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Dr. Ramsay Farah talks with patient Nancy Murdoch of Watertown Monday at Upstate University Hospital's outpatient dermatology clinic.
(Michelle Gabel | mgabel@syracuse.com)
Syracuse, N.Y. - At a time when the rate of skin cancer is soaring, a Central New Yorker who needs to see a dermatologist may have to wait 146 days for an appointment, according to a study.
Some health insurers are compounding the wait time problem by giving members inaccurate information that grossly overestimates the number of available dermatologists participating in their plans, the study shows.
Of 12 U.S. metro areas analyzed in the study recently published in JAMA Dermatology, a publication of the American Medical Association, Syracuse had the longest wait time to see a skin doctor. The average wait time across all those markets was 46 days. The shortest wait time - 10.5 - was in Lansing, Mich.
The study looked at wait times for people enrolled in Medicare Advantage health insurance plans. Medicare is the federal health insurance program for people 65 and older and people with disabilities. Medicare Advantage is a managed care version of Medicare offered by private insurers.
The study also looked at the accuracy of network directories posted by these insurers that show which dermatologists participate in their networks.
The 146-day wait in Syracuse is a symptom of a long-standing chronic shortage of dermatologists nationwide. Experts say medical schools are not producing enough dermatologists to meet the growing demand of the nation's aging population -- particularly baby boomers who worshiped the sun as youths and now are getting skin cancer.
"Skin cancer rates have skyrocketed over the past few decades," said study author Dr. Jack Resneck, a dermatologist who teaches at the University of California, San Francisco medical school.
The cost of treating skin cancer increased five times faster than the cost of treating other types of cancers between 2002 and 2011, according to a recent study by the federal Centers for Disease Control and Prevention. Annual U.S. skin cancer treatment costs increased from $3.6 billion to $8.1 billion during that period, while the number of U.S. adults treated for skin cancer grew from 3.4 million to 4.9 million.
A 2012 analysis by the Central New York Health Systems Agency, a health planning group, showed there were 1.3 dermatologists per 100,000 people in Onondaga, Madison, Oswego and Cayuga counties. That's less than half the national average of 3.2 per 100,000 people.
In addition to having the longest wait time, Syracuse stood out in the study published in JAMA Dermatology because it was the only metro area with an insurance plan -- Today's Options -- that listed 10 participating dermatologists, none of whom offered appointments.
"Insurance companies are not really being honest in their network directories about how many people they have to take care of people with skin disease," Resneck said.
Today's Options said it regularly reviews its network and updates its provider directories. The insurer also said it called seven Onondaga County dermatologists in its network after the study was published Oct. 29 and all of them verified they would accept patients covered by Today's Options.
As part of the study, scripted telephone calls were made to every dermatologist listed in the largest Medicare Advantage plans in the 12 metro areas. The caller sought an appointment for his fictitious father suffering from a severe itch for several months. The caller asked whether the dermatologists accepted the plans they were listed in and asked for the next available appointment date. The calls were made between July 7 and Aug. 3, 2014.
Less than half the doctors listed in insurers' directories in the 12 metro areas were reachable, accepted the plans and offered appointments. Some of the doctors listed were dead or had moved away, had telephone numbers that did not work or did not participate in the insurers' plans.
"I knew we were going to find directories that weren't perfect," Resneck said. "But the degree of inaccuracy was stunning to me."
Excellus has the largest Medicare Advantage plan in the Syracuse area. Of the 12 dermatologists listed in its directory, only two offered appointments. Three of the listings were duplicates - the same doctor with more than one office location. One of the doctors listed had died or retired, another did not accept the plan, three were not accepting new patients, one offered subspecialty services only and one doctor could not be contacted because the listing contained the wrong telephone number.
Elizabeth Martin, a spokeswoman for Excellus, said the insurer did not know how the researchers came up with the numbers cited in the study. She wouldn't comment further.
Of 18 dermatologists listed in UnitedHealthcare's directory, five accepted the plan and offered appointments with an average wait time of 124.6 days.
Maris Gordon Shydlo, a spokesman for UnitedHealtcare, said her company works with health care providers, hospitals and other facilities to ensure it has their most up-to-date information for members.
Dr. Ramsay Farah, chief of dermatology at Upstate University Hospital, agrees with the study's finding that insurers' provider directories are often inaccurate. "These errors make a bad situation worse," he said.
Resneck said the study shows consumers cannot trust insurers' online provider directories. He said this problem is not limited to dermatologists or Medicare Advantage plans. The same types of inaccuracies also occur in provider lists for some of the insurance plans sold through the new public health insurance exchanges. The New York Medical Society has complained about this problem.
Before enrolling in a plan, consumers should call their doctors listed in an insurer's directory to make sure they actually participate in the plan, he said.
He said state and federal regulators need to step in and force insurers to maintain accurate directories.
A long wait time does not pose a problem for patients who just need a routine check-up, Resneck said.
But a wait time of nearly five months is totally unacceptable for patients who may have skin cancer, he said.
Some Central New York patients with serious skin problems may be traveling long distances to get care in other cities that have more dermatologists, he said.
Farah of Upstate said anyone with a serious skin problem should have their primary care doctor contact a dermatologist to try to get a more timely appointment.
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