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Efficiently Implementing Photodynamic Therapy (PDT) for Actinic Keratosis (AK) in Dermatology Practices

In this episode of Business Unblemished, Dr Dawn Merritt and Dr Aaron Farberg discuss how to efficiently implement photodynamic therapy (PDT) for actinic keratosis (AK) in dermatology practices. They address common misconceptions about PDT’s cost, logistical challenges, and practical strategies to maximize both its clinical and financial value.Why use PDT for actinic keratosis?PDT is an effective field therapy for actinic keratosis. While individual lesions can be treated with cryotherapy, many patients require broader treatment, making PDT an excellent in-office option.Dr Merritt, an early adopter of PDT, has integrated the treatment into all 10 of her practice locations, where it is performed daily. Dr Farberg strongly believes every dermatology practice should offer PDT, noting that dermatologists are likely to see multiple patients every day who could benefit from it. While topical therapies remain a viable and effective option, PDT offers greater control over treatment application and adherence, ensuring patients receive consistent and effective care.Optimizing workflow and staffingDr Merritt emphasizes that proper scheduling is key to ensuring PDT does not disrupt clinic flow. Instead of scheduling PDT as a physician-led appointment, she recommends setting it up as a nurse visit:<ul><li>Medical assistants (MAs) handle the setup and patient preparation</li><li>The physician only needs to be present for consent, curettage, and product application, allowing them to continue seeing other patients while the PDT session runs in the background</li></ul>Dr Farberg adds that while MAs can manage most of the process, physicians should personally apply and initiate PDT for optimal reimbursement and quality of care. A simple way to improve efficiency is to provide patients with a bell to call for assistance while MAs manage other tasks such as prior authorizations or patient paperwork.Space considerations for PDT implementationOne common concern among dermatologists considering PDT is space requirements. However, PDT does not require a dedicated room:<ul><li>Dr Merritt recommends using a nurse visit room or an overflow exam room to allow smooth patient flow</li><li>Dr Farberg has successfully implemented PDT in small rooms, demonstrating that space limitations should not deter practices from considering the service</li></ul>Addressing cost concerns and maximizing revenueFor newer or smaller practices, the upfront cost of PDT equipment may feel like a barrier. However, both doctors emphasize that PDT is a long-term revenue generator:<ul><li>Established practices can confidently invest, knowing they will recoup costs over time</li><li>New practices with tighter budgets can explore equipment rental options, which allow them to offer PDT without large upfront costs</li></ul>Dr Merritt routinely budgets for PDT when opening a new office because she knows its profitability and value to patients.Educating patients about PDTDr Merritt emphasizes that patient education is crucial for successful PDT integration. She advises new practices to:<ul><li>Create a simple handout explaining what patients can expect</li><li>Always schedule 2 PDT treatments upfront, with a third follow-up visit 8 weeks later for evaluation.</li></ul>Dr Farberg finds that offering multiple field therapy options allows patients to choose what works best for them, though many prefer PDT due to its ease of use and convenience.Training staff to promote PDTDr Merritt utilizes rolling screen advertisements in her offices to inform patients about PDT before their appointment. Additionally, she has trained her MAs with instructional videos that cover:<ul><li>PDT setup and application</li><li>How to explain the procedure to patients</li><li>When to involve the physician during treatment</li></ul>This structured approach ensures the entire team is aligned and helps patients feel more comfortable with the procedure.Identifying ideal candidates for PDTDr Merritt has a simple rule of thumb for determining when to recommend PDT:<ul><li>If she has to freeze more than what fits on one hand, the patient needs field therapy—and PDT is her first choice</li></ul>Dr Farberg also sees PDT as a built-in marketing tool; patients who receive it often remark that they have never had it offered at other dermatology offices. These patients share their positive experiences with friends, bringing in new patients and strengthening practice growth.PDT remains one of the most effective and well-established treatments for AK field therapy. While some dermatologists hesitate due to logistical concerns, both Dr Merritt and Dr Farberg emphasize that with proper implementation, PDT can enhance patient care while becoming a valuable revenue stream.Key takeaways<ul><li>PDT offers precise, in-office field therapy for patients with AK</li><li>With efficient scheduling, PDT can be integrated seamlessly into any practice workflow</li><li>Space constraints should not deter practices from offering PDT</li><li>The cost of PDT equipment is quickly recouped, and rental options are available</li><li>A well-trained team and patient education help maximize PDT’s impact</li></ul>

