lee, MD, PhD, FAAD
Seung H. Lee, MD
Siong C. Lee, MD, FAAD
Jonathan N. Leonard, MD
Gloria I. Leon-Quintero, MD
Pamela A. Leve, MD, FAAD
Linda C. Leventhal, MD, PhD, FAAD
Jacob Levites, MD
Fiona M. Lewis, MD
Mark A. Lewis, MD, FAAD
Lawrence M. Lieblich, MD, FAAD
Chrang S. Lin, MD
T. Michael Lin, MD, FAAD
Barbara Lindman, MD, FAAD
Elizabeth A. Liotta, MD, FAAD
Howard D. Lipkin, DO
David M. Lipman, MD, FAAD
Amy H. Litchfield, MD, FAAD
Szu-Chen Liu, MD
Wen-Lin Lo, MD
Christoph R. Loeser, MD
Jun Lu, MD, FAAD
Don Lum, MD, FAAD
Linda Lutz, MD, FAAD
Mychael Luu, MD, FAAD
Wendy Lynch, MD
Christina J. Lyons, MD, FAAD
Marian L. MacDonald, MD, FAAD
Otavio R. Macedo, MD
Karen M. Mackler, MD, FAAD
Ruth M. Macsween, MD
Diane C. Madfes, MD, FAAD
Matthew H. Mahoney, MD, FAAD
Jeffrey Mailhot, MD, FAAD
Yousef A. Malallah, MD
Maria T. Maluf, MD
Rocio C. Mandry Pagan, MD, FAAD
Roberto M. Manlapig, MD
Valeria F. Marcondes, MD
Catherine Marcum, MD, FAAD
Leslie A. Mark, MD, FAAD
Ellen A. Markstein, MD, FAAD
Alfredo Marquart, Jr., MD
Marcia Helena d. A. Marques, MD
Amparo Marquina, MD
Robert J. Martin, MD, FAAD
I. Ricardo Martinez, MD, PhD, FAAD
Elena Martinho, MD, FAAD
Marion E. Marugg, MD
Laurie G. R. Massa, MD, FAAD
Antranick Massmanian, MD, PhD
Seth L. Matarasso, MD, FAAD
Robert T. Matheson, MD, FAAD
Ronald B. Matloff, MD, FAAD
Stella S. Matsuda, MD, FAAD
Janice Matsunaga, MD, FAAD
Lucretia Matthieu, MD
Hagit Matz, MD
Theodora M. Mauro, MD, FAAD
Dennis L. May, MD, FAAD
Josephine C. McAllister, MD, FAAD
Calvin O. McCall, MD, FAAD
William McClarin, Jr., MD, FAAD
Jonelle K. McDonnell, MD, FAAD
Michaela W. McDonnell, MD, FAAD
Scott D. McMartin, MD, FAAD
Samantha R. McNail, MD, FAAD
Telma Y. Meda-Alvarez, MD
Roland S. Medansky, MD, FAAD
Jeffrey J. Meffert, MD, FAAD
Matthew J. Meier, MD, FAAD
Wilhelm N. Meigel, MD
John L. Meisenheimer, Jr., MD, FAAD
Fortunata L. Mendoza, MD, FAAD
Guillermo M. Menendez, MD
Hans F. Merk, MD
David S. Mezebish, MD, FAAD
Jason R. Michaels, MD, FAAD
Timotheos M. Michas, MD
Jeffrey G. Middleton, MD, FAAD
Marion C. Miethke, MD, FAAD
Charles H. Miller, MD, FAAD
George D. Miller, MD
Michael P. Milligan, MD, FAAD
Kimberly M. Mills, MD, FAAD
Sara A. Mills, MD, PhD, FAAD
Stephen K. Milroy, MD, FAAD
Allan D. Mineroff, MD, FAAD
Volker Misgeld, MD
Randall T. Mita, MD, FAAD
Shunsuke Miura, MD, PhD
Takako Miura, MD
Leigh H. Miyamoto, MD, FAAD
Tomoko Mizutani, MD
Mona Y. Mohammed, MD
Montserrat Molgo, MD
Raynald Molinari, MD, FAAD
James F. Molloy, MD, FAAD
Benjamin Moncada, MD
Lillian M. Montalvo, MD, FAAD
Marcello Monti, MD
Zahra B. Moosavi, MD
Akimichi Morita, MD, PhD
Shinichi Moriwaki, MD
Laura F. Morris, MD, FAAD
Eliot N. Mostow, MD, FAAD
Pholile F. Mpofu, MBChB
Kurt K. Mueller, MD, FAAD
Channy Y. Muhn, MD, FAAD
Patrizio Mulas, MD
Stephen R. Murdoch, MBChB
Richard J. Murphy, MD, FAAD
Synnove S. Mynttinen, MD
Sergio Nacht, PhD
Kazu Nakano, MD, PhD
Marie L. Nakata, MD, FAAD
Luigi Naldi, MD
Fadi A. Nassr, MD
Joshua M. Newman, MD, FAAD
Nhiem Nguyen, MD, FAAD
Marjory G. Nigro, MD, FAAD
Nikolaos Z. Nikolaou, MD
Peerapat Nimkulrat, MD, MSc
Karen Y. Nishimura, MD, FAAD
David No, MD, PhD, FAAD
Rowland R. Noakes, MBBS
Nicola Nylander, MD, FAAD
Suzan Obagi, MD, FAAD
Steve Oberemok, MD, FAAD
Timothy J. O’Brien, MD
Naoto Ohtake, MD, PhD
Gokhan Okan, MD
Edward J. O’Keefe, MD, FAAD
Raymond E. O’Keefe, MD, FAAD
Ali A. Oliai, MD
Joana D. D. M. Oliveira, MD
Jean P. Ortonne, MD
Denis E. P. Ottoni, MD
Ercin Ozunturk, MD
Robert N. Page, MD
Grace H. Pak, MD, FAAD
Santiago A. Palacios, MD
Teddy D. Pan, MD, FAAD
Daphne I. Panagotacos, MD, FAAD
Peter J. Panagotacos, MD, FAAD
Olga S. Panova, MD
Lino J. Parra-Velasquez, MD
Laurie M. Parsons, MD, FAAD
Dipa S. Patel, MD, FAAD
Barry S. Paul, MD, FAAD
Earl S. Pearson, MD, FAAD
Francesco E. Pelloni, MD
Homero A. Penagos Gonzalez, MD
Hsien-Li P. Peng, MD
Jose C. Pereira, MD
Meriner M. Pereira, MD
Miriam P. Peres, MD
Antonio D. Perez, MD
