The American Academy of Dermatology (
Dr. George J. Hruza
The guidance pages are publicly viewable. Additionally, AAD has made a collection of COVID-19 articles from the Journal of the American Academy of Dermatology freely available for the next 6 months.
George Hruza, MD, AAD president, detailed regulatory updates and other federal actions as well as guidance regarding telemedicine and clinical practice in a message to AAD members.
“While many questions still need answers, I have appointed an Ad Hoc Task Force to assess dermatology’s needs, share knowledge, and provide ongoing guidance and information throughout the crisis,” Dr. Hruza wrote.
“The situation is changing rapidly, and we are committed to keeping you updated with reliable and practical information to help you adapt to the circumstances,” he noted, referring dermatologists to the AAD’s information hub for the coronavirus outbreak. “We are keeping this page updated frequently, and it will serve as your primary source for what we know now,” he noted.
The Centers for Medicare & Medicaid Services has recently relaxed key regulations regarding technology to provide telemedicine so that physicians and patients can use existing platforms such as FaceTime and Skype for virtual visits. The usual fines for HIPAA noncompliance have been waived. Additionally, telemedicine visits can now be reimbursed at the same rate as in-person visits.
Private payers are beginning to follow suit, said Dr. Hruza, noting that the AAD Association is working to harmonize private coverage with public reimbursement. The AAD also is tracking which payers are coming in line with federal policies on its teledermatology page.
These changes in regulation around telemedicine apply to patient encounters for any purpose, not just coronavirus-related encounters, noted Dr. Hruza. “The good news is that the government has taken action to make it much easier for us to provide virtual consults to patients. Dermatology has always been a leader in telemedicine, and it will be an important way to offer care to patients who can’t or don’t need to come into the office or clinic,” he added.
Importantly, said Dr. Hruza, CMS is allowing practices to have discretion over whether copays are collected, or collected in full, so that these payments don’t present a barrier to patient care in the current crisis environment.
For dermatologists who are new to telemedicine, AAD has created an online resource that includes information about various telemedicine platforms, updated guidance regarding regulations, and best practices for accurate coding and documentation of telemedicine visits.
The Academy has also been developing dermatology-specific guidance, including how to address the concerns of patients who are receiving biologic therapies and how to conserve personal protective equipment while still protecting physicians, staff, and patients from COVID-19 infection.
For patients on biologic therapy who show no sign of coronavirus infection, the decision to continue or stop biologics should be made on a case-by-case basis. Factors to be considered include patient age, comorbidities, and the severity of the original indication for biologic use.
Initiation of biologics should only be done after a similar risk-benefit analysis, with a recommendation to consider deferring initiation for patients 60 and older and those with comorbidities that may portend a worse course in the event of coronavirus infection. Biologics should be discontinued for patients who test positive for COVID-19.
Dr. Hruza outlined some of the federal measures taken that may affect the business side of dermatology practices. These include a $20 million transfer to the Small Business Administration to offset administrative expenses associated with increased loan volumes related to the coronavirus outbreak. Eligible expenses for loans may include new devices and environmental adjustments to accommodate telehealth services.
Additionally, it is anticipated that as employers are required to provide paid sick and family leave, a payroll tax credit will be issued to employers. Some self-employed individuals will also be able to claim a tax credit for sick and family leave.
A recent news release from the AAD encourages the public to use high-emollient moisturizers after handwashing. The release also provides other tips, such as using petrolatum at bedtime for hands that are particularly dry and focusing on the fingertips when moisturizing, as these areas are prone to cracking. The release also reaffirms that the most effective way to clean hands is soap and water, and that moisturizing after handwashing does not negate the antiviral effects of cleansing, contrary to some social media reports.
koakes@mdedge.com