INSIDE... DEPARTMENTS...
WORLDDERMATOLOGYDERMATOLOGYJULY 2001 VOLUME 11 NUMBER 7
An official publication of the American A...
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DERMATOLOGY WORLD • July 2001
The American Academy of Derma-
tology Association (AADA) held its
second annual Medical Di...
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DERMATOLOGY WORLD • July 2001
President’s Views by Ronald G. Wheeland, M.D., AAD President
Ronald G. Wheeland, M.D.,
AAD...
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DERMATOLOGY WORLD • July 2001
Banking on health care savings
Washington Report
Support for medical savings ac-
counts (M...
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DERMATOLOGY WORLD • July 2001
Members asked to complete online CME survey
The American Academy of Dermatology (AAD) rece...
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DERMATOLOGY WORLD • July 2001
Representatives from the American
Academy of Dermatology Associa-
tion (AADA) met with del...
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DERMATOLOGY WORLD • July 2001
Announcing New
AAD Insurance Administrator
Announcing New
AAD Insurance Administrator
In m...
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DERMATOLOGY WORLD • July 2001
LEGAL UPDATE
HMO lawsuits move forward
By Nancy Bannon, J.D.
In Pegram v. Hendrich, which ...
10
DERMATOLOGY WORLD • July 2001
For the first time in eight years, mem-
bers of the American Academy of
Dermatology (AAD)...
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DERMATOLOGY WORLD • July 2001
Summit, from p. 2
and second opinions,” and are looking
for doctors who will work as part...
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DERMATOLOGY WORLD • July 2001
Topics covered in the
July 2001 issue:
• Photodynamic Therapy
• Vitiligo Therapy
• Nonste...
m a x i m i z e p r o f i t a b i l i t y
e n h a n c e p a t i e n t c a r e
D E R M D E X
ow DDermdex iis eeven mmore pp...
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DERMATOLOGY WORLD • July 2001
The educational program for ACAD-
EMY 2001 will feature a range of
new and improved sessi...
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DERMATOLOGY WORLD • July 2001
ACADEMY 2001
Ronald G. Wheeland, M.D., presi-
dent of the American Academy
of Dermatology...
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DERMATOLOGY WORLD • July 2001
JULY 28 - AUGUST 1
The American Academy of Derma-
tology (AAD) has provided top-qual-
ity...
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DERMATOLOGY WORLD • July 2001
ACADEMY 2001
While at a family gathering, a distant
cousin asks you to look at a spot
on ...
Welcome to ACADEMY 2001
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Welcome to ACADEMY 2001

  1. 1. INSIDE... DEPARTMENTS... WORLDDERMATOLOGYDERMATOLOGYJULY 2001 VOLUME 11 NUMBER 7 An official publication of the American Academy of Dermatology Association Anaheim Calif., home of Disneyland, the Anaheim Angels, beautiful beaches and lush golf courses, welcomes dermatologists from all over the globe as it plays host to the American Acad- emy of Dermatology’s summer meeting, ACADEMY 2001, from July 29 through Aug. 1 at the Hilton Anaheim. “This meeting will offer dermatolo- gists the opportunity to participate in a great educational program, enjoy the exciting attractions of Anaheim, and treat their families to a fun-filled summer va- cation,” said Mark Lebwohl, M.D., chair of the ACADEMY 2001 Planning Com- mittee. This year’s meeting will kick off with an opening session featuring the latest clinical and socioeconomic information of importance to dermatologists. Irwin M. Braverman, M.D., the 2001 Everett C. Fox, M.D., Memorial Lecturer, will speak on “The Skin and the Eye.” “Dr. Braverman is a master of clini- cal dermatology. Those who attend this lecture can expect to receive valuable pearls on how to diagnose skin dis- eases,” said Dr. Lebwohl. AAD President Ronald G. Wheeland, M.D., will dis- cuss the movement to regulate office-based medicine in his President’s Message. President’s Guest Speaker Alan Gibofsky, M.D., J.D., will give a lecture on “Medicine and Law” (see p. 18). The opening session will also feature a se- ries of presentations on “Dermatology Advances in the New Millennium.” Leaders in the field will discuss skin cancer, nail disorders, cosmetic and la- ser surgery, psoriasis, and pigmentation disorders. In addition to the valuable infor- mation provided during the opening session, an all-encompassing scientific education program is planned for ACADEMY 2001. “This meeting will provide attendees with very compre- hensive coverage of medical derma- tology, surgical dermatology and der- matopathology,” said Dr. Lebwohl. The Welcome to ACADEMY 2001 The gateway to Anaheim welcomes derma- tologists to ACADEMY 2001. program includes hands on workshops on botox and dermatopathology; focus sessions on topical antioxidants, cosmetic procedures, and acne; topics in … ses- sions on biological therapy and ethnic skin disorders; and much more. Anaheim is also home to some of the foremost tourist attractions in the country. “In addition to the superior edu- cational program planned for members, a trip to Anaheim should be a lot of fun for families and especially kids,” said Dr. Lebwohl. ■ AMERICAN ACADEMY OF DERMATOLOGY ASSOCIATION P.O. Box 4014 Schaumburg, IL 60168-4014 The Officers and Board of Directors of the American Academy of Der- matology have appointed Thomas P. Conway executive director of the Acad- emy and the AAD Association. “The Academy is indeed fortunate to have as its new executive director Mr. Tom Conway,” said Ronald G. Wheeland, M.D., president. “He is a bright, young, energetic leader and an enthusias- tic supporter of the specialty of dermatology. Tom has many innovative ideas about how to keep the Acad- emy at the high level of professional esteem established by his mentor, former AAD Executive Director Brad Claxton. I personally wish him the very best as he assumes his new role and sincerely hope that he will remain our administrative leader for many years to come.” Conway, who has served as interim co-executive director of the Academy for over a year, accepted the position in May. Most recently, he served as associ- ate executive director with primary responsibility in the financial manage- ment and administration of the Academy. He is the Academy’s third executive di- rector since its incorporation in 1938. “We are very pleased that Tom has accepted this position. His knowledge of the Academy and his relationships with staff should make his transition to executive director very smooth and al- most seamless,” said Clay J. Cockerell, M.D., secretary-treasurer. Thomas P. Conway appointed executive director Thomas P. Conway See Conway, p. 12 PRESIDENT’S VIEWS ................. 3 WASHINGTON REPORT .............. 4 SKINPAC REPORT ..................... 4 RESEARCH NEWS .................... 34 CME CALENDAR ..................... 38 CLASSIFIEDS .......................... 39 MANAGED CARE Summit fosters cooperative spirit ... 2 Academy meets with Humuna ..... 6 OFFICE-BASED MEDICINE First in a series on the issues and concerns surrounding regulation ...... 8 HIPAA Interpretation of the privacy rule ............................................... 36 See ACADEMY 2001 pp. 15-23 Magistrate Judge Stephen T. Brown, of the U.S. District Court for the Southern District of Florida in Miami, has denied Sorrel S. Resnik, M.D.’s motion for a preliminary injunction in his challenge to the American Academy of Dermatology Board of Director’s de- cision to void the fall 2000 Academy election for President-elect. The magistrate found that Dr. Resnik failed to satisfy any of the four factors necessary to justify a prelimi- nary injunction. The highlights of the Magistrate’s June 12 opinion are as fol- lows: 1. Dr. Resnik failed to show that the Board’s decision was arbitrary, ca- pricious, or unlawful, and there- fore cannot demonstrate a sub- See Motion, p. 32 Judge denies motion in Resnik v. AAD stantial likelihood of success on the merits. 2. The court found that Dr. Resnik failed to establish that he will suffer irreparable harm if an in- junction is not issued. 3. The court found that the harm to the Academy of granting an in- junction for Dr. Resnik would outweigh “the minimal additional injury, if any, to Dr. Resnik of not issuing an injunction.” Specifically, granting an injunction would harm the Academy by preventing it from moving forward with the special election and potentially leaving the Academy without a President-elect for many months.