Carlos Alberto V. Perez, MD
Isaac Perez, MD, FAAD
John R. Person, MD, FAAD
Katherine J. Pesce, MD, FAAD
Frank C. Petr, Jr., MD, FAAD
Jacques Peyrot, MD
David S. Pezen, MD, FAAD
Richard G. Pfau, MD, FAAD
Athena N. Phan, MD, FAAD
Nicola Pimpinelli, MD
Aurea A. L. Pinto, MD
Soraya M. Pinto, MD
Eduardo H. Pittaro, MD
Adam S. Plotkin, MD, FAAD
Jennifer L. Popovsky, MD, FAAD
Bette C. Potter, MD, FAAD
John A. Powell, MD, FAAD
Steven M. Price, MD, FAAD
Lynn Proctor-Shipman, MD, FAAD
Bertrand D. Pusel, MD
Danyi Quan, PhD
Gary E. Quinby, MD, PhD, FAAD
Daniel C. Rabb, MD, FAAD
Forte C. Rabb, MD, FAAD
Harold S. Rabinovitz, MD, FAAD
Elyse S. Rafal, MD, FAAD
Anudeep K. Rahil, MD, FAAD
Zakia Rahman, MD, FAAD
April W. Ramsey, MD, FAAD
Nabeela M. Rashid, MD
Curtis A. Raskin, MD, PhD, FAAD
Christine S. Rausch, MD, FAAD
Dori N. Rausch, MD, FAAD
Larisa Ravitskiy, MD, FAAD
Helen A. Raynham, MD, PhD, FAAD
Abdul E. M. Razack, MD
Ana L. Recio, MD
Barbara L. Reiche, MD
Martin Reichel, MD, FAAD
Jason L. Reinberg, MD, FAAD
Francis S. Renna, MD, FAAD
Gordon J. Rennick, MBBS
Jack S. Resneck, Sr., MD, FAAD
Ronald J. Ressmann, MD, FAAD
*Includes contributions through August 20, 2013. The Academy apologizes for any errors or omissions.
Robert N. Richards, MD, FAAD
Hobart K. Richey, MD, FAAD
Troy K. Richey, MD, FAAD
Matthew R. Ricks, MD, FAAD
Antonio Riutort, MD, FAAD
Maria P. Rivas, MD, FAAD
A.L. Rivera De Los Rios, MD, FAAD
Heather J. Roberts, MD, FAAD
Robin A. Roberts, MD, FAAD
Joseph H. Robinson, MD, FAAD
Wanda S. Robles, MD, PhD
Alan S. Rockoff, MD, FAAD
Andrea S. G. D. S. Rodrigues, MD
David A. Rodriguez, MD
Heather Rogers, MD, FAAD
James B. Rohr, MD
R. Rosario-Guardiola, MD, FAAD
Ariff M. Rose, PhD
Kenneth A. Rosen, MD, FAAD
Nathan Rosen, MD, FAAD
Alan Rosenbach, MD, FAAD
Frank W. Rosenberg, MD, FAAD
Steven A. Rosner, MD, FAAD
Marla Ross, MD, FAAD
Monique E. Roth, MD, FAAD
Adam M. Rotunda, MD, FAAD
Cristina Routurou de Sanz, MD
Mark Roytman, MD, FAAD
Mark G. Rubin, MD, FAAD
Kimberly Ruhl, MD, FAAD
Ramzi W. Saad, MD, FAAD
Vernon E. Sackman, MD, FAAD
Somharn M. Saekow, MD, FAAD
Gilles L. Safa, MD
Bijan Safai, MD, FAAD
Greg K. Sakamoto, MD, FAAD
Thais Harumi Sakuma, MD
Stuart J. Salasche, MD, FAAD
Juan J. Salazar, MD
Alexey V. Samtsov, MD, PhD
Marcos Sastre, MD, FAAD
Brooke R. Sateesh, MD, FAAD
Purnima Sau, MD, FAAD
Jean H. Saurat, MD
Pascal Savard, MD, FAAD
Perry J. Scallan, MD, FAAD
Julie V. Schaffer, MD, FAAD
Donald R. Schermer, MD, FAAD
Luciano Schiazza, MD
Martin A. Schiff, MD, FAAD
Theodore A. Schiff, MD, FAAD
Lana D. Schmidt, MD, FAAD
George J. Schmieder, DO, FAAD
Christopher T. Scholes, MD, FAAD
H. Thad Scholes, MD, FAAD
Patricia P. Schulmann, MD
Caryn I. Schulz, MD, FAAD
Beth A. Schulz-Butulis, DO, FAAD
Laurel R. Schwartz, MD, FAAD
Mitchell E. Schwartz, MD, FAAD
Margery A. Scott, MD, FAAD
Sheldon Sebastian, MD, FAAD
Naribumi Sekido, MD
Robert E. Selby, MD, FAAD
Robert B. Seltzer, MD, FAAD
Victoria W. Serralta, MD, FAAD
Gabriel Serrano, MD
John T. Seykora, MD
Gregory P. Seymour, MD, FAAD
Kerry M. Shafran, MD, FAAD
Ajaz H. Shah, MD
Rana Shahab, MD, FAAD
Shabnam Shahabadi, MD, FAAD
Yasir H. Shaikh, MD
Ghannam Alwan Shallal, MBChB
Philip E. Shapiro, MD, FAAD
Robert S. Shapiro, MD, FAAD
Donald A. Sharp, MD, FAAD
Misty T. Sharp, MD, FAAD
Zuhayr M. Shbaklo, MD
Christopher N. Sheap, MD, FAAD
Robin I. Shecter, DO
Ora Shifer, MD
Joseph Shiri, MD
Michael Shohat, MD
Daniel I. Shrager, MD, FAAD
Dalia Shvili, MD
Guillermo R. Sicard, MD, FAAD
Jose G. Silva Siwady, MD
Joanne K. Simpson, MD, FAAD
Michael H. Simpson, MD, FAAD
Robert J. Sinclair, MD
Robert J. Siragusa, MD, FAAD
Maral K. Skelsey, MD, FAAD
Christopher S. Sladden, MBBCh, FAAD
M.E. Slotopolsky de Soffer, MD
Edward W. P. Smith, MD, FAAD
Eric P. Smith, MD, FAAD
L. Robert Smith, MD, FAAD
Leland Smith, MD, FAAD
Phyllis J. Smith, MD, FAAD
Margaret L. Sommerville, MD, FAAD
Vera Y. Soong, MD, FAAD
Marc J. Sorkin, MD, FAAD
Dora Soschin, MD
