I recently read a short newspaper story (USA Today, May 27, 2008) from California, where it was reported that "two lawmakers want greater protection for cosmetic surgery patients."

The other day, I was visiting with my doctor following my annual checkup, and I asked him about the key concerns that he faces in his regional, three-physician practice in the Baltimore, Md., suburbs.

Dr. Photo has lectured at numerous American Academy of Dermatology meetings. His lectures are well-attended and receive the highest attendee rankings. His PowerPoint presentations are always noted for their exceptional clarity.

Government reimbursements for dermatologic procedures are shrinking, while the number of cases of skin cancer continue to rise.

Lawmakers are scrambling to find a solution to a huge problem that stands to affect millions of Medicare patients and thousands of physicians across the nation.

The voluntary Physician Quality Reporting Initiative (PQRI), which began in 2007, may be a forerunner of a mandatory pay-for-performance from the Centers for Medicare and Medicaid Services (CMS). Under the PQRI regulations, a physician reports on specific best medical practices he follows. For example, under the PQRI, in 2007, dermatologists who asked patients with a history of melanoma whether they had seen any changes in moles or lesions, did full body exams on those patients and recommended patients do regular skin exams, and then reported they had followed those procedures in 80 percent of their melanoma patients, would earn 1.5 percent of their total CMS reimbursements as a bonus.

The federal budget for FY 2009, one that provides for $3.1 trillion in federal funding and includes overall Medicare reductions of $196 billion over five years, says about the problem that is the key to continuing Medicare physician reimbursement cuts – the Sustainable Growth Rate (SRG) formula.

Dr. Doc has an extraordinarily busy dermatology practice. In fact, he is so busy that he has little time to attend medical meetings. He depends on his pharmaceutical representatives to provide him with the latest information about off-label use of various dermatologic prescription drugs. He knows that physician off-label use of prescriptions is not only legal, but is actually encouraged by the Food and Drug Administration (FDA).

WASHINGTON – A new report to Congress this month by the Medicare Payment Advisory Commission (MedPAC) is expected to recommend that lawmakers approve an average increase in Medicare physician fees of 1.1 percent for 2009 rather than allowing a scheduled 5 percent reduction to take effect.