PracticalDermatology

Adaptation happens in all environments, whether human or corporate, and medicine is entering a phase where it will likely be more important to consider new additions or practices for how we deliver the “dermatology experience” to our patients. Without considering this, we may become less relevant and possibly fade in importance.

COVID-19 has taught us how fragile is our ecosystem and our ability to practice within it. During the initial months, when dermatology was deemed “non-essential” by many localities, we were sidelined. This happened to other medical specialties as well. It is incumbent on us, as a specialty, to make sure we develop methods to continue to provide care in the likely event that there is another pandemic.

Last weekend I was fortunate to be invited to a special rehearsal of our local Omaha Symphony. A hall that normally seats 2,500 patrons was occupied by 25 individuals. During the practice session, the director showed me a new endeavor that started during the pandemic in which techies are now recording the sessions for live-streaming and possible future “pay-walled” presentation.

While it was exciting to see these new approaches, I was reminded of a strategic planning board meeting five years ago when I had asked the previous director about the possibility of recording and live-streaming sessions; he told me it was too expensive. It is still expensive, with a current price tag of more than $250,000 for the LED display that will eventually show the orchestra performing to the in-house crowd; ancillary equipment will likely cost as much, if not more! But, without these new improvements, the outcome for this symphony could be dire if COVID continues to keep them from performing live. By using this talented crew’s efforts, more than 80,000 individuals all over the world were able to see the Symphony’s live Christmas spectacular. This is the largest audience to ever view a performance of the symphony, and it is only the beginning.

In a similar way, we have just begun to experiment with telemedicine. It could and should be our area of expertise and one area where we are leaders. A recent article by Yeroushalmi, et al (Journal of Drugs in Dermatology, January 2021) showed that 80 percent of dermatology patients felt the telemedicine experience was satisfactory and would consider it in the future, while 62.5 percent felt it offered a similar quality of care. Impressively, this is how telemedicine is faring early on in its mass adoption, with little or no refinement.

Telemedicine is a huge opportunity for our specialty to expand and control the narrative of the future. In order for us to move ahead, we must continue to lobby for legislation that allows for parity in pay for an in-office visit and a telemedicine visit or telemedicine won’t be financially feasible. The allowance of 99200-99215 codes was one of the essential parts of making telemedicine practical. Other areas that continue to be clarified include:

• The ability to see patients who may or may not be in a physical location that is rural or underserved and/or possibly limited by state regulations
• The ability to see patients who are “new” to the practice
• The ability to prescribe for patients who are new
• The ability to see patients who may not be in your state, which has been addressed by Federal means during the pandemic but remains a quagmire based on state regulations (many of my patients sat out COVID in other states).

Regulations have strangled the growth of telemedicine for far too many years. It is time that we use our lobbying power to promote this important method of practice and keep it profitable and free of excessive regulations.

In my practice, we are back to seeing any and all patients in the office if they wish to be seen, but approximately 15 percent of our patients continue to access us via telemedicine. The use of telemedicine keeps the reception area less crowded, allowing us to socially distance our patients. Additionally, for whatever reason, the schedule seems to run much more efficiently. We are seeing nearly the same level of patients now as before, but with nearly a flawless on-time record, something I never thought I would be able to say.

With time, perhaps the desire to use telemedicine will lessen to some degree, but I have seen positive aspects for its use in many situations and feel it is here to stay. Let’s hope our field captures this “firefly in a bottle.”