  2. 2. 2 DERMATOLOGY WORLD • July 2001 The American Academy of Derma- tology Association (AADA) held its second annual Medical Directors Sum- mit in Phoenix, Ariz., April 27-29, attracting medical directors from 13 of the largest managed care organizations in the country. The Summit is designed to help der- matologists and medical directors from managed care organizations share per- spectives and bridge the gaps between them. This year’s event was sponsored by unrestricted educational grants from Dermik Labs, Ortho Dermatological, and Novartis Pharmaceuticals Corporation. Academy President Ronald G. Wheeland, M.D., welcomed the group of medical directors, dermatologists, pa- tient advocates, and drug industry representatives. The Summit was moderated by Jo- seph McGoey, M.D. Steven R. Feldman, M.D., Ph.D., director of the Center for Dermatology Research at Wake Forest University School of Medicine, opened the Summit with an address to the group on the quality and cost-effectiveness of dermatologists in the treatment of skin conditions. Focusing on some common diseases such as acne, fungus, psoriasis, and skin cancer, Dr. Feldman provided an overview of treatment by dermatolo- gists, its cost, problems — such as formulary issues — the specialty has in working with managed care, and areas where the two groups can work together in the future. AAD Assistant Secretary-Treasurer David Pariser, M.D., spoke about improv- ing the relationship between derma- tologists and primary care physicians. He presented data on the cost implications of receiving care from a primary care physician versus a specialist trained in the treatment of skin disease. Kory J. Zipperstein, M.D., chair of the Dermatology Chief’s Group at Kai- ser Permanente, provided an overview of this staff model HMO. He also ad- dressed Kaiser’s response to providing access to dermatologic care. Among the solutions Kaiser has explored to address the overwhelming demand for derma- tology services are the use of nurse practitioners, instituting a roving der- matologist program, and providing education in dermatologic treatment to primary care physicians. Abby Van Voorhees, M.D., chair of the Academy’s Guidelines of Care Com- mittee, addressed the group regarding the process by which the Academy de- velops clinical guidelines of care, including historical background on how the process has evolved over time. A panel discussion on pre-authorization and direct access featured Randolph C. Stinger, associate medical director for Humana/ChoiceCare, and Andrew Burgoyne, medical director west region for Aetna/U.S. Healthcare, who pre- sented information on traditional attitudes toward these practices and where managed care will take them in the future. Medical Directors Summit fosters cooperative spirit with managed care James Zalla, M.D., chair of the AAD’s Classification and Coding Task Force, ex- pressed dermatologists’ concerns with managed care reimbursement practices, particularly bundling, non-recognition of modifiers, and the multiple surgical re- duction rule. Rachelle Dennis-Smith, M.D., vice president of health policy for Cigna, encouraged physicians to de- velop a good relationship with their local medical directors as the first step in ad- dressing some of these issues. The final speaker on the first day was Robert Scalettar, M.D., M.P.H., medi- cal director for the eastern region and vice president of medical policy for An- them Blue Cross/Blue Shield. He introduced the Coalition of Affordable Quality Health Care Initiative, which seeks to bring managed care companies and organizations together with the shared goal of improving service, qual- ity, and coverage for patients and phy- sicians. Future trends Lee Newcomber, M.D., executive vice president for Vivius, Inc., and a former medical director for United Healthcare, and Richard Bernstein, M.D., a former Aetna medical director who currently works as a consultant with DoctorQuality.com, discussed future trends in providing health care cover- age. Both speakers examined the increasing importance of patient choice in the health care industry and the de- fined contribution model. Lenore Kakita, M.D., responded to these pre- sentations with some possible physician concerns, including increased compe- tition among physicians and the role of physician profiles in such systems. Dr. Stinger picked up the issue of physician profiling in his presentation on best practices. He reviewed an evalua- tion of physician profiling conducted by the AADA and Humana, which resulted in the company dropping the practice. Becky Cherney, president and chief executive officer of the Central Florida Health Care Coalition also addressed profiling in her discussion. The Coalition, which works to assure the quality and cost effectiveness of healthcare on be- half of public and private employers, uses profiling to improve the quality of care for employees. Vicky Holets Whittemore, Ph.D., associate director of the Genetic Alli- ance, a coalition of patient advocacy groups, offered the patient perspective on managed care. She said health care consumers, “want access to knowledge- able physicians for diagnosis, treatment (Pictured l-to-r) Jan Berger, M.D., of Caremark, Summit moderator Joseph McGoey, M.D., and Drew Burgoyne, M.D., of Aetna/US Healthcare, enjoy a discussion over breakfast at the Medical Directors Summit in Phoenix, Ariz. AAD President Ronald G. Wheeland, M.D., welcomed dermatolo- gists and medical directors to the 2nd annual Medical Dir- ectors Summit. Dermatologist Joseph McGoey, M.D., served as moderator of the Academy’s 2nd annual Medical Directors Sum- mit. Philip Orbuch, M.D., (left) chair of the Academy’s Managed Care Task Force, and Alan Wirtzer, M.D., a member of the AMA CPT Advisory Committee, network during a break at the Medical Directors Summit. James Zalla, M.D., (left) a chair of the AAD Health Care Finance Committee, looks on as Rachelle Dennis-Smith, M.D., of Cigna Health Plans, answers questions from Summit participants. AAD Immediate Past President Richard K. Scher, M.D., makes a point to Aetna’s Drew Burgoyne, M.D., during a break in the meeting. Summit participants Lee New- comber, M.D., of Vivius, Inc. (left) and Richard Bernstein, M.D., of DoctorQuality.com with moderator Joseph McGoey, M.D. (center). David Lorber, M.D., with Advance PCS, gives a presentation at the Summit. See Summit, p. 12 Vicky Holets Whittemore, Ph.D., co-chair of the Coalition of Patient Advocates for Skin Disease Research; pro- vided the patient per- spective to Summit attendees. (Pictured l-to-r) Kory J. Zipperstein, M.D., of the Dermatology Chiefs’ Group at Kaiser Permanente, and Abby Van Voorhees M.D., chair of the AAD Guide- lines of Care Committee, are pictured with AAD Assistant Secretary-Treasurer David Pariser, M.D. The Medical Directors Summit was established last year at the suggestion of Dr. Pariser.
  3. 3. 3 DERMATOLOGY WORLD • July 2001 President’s Views by Ronald G. Wheeland, M.D., AAD President Ronald G. Wheeland, M.D., AAD President No one specialty owns the title of “surgeon” In the March 2001 Bulletin of the American College of Surgeons (ACS), ACS Executive Director Tho- mas R. Russell, M.D., expresses strong opposition to the Residency Review Committee (RRC) for Dermatology’s proposal for a fellowship training pro- gram in dermatologic surgery. In his article, he criticizes the creation of the proposed 12-month PGY-5 fel- lowship program stating that the RRC for dermatology is “seeking to estab- lish a subspecialty in dermatological surgery.” However, the proposed training requirements submitted to the Ac- creditation Council for Graduate Medical Education (ACGME), and opposed only by three of the 27 specialties who have RRCs in the ACGME, would not “create” a der- matologic surgery subspecialty, but would acknowledge the types of training that are already in existence. In fact, by 1990, over 90 percent of dermatology residency programs were training residents in dermato- logic surgery. Dr. Russell’s article points to “flaws” in the RRC proposal stating, “dermatologists traditionally have performed minor operations and Mohs micrographic procedures.” Dr. Russell goes on to explain that “the training program proposed by the RRC for dermatology, however, would allow their programs to go further and create ‘surgeons,’ who could perform a much broader range of operations including hair replace- ment, tumescent liposuction, soft tissue augmentation, fat transplan- tation, wound closure techniques, grafts, and flaps.” Dr. Russell misses the point that dermatologic surgeons pioneered many of these very tech- niques. His column demonstrates the all-too-common misimpression that other specialties have about the training and expertise of dermatolo- gists — not only in diagnosing skin disease, but also in the medical and surgical management of those same disorders. Dr. Russell states that the ACS has taken a strong position “by dis- couraging the ACGME from approving the proposed one-year dermatological surgical fellowship — asserting that it lacks the compre- hensiveness of the other surgical training programs.” He continues, “It does not, in our view, meet the cri- teria for producing surgical specialists.” He further states that approved programs cover such nec- essary components of surgical training as basic science, anatomy, an- esthesia, ethics, surgical techniques, wound healing, the diagnosis and man- agement of shock, pathology, pharmacology, oncology, epidemiology, legal and regulatory issues, however he fails to realize that many of these top- ics are already taught as part of the PGY 2-4 dermatology training program. I suggest that dermatologists view Dr. Russell’s “Perspective” in its entirety at the ACS Web site, www.facs.org/ June 6, 2001 Thomas R. Russell, MD, FACS Executive Director American College of Surgeons 633 N. St. Clair Street Chicago, IL 60611 Dear Dr. Russell: As President of the American Academy of Derma- tology, with over 13,000 members, I write to you to express my great disappointment with your published comments concerning dermatologic surgery in the March, 2001 Bulletin of the American College of Surgeons. The perspective you presented sadly demonstrates a severe lack of knowledge on your part regarding the evolution of dermatologic surgery in the specialty of dermatol- ogy as well as the current training requirements in dermatologic surgery mandated for all dermatology resi- dents by the American Board of Dermatology. I would appreciate having this opportunity to clarify these important issues for you and to help correct your many misimpressions about my specialty. The Ameri- can Board of Dermatology was established in 1932 as the fourth specialty board of the American Board of Medical Specialties (ABMS), following ophthalmology, otolaryngology and obstetrics/gynecology. When the ABMS and the American Medical Association Council on Medical Education established specialty requirements, the American Board of Dermatology followed suit by sponsoring its own Residency Review Committee in 1955. You should be aware that the Accreditation Council for Graduate Medical Education (ACGME) and ABMS do not create specialties, rather they react to the types of the training that are already in existence. By 1990, over 90% of dermatology residency programs were training residents in dermatologic surgery. As a result, significant dermato- logic surgery requirements were approved by the ACGME and mandated as part of the training requirements for all dermatology residents. All dermatology/PGY 2-4 training programs are also required to have a faculty member who serves as the dermatologic surgeon on staff to teach excisional surgery, reconstructive surgery with use of flaps and grafts, laser surgery, soft tissue augmentation, laser skin resurfacing, tumescent liposuction, chemical peels and Mohs micrographic surgery, among others. It is during fellows_info/bulletin/mar01russell.pdf. In response to Dr. Russell’s comments, I’ve written the letter that appears below, and I invite others to do the same. I also urge you to write to the ACGME in support of the fellowship program. Letters to the ACGME can be addressed to: Steven P. Nestler, Ph.D., Executive Director, ACGME, 515 North State Street, Suite 2000, Chicago, IL 60610. As physicians, we must stand to- gether with trust and mutual respect for residency that dermatology residents learn how to evalu- ate and treat patients, both medically and surgically. There they also develop the analytical skills to know when to properly apply the many surgical techniques they have been taught and how to manage the patients postopera- tively. In view of this, it is surprising that you would not be familiar with the extensive requirements in derma- tologic surgery that are already approved, mandated and in existence for all PGY 2-4 dermatology training programs. The subspecialty of dermatologic surgery will not be created by the fellowship training proposal for PGY-5 that is currently before ACGME, it already exists! Training in dermatologic surgery, just like dermatopa- thology, pediatric dermatology, and occupational dermatology, is already required by the RRC. In addi- tion, there are sixty-five fellowships in dermatologic surgery currently in existence, located primarily at aca- demic institutions. Some of these fellowships have been in existence for over 20 years. Despite this, no stan- dardized training program requirements have as yet been established to coordinate the types of educational op- portunities afforded each fellow. If approved, the pro- posal for PGY-5 fellowship training in dermatologic sur- gery would codify the training requirements by establishing a set of uniform standards to certify an iden- tical level of educational quality for all fellowship programs. Furthermore, the proposed PGY-5 fellowship program requires completion of a formal dermatology residency before an individual is allowed to expand on the significant base of surgical experience that has al- ready been learned during residency. Surgery has long been an important aspect of the specialty of dermatology and the incorporation of many surgical techniques into the formal training of derma- tologists has occurred over a long period of time. Many innovative cutaneous surgical procedures have been developed, modified or perfected by dermatologists. A few of these include: dermabrasion for scars (1952 – Dr. Abner Kurtin), hair transplantation (1959 – Dr. Norman Orentreich), chemoexfoliation (1960 – Dr. Sam Ayers, III), laser treatment of port-wine stains and tattoos (1963 – Dr. Leon Goldman), moist wound healing (1963 – Dr. Howard Maibach), cryosurgery (1967 – Dr. Douglas Torre), fresh tissue Mohs micrographic surgery (1974 – Drs. Theodore Tromovitch and Samuel J. Stegman), soft tissue implants (1983 – Dr. Arnold Klein), tumescent the benefit of our patients, not frag- ment over such issues as which specialty should own the title, “sur- geon.” ■ See Surgeon, p. 13
