Advocacy Is Clinical Care Now

Hey all! We're a few hours late… still recovering from AAD. Between the happy hours, the expo hall, and the realization that Medicare has been quietly cutting your pay for 25 years, we needed a minute.

This week is the AAD 2026 edition. Our deep dive breaks down the advocacy session that put a number on dermatology's pay erosion, why iPledge changes prove advocacy works, and what incoming AAD president Murad Alam wants from your wallet. Plus 5 stories: AI scribes, denial rate data, the end of faxing medical records, UHC's new AI assistant, and a spending blind spot most practices miss.

Let's dive in.

The conversion factor that determines what Medicare pays dermatologists was $36.69 in 1998. Today, it’s $33.40. Practice costs are up 60% since 2001. That's not a reimbursement problem. 

This year's AAD made one thing explicit: fixing it isn't someone else's job. 

Dermatology has been absorbing a slow-motion pay cut for 25 years, and the mechanism that drives it isn't going away on its own. The fee schedule was built for a different era. Every year it doesn't get fixed, independent practices lose a little more ground. The message from the room at AAD was clear: waiting is the most expensive option. 

The session "Advocacy in Dermatology with the Experts" didn't soft-pedal it. Klint Peebles, MD, called advocacy "clinical care outside the exam room." His framing was blunt: "Our future in dermatology is not going to be written just in journals; it's going to be written in the legislatures, and that's where it's being written now anyway." 

He's right… and the math proves it. 

Physician payments under Medicare haven't kept pace with anything. Economy-wide inflation is up 83%. Hospital facility updates are up 73%. Physician reimbursement, adjusted for practice costs? Down 33%.

If your practice has been feeling squeezed on reimbursement without being able to point to a single cause, this is it. It's not one bad year. It's a quarter century of payer contracts built on top of a sinking baseline.

From 2020 to 2025, MACRA gave physicians 0% annual updates. Zero. Five straight years. The One Big Beautiful Bill Act delivered a 2.5% bump for 2026, but it's temporary. It expires December 31. Without new legislation, physicians revert to 0.25% updates in 2027.

That's the cliff everyone at AAD was talking about.

Marta Van Beek, MD, laid out the mechanism. Budget neutrality requires CMS to offset any spending increase above $20M by cutting the conversion factor across all services. That $20M threshold hasn't been updated since 1992. So when CMS revalues E/M codes or adds new services in other specialties, the conversion factor drops for everyone. Dermatology loses revenue on procedures it didn't touch.

The 2021 E/M revaluation is the clearest example. CMS revalued office visits, triggering a budget neutrality adjustment that dropped the conversion factor 3.3% in a single year. Procedural specialties absorbed the hit.

Van Beek named three reform priorities: tie updates to the Medicare Economic Index so payments track costs, fix the budget neutrality threshold, and redesign the alternative payment model structure. Her message to dermatologists was direct: "It's really important for us to show up to make sure that we are not disregarded as a specialty."

Jack Resneck, MD, the former AMA president, widened the lens. He pointed to physician burdens piling up outside reimbursement: EHR inbox overload, prior authorization friction, staffing shortages. NIH paylines have dropped to roughly 4%, pushing early-career investigators out of research entirely.

None of these problems fix themselves. And the AAD has made Medicare payment reform its sole federal legislative priority for 2026. Not one of several. The only one.

The tools for participation aren't abstract. SkinPAC, the only dermatology-specific federal PAC, raised $1.21M in the 2023-2024 cycle, making it the #1 physician specialty PAC by contributions. It's bipartisan (54% Democrat, 46% Republican in the 2021-2022 cycle). Murad Alam, MD, who assumed the AAD presidency at the close of the 2026 meeting, made a direct push for SkinPAC donations. The math behind his pitch: for every dollar physician groups spend lobbying in Washington, pharma, hospitals, and insurers spend six. Physicians collectively spend about $100M per year on federal lobbying. Pharma alone spends $387.5M. The total health sector hit $751M in 2024. Dermatology's voice in that mix is a rounding error unless participation scales up.

RUC surveys, which determine how Medicare values specific procedures, feed directly into CMS rate-setting. CMS accepts over 90% of RUC recommendations. Low dermatologist participation means weak data and potential undervaluation of derm procedures. 

If you need evidence that advocacy delivers, look at iPledge. The FDA approved iPledge REMS modifications on February 9, 2026, effective August 8, 2026. The key change: monthly counseling documentation eliminated for patients who cannot become pregnant. AAD drove this through a multi-year campaign. Over 300 members sent roughly 600 messages to the FDA, and the iPledge Workgroup testified at the March 2023 advisory committee.

This is what showing up looks like. It took two years of sustained pressure, but advocacy moved the FDA. 

CareCredit set up a "Canine Cuddle Zone" with adoptable puppies from Lifeline Puppy Rescue. It's becoming a tradition for AAD's preferred patient financing partner since 2012, and it works. Lines around the booth. 

Bubble Skincare, the Gen Z brand founded in 2020 with $12-19 products in 17,000+ stores, showed up with clinical staff and education stations. Different stations walked providers through segments of the product line. Get a stamp at each section, get samples at the end. Board-certified dermatologists on hand to answer detailed questions. A brand doing $100M+ in annual net sales at Walmart and Target, building physician credibility at a medical conference. That's a signal worth watching.

Prequel Skin was on the floor too. Founded in 2023 by Dr. Sam Ellis (board-certified derm, 500K+ social following), backed by The Center, the incubator behind Naturium before it sold to e.l.f. Beauty for $355M. Products run $18-28, sold at Target nationwide, with roughly $18M in first-year DTC sales. Derm-founded, proven incubator pedigree, affordable clinical positioning. The expo hall had energy this year.

Clarity RCM manages revenue cycle for 200+ dermatology practices across 42 states. It's all we do. See how we work.