Questions about XP patient care? XP Expert Resource Group offers answers

Expert Resource Groups (ERGs) are ancillary Academy groups comprised of individuals with specific expertise who come together to share information and knowledge about a particular topic. The ERGs share a passion for the advancement of patient care and are valuable contributors to an array of Academy initiatives and efforts. The Academy presently has 10 approved ERGs: Atopic Dermatitis; Dermatologists in Industry; Epidemiology; Lesbian, Gay, Bisexual, and Transgender and Sexual Minority Health; Quality and Patient Safety Officers; Psoriasis; Sexually Transmitted Diseases; Society of Dermatology Hospitalists; Women’s Health; and Xeroderma Pigmentosum (XP). Member to Member recently interviewed John DiGiovanna, MD and Kenneth Kraemer, MD, co-directors of the XP-ERG, about the group’s mission. Member to Member: Why was the XP-ERG formed? Drs. DiGiovanna and Kraemer: Xeroderma pigmentosum (XP) and related disorders are very rare and have high morbidity and mortality. XP presents great difficulties for patients, their families and their treating dermatologists. These disorders may be difficult to diagnose. Skin cancer occurs in these patients at a frequency 10,000-fold higher than the general population, and typically affects young children, with an average age of less than 10 years. Infants with XP can develop severe blistering sunburns on minimal sun exposure. Sadly, distressed parents trying to address a severe, unexpected blistering sunburn can be wrongly accused of child abuse.   Skin cancer occurs in XP patients at a frequency 10,000-fold higher than the general population, and typically affects young children. Patients often are clocked in protective wear to protect against the sun. The large numbers of skin cancers at a very early age pose many logistic and management problems. The extreme degree of sun protection required is difficult to understand and to achieve. With many subtle differences in subtypes, understanding which problems need surveillance, and how to achieve that can be complex. Organized before 2000 as the XP Task Force, the AAD recognized that they could make a substantial impact on many of these problems and provide a huge service to dermatologists and patients by providing a venue for bringing dermatologists caring for these patients, together with experts having experience in XP management along with resources, such as the patient advocates and researchers. This group could facilitate development of practical solutions to difficult management problems. Since these stakeholders, including many international participants, typically attend the annual meeting of the AAD, the XP ERG provides a convenient opportunity to discuss difficult clinical problems and share the successes, hurdles and failures of their patients. By providing an accessible venue, dermatologists caring for patients can bring their challenging clinical problems to share with experts familiar with XP. Knowledge that can be gained from understanding XP and studying its underlying mechanisms gives us powerful insights into knowledge of how skin cancer develops and can be prevented in the skin of individuals in the general population. The DNA repair mechanisms which are defective in these patients protect most of the general population from skin cancer. Understanding, managing, and controlling the skin cancer epidemic is an important AAD goal. MTM: Who is involved in the XP-ERG? Drs. DiGiovanna and Kraemer: We are the co-directors, and participants include dermatologists, trainees, researchers and patient advocates with an interest in XP and related disorders. Approximately 35 participants meet at the AAD Annual Meeting to discuss patient care and related issues. We continually seek additional participants with expertise, interest and issues related to these disorders. MTM: What have been some of the group’s accomplishments to date? Drs. DiGiovanna and Kraemer: We provide information and avenues for patient diagnosis, cancer management, surveillance for neurological and other complications. We have brought together researchers with dermatologists...

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George Hruza, MD, selected incoming president-elect in 2017 Academy election

