PracticalDermatology

I think it is fair to say that 2020 has been a year unlike any other, and this is likely a gross understatement. The world as we know it changed forever when COVID-19 came on our shores in March 2020, and now nine months into it, we are still living in the grips of a pandemic with cases, hospitalizations, and death tolls rising daily. This grim reality has made all of us rethink everything about our lives and our lifestyles.

On a personal note, I moved from New York City to Miami in March and started a new job at the beginning of September.

Our professional lives as a whole were also dramatically altered. Shutdowns had devasting effects on the economy, and many practices were forced to furlough employees to cut costs and stay afloat. Patient care was also affected. Skin cancers that could have been identified early in more treatable stages may have advanced due to lapses in care. It will be months, if not years, before we truly know how COVID-19 affected morbidity and mortality from skin cancer.

When we reopened our doors, we did so slowly, operating at a mere fraction of our usual capacity and gradually increasing as case numbers and government entities permitted. We now offer “zero-contact” (or as close to it as possible) check-in and payment options and have virtual waiting areas or have markings in waiting rooms to help patients maintain social distance. Our staff sit behind plexiglass windows and all of us don masks at all times. There are no more handshakes or hugs, and we only see our colleagues over Zoom, as in-person medical meetings have been cancelled for the foreseeable future.

Telederm Prevails

CMS removed a lot of red tape to make it less burdensome and more economically feasible for us to provide telehealth services to patients, and 2020 will be remembered as the year that telemedicine found its foothold. Most recently, CMS also raised payments for audio-only telephone visits to match rates for office and outpatient visits. This is a good thing.

The hope is that some of these changes will remain even after the pandemic becomes a distant memory.

We know that store-and-forward teledermatology makes dollars and sense. In a pre-COVID-19 study, the response time for a consultation dropped from almost 84 days to under five hours when patients’ PCPs were able to photograph areas of concern and share them with dermatologists. Moreover, the study did not show any undue increases in utilization or cost that might prohibit making the practice widespread.¹

We can still use video conferencing and chat to treat patients without incurring the wrath of HIPAA enforcers, but video capabilities are not as sharp as our store-and-forward technology. To catch up, video must become more high-def so that dermatologists can better visualize and examine skin.

To keep pace with this new way of seeing patients, I advanced the concept of a new type of specialist: a virtualist. In dermatology, outpatient virtualists will be able to make certain diagnoses, design initial treatment plans, and refer patients for biopsy or further work-up as needed. There will be an increasing need for virtualists.

The use of augmented intelligence will also help advance teledermatology. With this technology, images can be compared via algorithms to let us know with pinpoint accuracy if a growth requires further evaluation. Machines won’t replace us, but this will be another way for us to provide care while minimizing face-to-face contact. Dermatologists will always need to explain next steps to the patient based on the digital diagnoses.

As the year draws to a much-needed close, we can only hope that 2021 ushers in a safe and effective COVID-19 vaccine so that we can get back on track with a newfound appreciation for what truly matters. I’ll end with a quote from Vinh Chung, MD, a dermatologist in Colorado Springs, CO, whom I interviewed for a two-part series on re-finding joy in dermatology in Digital Practice. “Don’t be a victim to your circumstances. The future is still to be written, so don’t let it go to waste.”

1. Mehta SJ, Jariwala NN, Snider CK, et al. Prospective Implementation of a Consultative Store-and-Forward Teledermatology Model at a Single Urban Academic Health System with Real Cost Data Subanalysis. Telemedicine and e-Health. Published Online: 4 Nov 2020.