DermOne Dermatology Centers
Taking the Practice of
Dermatology into the New Healthcare Arena
By Accredited Dermatology
We have already
witnessed a dramatic change in the practice of medicine within virtually every specialized
field. In addition to their role as clinicians, physicians need to pay close
attention
to the business side
of treating patients. Over time, the sole practitioner has become the exception
rather than the rule and even he or she has had to evolve significantly in
order to adapt.
Technology
is a double-edged sword. On one hand, it has provided physicians with the tools
to achieve miraculous outcomes for their patients as compared to what was
possible only a few short decades ago. Also, access to patient information has
been revolutionized. While these advancements markedly improve patient care,
the technology challenges physicians to keep pace from a financial perspective
and also in terms of mastering all of the new techniques that become available.
Moreover, health insurance administrators, whether through government plans or
private insurance companies tightly regulate reimbursement to providers, while
the costs of maintaining a medical practice escalate. A number of different
models for structuring medical practices have emerged as physicians look for alternatives
that more efficiently address practice management. One such model seems particularly
well-suited to the practice of dermatology, which for the most part is
exclusively office-based. Already established in many parts of our state, DermOne™
Dermatology Centers is a rapidly growing organization that will include dermatologists
as well as nurse practitioners and physician assistants throughout New Jersey
and beyond. DermOne actually began as Accredited Dermatology,
which was built by Rami Geffner, MD, who originally started as a sole
practitioner in Toms River in 1986. Through word of mouth his practice grew
quickly and before long he was dividing his time among three offices in southern
New Jersey. Eventually, in order to accommodate other areas as well, Dr.
Geffner found himself with six locations. He attempted to hire other dermatologists
to join with him to no avail. “At that point
I decided to hire and train physician assistants and I believe I was one of the
first in dermatology within New Jersey to do this,” Dr. Geffner points out.
Although some in the community were skeptical, Dr. Geffner relates that with
the extensive training he provided, the PAs he brought on board were extremely
proficient and skillfully worked with him to ensure patients received the
highest level of care. During this period Dr. Geffner, who was working
incredibly hard, continued to search for dermatologists to partner with and in 2000,
after a brief association with one physician failed to work out, he finally
found a female dermatologist who re-located from her
practice in Florida to join with him. “Patti,” as he refers to her, eventually
became his wife. PAs and NPs who were originally brought on board by Dr. Geffner
are instrumental in the DermOne organization.
As partners in
business and in life, the Geffners next, proceeded to buy a busy dermatology
practice in Northfield from a physician who was moving to another state. Then,
discovering the tremendous financial potential that expanding could realize, in
terms of cost-efficient and productive practice management, Dr. Geffner sent a
letter to every dermatologist in the state inviting them to merge with him or
sell their practices to him. As a result of this endeavor, Dr. Geffner purchased
practices based in Westville, Holmdel and Hawthorne from dermatologists who
were ready to retire. In the interim he began looking for additional physician
assistants and nurse practitioners to train so that they could function expertly
within these locations as well. “It developed into a sort of residency program
where we taught them the skills they needed to have,” Dr. Geffner explains.
“Before we allowed them to see patients, we tested their knowledge to make sure
they were ready,” he reports. By the time 2010 rolled around, in addition to a
highly-trained group of NPs and PAs, Accredited Dermatology employed ten
additional physicians and managed 33 offices. “We felt that it was too much for
my wife and me to manage, so we made the decision to find a partner,” Dr. Geffner
relates. They interviewed a number of equity firms and had a few generous offers
on the table. In the end, the Geffners chose Westwind Investors, LLP,
a group that they felt shared the philosophy of patient care that they had
worked so hard to uphold. “They understood what we were doing at the time. We
felt they were visionaries who were not afraid of tackling something at the
level of intensity with which we were working,” Dr. Geffner strongly states.