George Hruza, MD, MBA, a St. Louis-based dermatologist in private practice, was elected incoming Academy president-elect in the 2017 Academy election. Member to Member spoke with Dr. Hruza about his priorities as president. Member to Member: What excites you most about assuming the role of Academy president? Dr. Hruza: It’s an opportunity for giving back. Dermatology has been very good to me and my patients. The Academy represents the very best in dermatology, so for me to be able to contribute to the future success of dermatology and dermatologists as president of the Academy is very exciting. MTM: What motivated you to run for president? Dr. Hruza: I’ve been in private practice for years, and was in academics before that. I’ve seen over the last few years how the regulatory burden has gotten so much worse. It’s gotten to the point where many dermatologists in my area have retired early because they don’t want to deal with all the unfunded mandates that the government is forcing us to deal with. So, I ran for president to make an effort to preserve the private practice of dermatology. We need to reduce regulatory burden in order to take the best care of our patients. We are under attack from legislators, regulators and insurance companies. Their dictates interfere with the doctor-patient relationship. MTM: What issues do you plan to focus on as president? Dr. Hruza: It’s difficult to choose one because there are so many issues facing the specialty. My main focus will be to do whatever possible to clear the obstacles that prevent dermatologists from practicing dermatology. We need to clear the way for physicians to make the best decisions for their patients. I know we cannot eliminate all regulatory burdens. However, we can work towards reducing burdens. Maybe we can reduce some of the most intrusive and punitive regulations, whether it’s IPAB, HIPAA, MACRA, ACO’s or the crazy non-discrimination rule that requires you to post information in the top 15 non-English languages spoken in your state. There are a lot of rules that make no sense and don’t benefit patients. When Brett Coldiron, MD, was president of the Academy, he made narrow networks a focus. He did a great job in this area. In fact, he’s kind of my idol because he was able to move the needle in that area. And we saw change as a result of that in St. Louis, where I practice. I’d like to make similar changes that will directly benefit the specialty. The regulation that’s most top of mind is MACRA and MIPS. We can have the most impact in the area of  value-based health care as CMS is clearly struggling to find its way. We can make it easier for our members to comply with those rules, and, of course, to help reduce the burden of those rules. With the new administration in Washington, we have a once-in-a-lifetime opportunity to impact these regulations because there’s an appetite in Washington to change the regulatory environment. The key is to work toward alleviating the regulations that will result in improving the doctor-patient relationship and allowing us to practice dermatology. ELECTION RESULTS Election ballots were sent to 14,516 eligible voting members of the Academy. A total of 4,005 (27.59%) members returned ballots. The following are the tabulated candidate and proposed bylaws amendment results. Newly elected Officers and Directors will officially take office at the conclusion of the 2018 Annual Meeting in San Diego, CA on February 20, 2018. President-Elect George J. Hruza, MD, FAAD Vice President-Elect Jane M. Grant-Kels, MD, FAAD Results of 2017 Proposed Bylaws...

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JAAD introduces online virtual Journal Club

By Bruce Thiers, MD Editor, Journal of the American Academy of Dermatology You’ve read the articles, you’ve followed the Facebook page, you’ve retweeted the most intriguing pictures…ever wished you could engage with JAAD authors on a deeper level? Have you ever wanted to discuss a recent article with other practicing dermatologists, talk through the newest surgical pearl, or debate the latest study on a controversial treatment?   The new JAAD Journal Club allows dermatologists to get answers and insights directly from study authors.   JAAD is introducing a new online Journal Club, a forum that will allow dermatologists from around the world to convene, parse through important JAAD articles, discuss the implications for patient care, and get answers and insights directly from study authors. The online JAAD Journal Club can be accessed on Elsevier’s Mendeley platform. (See directions below.) The forum will post thought-provoking and engaging comments that you, the JAAD reader, are encouraged to analyze and use to enhance your knowledge base and clinical acumen. Every participant will have the opportunity to ask questions and voice his/her own thoughts, ideas, and opinions. The Journal Club will bring pressing dermatology issues into focus and participants will collaborate to generate solutions to difficult clinical problems. The JAAD Journal Club aims to help clinicians translate the latest JAAD articles into practical applications for their practice. For the first few months, discussion will be limited to the CME articles. Eventually we hope to include discussion of each monthly JAAD issue in its entirety. The JAAD online Journal Club will be launched with discussion of the January, February, and March, 2017 CME articles: January, 2017: Prevention and Management of Glucocorticoid-Induced Side Effects: Part 1, A review of glucocorticoid pharmacology and bone health January, 2017: Prevention and Management of Glucocorticoid-Induced Side Effects: Part 2, A review of gastrointestinal and endocrinologic side effects February, 2017: Prevention and Management of Glucocorticoid-Induced Side Effects: Part 3, A review of infectious complications and vaccination recommendations February, 2017: Prevention and Management of Glucocorticoid-Induced Side Effects: Part 4, A review of ocular, cardiovascular, muscular, and psychiatric side effects and issues unique to pediatric patients March, 2017: Psoriasis and Comorbid Diseases: Part 1, Epidemiology March, 2017: Psoriasis and Comorbid Diseases: Part 2, Implications for management To participate: Make sure you are logged into Mendeley. If you do not have an account, sign up for a free account at www.mendeley.com. Go to the JAAD Journal Club. Click the “Join” button in the upper right of the web page; you are now a member of the group. (This may not be necessary if you have previously joined the group). Note that each article has a separate link for a discussion specific to that article. You will find those links on the main Journal Club group page you have just accessed. After clicking one of those links, you will have to “Join” each discussion individually (link at upper right of each article’s web page) but you do not need to log in again. You can now start posting thoughts and comments. Use “Share your thoughts” (at the top of the page) for new questions or “Write a comment” further down to respond to a previous post. Click “Post” or hit “Enter” on your keyboard to register your comment. Questions? Please email us at jaad@aad.org. – See more at:...