Maria Victoria C. Souza, MD
Jeanne H. Spedale, MD, FAAD
Kerrie J. Spoonemore, MD, FAAD
David A. Spott, MD, FAAD
Christos G. Stamou, MD
Joseph W. Stanfield, Jr., MS
Andrija Stanimirovic, MD
Steven F. Stanowicz, MD, FAAD
Jennifer A. Steele, MD, FAAD
J. Barton Sterling, MD, FAAD
Sam Stieglitz, MD, FAAD
Carla T. Stillwell, MD
Georg Stingl, MD
Charles B. Stoer, MD, FAAD
Timothy J. Storer, MD, FAAD
Dina D. Strachan, MD, FAAD
John H. Strickler, Jr., MD, FAAD
Jennifer D. Stroble, MD, PhD, FAAD
Barbara R. Sturm, MD, FAAD
Diane P. Subin, MD, FAAD
Indukooru Subrayalu Reddy, MD, MBBS
Supanee Sugkraroek, MD
Radhakrishnan N. Sukumaran, MD
Janet N. Sullivan, MD, FAAD
Glenda L. Swetman, MD, FAAD
Lynn C. Sydor, MD, FAAD
Guy M. Sylvestre, MD, FAAD
Maxine C. Tabas, MD, FAAD
Michael P. Tabibian, MD, FAAD
Sujatha Tadicherla, MD, FAAD
Hachiro Tagami, MD
Marco Taglietti, MD
Takashi Takahashi, MD
Makiko Takechi, MD
Oon T. Tan, MD
Siak-Khim Tan, MD
Kim T. Tang, MD, FAAD
Emil A. Tanghetti, MD, FAAD
Jacques Tanguay, MD, FAAD
Shady S. Tanious, MD and Enas S. Gergis, MD
Tatiana Taranu, MD
Selma E. Targovnik, MD, FAAD
Steven J. Taub, MD, FAAD
Trisha A. Taylor, MD, FAAD
Margaret H. Terhune, MD, FAAD
Wilai Thanasarnaksorn, MD
Valencia D. Thomas, MD, FAAD
Kristian Thomsen, MD
Urban L. Throm, II, MD
Sanjay Tomar, MD, FAAD
Zohair S. Tomi, MD, FAAD
Peggy Tong, MD, FAAD
Lina D. Torralba, MD
Gabor G. Toth, MD, PhD
Kristen J. Townley, MD, FAAD
Jeffrey B. Travers, MD, PhD, FAAD
Robin L. Travers, MD, FAAD
Angel F. Triana, MD, FAAD
Cory V. Trickett, DO, FAAD
Karl K. Trimble, MD, FAAD
Janet M. Trowbridge, MD, PhD, FAAD
Jean G. Trudeau, MD, FAAD
Artis P. Truett, III, MD, FAAD
Duane C. Tucker, MD, FAAD
Sam C. Tumminello, MD, FAAD
Raj K. Tuppal, MD, FAAD
Vesna E. Turak, MD
James V. Twede, MD, FAAD
Nathan S. Uebelhoer, DO, FAAD
Setsuko Ueda, MD
Larry E. Urry, MD, FAAD
Seth A. Vaccaro, MD, FAAD
Manjunath Vadmal, MD, FAAD
Luis A. Valda-Rodriguez, MD
Jenny C. Valverde Lopez, MD
John S. Van Loock, MD, FAAD
Hugo Vazquez-Veiga, MD
Peter J. Velthuis, MD
Cassandra E. Venable, MD, FAAD
Tina C. Venetos, MD, FAAD
Vermen M. Verallo-Rowell, MD, FAAD
Frank C. Victor, MD, FAAD
Juan Vilaplana, MD
Carlos Villanueva, MD
Enriqueta B. Villar de Cipriani, MD
Mary T. Von Hoffmann, MD, FAAD
Erin A. Walker, MD, FAAD
Subash Walkhinde, MD
Scott R. Walsh, MD, FAAD
Reichan S. Walther, MD, PhD
Molly Wanner, MD, FAAD
Ken Washenik, MD, PhD, FAAD
Sawko W. Wassilew, MD
Satu M. Wastimo, MD
Alan B. Watson, MD
James R. Watt, DO, FAAD
Guy F. Webster, MD, PhD, FAAD
Lucinda L. Wegener, MD, FAAD
Wolf-Dieter Weidenmann, MD
David D. Weinstein, MD, FAAD
Charles Weka Lungunga, MD
Oliverio L. Welsh, MD
Ann-Marie Wennberg, MD, PhD
William A. Wesche, MD
Raymond J. Wesley, MD
Robert C. Wessler, MD, FAAD
Stanton K. Wesson, MD, FAAD
B. Lynn West, MD, FAAD
Alan I. Westheim, MD, FAAD
Terry A. Westmoreland, MD, FAAD
Bradley A. White, MD, FAAD
Lisa M. D. Whiteaker, MD, FAAD
Schield M. Wikas, DO
John K. Wildemore, IV, MD, FAAD
Andrea Willey, MD, FAAD
Christy M. Williams, MD, FAAD
Charles J. Wilson, MD, FAAD
A A G P Wiraguna, MD
Allan S. Wirtzer, MD, FAAD
Wendi E. Wohltmann, MD, FAAD
Jeffrey M. Wolff, MD, FAAD
John H. Wollner, MD, FAAD
David Y. Wong, MD
Winona Y. Wong, MD, PhD, FAAD
Richard M. Wyatt, MD, PhD, FAAD
Myriam Wyss, MD
Yuelin Xu, MD, FAAD
Preeta R. Yadav, MD
John D. Yadgir, MD, FAAD
Cynthia B. Yalowitz, MD, FAAD
Glenn K. Yarbrough, MD, FAAD
Regina M. Yavel, MD, FAAD
Sandra T. Yeh, MD, FAAD
Saryna P. Young, MD, FAAD
Summer M. M. Young, MD, FAAD
Hsin-Su Yu, MD, PhD
Sookjung Yun, MD, PhD
Shehu M. Yusuf, MD, MBBS
Mariana Zamir, MD
James E. Zeegelaar, MD
Craig L. Ziering, DO
Rony Ziv, MD
news + events
DW cover crawls away with two more design awards
WE KNEW THE HOT PINK
COVER of our March 2013 issue,
highlighting the article “Attack of
the arthropods: Global travel helps
spread of infestations, vector-borne
infections,” would attract attention.
