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    How the Trump presidency may impact dermatology

    Amid great speculation about how the Trump presidency will impact healthcare and providers, including dermatologists, there’s one thing that’s clear.

    We don’t know much.

    “We know enough to make some reasonable predictions about the likely impact of a Trump presidency for health. He has called the Affordable Care Act ‘broken’ and a ‘disaster,’ ‘The whole thing was a fraud,’ he has said. He had promised to repeal the Act on his first day in office…. But Trump has already stepped back from his ‘repeal and replace’ commitment. Since he has quickly jettisoned one of his central appeals to disaffected voters, we must admit that we now have no idea what he has in mind for healthcare,” according to an editorial “President Trump,” published online November 19 in TheLancet.com1.

    Some see this as a time of opportunity for medicine, especially given President-elect Trump’s choice for Secretary of Health, Tom Price, M.D., an orthopedic physician and House Budget Committee Chair.

    Nancy Taylor, shareholder and co-chair of the health and FDA business practice at the international law firm Greenberg Traurig LLP, says that while some expect that President-elect Trump will seek a repeal and replace of the Affordable Care Act, it is likely to be a “precision” repeal of only those issues that are considered burdensome on individuals, business, insurers and governors.

    “President-elect Trump and his team have many proposals and will rely on key Congressional Republican leaders to find a pathway that balances expansion of coverage, while reducing healthcare costs from less complex regulations and greater consumer engagement. A repeal bill without a thoughtful replacement may cause significant disruption to those with coverage and to providers, especially in rural and medically underserviced areas,” Ms. Taylor says.

    President-elect Trump’s selection of Dr. Price, she adds, shows Trump’s respect for physicians and their role in caring for patients. 

    “Dermatologists, like other specialty practices, have direct contact with their patients and understand that patients need information to make appropriate decisions relating to their care.  I believe that this new Administration will value the relationship between physician and the patient and encourage physicians to engage with their patients on issues relating to the cost and quality of the care they need,” Ms. Taylor says. “Dr. Price, as Secretary-elect, will bring a unique perspective to the role as both a physician and a former member of Congress. There will be no training needed for him to understand the process in Washington, D.C., or the unique needs of physicians.”

    AAD President Dr. Torres weighs in

    American Academy of Dermatology (AAD) President Abel Torres, M.D., J.D., a veteran in the health systems in Cleveland and Loma Linda, California-based dermatologist and lawyer, agrees that the upcoming changes in healthcare under the new Administration remain a mystery.

    “Obviously our biggest concern in dermatology is to make sure our patients have access to care and access to treatment,” Dr. Torres says. “In our advocacy efforts, that’s what we will be concentrating on: to make sure we minimize the impact for our patients specifically as it relates to access for dermatology.”

    The critical issues that AAD has identified and will lobby for in the new government are issues that impact dermatologists’ daily practices. The number one issue is to reassess the Affordable Care Act and how that impacts dermatology patients’ access to care and access to treatment, according to Dr. Torres.

    “We’re advocating for changes to the MACRA regulation, to ensure that the medical payment is more consistent with the realities of providing patient care. We would like to see penalties associated with electronic health records removed,” he says. “The other thing we’re looking for is a push for overall regulatory relief in general, so it allows dermatologists to prioritize their patients over paperwork. Lastly, we want to make sure that patients have access to us as dermatologists and the treatments we prescribe. Right now, we have these narrow networks, where insurers basically restrict the access to physicians — not just dermatologists but all physicians.”

    Hope for positive change

    Dr. Torres says that physicians have become progressively unhappier with increasing regulatory oversight for about the last decade.

    “I would say that in general, over the past 10 years, we’ve seen an increase in regulations and increased frustration by physicians because they have less time with their patients and have to deal more with regulations and restraints that are imposed on them,” Dr. Torres says.

    The fact that the new Health Secretary is a physician is good news, according to Dr. Torres.

    “He has a better understanding, I think, in terms of the issues that physicians have to face in the care of our patients. He especially has an understanding from the private practice physician’s point of view, since he had a private practice,” Dr. Torres says. “We’re hopeful that because of the fact that he is a physician and was in private practice and has an understanding of those issues, that  will help as it relates to any changes that are going to occur in healthcare, so we can do what’s best for patients.”