With the new partnership agreement in place, Accredited Dermatology became
DermOne and the unconventional, yet highly successful business model developed
by Dr. Geffner continues to evolve and expand. DermOne CEO, Ronald Geraty,
MD discusses how the new affiliation has enabled Dr. Geffner’s practice to successfully expand
even further. “We were able to take advantage of a glide path that Dr. Geffner
was on and growing,” Dr. Geraty remarks. “He did as well as he could to serve
as a single practitioner but by adding the infrastructure that we were able to
provide, instead of being able to manage 35 offices, we can manage 100 or 200
or 300 offices,” he adds. The infrastructure to which Dr. Geraty refers is
quite impressive and is really at the heart of creating a statewide or even nationwide
network of offices that provide a universally high level of dermatologic care
and treatment, while offering an extremely comfortable and productive
alternative for individual local practitioners. Some of the integral features
of the DermOne infrastructure support are as follows:
•
State-of-the-art equipment and technology
•
Centralized billing and collections
•
In-house pathology lab
• Integrated,
cloud-based practice management, EMR and laboratory information systems
•
Centralized HR and regulatory compliance management
• Immediate
second opinions and teledermatology via iPad-based EMR
•
Payer contract negotiation
•
Comprehensive training and supervision systems
•
Branding, marketing and sales support
With these and other
comprehensive and efficient support systems in place, the DermOne physician is
released from the burdensome, often expensive and certainly time consuming aspects
of medical practice that have become a persistent fact of life in our current
healthcare environment. Dr. Geffner, who now serves as Chief of Dermatology at
DermOne, speaks to those dermatologists who are searching for solutions to the
difficulties associated with practice management today. “All of the things that
doctors hate about with insurance companies, billing and trying to collect
payment, interviewing, hiring and training employees, etc. Our concept provides
a management team that takes care of everything that most physicians just don’t
want to deal with,” Dr. Geffner offers. “Doctors can do what they went to
medical school to be able to do – focus on their patients,” he asserts.
An
integral part of the DermOne infrastructure is an in-house pathology lab. At
DermOne immediate second opinions and teledermatology are available via small
iPad based EMR
Dr. Geffner goes on
to share that when they join DermOne, physicians retain a portion of equity in
their practice and also receive a generous salary. “They come into the office,
take care of their patients, get the income that they’re looking for and don’t
have to worry about the other issues,” he remarks. “They can really enjoy
life,” Dr. Geffner emphasizes. DermOne is a welcome alternative for patients as
well as physicians. In fact, Dr. Geraty shares the motto upon which all of the planning to
create DermOne was based. “We display the initials – PCU – Patient
is the Center of our Universe,” he informs. 6 New Jersey
Physician “Everything we’ve done is focused on that and out of that flow a
great many changes. Whether it’s our call center and the way our patients are
handled there, or surveys that allow patients to rate everything that we do,
with the objective being to constantly improve, we always want the patient to
be the center of our universe,” Dr. Geraty reiterates. With its expanding
network of providers and convenient neighborhood skincare centers, DermOne can
accommodate patients immediately. The goal at DermOne is to make
high-quality, affordable dermatology care accessible to everyone. Also,
extended hours are available at many of its locations, so that patients do not
have to take time from their busy work schedules to be seen. Dr. Geraty
explains the innovative design of the DermOne network. Here, the use of skilled
nurse practitioners and physician assistants that Dr. Geffner incorporated
while growing his practice,\ is taken to the next level to assure patients in virtually
any part of the state access to comprehensive dermatologic care, even where
there are a shortage of skilled dermatology specialists. Picture the idea of a
wheel and its spokes as depicted in Fig. 1, which illustrates the organization
of DermOne facility locations in southern parts of New Jersey, for example,
where traditionally patients have had to travel considerable distances at
times, in order to consult with the appropriate physician. The hub or center of
the wheel is the Northfield office
where one or more specialized dermatologists are based. The spokes are
satellite offices (Manahawkin, Cape May, Galloway, Vineland), which are staffed
with expertly-trained NPs and PAs who manage routine clinical cases. The
Northfield physicians work at the satellite offices on certain days during every
month. In the interim, iPad technology allows for an immediate visual
consultation with the specialist at the Northfield office whenever needed. In
the event that urgent specialized care is required, the patient is sent on to
the Northfield office. Of course the primary concern for dermatologists is the
prevention, detection and treatment of skin cancer, which is the most
commonly diagnosed cancer in the United States, according to the American
Cancer Society. DermOne offers convenient low-cost skin cancer screenings at
all of its locations. If skin cancer is detected, it will be thoroughly evaluated.