A respondent to our recent reader
survey singled it out, unprovoked,
for praise. Recently, we learned
that it also resonated with the
judges in two major graphic design
competitions.
For the second year in a row, Dermatology World won an American In-house Design
Award, sponsored by Graphic Design USA. (Last year’s award went to the February
2012 issue cover, “Getting your ducks in a row for the RAC.”) The 2013 award was one
of 10 the AAD collected.
In addition, the March 2013 cover and inside layout for the arthropods article won
a HOW InHOWse Design Award. The extremely selective awards program recognizes
the best creative work produced by designers working in corporations, associations,
and organizations, including, in 2012, Jim Beam, Kiehl’s, MetLife, Old Navy, and
Whole Foods. – RICHARD NELSON
DATEBOOK
WHAT’S COMING UP
AAD updates patient education on acne
Addresses concerns that patients are obtaining isotretinoin online and
self-medicating
RESPONDING TO REPORTS THAT SOME PATIENTS are obtaining the medication online
and treating themselves with it, often using a low-dose regimen discussed on many online
message boards, the AAD recently updated its patient education related to isotretinoin.
The Web page on isotretinoin now warns, in large type, “You put your health at serious
risk when you buy this medicine from an online site that does not require a prescription.”
A warning about isotretinoin also appears on www.aad.org/dermatology-a-to-z, the
home page of the Dermatology A to Z section of AAD.org — the most popular area of
the entire website. AAD Board of Directors member Neal Bhatia, MD, encouraged his
colleagues to take similar action on their own websites by adding links to the AAD website
and warning patients of the potential results of buying isotretinoin online, including
complications to pregnancies and the risk of receiving counterfeit medications. “Some
patients will seek this medication online no matter what we do, and some side effects will
go untreated as a result. But the more of us who warn against this practice, the more likely
it is that a patient looking to buy isotretinoin online will think twice. Even patients on low
doses of isotretinoin should be monitored by a dermatologist.”
The Academy’s position statement notes that the organization “opposes online Internet
dispensing, sharing, or use without physician supervision, because these activities do not
provide for sufficient patient education about isotretinoin risks and do not require participation in the iPLEDGE program.” – RICHARD NELSON
DERMATOLOGY WORLD // October 2013
41
accolades
celebrating members
Dermatologist’s letter appears
in New Yorker
niversity of Pennsylvania dermatologist Misha Rosenbach,
MD, recently read with interest a May 13 piece in the New
Yorker, entitled “Every Disease on Earth,” that addressed
medical education and the importance of academic medicine
and training from expert physicians.
The piece centered on a doctor at Elmhurst Hospital in
the Queens borough of New York who was both an expert in unusual diagnoses and a mentor to younger physicians. In response, Dr. Rosenbach wrote a
letter to the magazine addressing the bipartisan push for cuts to governmentsupported graduate medical education funding. (The AAD adopted a position
on this issue in August; see p. 40.) “Cost containment is a laudable goal, but
less funding for graduate medical education would mean fewer gifted teaching
clinicians, at the expense of our nation’s health,” Dr. Rosenbach said in his letter, which was published in the June 3 issue.
As an active reader of the New Yorker and a passionate advocate of better funding for medical education, Dr. Rosenbach said the original piece struck a chord.
“I think that in a lot of hospitals and academic centers, dermatologists fill the
role described in the piece. There are so many diseases that we know so much
about that many doctors don’t know or have forgotten about,” Dr. Rosenbach said.
“It’s important for us as a field to highlight this for our colleagues and decision
makers. It’s just unfortunate that this kind of training is in the crosshairs as the
government tries to reduce the cost of medicine in any way possible.”
In safeguarding medical education in particular and the future of medicine
in general, Dr. Rosenbach said that it may be time for the different medical specialties to come together on a concerted effort to advocate for common causes.
“When we hear about what goes on in Washington, a lot of the issues are
that each specialty and subspecialty has its own focus and goes to the Hill saying ‘we need this code preserved.’ But doctors as a whole should really work
together on some issues like tort reform, the SGR fix, and especially medical
education,” he said. “I think that medical education, which impacts all of medicine, could bring a lot of people together. We need to have an active voice in the
medical community for these things that affect everyone.” - JOHN CARRUTHERS
U
Media Highlight
Thank you to the Academy members who continue to share their valuable expertise and time with the media to educate the public about skin, hair, and nail health.
In the August issue of Fitness, (circ. 1,527,912), “All
Puckered Out,” Patricia Farris, MD, Bruce Katz, MD,
Howard Murad, MD, Neil Sadick, MD, and Molly Wanner,
MD, explain how cellulite forms and the treatments that
can make it look better.
You can find other stories of interest in the Academy’s new monthly Media Update newsletter available in
the Academy’s Media Relations Toolkit at www.aad.org/
members/media-relations-toolkit. Media Update can
keep you current on the stories your patients may see in
the media and ask you about when they visit your office.
