Telehealth expands the capacity to care for patients in rural and underserved settings. Store-and-forward teledermatology is a simple and effective approach which enables remote dermatological diagnosis and treatment. Implementing store-and-forward technology in rural Mississippi has the potential to expand access to dermatology services at locations, where an in-person dermatologist is not available including: emergency rooms, urgent care centers, and primary care practices. A survey study was conducted to assess perceived obstacles and attitudes about store-and-forward teledermatology among primary care providers in Mississippi's rural areas. Most providers are very interested in the telehealth program and the opportunities it provides them to best treat their patients. Key barriers to engagement in teledermatology were (1) primary non-adherence: this is rooted in misconception about teledermatology, the investment in time required to master the technology and establish digital links between primary care provider and consultant; and, (2) secondary non-adherence: this is related to the time required to submit a teledermatology consult which disrupts busy offices. Emphasizing the benefits of teledermatology to primary care physicians and simplification of the teledermatology consult submission process may increase the use of teledermatology in rural Mississippi and serve as a model for other academic teledermatology programs throughout the United States.
Hiring new dermatology faculty at academic medical centers (AMCs) can be a difficult process. Academic dermatology departments, however, must have the financial freedom to nimbly respond to the needs of their community. To determine the downstream revenue and profitability produced by dermatology faculty, a retrospective review of charges and expenses downstream of professional services was performed to assess dermatology faculty and nurse practitioners from January 2019 to December 2020 at a single AMC in the southern United States. The downstream revenue per dermatology faculty was calculated using institutional data based on the number of services performed and the exact compensation per service. When this was not possible, the Medicare Allowable Charge was used to estimate the compensation for the service provided. Revenue was included from internal referrals to dermatopathology, Mohs surgery and repairs, chemistry and microbiology labs, radiology, and phototherapy. Profitability was calculated using institutional cost data to estimate the expense of each additional unit of services performed. The most valuable source of downstream income was dermatopathology services, which generated $85,395/provider in 2019 and $102,746/provider in 2020. Mohs surgery was also a significant source of downstream revenue contributing $92,715 in 2019 and $96,599 in 2020. Repairs after Mohs surgery internal referrals generated $30,036 in 2019 and $36,507 in 2020. The total contributions of chemistry and microbiology labs, radiology, and phototherapy were considerable but less impactful overall. The total downstream revenue calculated from these services for 2019 was $228,304/provider and $255,549 in 2020. The total downstream profitability for these services was calculated to be $112,597/provider in 2019 and $92,344/provider in 2020. In conclusion, faculty of academic dermatology departments produces a great deal more revenue and profitability for AMCs than the sum of their professional charges.
Supplementary Information
The online version contains supplementary material available at 10.1007/s00403-022-02406-3.
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