  4. 4. 4 DERMATOLOGY WORLD • July 2001 Banking on health care savings Washington Report Support for medical savings ac- counts (MSAs) is gaining momen- tum as Congress and the White House begin working on proposals to in- crease the number of Americans covered by health insurance. More than 43 million Americans are lack- ing health insurance at this time, according to U.S. Census data. The American Academy of Der- matology Association (AADA) favors the widespread availability of MSAs as a way of making a dent in this woeful statistic. Medical sav- ings accounts were approved as part of the Health Insurance Portability and Ac- countability Act of 1996 (HIPAA). This law established MSAs as a four-year pilot program that began Jan. 1, 1997. The leg- islation limited availability to people who work for companies with fewer than 50 employees or who work on their own. Last year, Congress ex- tended the expiration date for this program to Dec. 31, 2002. The law sets a cap of 750,000 MSA accounts nationally. Only about 100,000 people have purchased them. Approximately one-third of these MSA holders previously had no health insurance coverage. MSA sup- porters argue that insurers are unwilling to invest the capital to mar- ket MSAs because they will expire shortly. A brief review of how an MSA works illustrates the possible benefits of this insurance vehicle. An MSA is a tax- exempt trust or custodial account established to pay for medical expenses in conjunction with a high-deductible in- surance policy. Either individuals or their employers may make contributions to an MSA. Contributions are deductible or ex- cludable from federal taxes. Distributions from the MSA are tax-exempt if they are used to pay for medical expenses. The Internal Revenue Code defines eligible medical expenses although some states allow additional ser- vices and items to be exempt from state taxes. Distribu- tions from an MSA for purposes other than medical ex- penses are subject to state and federal taxes as well as a 15 percent penalty. An MSA offers the patient and the health care community advantages that include cost savings, portability, and quality care uninterrupted by third-party interests. Because unused MSA funds are allowed to accrue from year to year, these accounts can encourage individual savings that could be used by elderly MSA holders, for example, to pay for long-term health care needs or benefits not covered by the Medicare program. Because an MSA is portable, a worker no longer needs to be job locked or decline to pursue other em- ployment options for fear of losing health insurance coverage. The funds in the MSA can be used to pay the pre- mium on a health insurance policy while a person is in between jobs. And be- cause an MSA allows patients the free- dom to choose any physician without interference from health plan gatekeepers, patients will have greater access to specialists such as dermatolo- gists. It should be noted that a recent study by the Rand Corporation discov- ered that when people spend their own money on health care services, they spend 30 percent less with no adverse health effects. Supporters of MSAs include Presi- dent George W. Bush as well as a bipartisan group of lawmakers that is sponsoring H.R. 1524, the Medical Sav- ings Account Availability Act of 2001, introduced on April 4 by representa- tives Bill Thomas (R-CA) and William Lipinski (D-IL) and awaits action in the House Ways and Means Committee. The Thomas-Lipinski bill would: • make MSAs permanent, • allow all Americans the option of choosing an MSA, • lower the minimum deductible for health plans that accompany MSAs to $1,000 for individuals and $2,000 for families, • allow annual contributions to an MSA to equal 100 percent of the deductible, • allow MSAs to be offered as part of cafeteria-style benefit plans, and • encourage preferred provider or- ganizations to offer MSAs. The Thomas-Lipinski bill is consis- tent with the Academy’s policy on MSAs, and for this reason Association members and staff plan to work closely with the MSA Coalition for its passage. The MSA Coalition includes a diverse group of sup- porters, such as the American Medical Association, anti-tax groups like Ameri- cans for Tax Reform, insurance in- dustry groups like the Health Insurance Association of America, companies that administer MSA plans, and trade associations like the Ameri- can Bakers Association. While MSAs are not the solution for all of our nation’s uninsured citi- zens, these accounts do represent an option for increasing health in- surance coverage that should be made available to everyone on a permanent basis. By increasing the field of health insurance options, Americans will be able to choose their own physicians and the health insurance coverage best suited to their needs. Questions about medical sav- ings accounts or H.R. 1524 should be addressed to Laura Saul Edwards, assistant director, federal affairs, at (202) 842-3555 or e-mail ledwards@ aad.org. Further information about the Academy’s federal affairs efforts can be found on the AADA Web site, www.aadassociation.org. ■ With the recent partisan switch of the United States Senate from Re- publican to Democratic hands, the 2002 elections are going to be even more com- petitive and more important to both parties. SkinPAC will be involved in mak- ing sure that Senators and Represent- atives elected in 2002 are supportive of dermatology and dermatology patients. In May, the SkinPAC Board of Advi- sors made decisions to support a handful of candidates for their election bids in 2002. One of these candidates is Sen. Max Baucus (D-MT). In January, Sen. Baucus became the top Democrat on the very influential Senate Finance Commit- tee. The SkinPAC Board of Advisors took this into consideration when it decided to support Sen. Baucus in his re-election bid. SKINPAC REPORT SkinPAC looks to support 2002 candidates Right after the SkinPAC Board de- cided to contribute to Sen. Baucus’s re-election campaign, Sen. Jim Jeffords of Vermont decided to leave the Repub- lican Party and become an Independent, which gave the majority of the Senate to the Democrats by one seat. This power shift has now propelled Sen. Baucus into the chairmanship of the Fi- nance Committee, which has jurisdiction over Medicare and health care programs. The SkinPAC Board is excited to be sup- porting a strong candidate that has the power and ability to make a positive change in America’s health care system. Sen. Baucus was first elected to the United States Senate in 1978. And, al- though he served for three consecutive terms, during the last election in 1996, he won re-election to his fourth term in the Senate with just 50 percent of the vote. This margin of victory indicates that the upcoming race should be very close, and that Sen. Baucus can use all of the support he can get. SkinPAC is looking forward to work- ing with the members of the American Academy of Dermatology Association to ensure a successful 2002 election cycle. With SkinPAC’s donation to the Baucus campaign, the specialty of dermatology will be represented at several events in Montana and Washington, D.C. A goal of SkinPAC is to have a der- matologist attend an event in the home state of every candidate we support. If you are interested in attending a fundraiser for a member of Congress on behalf of SkinPAC or have any questions regarding SkinPAC activities, please con- tact John Farner in the AADA’s Washington, D.C., office at (202) 842- 3555, or e-mail jfarner@aad.org. Information about SkinPAC can be found on the Association’s Web site, www.aadassociation.org. Members are invited and encour- aged to visit the SkinPAC booth at the ACADEMY 2001 summer meeting in Anaheim, Calif. SkinPAC will be located at Booth 206 in the Technical Exhibit Hall at the Anaheim Hilton. ■ An MSA offers the patient and the health care community advantages that include cost savings, portability, and quality care uninterrupted by third-party interests.
  5. 5. 5 DERMATOLOGY WORLD • July 2001 Members asked to complete online CME survey The American Academy of Dermatology (AAD) recently announced that an online continuing medical education program is under development. As part of the AAD’s efforts to create a program that is tailored to dermatologists’ needs, the Academy is asking members to participate in an online “CME Needs Survey for Members.” The survey is posted under the Members Only section of the AAD Web site and is designed to establish the parameters of future online CME exercises by seeking information on such issues as preferred topics, format, duration, and more. Members are encouraged to fill out the survey to help ensure that a pro- gram optimally suited to their needs can be established. Visit www.aad.org/Members/CMEsurvey.html today, to register your opinion.■ EDUCATION UPDATE The American Academy of Derma- tology will host a consensus confer- ence on isotretinoin Oct. 19-21 in Washington, D.C. Lowell A. Goldsmith, M.D., dean emeritus, University of Rochester School of Medicine and Dentistry, New York, will chair the conference. “The effective use of isotretinoin, one of the life changing drugs in our arma- mentarium, is being threatened once again,” said Dr. Goldsmith. “Data, reason and the understanding of the mechanisms of the real and the apparent complica- tions of isotretinoin is necessary to ensure the safe use of this drug. The conference will have experts from many disciplines discussing approaches to the safest and best use of this drug.” In addition to dermatologists, faculty from the specialties of psychiatry, obstet- rics andgynecology,teratogenicityexperts, and others will be invited to attend. The consensus conference is now in the planning stages. Barbara R. Reed, M.D., chair of the Academy’s Ad Hoc Task Force on Isotretinoin, will also provide leadership for the Conference Planning Committee, which currently consists of: • Jean L. Bolognia, M.D. • Jeffrey P. Callen, M.D. Oct. 19-21 set for isotretinoin consensus conference • Suephy C. Chen, M.D. • Steven R. Feldman, M.D. • Henry W. Lim, M.D. • Anne W. Lucky, M.D. • Diane M. Thiboutot, M.D. • Ronald G. Wheeland, M.D. The planning committee will sug- gest six focus questions to be discussed at the conference, as well as determine the invitees. Watch future issues of Dermatology World for more information about this important event as it develops. ■ An end to the five-year fight by the American Academy of Dermatol- ogy to obtain a national Medicare policy for the treatment of actinic keratosis (AK) appears to be in sight. Staff from the Health Care Financing Administration (HCFA) recently announced that a deci- sion would be made by July 9 about whether to issue a national coverage policy or ask the Medicare Coverage Advisory Committee to issue the policy. On May 29, Academy representa- tives met in Baltimore, Md., with the Health Care Financing Administration’s (HCFA’s) team that is considering the re- quest for an AK national coverage policy. Academy Past President Darrell Rigel, M.D., and AADA Council on Policy and Practice Chair Cliff Lober, M.D., summa- rized expert opinion on AK treatment, emphasizing that immediate treatment of AKs is the accepted medical standard of care. Drs. Rigel and Lober discussed some issues with the technical report is- sued in mid-May by the Agency for Healthcare Research and Quality. The report is only one of a number of sources that will be considered by HCFA as it responds to the Academy’s request for a national AK coverage policy that re- flects the medical standard of care. ■ Decision on AK national coverage policy expected
  6. 6. 6 DERMATOLOGY WORLD • July 2001 Representatives from the American Academy of Dermatology Associa- tion (AADA) met with delegates from Humana Inc. on May 10 in Louisville, Ky., to discuss various reimbursement issues. In addition to a general discussion of the recognition of AMA’s CPT modifi- ers, specifically modifiers –25, –57, –51 and –59, AADA representatives also fo- cused on numerous specific examples of evaluation and management services that were bundled with separate proce- dures; of modifier –51 being applied to Mohs surgery services; and examples of separate surgical services being bundled. Representing the AADA was James Zalla, M.D., chair of AADA’s Health Care Finance Committee, Jeffrey Richardson, M.D., a member of the AADA’s Coding and Reimbursement Task Force, and Bar- bara Dolan, AADA’s private sector manager. They also discussed the fact that Humana’s referrals to specialists by primary care physicians are not docu- mented in writing or verified in advance of the service. Dr. Zalla noted that a more “patient friendly” prior authorization policy would be more efficient, such as faxed autho- rizations in advance of any appointment — a procedure used by other major carriers. “An even better policy to decrease office staff frustration would be to discontinue the referral requirements for dermatologic care,” he said. The Humana representatives sug- gested that they would consider the AADA’s recommendations, and discuss them with other company leadership. Humana representatives attending the meeting included Thomas James, M.D., chief medical officer for Humana- Kentucky, Andrew Krueger, M.D., Humana’s director of emerging technolo- gists, and Connie Light, RN, director of technology assessment. Humana’s Se- nior Insurance Counsel Gary Reed, Jr., also attended the meeting, as did Marianne Finke, project manager for claims improvement programs. Multiple procedures In discussing Humana’s multiple- procedure policy, which reimburses at a rate of 100-50-25-25 percent for a se- ries of surgical services, Dr. Zalla pointed out that HCFA changed its multiple-pro- cedure rule to 100-50-50-50 in 1993. “Some carriers seem to be stuck back before 1993,” he said. “I think it might be because the company thinks it is sav- ing money by retaining an old policy.” Dr. Zalla explained that in the case of emergent services, the physician would be likely to provide each of four services on the same day, and lose money by being reimbursed at a level of 25 percent for the third and fourth procedures. However, if the services are elective in nature, Dr. Zalla suggested that it is likely a physician will ask the patient to return another day for the third or fourth procedure, rather than provide additional service on the same day and be reimbursed for less than it costs to perform the procedure. “The patients understand when we tell them that they need to return an- other day it is because their carrier’s policy reimburses multiple procedures at less than it costs the physician to pro- vide multiple services performed on the same day,” Dr. Zalla said. When the pa- tient returns another day, the services are reimbursed at 100 and 50 percent. Humana winds up paying more for the services than if they had initially allowed 100, 50, 50 and 50 percent reimburse- ment on the same day of service, following the HCFA and standard reim- bursement policy for multiply procedures. Humana representatives suggested that they would consider the implications of their current policy fur- ther. AK treatment Dr. Richardson pointed out that when he treated a patient with exten- sive actinic keratoses (AKs) with a chemical peel, the claim was denied as cosmetic. After appealing the claim for over a year and sending extensive docu- mentation, Dr. Richardson said the claim was still being denied although the treat- ment was clearly medically necessary. Asking for additional information, which Dr. Richardson provided, Humana rep- resentatives said they would look into the specific concern. In general, accord- ing to Dr. Krueger, there is no Humana policy that denies the treatment of AKs with chemical peels. “We want you to understand,” said Light, “there is no strategic attempt on the part of Humana to make the claims processing process difficult for physicians. In fact, we are trying to make it easier.” Light focused on Humana’s initiative to encourage electronic claims submis- sions, highlighting a new system that will “get us out of the paper processing busi- ness.” Dr. Zalla said that verification of the submitted claim confirming modifier submission is needed. An evaluation of benefits would be difficult to correlate to the claim, particularly if codes like evalu- ation and management services dis- appeared from electronic claims like they disappear from Humana paper remit- tance advice, he stated. Humana representatives assured Academy representatives that such veri- fication, adequate to meet the needs of a typical practice, would be available in its new electronic system. “You have to understand,” Dr. Zalla told the group. “Most dermatologists would much prefer slightly delayed cor- rect payments, rather than fast under- payments. It is an issue of fairness.” Humana representatives related in several cases that they would have to research the company’s policies further to clarify if the specific examples pre- sented to them regarding inappropriate claims processing were due to actual claims edits, or if there were other rea- sons for denials. Academy representatives look for- wardtoafollow-upmeetingwithHumana, and eventual resolution of the company’s claims processing issues. ■ Academy meets with Humana to discuss claims processing concerns “Most dermatologists would much prefer slightly delayed correct payments, rather than fast underpayments. It is an issue of fairness.”
