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Survey of Patch Test Business Models in the United States by the American Contact Dermatitis Society

Zhu, Tian, Hao, MD*; Suresh, Raagini, BS; Farahnik, Benjamin, MD; Jeon, Caleb, BS§; Warshaw, Erin, MD∥¶#; Scheinman, Pamela, MD**; Mowad, Christen, MD††; Botto, Nina, MD‡‡; Brod, Bruce, MD§§; Taylor, James, S., MD∥∥; Atwater, Amber, Reck, MD¶¶; Watsky, Kalman, MD##; Schalock, Peter, C., MD***; Machler, Brian, C., MD†††; Helms, Stephen, MD‡‡‡; Jacob, Sharon, E., MD§§§; Murase, Jenny, E., MD‡‡∥∥∥

doi: 10.1097/DER.0000000000000355

Background Allergic contact dermatitis (ACD) remains a significant burden of disease in the United States. Patch testing is the criterion standard for diagnosing ACD, but its use may be limited by reimbursement challenges.

Objective This study aimed to assess the current rate of patch test utilization among dermatologists in academic, group, or private practice settings to understand different patch testing business models that address these reimbursement challenges.

Methods All members of the American Contact Dermatitis Society received an online survey regarding their experiences with patch testing and reimbursement.

Results A “yes” response was received from 28% of survey participants to the question, “Are you or have you been less inclined to administer patch tests or see patients needing patch tests due to challenges with receiving compensation for patch testing?” The most commonly reported barriers include inadequate insurance reimbursement and lack of departmental support.

Conclusions Compensation challenges to patch testing limit patient access to appropriate diagnosis and management of ACD. This can be addressed through a variety of innovative business models, including raising patch testing caps, negotiating relative value unit compensation, using a fixed salary model with directorship support from the hospital, and raising the percentages of collection reimbursement for physicians.

From the *Keck School of Medicine, University of Southern California, Los Angeles; †University of California San Francisco School of Medicine; ‡College of Medicine, University of Vermont, Burlington; §John A Burns School of Medicine, University of Hawaii, Honolulu; ∥Department of Dermatology, University of Minnesota School of Medicine, Minneapolis; ¶Minneapolis VA Medical Center; and #Park Nicollet, Minneapolis, MN; **Department of Dermatology, Brigham and Women's Hospital, Boston, MA; ††Department of Dermatology, Geisinger Medical Center, Danville, PA; ‡‡Department of Dermatology, University of California, San Francisco; §§Department of Dermatology, School of Medicine, University of Pennsylvania, Philadelphia; ∥∥Department of Dermatology, Cleveland Clinic, OH; ¶¶Department of Dermatology, Duke University Medical Center, Durham, NC; ##Department of Dermatology, Yale School of Medicine, New Haven, CT; ***Department of Dermatology, Geisel School of Medicine at Dartmouth, Hanover, NH; †††Department of Dermatology, New York University School of Medicine, New York; ‡‡‡Department of Dermatology, University of Mississippi Medical School, Jackson; and §§§Department of Dermatology, Loma Linda University Medical Center; and ∥∥∥Department of Dermatology, Palo Alto Foundation Medical Group, Mountain View, CA.

Address reprint requests to Jenny E. Murase, MD, Department of Dermatology, Palo Alto Foundation Medical Group, 701 E El Camino Real (31-104), Mountain View, CA 94040. E-mail:

A.R.A. is a past consultant for Intraderm Pharmaceuticals and a lecturer for Med Ed Solutions, LCC. S.E.J. is founder and chief executive officer of the Dermatitis Academy Web site, a consultant for Johnson & Johnson, and an independent investigator for the Pediatric Research Equity Act safety and efficacy trials on the TRUE test. B.C.M. is a speaker for Pfizer. P.S. is a consultant for Squire Patton Boggs law firm, a lecturer for Brigham and Women's Hospital allergy department, and an author for UpToDate. K.W. is a board member of Yale–New Haven Hospital and an author of the UpToDate section on Prurigo Nodularis. J.S.T. has been a consultant for Johnson & Johnson and Kao Brands and received royalty payments from Decision Support in Medicine. He is a stockholder in Express Scripts, Opko Health, Johnson & Johnson, Merck, AstraZeneca, and Allergan. The other authors have no funding or conflicts of interest to declare.

© 2018 American Contact Dermatitis Society
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