Business Unblemished

In this episode of Business Unblemished, Erik Domingues, MD, sits down with Mark Kaufmann, MD, to unpack the coding strategies, buy-and-bill models, and overlooked CPT opportunities that can help dermatology practices stay afloat in the face of shrinking reimbursements and rising costs.They discuss how to:Use underutilized codes like G2211 to capture the full scope of careDetermine when buy-and-bill strategies are worth the riskAvoid common pitfalls that lead to lost revenueRecognize how accurate, complete coding can safeguard independent practiceAs Dr Kaufmann puts it: inflation is squeezing physicians, but smarter billing may be the key to better survival.

In this episode of Business Unblemished, Dr Stephen Lewellis, founder of Above & Beyond Dermatology, interviews Jamie Danley, Chief Human Resources Officer at Advanced Dermatology and Cosmetic Surgery, on how best to translate practice principles between small and large dermatology practices.Part one of this two-part episode, Dr Lewellis and Jamie discuss how to achieve employee engagement and establish culture across practice sizes, including the importance of defining culture and its role in creating a thriving practice.

In part two of this episode of Business Unblemished, Dr Stephen Lewellis and Jamie Danley continue their conversation about growing and evolving a small practice into a larger practice. They discuss ways of achieving buy-in from employees, empowering team members, and establishing culture based on a firm conviction in a practice's core values.

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:Medical assistants (MAs) handle the setup and patient preparationThe 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 backgroundDr 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:Dr Merritt recommends using a nurse visit room or an overflow exam room to allow smooth patient flowDr Farberg has successfully implemented PDT in small rooms, demonstrating that space limitations should not deter practices from considering the serviceAddressing 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:Established practices can confidently invest, knowing they will recoup costs over timeNew practices with tighter budgets can explore equipment rental options, which allow them to offer PDT without large upfront costsDr 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:Create a simple handout explaining what patients can expectAlways schedule 2 PDT treatments upfront, with a third follow-up visit 8 weeks later for evaluation.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:PDT setup and applicationHow to explain the procedure to patientsWhen to involve the physician during treatmentThis 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:If she has to freeze more than what fits on one hand, the patient needs field therapy—and PDT is her first choiceDr 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 takeawaysPDT offers precise, in-office field therapy for patients with AKWith efficient scheduling, PDT can be integrated seamlessly into any practice workflowSpace constraints should not deter practices from offering PDTThe cost of PDT equipment is quickly recouped, and rental options are availableA well-trained team and patient education help maximize PDT’s impact

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 & 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:Request updated insurance information at every check-inVerify deductibles and out-of-pocket costs, particularly for surgical and biologic patientsTrain front-desk staff to confidently collect copays and discuss financial policies with patientsDr 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:Annual deductible remains at $257Out-of-pocket maximum drops to $2000 (down from $3300)Elimination of the "donut hole"—patients reaching the out-of-pocket limit no longer have additional costs for the yearFor 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:Novartis, AbbVie, and Regeneron programs have adjusted eligibility criteriaBoth Medicare and commercially insured patients may see changesLucas 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:Review and update processes for insurance verificationEducate staff on policy changes so they can confidently assist patientsDevelop handouts and resources to help patients understand coverage updatesPrioritize shared decision-making, balancing medical need with insurance realitiesDr 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:Verify insurance at every visit—patients’ benefits may have changedMedicare Part D reforms may expand access to biologics, lowering costs for patientsReapply patients for patient assistance programs, as eligibility requirements are shiftingEducate staff on financial processes to improve workflow and patient experienceProactive planning ensures smoother insurance navigation and better patient outcomes