  7. 7. 8 DERMATOLOGY WORLD • July 2001 Announcing New AAD Insurance Administrator Announcing New AAD Insurance Administrator In many states that have initiated the regulation of office-based medicine, the debate began dramatically — with highly publicized, negative outcomes and patient deaths related to cosmetic surgery. The media frenzy that followed prompted state legislators to call for in- creased regulation of surgery performed in physician offices. “Most people think that the regula- tions are about ambulatory surgery centers where general anesthesia is used, especially for performing cosmetic surgery. However, that is not the truth,” said Ronald G. Wheeland, M.D., presi- dent of the American Academy of Dermatology. “These regulations can be applied to any and all procedures per- formed in an ambulatory setting, with and without anesthesia, and for purposes other than cosmetic.” Dr. Wheelend points to the Clinical Laboratory Inspection Amendments (CLIA) as an example of how concern for patient safety can result in inappro- priate and burdensome regulations for a wide range of practitioners. “CLIA was originally driven by incompetent Pap smear labs that did a horrible job of inter- preting the results causing many women to die of cervical cancer,” Dr. Wheeland explained. “However, cumbersome regu- lations were developed that covered most tests from simple skin scraping for fungal infection and scabies to hair analy- sis. These were never life or death issues, nevertheless the regulations remain.” CLIA, he said, has created a costly bureaucracy with no appreciable im- provement in quality of care. “Similarly,” he continued, “when outpatient surgical procedures are driven into the hospital or ambulatory surgery clinic under the guise of improved patient safety, the cost will also go up dramatically and many patients will be significantly inconve- nienced. All without improving patient safety or public health.” Lawmakers and regulatory bodies promulgating these regulations often have a limited understanding of current practices in physician offices, according to Dr. Wheeland. “Ignorance of what is currently being done in the ambulatory setting and the high safety levels that have typified this practice for years has moved legislators and members of medi- cal boards into new arenas,” he said. California According to Margaret E. Parsons, M.D., president of the California Society of Dermatology and Dermatologic Sur- gery (CDS), the regulatory debate in California demonstrates this point. In Cali- fornia, the movement to regulate office-based surgery began in the early 1990s, and mandatory accreditation of offices has been proposed as a solution to safety concerns. “How can we, as phy- sicians, say ‘well we don’t want to be accredited?’ It sounds negative, as if we don’t want to meet some reasonable stan- dard for patient safety. Accreditation is a word that appeals to many people that may or may not understand what’s hap- pening in our offices,” said Dr. Parsons. Although health care issues have taken a back seat in the legislature to California’s escalating energy crisis, vari- ous proposed bills — which were subsequently amended or are caught in committee — would have impinged on all dermatologists in the state. For example, the original language of a bill passed in 1999 that requires reporting of all patient deaths or emergency transfers, would have required that all outpatient settings be ac- credited — even those performing only minor surgical procedures. Another proposed piece of legisla- tion in California that garnered criticism from office-based practitioners was Sen- ate Bill 595, which would have tightened accreditation require- ments. “Language was proposed where you couldn’t do any intramuscular analgesics, so an orthope- dist wouldn’t even be able to do a shot of IM Demerol to pop a dislocated shoul- der back into place,” said Dr. Parsons. New York This state recently adopted volun- tary guidelines. Legislation has also been introduced. The original proposed guide- lines would have placed accreditation re- quirements on all physicians practicing in their offices regardless of the complex- ity of the procedure. “Fortunately, thanks to efforts by some very active dermatologists and sur- geons who had a significant input into the process, the resulting guidelines were fairly reasonable — although originally they were not going to be,” said Duane Whitaker, M.D., chair of the Academy’s Blue Ribbon Committee on Office-Based Medicine. Additionally, a bill has been in- troduced in the state legislature that would require mandatory reporting of any ad- verse incident to the commissioner of health — even allergic reactions to local anesthetic. That bill is currently under re- view by the Health Committees of the New York House and Senate. Academy efforts To address these issues, the Acad- emy has opted to educate its members and prepare them for the advent of regu- lations. As part of this effort, the Academy has begun working with the Accredita- tion Association for Ambulatory Health Care (AAAHC) to develop an accredita- tion option for dermatologists who perform only minor surgical procedures in their offices. “We should soon have an appropriate process available to derma- tologists that is reasonably affordable and really not burdensome to a small prac- tice,” said Dr. Whitaker. This kind of proactive stance is be- ing encouraged by Dr. Wheeland as a major initiative of his year in office. “It is imperative that all members of our spe- cialty be united in their understanding that the legislation and regulations being considered are applicable to everyone in dermatology,” he said. “Although pa- tient safety must be everyone’s concern, until there is proof that a problem exists with what most dermatologists do in their office setting, a burdensome and expen- sive office accrediting process is unwarranted.” ■ Regulating office-based medicine: not just a surgical issue anymore JLT Services Corporation AAD Group Insurance Plans 300 South Wacker Drive Suite 700 Chicago, IL 60606 888-747-6866 Over 63 Years As An Association Insurance Specialist! • Term Life Insurance • Health Insurance • Disability Income • Business Overhead • Cancer Insurance • Hospital Indemnity • Accidental Death & Dismemberment Contact JLT Services Corporation for information on how you can save on comprehensive protection for you and your family. Officially sponsored by Currently, 17 state legislatures or medical boards have attempted to regulate physicians’ offices where surgical procedures are performed and more states are expected to take up the cause. This article is the first in a series that will explore the is- sues and concerns surrounding the regulation of office-based medicine and its impact on the scope of the dermatology practice.
  8. 8. 9 DERMATOLOGY WORLD • July 2001 LEGAL UPDATE HMO lawsuits move forward By Nancy Bannon, J.D. In Pegram v. Hendrich, which was decided approximately one year ago, the United States Supreme Court said that plan coverage decisions often involve a mix of medical and admin- istrative components, and Federal Em- ployee Retirement Income Security Act (ERISA) immunity does not extend to the medical component of plan deci- sions. Earlier this year, the Pennsylvania Su- preme Court cited the Pegram decision when it ruled that insurance companies that make medical decisions are subject to state laws governing medical negli- gence. It said that plans should be held liable under state medical malpractice laws for harmful medical decisions (Pappas v. Asbel). Other recent court decisions in Cali- fornia, Illinois, New York, and Pennsyl- vania have found that plan participants and beneficiaries can bring negligence claims against health plans in state court— ERISA does not pre-empt them. Still, the results in the courts are not always uni- form. Some courts continue to block liabilityclaimsbroughtinstatecourtagainst HMOs. For example, the federal 3rd Cir- cuit Court of Appeals (which encompasses Pennsylvania) recently found that ERISA pre-empts claims against HMOs. Part of the reason for the lack of uni- formity is the difficulty in distinguishing between the administrative and the medical care portion of an HMO’s deci- sion. The outcome of an individual case will depend on how a court character- izes the HMO care decision that led to the injury. Expect to see continued varia- tions in decisions until a consensus develops among the courts or until Con- gress passes federal guidelines on plan liability. Physician-filed class actions Meanwhile, an important class action lawsuit against health plans has been suc- cessfully moving through the federal U.S. District Court in southern Florida. The law- suit consolidates claims by 20 individual doctors in seven states charging that health plans are intentionally violating prompt-pay laws and violating the pro- visions of RICO. In March, the California Medical Association, the Texas Medical Association, and the Medical Association of Georgia joined the lawsuit against the insurers. The class action charges that there is a conspiracy among managed care companies to deny, delay, and di- minish payments to providers. The defendant insurers include Aetna, Humana, Cigna, PacifiCare, Foundation Healthcare Systems, Prudential, United Healthcare, Connecticut General Life, and Wellpoint Health Networks. So far, this class action suit has cleared the obstacles insurers have used to try to block the lawsuit. In March of this year, the judge in the case rejected the insur- ers’ argument that the lawsuit should be dismissed because of ERISA protections. A number of lawsuits continue to chip away at ERISA’s liability protec- tions for HMOs. During the past year, courts have become more receptive to liability claims against HMOs, as well as prompt payment class action lawsuits filed by physicians under the federal Racketeer Influenced and Corrupt Organization Act (RICO). Referring to Pegram v. Herdrich, the judge said, “Defendants read Pegram as if it were a talisman before which all of Plaintiffs’ claims should fall. Yet the court in Pegram did not fashion an all-encom- passing cloak of immunity for the health care industry…HMO-type structures will not be imperiled if such entities are held accountable for concrete harm flowing from acts of fraud, extortion, and breach of contract, as alleged by the plaintiffs.” Although the judge also went on to dismiss the physicians’ claims because of flaws in the language of the complaint, he permitted the physicians to amend their complaint and restate their claims, allowing the case to move forward. At a recent hearing on the class ac- tion in May, the judge again rejected the insurers’ request to dismiss the physicians’ lawsuit. Instead, he ordered the case to move into the discovery phase, which is the next step in the litigation process. During the coming year, the physicians’ attorneys will review health plan docu- ments to see if they reveal systematic attempts to control medical decisions and manipulated payments. Connecticut The Connecticut Medical Society has filed its own class action lawsuit against HMOs on behalf of its members. The suit claims that the defendant health plans— Oxford, Cigna, Aetna, Connecticare, Anthem Blue Cross/Blue Shield, and Phy- sician Health—systematically breach the terms of their contracts with physicians, thereby harming physicians and their pa- tients. Based on recent cases in other jurisdictions, the lawsuit has a good chance of having at least some initial success. Physicians and their representatives note that injury claims arising from medi- cal treatment historically have been governed by state law and resolved in the state court. The Supreme Court rea- soning in last year’s Pegram decision supported the contention that state courts are the appropriate forum for holding health plans accountable. Now, ERISA experts see a definite trend in the fed- eral courts where causes of action against health plans based on medical decisions or “mixed” medical eligibility decisions are not being pre-empted by ERISA. In other words, physicians and patients are increasingly empowered to pursue legal remedies in state courts under state law. This LEGAL UPDATE column is the first in a semi-regular feature series that will cover the various legal issues dotting the managed care landscape today. ■ Expect to see continued variations in decisions until a consensus develops among the courts or until Congress passes federal guidelines on plan liability.