New Year Deductibles and Reimbursements

Welcome to Business Unblemished, a video series that explores the business side of dermatology. Each episode will feature practice owners, managers, business leaders, and other experts sharing best practices to streamline operations, improve patient care, and navigate daily challenges.In this episode, Erik Domingues, MD, (Founder &amp; CEO, Modern Dermatology) and Leslie Lucas, MBA, (COO, Oakview Dermatology) break down essential updates for 2025, including insurance benefits and changes impacting patients, updates to patient assistance programs, and the Inflation Reduction Act and its effects on dermatology practices.Insurance changes: starting the year proactivelyWith each new year, insurance benefits reset, and dermatology practices need to be proactive. Leslie Lucas emphasizes the importance of treating every patient as if something has changed, whether it's a job change, aging into Medicare, or new coverage details. Practices should:<ul><li>Request updated insurance information at every check-in</li><li>Verify deductibles and out-of-pocket costs, particularly for surgical and biologic patients</li><li>Train front-desk staff to confidently collect copays and discuss financial policies with patients</li></ul>Dr Domingues shares that his practice requires annual patient sign-off on financial policies, ensuring transparency and clear expectations. Lucas adds that thorough staff training, including scripting for financial conversations and understanding how insurance impacts billing, can improve workflow and reduce claim issues.Medicare Part D reforms: expanding access to biologicsThe Inflation Reduction Act introduces major Medicare Part D changes in 2025, significantly improving access to costly dermatologic treatments. Lucas outlines 3 key updates:<ul><li>Annual deductible remains at $257</li><li>Out-of-pocket maximum drops to $2000 (down from $3300)</li><li>Elimination of the "donut hole"—patients reaching the out-of-pocket limit no longer have additional costs for the year</li></ul>For dermatology patients, these changes may increase affordability for biologics. Patients previously limited to topicals or traditional immunosuppressants may now be able to more easily access safer, more effective injectable and oral therapies.Additionally, early financial planning can help patients manage biologic costs, as patients who enroll early can spread medication payments throughout the year, improving adherence and long-term outcomes.Patient assistance programs: reapplications and eligibility changesPatient assistance programs remain a critical resource, but eligibility thresholds are shifting in 2025. Dr Domingues and Lucas recommend reapplying for every patient, even if they were ineligible before.Key updates include:<ul><li>Novartis, AbbVie, and Regeneron programs have adjusted eligibility criteria</li><li>Both Medicare and commercially insured patients may see changes</li></ul>Lucas highlights the importance of staff education so teams can effectively communicate financial assistance options to patients.Planning for insurance and policy changes in your practiceBoth experts stress proactive planning as the key to navigating insurance updates:<ul><li>Review and update processes for insurance verification</li><li>Educate staff on policy changes so they can confidently assist patients</li><li>Develop handouts and resources to help patients understand coverage updates</li><li>Prioritize shared decision-making, balancing medical need with insurance realities</li></ul>Dr Domingues underscores that the most important goal is ensuring patients receive the best possible treatment with minimal financial barriers. By staying informed and prepared, dermatology practices can streamline access to care and optimize patient outcomes.Key takeaways:<ul><li>Verify insurance at every visit—patients’ benefits may have changed</li><li>Medicare Part D reforms may expand access to biologics, lowering costs for patients</li><li>Reapply patients for patient assistance programs, as eligibility requirements are shifting</li><li>Educate staff on financial processes to improve workflow and patient experience</li><li>Proactive planning ensures smoother insurance navigation and better patient outcomes&nbsp;</li></ul>

Office Practice & Coding Tips You May Not Be Aware Of

It is essential to understand billing and coding to run a successful practice, and Mark Kauffman, MD delivered a rigorous session to get us up to speed on coding strategies and the current fiscal physician landscape. He informed us of the dramatic decrease in physician reimbursement throughout the 2000s. While lobbying, legislation, and larger bureaucratic changes are required to truly fight inflation’s impact on physician salary, there are some small steps to take in your practice right now.&nbsp; He warned us to be aware of E/M leveling as payers begin to lump diagnoses into specific complexity levels robbing clinicians of the ability to make appropriate claims. These leveled claims should be appealed if necessary. Perhaps one of the most actionable tips Dr. Kauffman gave us is that suture removals can now be billed to capture clinic supplies required for these minor procedures. Explicitly, 15853 should be used for removing sutures or staples, whereas 15854 should be used for sutures and staples. However, both of these codes are for 0-global day procedures or can be used when outside of a global period when an E/M service is performed in the office setting, such as reviewing pathology results. They can never be reported during a global period of any procedure. A few notable changes to the 2024 Current Procedural Terminology book: 96920-96922 for the treatment of psoriasis with excimer laser now requires both a specific diagnosis and specific laser for billing.&nbsp; Dr. Kauffman ended this session by reminding us to use the entire fee schedule including facility fees or J codes when a drug requires an infusion or injection. In practices with multiple subtypes of dermatologists, such as pediatric, procedural, and dermatopathologic, each physician can bill and be paid without regard to their membership in the same group. Important dermatologic taxonomies are as follows: Dermatology 207N00000X, Mohs Surgery 207ND0101X, Clinical and Lab Derm Immunology 207NI0002X, Pediatric Dermatology 207NP0225X, Procedural Derm 20NSO135X, and Dermatopathology 207ND0900X.&nbsp;

