In the wake of the closing of dermatology practices in the midst of the COVID-19 pandemic, the Dermatology Education Foundation (DEF) identified a need for education and resources for nurse practitioners and physician assistants working in dermatology. The DEF NP/PA VideoSeries was born. I have had the privilege of hosting these weekly programs and have collected some pearls, as presented ahead, to share. For access to past webinars and information about future programs, visit our Blog page at DermNPPA.org.
Be Alert for Skin Signs of COVID-19
While COVID-19 was described initially as a respiratory illness, other organ systems are showing involvement. Cutaneous manifestations of COVID-19 have been identified and described. According to dermatologist Brad P. Glick, DO, MPH, FAAD, these have largely been classified into six main patterns of presentation: urticarial, acral ischemia, morbilliform, livedo riticularis, vesicular, and petechial. Acral ischemia in the form of so-called “COVID toes” has garnered national press attention.
Those who see these symptoms in the clinic should maintain an index of suspicion for COVID-19 while ruling out other potential causes. To that end, when patients present with morbilliform rash, Dr. Glick emphasizes the importance of a drug history (remove any potential offending agents), as well evaluating for COVID-19 infection or exposure. Treatment considerations include high-potency topical steroids to help with erythema and pruritus (clobetasol or triamcinolone), antihistamines, or systemic steroids. If appropriate, consider liver function tests (LFTs) and evaluate for drug reaction with eosinophilia and systemic symptoms (DRESS syndrome).
Numerous registries have been established to collect data on cutaneous manifestations of COVID-19 (See the sidebar below).
COVID-19 Patient Registries Relevent to Dermatology
AAD Dermatology COVID-19 Registry
aad.org/covidregistry: Report patients with COVID-19 (confirmed or suspected) who develop dermatologic manifestations; Patients with existing dermatologic conditions or on existing dermatologic medications who subsequently develop COVID-19
IPC COVID-19 Psoriasis Registry
psoprotect.org: Report outcomes of COVID-19 in individuals with psoriasis.
Global COVID-19 Psoriasis Patient Registry
redcap.wakehealth.edu/redcap/surveys/?s=NHMT4LAK77: International pediatric and adult registry to monitor and report on outcomes of COVID-19 occurring in psoriasis patients.
Global COVID-19 Atopic Dermatitis and Alopecia Areata Patient Registry
covidderm.org: Atopic Dermatitis & Alopecia patients on immunomodulating therapy (including hydroxychloroquine)
Global COVID-19 IBD Patient Registry
covidibd.org: To determine the impact of COVID-19 on patients with IBD and how factors such as age, comorbidities, and IBD treatments impact COVID outcomes.
Global COVID-19 Hidradenitis Suppurativa Patient Registry
hscovid.ucsf.edu: International pediatric and adult database to monitor and report outcomes of COVID-19 occurring in hidradenitis suppurativa (HS) patients.
Consider Telehealth…The Right Way
DERM2020 faculty member, Adam Friedman, MD and telehealth expert Jennifer Tinkler, FNP-BC, DCNP addressed the growth of telehealth. Providers should always follow the guidance of their dermatology office management team and the mandates provided by state and local government.
The use of codes and modifiers is continuously changing, Dr. Friedman notes. Telehealth visit reimbursement changed upon the pandemic, which allows visits to be submitted using existing office visit codes.
One overlooked component of telehealth may be phone consults with patients. These may be reimbursed by some insurers, which is relevant for prescription refills and the like.
Limit telehealth practice to the states in which you are licensed, advises Ms. Tinkler. While CMS has relaxed some restrictions on telehealth delivery, the same may not be true for private carriers.
The DEF provides numerous resources on its pages:
- State by State regulations and reimbursement coverage can be found on the Center for Connected Health Policy website.
- The AAD has comprehensive, current telemedicine guidelines and billing information if you work with a physician who has access to the AAD website.
Employment Challenges and Opportunities
Did you know that dermatology NPs and PAs who have had a reduction in hours or pay may be eligible for unemployment benefits? In an April DEF VideoSeries, Kara Gooding, MS, PA-C and Michelle Sullentrup spoke about options for those affected by the pandemic.
For those who have been laid off or whose employers have closed, the goal may shift to seeking new employment opportunities. To that end, ensure your LinkedIn profile is updated.
Update your resume, taking care to highlight all of your experience in dermatology with specifics on types of care, procedures, and technology—including medical, cosmetic, and surgical dermatology.
If you are job hunting, consider seeking support from a professional service. For example, myDermRecruiter provides personal consultative job search coaching and resources for interview assistance, compensation trends, and more. The organization does not take a fee from jobseekers. Additionally, at the upcoming DERM2020 NP/PA CME Conference to be held in August 2020 in Las Vegas, the DEF will be offering additional resources.
Finally, try to stay positive!
Additional installments of the DEF NP/PA VideoSeries are planned to help attendees learn more and connect with NP and PA colleagues. Check the website for more updates, upcoming meeting offerings, and free CME.