  9. 9. 10 DERMATOLOGY WORLD • July 2001 For the first time in eight years, mem- bers of the American Academy of Dermatology (AAD) will be voting on a proposed dues increase this fall. On June 9, the Academy’s Board of Directors unanimously approved sending this is- sue to the membership for approval. The revenue from the increased dues will be directed to developing measures to pro- tect office-based medicine and to new programs of importance to dermatolo- gists in the area of government affairs, as well as providing services to dermatolo- gists to help them run their practices, and AAD members to vote on proposed dues increase other initiatives to benefit members. “There was unanimous support from the entire Board of Directors for finding the necessary funds to enact these im- portant membership programs,” said Ronald G. Wheeland, M.D., president. “Academy members will see direct and immediate benefits from the programs if the dues increase is approved.” The unanimous Board support came after dermatologists from across the country expressed strong support for increasing Academy dues so that these important member programs get the appropriate level of funding. “A number of my colleagues have not only called on the Academy to in- crease dues to pay for government affairs programs, but they feel that this step should have been taken a long time ago,” said Linwood G. Bradford, M.D. of Sumter, S.C. “It’s been over seven years since we last raised the level of dues. This is long overdue.” Dues for the Academy are on the lower end of the scale when compared with other medical specialty societies (see chart below, right). For example, the American Society of Plastic Surgeons (ASPS), who have been leading the charge against dermatologists and their ability to practice medicine in an office- based setting, have a dues level nearly three times higher than the Academy. This does not include assessments that members of ASPS have been charged to pay for negative campaigns targeted at dermatology. “We are under attack and we need to fight back,” said Robert Brodell, M.D., of Warren, Ohio. “Other medical spe- cialties are trying to tell us what type of medicine we can practice. If we don’t find the resources for programs to counter these assaults, dermatologists will not be able to practice medicine in the manner in which we have been trained, which would be to the detriment of our patients.” Clay J. Cockerell, M.D., secretary- treasurer, has indicated that funds are not currently available to adequately sup- port the numerous new programs demanded by Academy members while maintaining the traditional educational mission of the Academy. “If something is not done to increase funding, we will not even be in a position to fight these battles,” said Dr. Cockerell. “ The strong vote from the Board shows the clear consensus that we need to take this ac- tion in order to be responsive to the wishes of the membership.” ■ 2001-U.S. Organization .....member dues American Society of Plastic Surgeons ............... $1,260 American Association of Neurological Surgeons ..... $ 790 American Academy of Ophthalmology ................ $ 675 American Academy of Orthopedic Surgeons ....... $ 600 American College of Emergency Physicians ..... $ 515 American Osteopathic Association ....................... $ 490 American Society of Anesthesiologists .............. $ 450 American Academy of Dermatology ............ $ 450 American Academy of Otolaryngology-HNS ... $ 400 American College of Cardiology ................... $ 350 American College of Obstetrics-Gynecology $ 350 American Urological Association ........................ $ 350 Major medical specialty society dues comparison Looking to make the smartest investment in your continuing education? Look no further . . . The 2001 ASDS-ACMMSCO Combined Annual Meeting offers the most comprehensive learning opportunities to expand and enhance your skills in cosmetic and reconstructive dermatologic and Mohs micrographic surgery. Choose from a multitude of educational sessions — from basic to advanced, cosmetic to reconstructive — to best meet your needs. • learn what's new in cosmetic dermatologic surgery — peels, fillers, lasers and other medical and surgical rejuvenation techniques • review the fundamentals of dermatologic surgery • hear the latest studies showing the efficacy of Mohs micrographic surgery in the treatment of lentigo maligna • discover the latest techniques in advanced facial reconstruction • learn about late-breaking developments in transplant oncology and radiation and medical oncology • understand how the regulatory and legislative policies being promulgated across the country will impact your practice Call today and receive a registration brochure at 847/330-9830, e-mail esmith@aad.org or download the registration brochure at www.aboutskinsurgery.com.
  10. 10. 12 DERMATOLOGY WORLD • July 2001 Summit, from p. 2 and second opinions,” and are looking for doctors who will work as partners with them. In her opinion, patients will pay more for the right to choose the most knowledgeable physician. Addressing the role of the pharmacy in the managed care system were David B. Lorber, M.D., assistant vice president of medical affairs for AdvancePCS, on formularies, and Jan Berger, M.D., vice president of clinical services and quality, associate medical director of patient care for Caremark Inc., on coverage for “quality of life” drugs versus medically necessary drugs. Discussion also centered on physi- cian problems with preauthorization for prescriptions and keeping track of the formularies required by various man- aged care plans. Dr. Whittemore said a key element in these issues is keeping employees educated about the details of their plans, and Cherney agreed, as- serting that employers as the purchasers of health care coverage have to take an active role in creating posi- tive change in the system — including better educating employees. Dr. McGoey concluded the meet- ing. “We welcome your ideas for collaboration. We have some of our own ideas. Because things aren’t so black and white, it’s very important that we con- tinue to collaborate, seek ideas and explanations,” he said. ■ During the transition period, Conway has provided management sta- bility to the Academy — its officers and board, as well as staff. He has imple- mented several significant board approved policies and programs affect- ing the Academy, including the establishment of a sister 501(c)6 orga- nization, as well as the development and recent implementation of a governance reorganization plan. In addition, he has overseen the Academy’s Washington, D.C. office, as well as reorganized the staff management structure and revised staff performance appraisal and incen- tive programs. Through Conway’s experience with Conway, from p. 1 the Academy, he recognizes that infra- structure — the financial, technological, and workforce resources of the Academy, as well as its management structure — is a vital component to the successful deliv- ery of Academy services and programs. “One of the many jewels I gleaned from my mentor, Brad Claxton, is that the Academy is only as strong as its vol- unteers and staff. Dermatology is blessed with member participation that is with- out a peer, so I intend to follow Mr. Claxton’s credo and assure that the Acad- emy has the best staff possible in order to carry out the board’s goals and objec- tives.” Such objectives include using tech- nology to deliver distance learning; pursuing legislative, regulatory, and pri- vate sector advocacy channels as a means for facilitating fair reimburse- ments for physician services, as well as securing unrestricted treatments and vis- its for patients and access to specialized services; preserving office-based medi- cine and protecting the scope of practice; investigating research oppor- tunities; and building public awareness of the importance of dermatology. “I view the role of the executive director as a facilitator between the lead- ership and staff, to ensure that the board’s established objectives are car- ried forward by staff to meet the needs of the membership,” said Conway. “One of the duties of the executive director is to ensure that the board conducts an ongoing strategic planning process in which the continuation of current plans is assessed and new opportunities are evaluated. Once the board has estab- lished a priority, the executive director must identify the efficient utilization of resources that will empower staff to at- tain that priority.” Conway brings to the job 19 years of diverse and specialized business ex- perience. Prior to joining the Academy in 1996, he held executive management positions spanning 14 years. His experi- ence includes 10 years as vice president and treasurer of the National Futures As- sociation, a not-for-profit, self-regulating organization serving the futures industry, with a staff of 275 and an annual budget in excess of $30 million. Prior to that, Conway was a certified public accoun- tant (CPA) with Oak Brook, Ill.-based Cray-Kaiser, Ltd., providing accounting, auditing, management advisory services, and tax consultation to a wide variety of industries and not-for-profit organizations. Additionally, he spent two years as an accounting manager for Cooperative Mar- keting Company, a privately-held marketing and printing business. He holds a Masters of Business Administration from Loyola University of Chicago, Graduate School of Business. Conway is a devoted family man who enjoys spending time with his wife Kerri and their three children, son Sean, 8, and daughters Taylor, 9, and Riley, 4. The Conway’s reside in Glen Ellyn, a western suburb of Chicago, where Tom spends his leisure time coaching his son’s Little League baseball games, as well as playing golf and recreational hockey, when time permits. ■
  11. 11. 13 DERMATOLOGY WORLD • July 2001 Topics covered in the July 2001 issue: • Photodynamic Therapy • Vitiligo Therapy • Nonsteroidal Topical Therapy On April 25, the American Academy of Dermatology launched Mela- noma/Skin Cancer Detection and Pre- vention Month with a press conference in New York City. The press conference and related media activities generated more than 81 million media impressions. As a result of the press conference, ABC World News Tonight interviewed AAD’s Melanoma Month activities reach record-breaking 81 million people Darrell Rigel, M.D., about skin cancer risk. An interview with Darrell Rigel, M.D., Barbara Gilchrest, M.D., and Neal Schultz, M.D., about skin cancer prevention and detection was broadcast on 42 ABC-TV affiliates nationwide. Ri- chardGlogau,M.D.,discussedskincancer awareness with the FOX-TV affiliate in San Francisco. The AAD’s skin cancer San Francisco Giants screened for skin cancer On Melanoma Monday, May 7, American Academy of Derma- tology President Ronald G. Wheeland, M.D., examined San Francisco Giants pitcher Kirk Reuter for skin cancer. AAD members John Epstein, M.D., and Peter Panagotacos, M.D., also par- ticipated in the screening of 51 players, coaches, front office staff and family members of the Giants. The event generated more than 3 million media impressions. ■ screening program was the subject of The Today Show’s interview with Marsha Gordon, M.D. The skin cancer informa- tion presented at the press conference was also featured in TheWashingtonPost, USATODAY.com, Fashion Wire Daily, ABCNews.com, and WebMD. In addition, a satellite media tour featuring Ronald Wheeland, M.D., and Barbara Gilchrest, M.D., reached more than 1 million viewers throughout the country, while a radio media tour featuring Ronald Wheeland, M.D., and James Spencer, M.D., reached over 32 million people nationwide. A video news release featuring Darrell Rigel, M.D., reached more than 23 mil- lion people throughout the country, while a video news release featuring professional golfer Greg Norman and Clay Cockerell, M.D., has reached 800,000 to date. The Weather Channel and the San Francisco Giants helped launch