    The AAD has released its wish-list of priorities for the future of healthcare and will spend the next few months identifying key people in government and arranging to have conversations with them — to educate them about the issues that physicians are experiencing on the frontlines.

    ASDS offers Guidance

    American Society for Dermatologic Surgery (ASDS) President Thomas E. Rohrer, M.D., says time will tell how the new Administration will impact dermatologic surgery patients and ASDS members.

    Dr. Rohrer says that President-elect Trump understands business and how important quality healthcare is for employees and their families. He also understands that the government’s undue burdens on physicians can impact that quality, impeding access to needed healthcare services.

    According to Dr. Rohrer, the American Society for Dermatologic Surgery Association (ASDSA) has reached out to the Trump Transition Team and offered to help on healthcare issues.

    “Our organization does not weigh-in on Cabinet-appointees, but I see having a physician in-charge of Health and Human Services as a positive for patients,” Dr. Rohrer says.

    ASDSA has identified three area for the new Administration to address, according to the ASDS president:

    “Repeal of the Independent Payment Advisory Board (IPAB). Created by the Affordable Care Act (ACA), the IPAB is a government board whose sole responsibility is to cut Medicare spending once it reaches an arbitrary level. Such significant healthcare decisions should not be made by Presidential appointees who have little to no clinical experience and who are not subject to administrative or judicial restraint. It is predicted that the IPAB will go into effect in 2017, decreasing provider reimbursement without appropriate oversight, stakeholder input or transparency. If the IPAB fails to report recommendations, this responsibility will rest in the hands of a single individual — the Secretary of the Department of Health and Human Services. It should be the responsibility of the Congress to create policies that meet the needs of their constituents and design a healthcare system that can respond to their diverse communities.

    ASDSA members are also concerned about the way the Centers for Medicare and Medicaid Services (CMS) has handled the coding for physician payment, particularly related to the global surgery codes and requirements as set forth in the 2017 Medicare Physician Fee Schedule final rule. ASDSA will continue to work for a fair global surgical package and we hope to work with the incoming Administration to help physicians spend more time with patients and less time on administrative work.

    Working to stop the U.S. Food and Drug Administration (FDA) efforts to encroach on the practice of medicine regarding in-office compounding. The FDA’s interpretation of the Drug Quality and Security Act (“DQSA”, P.L. 113-54) has been interpreted narrowly by the FDA, and therefore limits our physicians in providing timely care to their patients. ASDSA, along with other medical and pharmaceutical societies, have worked together to make drug compounding a safe in-office practice while ensuring patients have access to these medications without being hindered by government rules.”

    Dr. Rohrer says he has advised ASDS members to become politically active, donate to American Academy of Dermatology Association’s (AADA’s) SkinPAC [and to] candidates who share the positions ASDSA advocates for on behalf of patients and dermatologic surgeons who treat them.

    “We encourage our members to advocate for their patients on local, state and federal levels,” Dr. Rohrer says.

    Finally, a little perspective

    While the Trump Administration’s impact on practicing doctors is big, it’s probably not the biggest wave of change coming providers’ way, according to Rick Mayes, Ph.D., professor and co-chair of health studies at the University of Richmond, Richmond, Va.

    “A Trump presidency will not have an immediate effect on physicians nearly as much as the Medicare Access and Chip Reauthorization Act (2015, MACRA) will starting in 2019. MACRA was passed in a bipartisan way in a polarized Congress in spring 2015, and it will have a much bigger impact on physician pay and organization than anything else has coming out of Washington, D.C., in a long time,” says Dr. Mayes, who worked on Medicaid policy in the White House Office for George H.W. Bush and on health insurance and Medicare policy at AARP during the healthcare reform effort of 1993 to ’94.

    According to AAD, on Capitol Hill, Rep. Greg Walden (R-Ore.) has been selected as the chair of the U.S. House Energy and Commerce Committee, which is the primary committee for addressing the Affordable Care Act (ACA), the Medicare Access and Chip Reauthorization Act (MACRA), compounding, and drug pricing.

    References:

    President Trump. The Lancet. 2016;388(10059):2449. Retrieved from www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)32216-4/fulltext published November 19.

    Lisette Hilton
    Lisette Hilton is president of Words Come Alive, based in Boca Raton, Florida.

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