Towards Developing Strategies to Reduce Health Care Costs in Dermatology

Abstract

Background: The American Board of Internal Medicine has challenged medical specialties to develop Top Five lists in order to identify potential areas of wasted health care resources. The American Academy of Dermatology has not yet developed a Top Five list. Objective: To provoke discussion on the need for more evidence, guidelines, and quality measures to reduce waste in Dermatology. Methods: Dermatologists and medical professionals attending the 2010 Cochrane Skin Group Annual meeting were invited to complete a short-answer survey. Results: The study had a response rate of 39% (n=24). Most responses fit under a common theme related to the lack of, and poor adherence to evidence-based guidelines including lack of randomized controlled trials for treatment of prevalent skin disease, use of expensive biologics, antibiotics or procedures when cheaper treatment alternatives exist, the use of screening or diagnostic procedures for diseases for which no effective treatment exists, inappropriate diagnostics (biopsies, allergy tests) or treatments (excision of benign lesions, inappropriate Mohs surgery) of skin diseases and lastly, inappropriate dermatology referrals from PCPs. Limitations: The survey sample is small and limited to a small subset of medical professionals familiar with dermatology. While not definitive the survey results inspired this commentary and provided an initial basis for further discussion. Conclusion: This commentary and survey are intended to encourage discussion regarding development of a Top Five list of ways to improve dermatology quality and efficiency.