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Bogged down in prior authorizations? New AAD tool helps you create letters to insurers in less than a minute

This month, the Academy launched the Prior Authorization Letter Generator, a web-based tool designed to allow member to easily create letters to help patients get medication approvals they need from insurers. This new tool, which is free to AAD members, is part of the Academy’s new Practice Management Center. Member to Member discussed the creation of the tool with Mark, Lebwohl, MD, who helped lead its development. Member to Member: Why did the Academy develop the Prior Authorization Letter Generator tool? Dr. Lebwohl: When we surveyed dermatologists about complaints they had about practice, at the top of the list was their inability to prescribe the medications they want for their patients. Neal Bhatia, who is on the AAD Board of Directors, eloquently stated it when he said, “What used to be called the prescription pad is now the suggestion pad.”   The tool allows users to generate letters for acne vulgaris, atopic dermatitis, primary focal hyperhidrosis, psoriasis vulgaris, and urticaria. Access the tool. Nine out of 10 times when we write a prescription it gets denied at the pharmacy level. It’s denied because the pharmacy benefit manager doesn’t want the patient to get the drug, or the insurance company suddenly decides it’s not going to cover it. What they cover on Monday, they don’t cover on Tuesday. It changes from day to day. It wastes our time and prevents us from giving the medication we want to our patients.Even worse, there are times when we know that a patient needs a particular medicine for a particular reason. Invariably, we are told they have to fail something else in order to get that particular medication, even when we know the steps they have to fail are not correct for them. The Academy’s advocacy team, through the State Access to Innovative Medicines Coalition, wrote the language that ended up in many step therapy bills around the country. Theoretically, in states with step therapy laws, insurers should not be able to deny medications. But that’s not the way it works. Step therapy laws don’t prevent insurance companies from suggesting steps. But if the doctor challenges the steps in states with step therapy laws, it puts the insurance companies on the spot. If you send them a letter explaining your rationale for a particular prescription, it difficult for them to deny your patient that drug. This also can work in states where the laws don’t exist. What’s happening is that insurance companies are telling us that instead of using Drug A, use Drug B. Dermatologists are using Drug B because they feel like they don’t have a choice. However, particularly in the states with step therapy laws but also in other states, we do have a choice. And sending a letter gets their attention. No one went to medical school to write letters. So, we thought, how do we make sending prior authorization and step therapy protocol override determination letters easy for our members? We decided to create a web-based tool that allows AAD members to generate a prewritten letter that gives all of the reasons for patients to get a particular drug. With this new tool, it takes less than a minute to generate a comprehensive letter describing why a particular drug should be given to a particular patient. For every drug, we explain why that drug should be prescribed ahead of any other drug. M2M: Who created the Academy’s new Prior Authorization Letter Generator? Dr. Lebwohl: When I was president of the Academy in 2014, I created the Drug Pricing and Transparency Taskforce. The taskforce worked with AAD staff to develop a...

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American Academy of Dermatology New PSA Campaigns

The American Academy of Dermatology released a new PSA campaign this summer to help raise awareness of the importance of skin cancer prevention and detection. The campaign consists of two new TV PSAs – Looking Good (for men over 50) and Arms (for teen girls) – and one new radio PSA, “If Skin Could Talk.” We hope that you will consider sharing the PSAs with your members. To include the TV PSAs in a community presentation or to loop in patient waiting rooms, you or your members can email mediarelations@aad.org for a PSA permission request form....

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ST. LOUIS DERMATOLOGICAL SOCIETY FALL MEETING: OCT. 4

Mark Your Calendars for the St. Louis Dermatological Society 2016 Fall Meeting! October 4th, 2016 6:00 pm Boundary at the Cheshire Hotel 6300 Clayton Rd. St. Louis, MO 63117 (314) 647-7300 http://www.cheshirestl.com/ More information coming...

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