Melanoma Monday on May 7. Media coverage of these screenings reached over 3 million people nationwide. Additional coverage of Melanoma Monday included interviews with James Spencer, M.D., on the FOX- TV affiliate in New York and Desiree Ratner, M.D., on the NBC-TV affiliate in New York. Major articles were published in The Tampa Tribune and The Balti- more Sun. In addition, the American Academy of Dermatology’s Melanoma Monday was the answer to one of the trivia questions on Jeopardy! ■ AAD, The Weather Channel promote sun safety (above) Participating in the AAD’s Melanoma Monday skin cancer screening event at The Weather Channel (TWC) headquarters in Atlanta, Ga., on May 7 are (pictured l-to-r): Kenneth Beer, M.D., Harold Brody, M.D., Boni Elewski, M.D, AAD Vice President, Lawrence Schachner, M.D., Thomas Rohrer, M.D., Darrell Rigel, M.D., Jacqueline Marie Junkins-Hopkins, M.D., and TWC on-camera meteorologists Paul Goodloe and Jennifer Lopez. (above) Darren Casey, M.D., (left) screened a Weather Channel employee for skin cancer on Melanoma Monday, May 7. A total of 163 Weather Channel employees were screened. Atlanta-area AAD members Harold Brody, M.D., Cynthia Dolan, M.D., and Gabrielle Sabini, M.D., also volunteered their time and expertise at the screening. AAD President Ronald G. Wheeland, M.D., screens San Francisco Giants pitcher Kirk Reuter for skin cancer. Did you receive your copy of the Member Needs Assess- ment Survey? Please be sure to fill out and return the printed version, or access the survey online under the Members Only section of the AAD Web site, www.aad.org, by July 31. Don’t miss this very im- portant opportunity to contribute. This survey is conducted only once every three years and your re- sponses are vital in guiding the development of future Academy programs. ■ Member needs survey due by July 31 To subscribe, call the AAD Order Desk at (847) 240-1279. Dialogues in Dermatology The audio journal of dermatology liposuction (1987 – Dr. Jeffrey Klein) and most of the cutaneous laser sur- gical procedures being performed today. In addition the first textbook on dermatologic surgery written by a dermatologist, Dr. Erwin Epstein, Sr., was published in 1956, and the Journal of Dermatologic Surgery and Oncology began publishing in 1975. Finally, I am particularly of- fended by your apparent proprietor- ship of the term “surgery.” The de- termination of what specialties are surgical is not, as you mistakenly state, developed by ABMS. In fact, the specialty boards of the ABMS do not distinguish between medical and surgical specialties. The specialty boards themselves define a scope of practice that is modified as prac- tice innovations occur. Many of the subjects you mentioned as being re- quired to become a “surgeon,” including basic science, anatomy, an- esthesia, ethics, surgical techniques, wound healing, oncology, and the management of postoperative com- plications, are already taught as part of the PGY 2-4 dermatology train- ing program and questions relevant to these topics are included on the American Board of Dermatology certi- fying examination. I conclude by most strongly rec- ommending the next time before writing your “Perspective” column that you more carefully review the facts before making broad, sweeping and incorrect statements that can have dam- aging effects on others. The specialty of dermatology is not just about syphi- lis and warts any more, Dr. Russell. Join the 21st century and see for yourself the quality of training dermatologists routinely receive in surgical topics as currently mandated by the American Board of Dermatology and the ABMS. While you are at it, why not also re- view the many innovative contributions to advancing skin surgery that have been made by many dermatologists over the years and which are routinely used on a daily basis by many other “surgical” specialties. The collegiality of physicians has always included a willingness to share both clinical and basic research ideas and techniques with others so that our patients can benefit from the latest technologies and most creative research available. Working for the common good of our patients also requires mu- tual respect and trust between all specialties and is part of what it means to be a doctor. Your unwar- ranted and fallacious attack on the specialty of dermatology serves only to undermine these basic tenets while inciting mistrust, promulgating confusion and demonstrating your basic ignorance and prejudice on this particular topic. I would welcome the opportu- nity to speak with you at any time to help further clarify these issues for you. Sincerely, Ronald G. Wheeland, MD President, American Academy of Dermatology Surgeon, from p. 3
  12. 12. m a x i m i z e p r o f i t a b i l i t y e n h a n c e p a t i e n t c a r e D E R M D E X ow DDermdex iis eeven mmore ppowerful. HHaving jjoined SSal u® , wwe nnow ooffer oover 500 proprietary ppracctticcee ooperations ssolutions, iincclluding aa ffree PPracctticcee WWebsite, aall designed tto hhelp yyou mmaximize yyour ppracctticcee eefficciienccyy aand pprofitability wwhile ccoontinuing tto bbe tthe lleading, 24-hhour, oonline pprovider oof ccoosmecceeuticcaals, mmediccaal aand officcee ssupplies, ccoorreccttive ccoosmeticcss, mmediccaal/spa ssolutions aand aanti-aaging pproducctts. To ffind oout hhow DDermdex ccaan hhelp yyour ppracctticcee bbe mmore eefficciient aand mmore pprofitable, visit uus ttoday aat wwww.dermdex.ccoom, oor ccaall 1-8888-5550-77405, MM-FF 8 am tto 5 pm EEST. N © 2001 Salu® , Inc. DermdexSM . DermdexSM is a division of Salu® , Inc. A t t e n d tt h e DD e r m d e x CC M EE - AA c c r e d i t e d AA n n u a l MM e e t i n g “ T h e CC h a n g i n g FF a c e oo f CC o s m e t i c SS u r g e r y ” N o v e m b e r 99 - 11 1 , 22 0 0 1 ii n DD e l r a y BB e a c h , FF l o r i d a O u r ww o r l d - rr e n o w n e d ff a c u l t y ww i l l bb e ss p e a k i n g oo n bb o t o x tt e c h n i q u e s , ll a s e r s u r g e r y , pp e e l s , ss k i n cc a n c e r tt r e a t m e n t s aa n d mm o r e . HH e a r II n g a EE ll l z e y dd i s c u s s c o d i n g ss o l u t i o n s ff o r tt h e cc o s m e t i c aa n d dd e r m a t o l o g y pp r a c t i c e . RR e c e i v e 99 cc m e c r e d i t s . RR e g i s t e r bb y cc a l l i n g 11 - 88 8 8 - 55 5 0 - 77 4 0 5 ee x t 11 5 oo r 22 1 . D e r m d e x MM e m b e r s RR e c e i v e aa 22 0 % DD i s c o u n t oo n RR e g i s t r a t i o n , a n d MM e m b e r s h i p tt o DD e r m d e x ii s FF r e e . i n c r e a s e p r a c t i c e e f f i c i e n c y
  13. 13. 15 DERMATOLOGY WORLD • July 2001 The educational program for ACAD- EMY 2001 will feature a range of new and improved sessions on every- thing from patch testing to giving a media interview. “The Academy’s best teachers will be offering vital informa- tion on the issues of most importance to dermatologists,” said Mark Lebwohl, M.D., chair of the ACADEMY 2001 Plan- ning Committee. Most of the educational sessions are eligible for continuing medi- cal education credit. Several exciting interactive work- shops will be available to attendees. There will be two workshops on botu- linum toxin, in the morning and after- noon on Tuesday, July 31. The after- noon workshop will feature live demonstrations il- lustrating injection techniques. An- other workshop will explore patch testing, including a “hands-on” patch testing exercise. “While the Academy has offered botulinum toxin workshops in the past, this year’s summer meeting boasts more and considerably improved sessions,” said Dr. Lebwohl. “The same is true of the patch test workshop. While it may have been offered in previous years, this workshop will be considerably more comprehensive.” Other workshops will cover the use of lasers, dermatopathol- ogy, and the art of mastering media interviews. A number of hands-on computer training sessions are also planned to help dermatologists and their staffs increase their computer know-how. Sessions on Windows ‘Me — the Millennium edition of Windows, most com- monly used in homes and small businesses; Microsoft Word; and PowerPoint will aid everyone from the novice to the more ad- vanced computer operator. Two open labs will also be offered to allow attendees to practice the skills they learn. Another interactive session available at this ACADEMY 2001 educational sessions tackle wide range of topics year’s summer meeting is a symposium on clinicopathologic correlation in the diagnosis of dermatologic disorders. Members of an eight-person panel will be presented with patient case histo- ries and biopsy specimens and asked to provide a differential diagnosis. Mi- croscopes will be made available outside the session room for attendees to examine the specimens themselves. “Dermatoscopy/ELM Training,” a top- ics in … session will also offer an opportunity to use the technology in- volved while learning this technique for diagnosing melanoma. A number of industry-sponsored sessions will once again be offered at the summer meeting. Galderma is spon- soring a session on “Insights into Skin of Color: Diagnosis and Treatment.” Allergan Skin Care will offer “Innova- tions in Improving Facial Appearance,” and Berlex Laboratories has sponsored an event titled “Maximizing Your Clini- cal Practice: Treating Actinic Keratoses in the Managed Care Setting.” “New Therapies for Atopic Dermatitis: Itch- ing to Know More!” will be offered by Novartis Pharmaceuticals Corporation, and “Latest Breakthroughs in Psoriasis Therapy” by Genentech, Inc. Industry sponsors are responsible for the con- tent of these sessions, as well as for securing continuing medical education credit. Popular sessions returning this year include a concurrent session on Thera- peutic Pearls that will present attendees with practical and innovative strategies in diagnosis and management for the office-based practitioner. New Thera- pies also returns again this year offering attendees up-to-date information on the newest, most effective therapies for commonly encountered conditions. Also returning are sessions on pediatric Mark Lebwohl, M.D., chair, Academy 2001 Planning Committee dermatology, nails, drug reactions, and more. For detailed information such as dates, times, locations and ticketing re- quirements for these and the numerous other sessions being offered at ACAD- EMY 2001, consult the program book. ■ New and improved sessions on subjects as varied as patch testing to developing media interview skills await dermatologists at the ACADEMY 2001 summer meeting. On-site registration On-site registration is available for meeting attendees who did not return their advance registration materials for ACADEMY 2001 before the dead- line of June 29, 2001. The on-site registration desk will be located in the California/Pacific Foyer at the Hilton Anaheim. Tickets for available sessions, courses, workshops, and computer training sessions can be purchased at the on-site registration desk, based upon availability. Registration will be open during the following hours: Saturday, July 28 .................................................................... 2 p.m. to 8 p.m. Sunday, July 29 ........................................................................ 7 a.m. to 5 p.m. Monday, July 30 ....................................................................... 7 a.m. to 5 p.m. Tuesday, July 31 ...................................................................... 7 a.m. to 5 p.m. Wednesday, August 1 ................................................................ 