Skin of Color Savvy: Reimbursement, Coverage, and Care Gaps for Patients With Skin of Color

Welcome to Skin of Color Savvy: The Art and Science of Treating Patients of Color!

In this episode of Skin of Color Savvy, a show hosted by Skin of Color Society (SOCS) leaders and produced by HCPLive, host Elizabeth Kiracofe, MD, a board-certified dermatologist in Chicago and co-chair of the SOCS Advocacy Committee, speaks alongside Murad Alam, MD. Alam is a dermatologist at Northwestern University, a former SOCS board member, and president of the American Academy of Dermatology (AAD).

The pair of leaders in the field of dermatology discuss how health policy shapes access to dermatologic care, particularly for individuals with skin of color. They have met with Illinois legislators together in Washington, DC, and both frame advocacy as a natural extension of patient care rather than a separate or self-serving pursuit.

Alam explains that patients, including those with skin of color, increasingly struggle to get prompt appointments and needed medications. Closing these gaps at scale, he says, requires persuading policymakers to commit more resources. He recommends clinicians start by learning the issues at the state, federal, and regulatory levels. They can then share patient stories that humanize the problem for legislators who never see the effects of prior authorization delays or coverage denials firsthand.

What Policy Barriers Limit Dermatology Access for Underserved Patients?

According to Alam, the first barrier is recognition. Many conditions affecting underserved communities are understudied and poorly documented, so policymakers may not acknowledge them as problems. Beyond that, access depends on basic factors: whether enough dermatologists practice locally, whether patients can afford transportation and visits, and whether medications are covered. He suggests pop-up clinics, trained advanced practice providers, and community education as ways to build care pathways that are at least adequate.

Kiracofe notes that treatments for conditions that disproportionately affect patients with skin of color are often not covered, which raises out-of-pocket costs. These conditions include hyperpigmentation, pseudofolliculitis barbae, and hidradenitis suppurativa. When practices cannot sustain staffing, patients may turn to emergency departments, which shifts costs and lacks dermatology expertise. Alam adds that the resulting delays in diagnosis can allow disease that might have responded to topical therapy to progress until it requires systemic treatment. Kiracofe points to atopic dermatitis as one condition often diagnosed later and at greater severity in patients with skin of color.

How Does the Medicare Conversion Factor Affect Dermatology Practices?

Alam describes the Medicare conversion factor, currently about $32, as the dollar amount multiplied by relative value units to set payment for every service. Many private insurers peg their payments to a multiple of Medicare rates, so a decline reduces reimbursement across the board. Over roughly 25 years, payments to hospitals, nursing homes, and pharmaceutical companies have kept pace with or exceeded inflation. Physician payments have stayed flat and, in the past 5 to 6 years, declined as inflation accelerated. He emphasizes that reimbursement is not about physician income. It funds the staff, rooms, equipment, and appointments that make access possible, and patients without financial reserves are hit hardest when that funding falls short.

How Can Dermatologists Get Involved in Health Policy Advocacy?

Alam encourages clinicians to engage patients as advocates, since constituents describing their own experiences carry significant weight. Professional societies such as SOCS and the AAD can track legislation, alert members, and organize grassroots responses. He notes that recent changes to dermatology residency requirements call for advocacy training, though department chairs and program directors must still implement them. Effective advocacy, he stresses, requires authenticity and preparation rather than showmanship.

As action steps, he recommends contacting legislators through their local district offices and supporting SkinPAC, the AAD's political action committee, which contributes to candidates of both parties who support dermatology priorities. Kiracofe, a former lobbyist, adds that other health care sectors employ far more advocacy professionals than dermatology does. Looking ahead, Alam is hopeful for gradual reimbursement improvements and for artificial intelligence to expand telemedicine and make drug development more efficient.

To learn more about SOCS’s programs and initiatives, visit the Skin of Color Society website.

Editor's note: Both Alam and Kiracofe had no relevant disclosures of note. This episode summary was edited with the help of AI tools.