Open Access: Thoughts for the Ballot Box

Everyone is talking about the upcoming US Presidential election, and with good reason. There is a lot to take in and there is certainly a great deal at stake—especially when it comes to healthcare and the practice of dermatology.

Regardless of whether you are “with her” or “with him,” protecting patient access to doctors and prescription medications is paramount. It is important to know where your candidate or party stands on the issues that matter most to us and to our patients.

The Issue at Hand: Narrow Networks

Health insurance marketplaces use “narrow networks” of providers that restrict access to specialists. When faced with ever-narrowing networks, patients are left with sub-optimal choices: They can change insurance carriers, seek care from other in-network physicians, delay care, or skip it all together.

This noose is especially constrictive for our patients as dermatologists are already in short supply in many parts of the country. We need to make sure networks are ample and up-to-date. As it stands, many comprise names of doctors who are deceased, retired, have moved, or do not treat the entire spectrum of skin diseases.

What you can do: Make some noise at the state and local levels. Our patients are counting on us.

The Issue at Hand: Rising Prescription Drug Costs

The skyrocking cost of prescription drugs—and how to best contain it—is a big issue in this election and to our patients. A Kaiser Family Foundation poll found that more than 70 percent of those surveyed felt that drug prices were too high and that companies were too concerned about making profits. Among the most expensive drugs out there are the biologics that we count on to treat severe psoriasis. The advent of biosimilars may help drive the costs down some and allow more of our patients to benefit from these drugs. (For an update on Biosimilars, check out the July edition of Practical Dermatology® online at PracticalDermatology.com.) That said, other measures are also needed to curb costs. For starters, Congress should pass legislation to allow Medicare to negotiate their drug prices directly. It’s also time put an end to extending exclusivity periods beyond what is currently granted to allow for greater availability of less costly generic drugs.

What you can do: Research where your candidate stands on this issue, and how he or she plans to stem the tide. We should be working with our patients to help them access life and quality-of-life saving medications via financial assistance programs and other cost-saving measures.

The Issue at Hand: MACRA Machinations

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) became law on April 16, 2015, and it is a significant bipartisan achievement. Like anything else, however the devil is in the details and the details are seeming pretty diabolical for dermatologists so far. It’s either Merit-based Incentive Payment System (MIPS) or Advanced Alternative Payment Models (APMs) for us under MACRA.

As it stands, both the MIPS and APM proposals will have a chilling effect on small/solo practices. The Centers for Medicare & Medicaid Services estimates that 87 percent of solo practices and 70 percent of small practices will face a penalty in the first year. The American Academy of Dermatology is calling for a revisiting of the threshold for exemption to avoid the penalty and allow small/solo clinicians more time to migrate onto MIPS.

What you can do: Speak up and speak out to let your party know how you feel about these changes and what they will mean to your practice and your patients.

We are the ones who see patients every day and understand exactly how these macro issues truly affect their care and our ability to care for them. It’s time we make ourselves heard at the state local and national levels.

Get out and vote. n

Mark D. Kaufmann, MD is an associate Clinical Professor of at the Icahn School of Medicine at Mount Sinai in New York City.