In episode 18 of Cutaneous Miscellaneous, our host, Nicholas Brownstone, MD, speaks with Jacqueline Fisher, DO, a board-certified dermatologist and CEO/owner of <a target="_blank" rel="noopener noreferrer" href="https://www.cincyskin.com/">CincySkin Medical &amp; Cosmetic Dermatology</a> in Cincinnati, OH.&nbsp;

In episode 18 of Cutaneous Miscellaneous, our host, Nicholas Brownstone, MD, speaks with Jacqueline Fisher, DO, a board-certified dermatologist and CEO/owner of <a target="_blank" rel="noopener noreferrer" href="https://www.cincyskin.com/">CincySkin Medical &amp; Cosmetic Dermatology</a> in Cincinnati, OH.&nbsp;The episode begins with board review on rosacea. Dr Brownstone discusses key facts on rosacea and reviews the important rosacea subtypes. Dr Fischer then reviews rosacea variants along with the details mostly likely to show up on board exams. Dr Fischer also shares her method on how to best counsel patients on a diagnosis of rosacea in the clinic.&nbsp;In the main part of the episode, Dr Fischer discusses how to build a brand as a dermatologist. She highlights the importance of branding, the definition of branding, and how it differs from marketing. She gives some tips on how to develop a brand identity, a brand message, and what constitutes a brand. She ends the discussion with some of the pearls and pitfalls she discovered when building her dermatology brand along with her thoughts on hiring a professional branding firm.&nbsp;Whether you are about to begin practice or have been practicing for many years and desire to create or improve your brand, you can’t miss the episode!Introducing Cutaneous Miscellaneous Boards Booster!In this new feature, we’ll put your knowledge to the test with high-yield board review questions written by dermatology residents and fellows and sourced from key resources like Bolognia’s Dermatology, Andrews’ Dermatology, and Alikhan’s Review of Dermatology. These quiz questions will test your skills on the board review topic that’s discussed in each episode. <a target="_blank" rel="noopener noreferrer" href="https://www.research.net/r/JDMJL69">Click here to answer this month's question</a>.

Cutaneous Miscellaneous Podcast

Building Your Brand as a Dermatologist

In this episode of Derms and Conditions, our host, James Q. Del Rosso, DO, interviews Cory Rubin, MD, dermatologist and owner of the Michigan Dermatology Institute, about the business side of running a practice, with specific focus on the buy-and-bill model.

In this episode of Derms and Conditions, our host, James Q. Del Rosso, DO, interviews Cory Rubin, MD, dermatologist and owner of the Michigan Dermatology Institute, about the business side of running a practice, with specific focus on the buy-and-bill model.&nbsp;Dr Rubin shares some of the challenges he has faced and explains the value of buy-and-bill for dermatologists, particularly in complex cases where medications may not be easily accessible through traditional pharmacies. They cover suitable medications, such as biologics for psoriasis, cutaneous T-cell lymphoma, and other conditions, as well as the financial benefits, clinical advantages, and patient convenience associated with in-office administration.&nbsp;The conversation dives into the practical aspects of implementing buy-and-bill. They explore the importance of understanding insurance processes, obtaining prior authorizations, and tracking patient outcomes. The pair emphasize the need to start small, gradually expanding buy-and-bill capabilities while ensuring proper documentation and reimbursement.&nbsp;Dr Rubin offers rich practical advice and reiterates the importance of mentorship and seeking assistance from experts in billing and reimbursement. He also extends an invitation for further consultation via email and expresses his willingness to support colleagues in navigating the complexities of practice management. This episode is a valuable listen for dermatologists looking to optimize their practice operations and enhance patient care through buy-and-bill.