- JENNIFER ALLYN
42 DERMATOLOGY WORLD // October 2013
Members Making A Difference:
Allison Vidimos, MD
DERMATOLOGIST LEARNS TO PRACTICE
UNDER ALL CONDITIONS IN HONDURAS
CLEVELAND CLINIC dermatologist
Allison Vidimos, MD, became
involved in medical mission trips
to Honduras after a cardiologist
colleague began a service
organization aimed at aiding
the devastation wrought by Hurricane Mitch in
1998. Since her first trip, Dr. Vidimos has not
only stayed on as one of a regular group of eight
physicians, but has brought her two daughters
along over a five-year span.
“My office is in a classroom, and my
operatory suite is a desk. It’s a real
test of your knowledge.”
• The group, based in San Pedro Sula, travels to
cities and towns throughout Honduras, ranging
from towns 20 minutes away to remote villages
that require a four-hour trip.
• Dr. Vidimos and her colleagues stay at the sites for
six days, seeing between 400 and 700 patients each
day. Two-thirds of the patients, she said, are kids.
• “We’ve gone to some of the same villages since
I’ve been doing this so long. I’ve started to recognize patients I’ve seen before, and it’s nice to see
that they’ve done well with their procedures,” Dr.
Vidimos said. “We’ve taken off skin cancers and
seen the patients years later. It’s very gratifying.”
• In addition to bacterial and fungal infections that
led to dermatologic issues, Dr. Vidimos has seen a
number of cases usually brought to other specialties
in the U.S., including half-a-dozen children with extra digits and a number of serious machete wounds.
• “You have no labs, no cultures, and basically have
to look at something and treat it,” Dr. Vidimos said.
“It’s a tremendous learning experience. We’ve set
broken bones with less-than-optimal splint material. You look at your toolbox and say you’re going
to do the best you can with what you have.”
• “It’s been a good experience for the residents, a
great experience for my daughters, and I continue
to go because it’s one thing that I can do to help
people in another part of the world.”
– JOHN CARRUTHERS dw
www.aad.org/dw
Upcoming CME Activities
Closure Course, Fundamentals of Mohs Pathology, and Fundamentals
of Mohs Surgery Fundamentals of Mohs Pathology is new this year!
DoubleTree Hotel San Diego, Mission Valley
San Diego, California
October 28-30, 2013 – Closures Course for Dermatologists
Course prerequisite is basic experience in cutting and sewing skin, with program designed to take dermatologists
to the next level of dermatologic surgery practice. This is an intense learning experience in closure considerations
for the surgeon with a primary interest in closing surgical defects. It will feature practical techniques, site specific
discussions, and numerous reconstruction “pearls,” based upon presenter’s extensive derm surgery experience.
October 29, 2013 – Fundamentals of Mohs Pathology
This one-day course is tailored to the needs of clinicians performing Mohs surgery or desirous of performing
Mohs surgery, who are returning to dermatopathology after a period of years or whose training may never have
included significant exposure to skin pathology. Our goal is to familiarize attendees via multiple microscopic
presentations with the most common entities treated by Mohs surgery: basal cell carcinoma and squamous
cell carcinoma. The course will cover all variations of these two common cancers, as well as common mimics
often found within surgical tissues usually excised during Mohs procedures – including normal histologic
structures and inflammatory and reparative findings. Course work will include study sets viewed by attendees
using high quality Mohs microscopes and didactic lectures by faculty dermatopathologists.
October 31-November 3, 2013 – Fundamentals of Mohs Surgery for Dermatologists and Mohs Technicians
Developed as a comprehensive introduction to Mohs surgery, the course provides an overview of Mohs indications,
mapping techniques, office set-up and instrumentation, and interpretation of Mohs histopathology. Instruction in
key concepts is facilitated by lectures, “pearls” discussions, interactive Q&A sessions, video microscope
demonstrations, and challenging microscope electives. The Mohs technician program will feature hands-on
training in Mohs laboratory techniques and incorporate important safety and regulatory guidelines and updates.
A high faculty-to-student ratio helps ensure rapid skill development and advancement, and allows for discussion
of critical troubleshooting techniques relative to tissue processing and slide preparation.
AMA PRA Category 1 Credit Available
Annual Clinical Symposium – Dermatologic Surgery: Focus on Skin Cancer
Hyatt Regency Tamaya Resort & Spa
Santa Ana Pueblo, New Mexico
Memorial Day Weekend, May 22-25, 2014
Top experts in the field will provide updates on a wide range of dermatologic surgery and Mohs surgery topics.
Interactive forums and panels will discuss appropriate repair strategies for a variety of surgical wounds and
innovative approaches to melanoma treatment. Both Mohs and non-Mohs cases will be featured in the
microscope laboratory. Mohs support personnel accompanying physicians to the meeting will participate in a
standalone session dedicated to important technical topics and updates, discussion of special advanced Mohs
laboratory techniques, and sharing of patient care concerns encountered on a regular basis in their work.
AMA PRA Category 1 Credit Available
For additional information regarding ASMS educational activities, membership opportunities, and patient resources, please contact:
Novella Rodgers, Executive Director
American Society for Mohs Surgery
5901 Warner Avenue, Box 391
Huntington Beach, CA 92649-4659
Tel: 800-616-2767 or 714-379-6262
Fax: 714-379-6272
www.mohssurgery.org
[email protected]
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Equal Housing Opportunity. The Corcoran Group is a licensed real estate broker located at 660 Madison Ave,
NY, NY 10065. All information furnished regarding property for sale or rent or regarding financing is from
sources deemed reliable, but Corcoran makes no warranty or representation as to the accuracy thereof. All
property information is presented subject to errors, omissions, price changes, changed property conditions, and
withdrawal of the property from the market, without notice. All dimensions provided are approximate. To obtain
exact dimensions, Corcoran advises you to hire a qualified architect or engineer.
classifieds
OFFICE SPACE AVAILABLE
PROFESSIONAL OPPORTUNITIES
DC SUBURB
Share sleek facility with plastic surgeon
in Urbana, Maryland. Alternate days.