Treatment options will vary depending upon the type of cancer (melanoma vs.
non-melanoma) and also by its size, stage and location. For certain
non-melanoma skin cancers, DermOne surgeons perform Mohs surgery, which
is the removal of cancerous tissue one thin layer at a time. After each layer
is removed, it is examined under a microscope. When the layer appears normal,
with no trace of cancer, the surgeon stops removing tissue. This minimally
invasive procedure is performed under local anesthesia and removes cancer while
preserving normal, healthy surrounding tissue.
Manahawkin
Galloway Cape May Vineland
At
DermOne, the primary concern is the prevention, detection and treatment of skin
cancer.
An innovative
non-surgical alternative for the removal of basal and squamous cell skin
cancers that is available at DermOne Dermatology Centers is Superficial
Radiotherapy Treatment (SRT). Performed in the office, without any
anesthesia required, SRT is a low energy radiotherapy that goes no deeper than
the thickness of the skin. Because the low-energy radiation mainly does not
penetrate below the skin’s surface, SRT is safe, painless and is with minimal side effects. DermOne
physician Robin Smith, MD is a radiation oncologist, specializing in dermatologic cancers.
Dr. Smith shares that many patients are concerned about undergoing surgery,
especially to cosmetically delicate areas such as the nose, lip or ear. He goes
on to relate that SRT is a good alternative in these situations because it does
not remove any tissue. “Radiation damages the DNA of the cancer cells,” Dr.
Smith explains.
DermOne
offers low cost skin cancer screenings at all of its locations. Findings are
carefully
noted
and maintained for future comparison.
Patients who opt for
SRT undergo between 20 and 30 one-minute treatments, daily for 4 to 6 weeks, depending
upon the size of the lesion. Dr. Smith makes a point of mentioning that SRT is
not only for patients who are worried about preserving their appearance. “Radiation
is also very suitable for patients who have had numerous {skin cancer} surgeries
in the past and do not want to have any more surgeries and for some who are
elderly and surgery is just not for them,” he reports. “It’s a matter of patient
choice,” Dr. Smith adds. “And I’d really like to stress that,” he says. “It’s
important to note that at DermOne we want to - and we can offer patients an option,”
Dr. Smith emphasizes. He, of course, is referring to the fact that for smaller
dermatology practices, this technology might not be affordable. Besides offering
comprehensive, cuttingedge medical dermatology services, DermOne is also a
leader in cosmetic dermatology,
offering services that include but are not limited to: Dr.
Smith is adjusting SRT equipment.
•
Laser treatments
•
Hair replacement
•
Botox® injections
• Injectable
fillers (Restylane®, Juvederm® and collagen)
•
Chemical peels
Recently joining
DermOne, Isaac Mordecai, MD, was a sole practitioner for many
years. In addition to his considerable expertise in medical dermatology,
Dr. Mordecai is a highly skilled and
experienced
cosmetic dermatologist. He is extremely excited about the opportunities to
improve and expand his practice that have been created since selling to
DermOne. “They’re going to give me the means to do the things I want,” Dr.
Mordecai candidly shares. “They have an excellent reputation and they will be
providing me with whatever I need,” he continues. “I’ve been in practice for a
long time and they’re leaving it up to me,” Dr. Mordecai adds. Besides having
access to the latest equipment Dr. Mordecai looks forward to the support he
will receive for managing
his practice. “It’s all very complicated now,” he says, referring to electronic
record keeping, dealing with insurance and the other 8 New Jersey Physician tedious aspects of
practice management. “I’m glad that they will be taking care of that, too, Dr.
