Managed-Care Systems Could Save By Eliminating Restricted Access To Dermatologists

WINSTON-SALEM, N.C. -- Health-maintenance organizations and medical consumers take note: For treatment of skin disease, you're better off medically and financially by going straight to a dermatologist.

That's the conclusion of two recent studies being presented as exhibits at the annual meeting of the American Academy of Dermatology in New Orleans. One study shows that for even common skin problems, primary care doctors and other "gatekeepers" in managed-care systems have a propensity to refer patients to a dermatologist. The other study determined that dermatologists take less time to diagnose skin diseases than other doctors.

The implication of both is that the medical system -- HMOs and other managed-care systems in particular -- would save money, and their patients would receive appropriate care sooner, if patients were allowed direct access to a dermatologist, says Steve Feldman, M.D. Feldman is a co-investigator of both studies and the director of the Westwood-Squibb Center for Dermatology Research at the Wake Forest University Baptist Medical Center, which conducted the studies.

The study on referral rates compared the rates of referral for all visits to primary care doctors with rates of referral for patients with a single dermatologic diagnosis.

"You would think that skin problems are a simpler-than-average medical problem that primary care doctors would treat," said Feldman, associate professor of dermatology, "but it turns out that on average you are 20 percent more likely to be referred for a skin problem than for other medical problems, showing that skin problems are relatively complex to primary care doctors.

"And when you look at what the referrals are for, you see they're for what one might call simple skin problems -- dermatitis, warts, cysts, cellulitis, acne."

The study concludes that HMOs would save at least $77,000 for every 100,000 patients by letting their members have direct access to dermatologists. This figure i

Contact: Robert Conn, Mark Wright or Jim Steele
Wake Forest University Baptist Medical Center

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