Visit dccosmetics.com/derm.aspx.
FT. LAUDERDALE, FLORIDA
Partnership available. Established
practice. Contact Jeff, (866) 4884100 or [email protected].
Wonderful Dermatology opportunity in
Central Florida for BC/BE Dermatologist
PRACTICES FOR SALE
OCALA, FLORIDA
We Buy Practices
• Why face the changes in Health
Partnership available. Established
practice. Contact Jeff, (866) 4884100 or [email protected].
Care alone?
A qualified candidate will enjoy a professional career that will allow for a balance of work-life and
perusal of personal interest which are unique to the Winter Haven/Lake Wales area. This position
offers a competitive salary structure, productivity bonus, health and dental benefits, partnership
opportunities, a generous PTO schedule, malpractice coverage, CME, and licenses and membership dues.
• Sell all or part of your practice
• Succession planning
• Lock in your value now
• Monetization of your practice
CHICAGO NORTHWEST SUBURBS
• Retiring
FT/PT BC/BE medical and/or surgical
Please call Jeff Queen at
(866) 488-4100 or e-mail
[email protected]
Visit www.MyDermGroup.com
dermatologist to join our busy, established practice. 10,000 sq. ft. stateof-the-art facility with CLIA-certified
Mohs lab, comprehensive psoriasis
treatment center, aesthetic laser
ROSEVILLE, MICHIGAN
center, and clinical research. Forward
Solo dermatology practice for sale.
CV to practice administrator: joann@
Retiring. Interested parties contact
dundeedermatology.com.
[email protected].
PROFESSIONAL OPPORTUNITIES
QUINCY, MASSACHUSETTS
BC/BE Dermatologist to join busy,
YUMA, ARIZONA
Partnership available. Established
practice. Contact Jeff, (866) 4884100 or [email protected].
well-established dermatology
practice less than 10 miles south
of Boston. Please send CV to
[email protected].
ANN ARBOR, MICHIGAN
PORTERVILLE, CALIFORNIA
Ann Arbor Dermatology is looking for a
Partnership available. Established
career oriented, conscientious, well-
practice. Contact Jeff, (866) 488-
trained dermatologist to join a busy,
4100 or [email protected].
growing practice. This position offers
an opportunity to build a comprehensive practice that encompasses all
aspects of dermatology including Mohs
surgery and cosmetic work with a
MONTROSE, COLORADO
Partnership available. Established
practice. Contact Jeff, (866) 4884100 or [email protected].
Central Florida Dermatology and Skin Cancer Center (CFD) is seeking a BE/BC
Dermatologists and/or Derm-trained Dermatopathologist, interested in joining a
successful and growing practice. CFD serves a growing community with offices in
Winter Haven and Lake Wales. A physician who joins the practice will be busy
immediately. We provide the very best for our patients through personalized patient experience
and a world class operating environment.
highly competitive salary plus bonuses,
full benefits and early partnership. For
more information please contact A.
Craig Cattell, M.D. by phone (734)
996-8757, fax (734) 996-8767, or
email: [email protected].
CFD is currently staffed with a fellow trained Mohs surgeon, a B/C Dermatologists, and four midlevel extenders. We have an in-house Mohs and Biopsy lab. The lab is CLIA certified and has CAP accreditation. CFD has secured a highly respected reputation in the Central Florida area, and is considered
a go-to resource for Dermatology and Dermatological-Surgery care in the area.
We are seeking a highly motivated individual who has a strong work ethic, is conscientious, ethical,
and committed to providing excellence in care. We are seeking individuals who have a strong interest
in practicing medicine in the Central Florida area.
Please call Dan Lackey at (863) 293-2147 opt. 7, or email CV to
[email protected]. Visit us on the web at www.centralfldermatology.com
Cambridge Health Alliance
Dermatology
Cambridge Health Alliance (CHA) is a nationally recognized, award winning public
health system and we are currently recruiting dermatologists to establish a
Dermatology Division within the Department of Medicine. CHA is a teaching affiliate
of both Harvard Medical School and Tufts University Medical School.
Our well respected health system is comprised of three campuses and an integrated
network of both primary and specialty care practices in Cambridge, Somerville and
Boston’s Metro North Region. As we transition to becoming an Accountable Care
Organization, dermatology services will be essential to the success of our Patient
Centered Medical Home Model.
These positions are primarily clinical and will practice general dermatology in an
ambulatory setting as well as inpatient and emergency department consultations.
For the right candidate, leadership opportunities exist and we will consider either
PT or FT. Ideal candidates will be BC, possess two years of post residency experience
and substantial interest in building a Dermatology Division, developing quality
improvement projects, Tele-dermatology services, as well as curriculum development
for both medical student and resident education. Candidates must possess excellent
clinical/communications skills, commitment towards our multicultural, underserved
patient population and a strong interest in teaching. Ability to collaborate and work
in a multidisciplinary team environment is required.
At CHA we offer a supportive and collegial environment with a strong infrastructureincluding an EMR system, as well as the opportunity to work with dedicated
colleagues committed to providing high quality health care to a diverse patient
population. Excellent opportunities exist for teaching medical students/residents, and
we strongly encourage both women and minorities to apply. Please forward CV’s to
Laura Schofield, Director of Physician Recruitment, Cambridge Health Alliance, 1493
Cambridge Street, Cambridge MA 02139. Telephone (617) 665-3555, Fax (617) 6653553 or via e-mail: [email protected]. EOE. www.challiance.org
DERMATOLOGY WORLD // October 2013
45
classifieds
PROFESSIONAL OPPORTUNITIES
New Hampshire
We are seeking a part or full time Dermatologist to join our group of ten
Board Certified Dermatologists in a professionally run practice with Dermatopathology, Mohs, Medical Aesthetics, and consulting facial plastic surgeon.
This opportunity would allow a highly qualified dermatologist to practice
with excellent support staff in a collegial practice in New Hampshire with
competitive salary, benefits and practice ownership. For more information,
please contact: Glenn Smith, MHA, Administrator and Chief Operating
Officer, at (978) 610-3701 or email to [email protected].
www.apderm.com
Exceptional Opportunity for
General Dermatologist in Philly
$400k plus bonus and other incentives. Just 30 minutes
outside of center city, this successful practice is seeking a
general dermatologist. Join another Dermatologist, a PA,
and 26 full-time staff members in a brand new office.