Mordecai states. In terms of being able to provide the highest level of care to
his patients, Dr. Mordecai is cognizant
of the significant advantages associated with being part of a large\ network.
He anticipates receiving referrals from colleagues in DermOne who might want
their patients to benefit from his vast experience, especially regarding
cosmetic dermatology. Conversely, when, for example, after performing a biopsy
on a suspicious mole, Dr. Mordecai diagnoses skin cancer that might be amenable
to Mohs surgery or SRT, he appreciates the ability to refer that patient to a
DermOne specialist. “This allows not only for continuity of care but expediency
of care, as well,” Dr. Mordecai points out.
Dr.
Pistone is renowned for his hair transplantation procedures.
Dr.
Mordecai is extremely excited to be joining the DermOne family.
Another exciting new
member of the DermOne team is Gregory Pistone, MD. Dr. Pistone,
too, is board-certified in general dermatology with expertise in both medical
and cosmetic dermatologic care and treatment. In addition to those skills, Dr.
Pistone is renowned for his hair transplantation
procedures. Having performed more than 15,000 procedures to date,
Dr. Pistone consults with patients (predominantly men) from all across the
United States and abroad. Dr. Pistone specializes in the Follicular Unit
Transplantation (FUT) hair restoration technique, during which a patient’s hair
is transplanted naturally, in groups of 1 to 4 hairs, called follicular units.
This technique is a vast improvement over older transplantation procedures that
often produced a “pluggy” unnatural look. In contrast, the results of Dr.
Pistone’s hair restoration procedures mimic the way hair grows naturally and
are undetectable as being transplanted. It is important to note that Dr.
Pistone is highly-skilled in both the traditional FUT technique in which hair
is harvested using a long, thin donor strip that is dissected into individual
follicular units and an alternative
harvesting method, called Follicular Unit Extraction (FUE). FUE involves
removing individual follicular unit grafts directly from the back and sides of
the scalp using specially-designed instrumentation.
When asked why he decided to join DermOne, without hesitation, Dr. Pistone offers
numerous reasons. “Number one, private practice is getting very onerous,” he
states. “It’s difficult to maintain what you need to from the government’s perspective
in terms of record keeping and computerization. Also, the practice management
time has gone from a smallamount of time to an excessive amount of time,” Dr.
Pistone adds. “Number two is collegiality. Basically, after 28 years of solo
practice, you get lonely for colleagues,” Dr. Pistone acknowledges. It’s very
important to have that atmosphere of support so that you can discuss various
cases together and can assist each other,” he shares. Dr. Pistone also
appreciates the benefits of cost-sharing that are derived from joining a large
group, as well as the ability to negotiate better rates with insurance companies
and others with whom you do business. “There’s definitely strength in numbers,”
Dr. Pistone says. For dermatologists and patients in New Jersey, DermOne is a
vehicle to carry them into a much-changed healthcare environment. Patients
throughout the state will have access to the highest level of compassionate,
affordable skincare, regardless of where they live. Sole practitioners or
dermatologists who have formed small groups now have an alternative business
model to consider, one that offers an attractive solution to the myriad of
practice management concerns that interfere with their ability to focus primarily on treating
patients. With the establishment of DermOne Dermatology Centers, perhaps a
brighter healthcare future is beginning to take shape.
For
more information on referring patients or becoming a DermOne physician please visit
www.dermone.com or call Ron Geraty at (617) 510-4642.
Lisa Wall graduated from Philadelphia University in 2000 with a bachelor’s degree in science and physician assistant studies and immediately began working in cardiothoracic surgery at Crozer Medical Center in Pennsylvania. Since then, Ms. Wall has worked in liver transplant and orthopedic surgery at Albert Einstein Medical Center in Philadelphia. She began her career in dermatology in 2009, bringing her surgical and clinical expertise to DermOne. In her free time, she enjoys traveling and spending time with her husband and three children. 