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Forge the path


In this complicated new era of health care, a prominent dermatologist says, there are some battles to fight and other changes to accept.

Jack Resneck Jr., M.D.In this complicated new era of health care, a prominent dermatologist told colleagues recently, there are some battles to fight and other changes to accept.

"There are some things where we have to put our foot out down and say this is totally unacceptable," says Jack Resneck Jr., M.D., professor and vice-chair of dermatology at the University of California at San Francisco. "There are other things we’re going to have to acknowledge and live with."

In a session at the CalDerm Symposium 2016 (September 2016, Carlsbad, Calif.), a continuing education seminar offered by the California Society of Dermatology & Dermatologic Surgery, Dr. Resneck offered his suggestions about areas for resistance and acceptance.

The fight for wider networks

Dr. Resneck urged his colleagues to "aggressively and unapologetically" fight certain battles in several areas such as physician networks that are too small.

"We are changing the laws to fight networks that are so narrow they harm patient access to care. The American Academy of Dermatology and the American Medical Association led this fight, and we brought data rather than anger," he says.

Indeed, he was lead author of a 2014 study1 that revealed major holes in access to dermatologists under Medicare Advantage plans. When mock patients contacted listed dermatologists under the largest plans in 12 metropolitan areas, "many of the dermatologists listed had incorrect contact information, were deceased, retired, or had moved, were not accepting new patients, did not accept the insurance plan, or were subspecialized." Among the other dermatologists, the average wait for an appointment for a case of severe itch was 45 days.

He also pointed to fines that target insurers whose directories are inaccurate.

However, a December 2016 New York Times story2 reported that the Centers for Medicare & Medicaid Services had not fined or eliminated any plans due to poor directories.  

The story also noted that an October 2016 federal survey of Medicare plans for seniors3 "found errors in nearly half of the listings in doctor directories." The State of California, on the other hand, did fine two major insurers for faulty directories.

Beware of mergers, EHR overreach

When Dr. Resneck asked the CalDerm audience whether they love their electronic health record system, maybe six or seven people raised their hands. That was more than the previous year, he says, "when I couldn't get a hand."

Increased acceptance isn't the only progress on this front. Other progress is being made regarding federal "meaningful use" regulations regarding the use of technology in the medical office.

"Inflexible meaningful use criteria have led to electronic health records that are an impediment to efficient patient care," he says. "The AMA has put a huge amount of effort into this, fighting very aggressively on electronic health record rules. What's most challenging for us as physicians is that our records are not interoperable. "

Mergers are another area where physicians should speak up and be heard, he says. "We are fighting a serious merger threat. If both the Anthem-Cigna and Aetna-Humana mergers are approved and go through, instead of having five major insurers with footprints we’d have three."

As of early February, a federal judge blocked Aetna from completing a $37 billion merger with Humana , while another judge was still considering the $48 billion merger between Anthem and Cigna.

Drug costs

On another front, Dr. Resneck says physicians must fight back against the soaring costs of drugs.

"We’re now seeing this world where very old branded drugs are being sold like commodities by companies doing absolutely no research and development," he says. "And some costs are being driven by inexcusable behavior by generic manufacturers."

Adapting to new measures

But in regard to other issues, he says, "we must avoid living in denial."

The federal commitment to quality and value measurement, for instance, is not going to go away, he says. 

He specifically pointed to dermatopathology kickbacks, medically unnecessary services  and shoddy corporatized, fragmented teledermatology services.

"We," he says, "are not an island anymore." 

Disclosure: Dr. Resneck reports no relevant disclosures.


1. Resneck JS, Quiggle A, Liu M, Brewster DW. The accuracy of dermatology network physician directories posted by Medicare Advantage health plans in an era of narrow networks. JAMA Dermatol. 2014;150(12):1290-7.

2. Hancock J. Insurers’ Flawed Directories Leave Patients Scrambling for In-Network Doctors. New York Times. December 3, 2016. https://www.nytimes.com/2016/12/03/us/inaccurate-doctor-directories-insurance-enrollment.html. Accessed January 31, 2017.

3. Galewitz P. Feds Find Doctor Listings Often Wrong In Medicare Advantage Directories. Kaiser Health News. October 24, 2016. http://khn.org/news/feds-find-doctor-listings-often-wrong-in-medicare-advantage-directories/. Accessed January 31, 2017.


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