Flexible schedule available.
For more information, email Doug Kangur at
[email protected] or call 801.930.3353.
Ref job #943328.
SOUTHERN NEW JERSEY
NORTH CAROLINA
NORTHERN VIRGINIA
Great opportunity for BC/BE derma-
Very busy, highly respected, practice
PT/FT BC/BE dermatologist needed for
tologist in Medford, NJ. Beautiful
in smaller town adjacent to Chapel
community near Philadelphia, PA and
Hill, Raleigh, Cary, and Durham seek-
Cherry Hill, NJ. Well-established busy
ing BC/BE dermatologist. Competitive
dermatology practice in a brand new
salary, benefits, early partnership.
facility, with associated medical spa.
Close to desirable NC triangle area.
Opportunity for competitive salary,
benefits, and practice ownership. FT/
PT position available. Email inquiry or
Beaches, mountain 3 hours. Email:
[email protected] or
call (919) 775-7926.
CV to [email protected].
NEW YORK
PORTLAND, OREGON
FT/PT BC/BE dermatologist needed
The Portland Clinic, a large partner-
to join as associate. Excellent oppor-
owned multi-specialty clinic, is
tunity to join busy Plastic Surgery solo
practice on LI. Forward CV to
[email protected]
seeking a BC/BE general dermatologist to join our eastside location.
Please contact Jan Reid at
CHAPEL HILL, NORTH CAROLINA
(503) 221-0161 x4600 or email
Fantastic location! Central Dermatology
[email protected].
Center, P.A. is seeking a full or part time
Dermatologist to join our group of six
Board Certified Dermatologists and four
physician assistants in a comprehensive
practice that includes general dermatol-
medical/cosmetic dermatology pracPENNSYLVANIA
Busy group of seven derms and
one PA in a highly-regarded, wellestablished practice seeking a FT/
PT BC/BE dermatologist. Our new
state-of-the-art 12,000 sq. ft. facility includes general dermatology, Mohs with office-based surgical
rooms, dermatopathology, lasers,
phototherapy, and an aesthetic
center suite. Our continually growing population base offers a new
dermatologist an established, large
patient base with excellent
managed care contracting and a
very good insurance mix. We’re
located within 1 hour of Philadelphia and Baltimore and 2 hours
from NYC and enjoy a strong and
diverse community. Call Bonnie
Oberholtzer, Practice Administrator at (717) 509.5698 or email:
[email protected]. Website: www.
dermlanc.com.
tice. Please contact (703) 867-6566
or fax resume to (703) 461-7887.
WASHINGTON DC
NW seeking a full/part time dermatologist to provide medical dermatological
care. Please call office manager for
more information (202) 965-7546 or
[email protected].
SALES INFORMATION
UPCOMING DEADLINES
FOR FUTURE ISSUES:
December ................ October 25
January................. November 25
February .....................January 3
March* .................... January 24
April ....................... February 14
*Bonus distribution at the Annual
Meeting in Denver, March 21-25
ogy, Mohs with office-based surgical
rooms and Mohs lab, dermatopathology,
lasers, phototherapy, and a successful
medi-spa. Very close to University of
Search Dermatology World
North Carolina and Duke University. We
desire a highly motivated individual who
is committed to stellar patient care and
has a strong work ethic. We provide
excellent support staff and a collegial
“An ACO just called...”
“The auditors are coming...”
“I need to hire a new receptionist...”
environment with competitive salary,
benefits and practice ownership potential. Our website is www.centralderm.
net. For more information, please
contact: Greg Catt, MBA, Practice
Administrator, at (919) 282-5536 or
You’ve read all about these issues in Dermatology World. Now, you can find the
information you remember reading right when you need it — without digging
through all of your old copies. Visit www.aad.org/dw and use the “Search
Dermatology World” box. The help you need is a click away!
email to [email protected]
46 DERMATOLOGY WORLD // October 2013
www.aad.org/dw
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Dermatology World
Statement of Ownership, Management and Circulation
(Required by 39 U.S.C. 3685) 1. Publication Title: Dermatology World. 2.
Publication No.: 10602445. 3. Filing Date: September 5, 2013. 4. Issue
Frequency: Monthly. 5. No. of Issues Published Annually: 12. 6. Annual
Subscription Price: $108.00. 7. Complete Mailing Address of Known Office
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the Publisher: 930 E. Woodfield Rd., Schaumburg, IL 60173-4729. 9. Full
Names of and Complete Mailing Address of Publisher, Editor, and Managing
Editor: Publisher — American Academy of Dermatology, Inc., 930 E. Woodfield Rd., Schaumburg, IL 60173-4729. Publisher — Lara Lowery, American
Academy of Dermatology Association, 930 E. Woodfield Rd., Schaumburg,
IL 60173-4729. Editor — Katie Domanowski, American Academy of Dermatology Association, 930 E. Woodfield Rd., Schaumburg, IL 60173-4729.
We gratefully acknowledge the following advertisers in this issue:
Company
Product/Service
Altair Instruments ..............................HydroPlus+ ......................................... IFC
American Society for Mohs Surgery ..CME ....................................................... 43
Canfield Scientific Inc .........................Veos ......................................................... 7
Care Credit ..........................................Corporate .............................................. 15
Henry Schein.......................................AAD Advantage ................................... IBC
Mela Sciences, Inc. .............................MelaFind ............................................... 13
Modernizing Medicine ........................EMR ......................................................... 3
Mushatts .............................................Mushatts No. 9........................................ 5
NexTech ..............................................EMR & PM ............................................ BC
Officite .................................................Corporate .............................................. 21
Pacific World .......................................Bio Oil .................................................... 17
Simone Development .........................Office Space Available .......................... 44
Managing Editor – Richard Nelson, American Academy of Dermatology Association, 930 E. Woodfield Rd., Schaumburg, IL 60173-4729. 10. Owner:
American Academy of Dermatology, Inc., 930 E. Woodfield Rd., Schaum-
Recruitment Advertising
Adult & Pediatric Dermatology, pc.................................................................... 46
burg, IL 60173-4729. 11. Known Bondholders, Mortgagees and Other
Cambridge Health Alliance ............................................................................... 45
Central Florida Dermatology ............................................................................ 45
Security Holder Owning or Holding 1 Percent or More of Total Amount of
Comp Health ...................................................................................................... 46
Bonds, Mortgages, or Other Securities: None. 12. The Purpose, Function
and Nonprofit Status of this Organization and the Exempt Status for Federal
Income Tax Purposes: Has Not Changed During Preceding 12 Months. 13.