Derms and Conditions Podcast

Prescribed Success: Navigating Buy-and-Bill Strategies in Dermatology Practice

<h5>RVUs (Relative Value Units)</h5>RVUs are a measure of the relative value of healthcare services provided by physicians and other healthcare professionals. They quantify the resources (time, skill, intensity) required to perform a particular service relative to a standard set by Medicare and other payers.There are various components to RVUs, including…<ul><li>Work RVU: Measures the physician’s time, skill and effort involved in providing a service.</li><li>Practice Expense RVU: Accounts for the practice’s overhead costs associated with delivering the service.</li><li>Malpractice RVU: Reflects the cost of malpractice insurance related to the service.</li></ul>RVUs are calculated based on the <a target="_blank" rel="noopener noreferrer" href="https://mmshub.cms.gov/measure-lifecycle/measure-specification/specify-code/CPT#:~:text=CPT%20is%20a%20registered%20trademark,and%20procedures%20performed%20by%20physicians.">Current Procedural Terminology</a> (CPT) codes assigned to each service or procedure. Each CPT code is assigned a specific RVU value (find 2024 dermatology RVUs <a target="_blank" rel="noopener noreferrer" href="https://assets.ctfassets.net/1ny4yoiyrqia/7co5LFBrmRHZPaZ6QVEC8w/c08cdc71b98ae5c7b542b03fa14b7e07/AAD-Coding-Dermatology-RVUs-2024-Final.pdf">here</a>).RVUs play a pivotal role in the healthcare system, determining Medicare and other insurer reimbursement rates. They also serve as a metric to assess physician productivity and workload.Dermatologists often have productivity targets based on RVUs. Higher RVUs generally indicate more services provided and potentially higher reimbursement.To optimize your RVUs, you can focus on high-value procedures or services, and ensure accurate documentation of your work. Understanding this system empowers you to navigate it more effectively, ensuring fair compensation for your services.<h5>Collections</h5>Collections refer to the actual revenue generated from the services provided by a physician. They represent the amount of money collected from patients or insurers for physician services.Factors that can affect collections include…<ul><li>Reimbursement Rates: Different payers (Medicare, private insurers, etc.) reimburse at different rates for the same service.</li><li>Billing and Coding Accuracy: Errors in coding or billing can impact collections.</li><li>Patient Demographics: Patient insurance coverage and ability to pay.</li></ul>While RVUs measure the work and resource intensity of services, collections measure the actual financial outcome of providing those services. Collections directly impact the financial health of the practice and, consequently, your income.<h5>Key Differences Between RVUs and Collections</h5>RVUs measure the relative value of services in terms of time, effort and resources, while collections measure the actual revenue generated from those services.RVUs are often used to determine productivity and sometimes influence compensation models (like RVU-based bonuses). Collections, on the other hand, directly affect the practice’s revenue and provider income.Collections-based compensation and incentives are typically more straightforward, which is why we recommend dermatologists making a career change seek out opportunities offering packages structured using this method.<h5>Customized Compensation Guidance</h5>We hope this deep dive into dermatology RVUs and collections clarifies their differences and impacts on you. However, if you want personalized support navigating the vast intricacies of compensation, contracts and more, <a target="_blank" rel="noopener noreferrer" href="https://mydermrecruiter.com/job-seekers/">myDermRecruiter</a> is here for you.Our <a target="_blank" rel="noopener noreferrer" href="https://mydermrecruiter.com/team/">Dermatology Recruitment Specialists</a> are dedicated to your specialty and have the industry knowledge in dermatology to ensure your next career move provides everything you want and need for personal and professional satisfaction.Our services are always free to career seekers. And your privacy is our top priority. We never share your name or personal information with practices without your consent. Send an email to <a href="mailto:Brent@myDermRecruiter.com">Brent@myDermRecruiter.com</a> today to learn more!

Understanding RVUs (Relative Value Units) and collections is crucial for dermatologists as these metrics play a significant role in how your compensation and productivity are evaluated. Let’s examine these metrics in depth so you can clearly understand how they impact your income and career goals.

RVUs vs. Collections in Dermatology: Understanding Productivity and Revenue Metrics for Dermatologists

Explore why Dermsquared Career Services is the go-to choice for both job seekers and practices:<ul><li>800+ positions: Access the largest dermatology job board in the nation with over 800 openings currently posted</li><li>Opportunities for all: Whether you're a dermatologist, PA, NP, or support staff, we have opportunities for professionals at every stage of their career</li><li>Practice support: Practices can advertise their job openings and connect with top talent</li><li>Educational resources: Benefit from video resources and articles that support and educate both employers and employees</li></ul>

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