7 a.m. to noon Don’t miss ACADEMY Welcome Reception Kick off your time at ACADEMY 2001 by attending the Welcome Reception on Saturday, July 28, from 6 p.m. to 7:30 p.m. in Pacific Ballroom D at the Hilton Anaheim Hotel. Registered physicians, spouses and children are invited to this fun-filled event. The event is free, however badges are required for complimentary admittance. Participate in Dermatology World focus groups Dermatology World is seeking readers who are interested in providing input on the publication’s content. Dermatology World will hold two focus group sessions on Monday, July 30, during the ACADEMY 2001 meeting in Anaheim, Calif. Session 1 is scheduled for 7 to 8:30 am on July 30, a complimentary continental breakfast will be served. Session 2 is scheduled for 1 to 2:30 p.m. on July 30, a complimentary box lunch will be served. Both sessions will be held at the Hilton Anaheim — the ACADEMY 2001 host hotel. Free Academy products valued at over $100 will be awarded to all partici- pants. Input received from the sessions will be kept confidential by a third party focus group moderator. Selection for the groups will begin immediately. If you will be attending ACADEMY 2001 and are interested in participating in one of the two available focus group time slots while you are at the meeting, please contact Lara Lowery, managing editor, at (847) 240-1776, fax (847) 330-8907, or e-mail llowery@aad.org. ACADEMY 2001 approved for CME credit The Accreditation Council for Continuing Medical Education (ACCME) accred- its the American Academy of Dermatology (AAD) to sponsor continuing medical education (CME) for physicians. All ACADEMY 2001 activities are approved for direct-sponsored Academy Category I or I-S credit toward the AAD CME Award. Credit is calculated on an hour-for-hour basis and will be reflected on the February transcript issued to all registered participants in the AAD Transcript Program. The maximum number of hours that may be claimed is 33. Check the ACADEMY 2001 Program Book for credit hours earned per session. The AAD designates this continuing medical education activity for a maxi- mum of 33 hours in Category 1 credit towards the American Medical Association’s Physician’s Recognition Award of the American Medical Association. Each phy- sician should only claim those hours of credit that he/she actually spent in the educational activity. ■ (right) The popular Technical Exhibit Hall, where dermatologists can learn about the latest in industry products and diagnostic equipment, will be held Sunday through Tuesday in the California Pavilion at the Hilton Anaheim Hotel.
  14. 14. 16 DERMATOLOGY WORLD • July 2001 ACADEMY 2001 Ronald G. Wheeland, M.D., presi- dent of the American Academy of Dermatology and AAD Association, will address the topic of office-based medicine during the Open- ing Session at ACADEMY 2001 on Sunday, July 29. Office-based medicine, which encompasses nearly any procedure performed in an outpatient setting – is an important topic for all der- matologists, according to Dr. Wheeland, because it af- fects every dermatologist – no matter how big or small the procedures that they perform. “Many of the proposed restric- tions on how we practice in our offices will severely impact on our ability to provide the best possible care for our patients in the most cost- efficient manner,” said Dr. Wheeland. The Academy is working to pre- pare members for the challenges any restrictions or regulations may impose on dermatologists. Several significant steps have been taken, including the close monitoring of all state legislative activities relative to office-based prac- tices in concert with state dermatology leaders. The Academy has also developed an affiliation with the prestigious Accredi- tation Association for Ambulatory Health Care (AAAHC), a nationally-recog- nized, non-profitorganization, that has resulted in the recent development of an appropri- ate set of standards that would allow accreditation of offices for office-based practitioners. “While mandatory accreditation of dermatologists’ offices may not be re- quired in every state in the immediate future,” said Dr. Wheeland. “The mechanism for obtaining that accredi- tation is now in place should that eventuality occur. Hopefully, by tak- ing these actions, dermatologists can continue to provide the highest qual- ity of medical, cosmetic or surgical care to their patients.” ■ Ronald G. Wheeland, M.D. AAD President’s Message to address office-based medicine The most common error of observa- tion is that “we see only what we’re looking for,” according to Irwin M. Braverman, M.D., professor of derma- tology at Yale Medical School, who will be presenting the Everett C. Fox, MD Memorial Lecture at the ACADEMY 2001 meeting in Ana- heim, Calif. Physicians have a tendency to filter out information in an attempt to diagnose a patient. “When they see a patient and have a rough idea of the patient’s condition, often times the only thing they look for is what corroborates the diagnosis,” he said. By discarding the other information they could be missing out on a clue that could lead to another diagnosis. Using art to teach physicians observational skills By Ruth Carol Dr. Braverman hopes to teach medical students and residents to reverse that process.“They should start with a blank slate and look for all the details that are present, and on that basis come up with a diagnosis,” he said. In his lecture titled “The Skin & the Eye,” which is slated for the Opening Session on Sunday morning, Dr. Braverman will discuss a method to im- prove the observational skills of medical students and residents through art. Students are neither trained in medi- cal school nor are residents trained in residency programs to “see,” according to Dr. Braverman. “We teach them pat- tern recognition. We point out a particular lesion, how it’s arranged, all its details. We essentially turn them into a walking atlas,” he explained. The problem with this kind of training is that it’s passive, Dr. Braverman ar- gued, and it doesn’t teach physicians how to analyze a lesion or rash they are ob- serving for the first time. “When looking at a foreign object, such as a painting, you tend to describe all of its details because you don’t know which ones are more important,” he said. “If you keep practicing that exercise of looking for the details, this skill will become second na- ture. So that no matter what you are looking at, you’ll see the details there.” Dr. Braverman contends that many der- matologists and physicians acquire this skill only after years of practice, and he questions whether this skill can be taught or enhanced earlier in one’s medical edu- cation. For the past 4 years, Dr. Braverman Irwin M. Braverman, M.D. has taken a field trip to the art museum with his first-year medical students and residents. While there, the students are asked to describe what they see in vari- ous paintings. “As the students describe these paintings, you realize how they’re seeing and can guide them in a more appropriate direction, if necessary,” he said. Some students only see the over- all theme, while others only see the details. “You can relate their comments directly to clinical medicine; for example, how they describe contradictory features in the painting can be similar to inter- acting with a patient with contradictory symptoms.” Dr. Braverman believes that obser- vational skills can be improved provided students, residents and new doctors are taught more than just to recognize pat- terns. “It isn’t just about turning them into a walking atlas,” he concluded, “it’s about turning them into a walking Sherlock Holmes who will create his own atlas.”■ Dr. Braverman will discuss a method to improve the observational skills of medical students and residents through art. The online Personal Itinerary is avail- able for the ACADEMY 2001 meet- ing in Anaheim, Calif. This planning tool enables members to create a personal- ized itinerary to keep track of dates and times of sessions they plan to attend. The Personal Itinerary allows mem- bers to view information for all of the events scheduled during the meeting. Information is obtained by searching through a variety of subjects such as committee/ancillary meetings, computer training sessions, educational sessions, optional activities and more. Users can also search by date and key words. Mem- bers can view a brief synopsis of any session including date, time, and faculty. AAD Resource Center..............Booth 501 AV Preview Room...................... Palisades Business Center ...................Lower Lobby Convention Office ...............Green Room Message Center ...California/Pacific Foyer Poster Exhibits ....... California Promenade Press Conference Room ...... Capistrano B Press Office .......................... Capistrano A Registration ..........California/Pacific Foyer Technical Exhibits ........ California Pavilion Continuing medical education credit for Academy members will be tabu- lated based on submitted CME Reporting Forms that are available in the registration packets. Attendees must write their six-digit AAD Master Identification Number and name on the CME Reporting Form and place the completed form in the desig- nated collection boxes. Registrants need only submit one CME Reporting Form for the entire meeting. All sessions will be listed on the one form. A separate Session Evaluation Form should be completed for each educa- tional activity to provide feedback for future planning. Educational activities qualify for Category I CME credit as follows: • Opening, Concurrent, General Sessions ............. hour for hour credit • Course ............................................................................... six hours credit • Seminars, Workshops................................................. three hours credit • Topics In… .............................................................. one hour credit each • Focus Sessions ....................................................... two hours credit each • Personal Computer Sessions ................................. two hours credit each Those sessions dealing with socioeconomic and practice issues qualify for AAD Category I-S CME credit and those sessions not qualifying for any CME credit are indicated in the sessions’ description. ■ By clicking on a particular session it can be added to the user’s itinerary, which can either be printed or viewed online. Members can add or delete ses- sions at anytime throughout the meeting. However, the Personal Itiner- ary tool will not allow users to register for the meeting or individual events. To register, members must visit the on- site registration desk in the California/ Pacific Foyer at the Hilton Anaheim Hotel. The Personal Itinerary is accessible under Hot Topics on the AAD homepage and under the Highlights section on the Members Only portion of the AAD Web site, www.aad.org. ■ Continuing Medical Education reporting, session evaluation Plan ACADEMY 2001 itinerary online Academy offices, exhibits The Business Service Center is located in the Lower Lobby of the Hilton Anaheim Hotel. It will be open Saturday, July 28 through Wednesday, Aug. 1. Major credit cards are accepted. ■ All locations are in the Hilton Anaheim Hotel: Business Center