Publication Name: Dermatology World. 14. Issue Date for Circulation Data
Below: September 2013
Average
No. Copies
Each Issue
During
Preceding
12 Months
Actual No.
Copies of
Single Issue
Published
Nearest to
Filing Date
15. Extent and Nature of Circulation Copies.
a. Total No. Copies (Net Press Run)
18,019
18,372
b. Paid and/or Requested Circulation
1. Sales Through Dealers and Carriers,
Street Vendors and Counter Sales
2. Paid and/or Requested Mail Subscriptions
c. Total Paid and/or Requested
Circulation (sum of 15b1 and 15b2)
0
0
17,098
17,277
17,098
17,277
d. Free Distribution by Mail, Carrier or
Other Means; Samples, Complimentary
and Other Free Copies
576
750
e. Free Distribution Outside the Mail
(Carriers or Other Means)
144
0
f. Total Free Distribution (Sum of 15d and 15e)
720
750
17,818
18,027
201
345
0
0
18,019
18,372
95.95%
95.83%
g. Total Distribution (Sum of 15c and 15f)
h. Copies Not Distributed
1. Office Use, Leftovers, Spoiled
2. Return from News Agents
i. Total (Sum of 15g, 15h1 and 15h2)
Percent Paid and/or Requested Circulation
(15c/15G x 100)
Classified ads are welcomed from dermatologist members of the American
Academy of Dermatology, from dermatology residents of approved training
programs and institutions with which they are affiliated, as well as from
recruitment agencies or organizations that acquire and sell dermatology practices and equipment. Although the AAD assumes the statements being made
in classified advertisements are accurate, the Academy does not investigate the
statements and assumes no liability concerning them. Acceptance of classified
advertising is restricted to professional opportunities available, professional
opportunities wanted, practices for sale, office space available, and equipment
available. The Academy reserves the right to decline, withdraw, or edit advertisements at its discretion. The publisher is not liable for omissions, spelling,
clerical or printer’s errors. For more information about classified advertising,
contact Carrie Parratt, advertising specialist, at [email protected] or 847-2401770 or visit www.aad.org/recruitment-opportunities.
ADVERTISING MANAGEMENT:
American Academy of Dermatology
Brian Searles - Advertising Manager
PHONE: (847) 240-1819
EMAIL: [email protected]
TO PLACE A DISPLAY ADVERTISEMENT:
The Townsend Group, Publisher’s Representative
Richard Sieber
PHONE: (301) 215-6710, ext 116 FAX: (301) 215-7704
EMAIL: [email protected]
ADVERTISING STATEMENT:
The American Academy of Dermatology and AAD Association does
not guarantee, warrant, or endorse any product or service advertised
in this publication, nor does it guarantee any claim made by the
manufacturer of such product or service.
THE AD INDEX IS PROVIDED AS A COURTESY TO OUR ADVERTISERS. THE PUBLISHER IS NOT
LIABLE FOR OMISSIONS OR SPELLING ERRORS.
DERMATOLOGY WORLD // October 2013
47
facts at your fingertips
data on display
CAMP DISCOVERY CELEBRATES 20TH ANNIVERSARY
T
he Academy’s Camp Discovery program, a summer camp for children with skin conditions, hosted its 20th annual program this summer. Campers and volunteer counselors and medical staff gathered for six different camps at five locations: Hebron, Conn., Crosslake,
Minn., Millville, Pa., Burton, Texas, and Carnation, Wash. The resulting experience, documented below, is one that the children who
camped and the adults who watched over them will cherish. To learn more or make a donation to support Camp Discovery, visit
www.campdiscovery.org or www.AADdevelopment.org/SustainingFund.html. – RICHARD NELSON dw
-
Six exciting weeks
Five different locations
357 campers
250 volunteers
45 AAD member
volunteers
48 DERMATOLOGY WORLD // October 2013
www.aad.org/dw
AAD’s Member Buying Program
Exclusive AAD Member Benefits
The AAD is pleased to announce a cost-savings supply program negotiated
exclusively for its members, and available only through Henry Schein Medical.
RELY on Henry Schein
We deliver business solutions for
your practice and savings for you
The AAD Program is supported
by industry leaders, dedicated
to consistently providing reliable
solutions, services, and products
for its members:
The American Academy of Dermatology
promotes leadership in dermatology
and excellence in patient care through
education, research, and advocacy.
Henry Schein Medical serves over
120,000 physician offices with products
and services, offering best-in-class distribution for over 90,000 SKUs and dedicated
resources for dermatology practices.
Provista, a GPO affiliate of Novation,
leverages nearly $40 billion in annual purchasing power across the health care industry to command competitive prices on a
broad range of products and services.
Practice Solutions:
– Easy Ordering via Dedicated AAD
Member Web site
– OSHA Certification
– Revenue Generation ideas
– Inventory Management best
practices
– Computers and IT Support
– Reporting and Web tools
– Equipment Repair
– Practice Set-Up Assistance
– Financial and Leasing Services
– Building Design and Layout
Assistance
– Pathology and Mohs
Consulting Services
– Office Furniture
Savings for You:
–
–
–
–
–
Sprint and AT&T—Up to 24% off
Sherwin Williams—10% discount
FedEx—45% Discount
Allied & Atlas Van Lines
Avis & Enterprise
Auto Rental
and much more.
For more information contact your Henry Schein Sales Consultant or e-mail:
[email protected]. visit: www.henryschein.com/aad
13MM9162