With health care reform looming, dermatologists find themselves battling for health care funds. The result of this shift will change the specialty and could make it more focused on cosmetic procedures.

Those were among the predictions presented by Brett M. Coldiron, M.D, Friday in the "Hot Topics" presentation "Utilization, Politics, and the Future of Dermatology." Dr. Coldiron is a clinical associate professor of dermatology at the University of Cincinnati, and has served on AAD and AMA committees related to health care reform.

"It upsets me to see the specialty turn into a cosmetic specialty. We are medical scientists and we know something," Dr. Coldiron said. "It is imperative that we educate Congress, MedPAC, and CMS about the skin cancer epidemic and that dermatologists are the solution, not the problem."

Between 1995 and 2008, an increased number of dermatologic procedures drove a 62 percent increase in the dermatology reimbursement from the RVU pool, which receives federal funds, he said. Only 1 percent of physicians are dermatologists, but they received 2.9 percent of the RVU pool funding.

That put dermatology in a bad light among the groups that oversee federal health care funding, Dr. Coldiron said. But the increase was driven by an increase in skin cancers.

"There is an epidemic of skin cancer, and we are treating it. The specialty has reinvented itself, so it is now a surgical specialty. We do more skin surgery than all others," he said, adding that the number of biopsies per cancer has increased.

Despite this increase in cancer treatments needed, no additional funding has been approved by Congress, and more physician groups are lobbying for funds at the same time. The bottom line is that dermatology has suffered funding cuts as many of its billing code reimbursements have been reduced.

Another group, the Independent Payment Advisory Panel (IPAP), will be created under the health care reform law to root out overused, overpaid, or useless services, and that, too, is a threat to small specialties, Dr. Coldiron said. It could result in reductions of funding for procedures such as Mohs surgery, so IPAP could be the "greatest threat" to dermatology.

With that, Dr. Coldiron listed 15 predictions for the next five years. Some of those predictions:

•   Physicians, especially specialists, will take the brunt of any cost savings attempts by Congress. Hospitals will close if pressed, insurers will go into other lines, and physicians will be left with few options. The new health care law stipulates that only providers take cuts; beneficiaries cannot pay more.
•   Mohs surgery will not regain its multiple surgery reduction exemption.
•   The skin cancer epidemic will continue to accelerate as "sun-kissed baby boomers age."
•   Boomers are a huge voting block and the cost of health care will not be shifted to them, which will be reflected in health care law.
•   Dermatology will continue to be targeted for cuts due to its increased utilization and fiscal success.
•   Appropriateness criteria will be developed for Mohs surgery and AK destruction.
•   Mohs surgeons will band together in groups.
•   Ambulatory surgery centers will become harder to license. Those already licensed will become more valuable.
•   Pathology codes for skin will not be cut for five years, depending on how fast utilization increases.
•   Cosmetic procedures will continue to increase as boomers age.