Ask an Expert

By Joel Schlessinger, MD

Q How can a cosmetic practice improve follow-through for procedures?
First of all, it depends on quite a few factors including how many patients actually show up for appointments, how many commit at the time of the appointment, and how many come back for further treatments. We track all of this in our system. Having a patient coordinator helps to keep all this information in one place with one individual in charge of it.

Without a doubt, having a patient coordinator improves follow-through and the likelihood of better results now and in the future. This may not lend itself to a short answer, but it is the first and most important step in optimizing your practice and its cosmetic revenue.

– JS

Q Do you use any programs to help hone your managers?
Six of our managers (myself included) recently attended a course led by Gallup Organization, under their Gallup University section, called "Great Managers." This course teaches organizations to harness employees' strengths instead of concentrating on weaknesses in order to improve the organization. The course took place over two and a half days and presents material in a very accessible manner with interventions that make sense for any environment and can be implemented easily. During these challenging economic times, it is important for every organization to be at its best, which is why a course or program might benefit you and your practice.

– JS

Those seeking more information on "Great Managers" can visit the website: The program is held in many cities across the US, including Omaha, the headquarters of Gallup. I highly recommend it and feel it has changed my organizational strategy greatly.

Practical Pearls in This Issue

  • Nevus of Ito is predominant in Asian and darker-skinned races and may be associated with an ipsilateral or bilateral nevus of Ota. Differential diagnosis includes pigmented macular ADM, acquired patch or plaque blue nevus, a nevus spilus that develops blue nevi, an aberrant Mongolian spot, melanoma metastasis, ecchymoses, vascular malformations, and a fixed drug eruption.

  • Chemohistological detection of elevated expression of pSTAT3 in atypical nevi may indicate a progression toward malignancy and could indicate a high level of risk. Further research will be able to confirm the value of pSTAT3 as a risk marker for melanoma and may support wide application of pSTAT3 screening in the near future.

  • Because some biologics (e.g. TNF antagonists) may increase risk of demyelinating disorders, it is important to screen for these during follow-up. Ask about new-onset tingling in fingers or toes, sudden changes in visual field (to screen for optic neuritis), and new problems with balance.

  • Implementation of a staff incentive compensation plan is probably the most enjoyable part of practice operation, aside from handing out money for a job well done. Present the plan at a staff meeting when there is ample time for questions. Plan specifics should be presented in a written document, complete with examples.

  • One major difference between RAC audits and previous Medicare audits is that, because RAC auditors are paid a percentage of what they collect, this could cause more aggressive audits. In previous Medicare audits, there was no financial incentive for auditors. All providers should be aware that an appeal process exists.

  • Topical interventions are generally considered first-line for hyperhidrosis management, but some patients are clearly candidates for procedural interventions. These include patients whose degree of sweating is moderate to severe and not likely to be sufficiently controlled with topical agents, those experiencing functional impairment due to sweating, and those with facial sweating, which is often difficult to manage with other interventions.

  • Although molluscum is rarely seen in children younger than one year, newer reports suggest that the vertical transmission of MCV is possible. So far, seven reports detail the development of molluscum lesions in infants that were likely due to the transfer of virus during the birthing process.

  • Physicians and legislators are best to remain careful not to prematurely embrace EHR when we cannot yet realistically manage or even conceptualize a model for widespread use in medicine. Organized efforts to spread awareness about EHR would benefit physicians more by informing them about the practical details of e-prescribing and electronic medical records.

Contact Info

For advertising rates and opportunities:
Rick Ehrlich
Group Publisher
(609) 922-0337

About Practical Dermatology

Practical Dermatology is the monthly publication that provides coverage of medical care, cosmetic advancements, and practice management for clinicians in the field. With straight-forward, how-to advice from experts in various fields, we strive to enhance quality of care and improve the daily operation of dermatology practices.