  15. 15. 17 DERMATOLOGY WORLD • July 2001 JULY 28 - AUGUST 1 The American Academy of Derma- tology (AAD) has provided top-qual- ity patient education pamphlets for over 20 years, and the pamphlet line has con- tinued to grow and evolve with the specialty of dermatology. Thirteen new and revised titles for 2001 include: Sunscreens, Black Skin, Solving Problems Related to the Use of Patient literature offerings expanded Cosmetic and Skin Care Products, The Sun and Your Skin, Skin Conditions Related to AIDS, Squamous Cell Carci- noma, What’s In a Scar, Nail Health, Pruitus, Dysplastic Nevi, Basal Cell Car- cinoma, Malignant Melanoma, and Actinic Keratosis, which is scheduled to debut in the fall. The total patient pamphlet line num- AAD Pamphlets Committee The AAD Pamphlets Committee consists of the following members: • Robert B. Skinner, M.D., Chair • Tina S. Alster, M.D. • Mark D.P. Davis, M.D. • W. Christopher Duncan, M.D. • Charles W. Lynde, M.D. • Linda Susan Marcus, M.D. • Ginat W. Mirowski, M.D., D.M.D. • Sandra I. Read, M.D. • Mark Naylor, M.D. ■ bers 50 strong, and it is still growing. Pam- phlet authors are selected, upon recommendation by their colleagues, for their extensive knowledge of the topic. Each of the pamphlets, written in an easy- to-understand format, clearly illustrates a particular dermatologic condition and the possible treatments with outcomes that can be expected. Each patient pamphlet title goes through an extensive review process prior to final approval. The draft manuscript is seen by a second recog- nized expert on the specific condition, followed by the Guidelines and Out- comes committee, and finally the chairs of the Communications Council. Changes and rewrites occur throughout the pro- cess to ensure the most up-to-date and accurate information available. The success of the pamphlet line is due in large part to the dedication and commitment of the Pamphlets Commit- tee (see sidebar). The Committee, chaired by Robert Skinner, M.D., from the University of Tennessee-Memphis, is composed of nine dermatologists who review the text and graphics for each new and revised pamphlet. They also recommend new pamphlet titles based on member requests from the Member Needs Assessment Survey and the re- cent Pamphlet Survey. “Pamphlets are a vital patient edu- cation tool, reinforcing important information and often answering the patient’s forgotten question,” said Dr. Skinner. In addition to use by more than 40 percent of North American members, pamphlets are also purchased in bulk by such organizations as the National Park Service, which distributes them as a means of public awareness. A grant from The National Dermatology Public Awareness Program (NDPAP) also makes these pamphlets available to individual consumers who write to the Academy or call the special 800 number. A new brochure listing all of the current and upcoming pamphlets will be mailed to all Academy members this summer. Complimentary pamphlet sample packs will also be available at I’m interested in reviewing additional information about: ❑ AAD Advantage – Member Buying Program ❑ AAD Financial Connection – Equipment Leasing and Financing ❑ AAD Financial Connection – Credit Card Processing Fax to (847) 240-1859 Name __________________________________________________________ Address _________________________________________________________ City, State, Zip ___________________________________________________ Phone _________________________ Fax___________________________ E-mail __________________________________________________________ AAD offers money saving programs for practice expenses the AAD Resource Center, booth 501 in the Technical Exhibit Hall, during ACAD- EMY 2001 in Anaheim, Calif. For additional information, contact the AAD Marketing Department at (847) 240- 1280, fax (847) 240-1859, or visit the AAD Web site at www.aad.org. ■ To assist Academy members with sub- stantial savings on practice expenses, the American Academy of Dermatology (AAD) offers AAD Advantage and AAD Financial Connection, two member programs available through an Academy partnership with Henry Schein, Inc. AAD Advantage and AAD Finan- cial Connection were developed in response to an overwhelming member request for the Academy’s help in reduc- ing practice expenses. These programs provide three key areas of money sav- ing opportunities for members. • AAD Advantage — Member Buy- ing Program. Offers substantial savings on all medical, surgical, and front-office supplies as well as brand name and generic pharmaceuticals. Compare prices in the latest formu- lary. There’s no enrollment fee or minimum order commitment of any kind — just great savings on the products that dermatologists use most. The membership program code is AAD-91. • AAD Financial Connection — Equipment Leasing & Financ- ing. Favorable rates, negotiated exclusively for Academy members, are significantly less than current market rates. Members can pre-ap- prove themselves for up to $200,000 on a simple, six-line ap- plication. Take advantage of 100 percent financing and a payment schedule that fits individual cash flow and financing requirements. Henry Schein Financial Services is now reducing the already com- petitive financing rates by ½ percent for all applications re- ceived through the end of July, including all applications taken at ACADEMY 2001. • AAD Financial Connection — Credit Card Processing. There is one fixed, low processing rate — no monthly fees, no statement fees, no per transaction fees. Funds are electronically deposited within 48 hours. Henry Schein Financial Ser- vices offers this program in association with Harris Bank, the third largest bank in North America. To learn more about AAD Finan- cial Connection or AAD Advantage, visit the AAD Resource Center, booth 501, in the Technical Exhibit Hall dur- ing ACADEMY 2001, or contact AAD Financial Connection at (800) 443- 2756 ext. 4 or AAD Advantage at (800) 772-4346 program code AAD-91; fax the form accompanying this article to (847) 240-1859, or visit the AAD Web site at www.aad.org. ■ The American Academy of Dermatology (AAD) gratefully acknowledges the following Partners in Education for their contributions in support of ACADEMY 2001. Contact Robert Wulff, AAD’s director of development, at (847) 240-1037 to become a Partner in Education for upcoming Academy meetings. Special thank you to Partners in Education Diamond Contributors ($75,000) • Allergan Skin Care • Galderma Laboratories, Inc. • Novartis Pharmaceuticals Corporation Gold Contributors ($50,000) • Berlex Laboratories, Inc. • Genentech, Inc. Silver Contributors ($25,000) • Bristol-Myers Squibb Bronze Contributors ($15,000) • McGhan Medical Corporation
  16. 16. 18 DERMATOLOGY WORLD • July 2001 ACADEMY 2001 While at a family gathering, a distant cousin asks you to look at a spot on his wrist. You say it doesn’t look like anything with which to be concerned. Have you just established a physician/ patient relationship? “Yes,” according to Allan Gibofsky, M.D, J.D., profes- sor of medicine and public health at Weill Medical College of Cornell University, the presidential guest speaker at the ACADEMY 2001 meeting in Ana- heim, Calif. “Very often, doctors are asked questions at a social event, a sporting event, or a fam- ily gathering. I don’t think physicians realize that their comments may be con- sidered a professional opinion, even if said in an informal situation.” Entering into a physician/patient re- lationship fulfills the element of duty, which is one of the four basic and required elements of the tort of medical malprac- tice. In his lecture titled “Medicine & Law,” Dr. Gibofsky will discuss all four elements: When law and medicine converge By Ruth Carol duty, breach, causation, and damages. Briefly, duty is defined as an obligation to perform an act or refrain from performing an act. Breach is an act of commission or omission. Causation can be direct or indi- rect and refers to the relationship between an alleged breach of duty and the outcome or injury to the patient. Damages can be economic, such as lost wages, or non-eco- nomic, such as pain and suffering. “Physicians need to understand the four elements of medical malpractice so they can anticipate problems before they occur,” said Dr. Gibofsky, who will elabo- rate on tort law, under which the majority of disputes between a patient and physi- cian fall. “Unfortunately, we live in a society in which individuals are desirous and demanding of a perfect outcome. Because medicine is as much an art as a science, a perfect outcome isn’t always possible despite our best efforts. So phy- sicians need to understand how to best protect themselves against allegations of unprofessional conduct especially in those situations when people have unrealistic expectations.” Such unrealistic expectations can sometimes lead to patient dissatisfaction, which should not be confused with medi- cal malpractice, Dr. Gibofsky explains. Medical malpractice occurs when a phy- sician’s conduct is negligent in some fashion, resulting in an injury to the pa- tient. But a patient can be displeased with the aesthetic result of a cosmetic proce- dure, for example, even though the dermatologist performed the procedure perfectly. “If the patient is dissatisfied,” he said, “they may say it’s the result of medical malpractice, rather than an out- come with which they’re unhappy.” Then there are those patients who simply don’t listen to the physician’s in- structions and blame the doctor when the procedure does not meet their ex- pectations. For example, Dr. Gibofsky related the story of a woman who had surgery on her foot to remove a bunion. The doctor told her to stay off her feet for the next few days. The next day, he sees her walking in the street, wearing high heels. When he questions why she is on her feet and wearing high heels, she responds saying, “For me, this is stay- ing off my feet.” “Needless to say, the result didn’t turn out the way she wanted it to,” said Dr. Gibofsky. ■ To advertise, contact Atwood Publishing, LLC, (913) 469-1110 ext. 214.Product ShowcaseProduct Showcase Top practitioners in the field of dermatology will address ACADEMY 2001 attendees during the General Session on Wednesday, Aug. 1. Two open admission, general sessions are planned for this final day of the meeting. These sessions will provide attendees with information on the latest treatments and therapies and how they will impact the clinical dermatologist’s practice. From 9 a.m. to 10:15 a.m. the “Therapeutics” session, which is divided into two parts — medical and surgical dermatology — will address eczema, psoriasis, and dermatology surgery. Session director John Y.M. Koo, M.D., and faculty Christopher B. Zachary, M.D., will present information on new developments in the treat- ment of psoriasis and eczema and in the field of dermatology surgery. Attendees will walk away with a better understanding of how to select the best treat- ments for psoriasis, eczema and dermatology surgical cases. From 10:45 a.m. to 12 p.m. the “What’s New” session will feature the most recent information on la- sers, soft-tissue augmentation, and neurotoxins. Experts will discuss what works, what doesn’t, and what is right around the corner for these rapidly developing thera- pies. Richard G. Glogau, M.D., session director, will present on neurotoxins, and faculty members, Gary Lask, M.D., and Arnold W. Klein, M.D., will present on lasers and soft-tissue augmentation, respectively. These general sessions will take place in Pacific Ball- room AB of the Hilton Anaheim Hotel. ■ Aug. 1 General Session to highlight latest therapies, advances Allan Gibofsky, M.D, J.D. John Y.M. Koo, M.D. Richard G. Glogau, M.D. Use six-digit AAD master identification number American Academy of Dermatology (AAD) members are asked to use their six-digit AAD Master ID number on all continuing medical education forms and correspondence at the AAD’s ACADEMY 2001 meeting. For members’ convenience during the ACADEMY meeting, the six-digit identification number will appear on the bottom of the member’s name badge. For clarification, the six-digit AAD Master ID number also appears on the AAD membership cards that members receive each year. This number should not be confused with a five-digit number that also appears on the ACADEMY 2001 name badge, which is generated by the meeting registration company. This five-digit number should NOT be used on any AAD documents or forms filled out during ACADEMY 2001. The AAD Master ID number, implemented in the past few years to in- crease efficiencies and improve data integrity, is to be used as the primary identification number for all Academy-related communications. ■ Summer’s here, and the American Acad- emy of Dermatology can ensure you’re dressed to enjoy it. Tight weave golf shirts protect skin from the sun while keeping you cool in the summer heat. Baseball caps and hats help shield faces from the harmful UVB rays. Pick up these items and more at the Academy 2001 Resource Cen- ter, booth 501 in the Technical Exhibit Hall, or call (847) 240- 1280 to place an order now. Get set for summer with AAD Membership Merchandise

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