16 CHAPTER 1 The mandatory basic insurance for all Dutch inhabitants usually fully covers all patient visits in GP practices and applies deductible excess for visits in secondary care. Nowadays, most Dutch health insurance companies reimburse digital dermatology consultations without deductible excess. This means that as long as the patient is not physically referred to the dermatologist and remains treated in GP care, the patient does not have to pay excess costs. GPs can declare these consultations as a Modernization and Innovation (M&I) service (code 13009). This M&I financing form has been introduced for special procedures in general practice, among others, to promote the quality of GP care and to substitute care from secondary to primary care [55]. TDs receive financial compensation by the telemedicine organization for each assessed consultation. Box 1.1: Evaluation questions asked to general practitioners (GPs) and teledermatologists (TDs) before, during, and after teledermatology and teledermoscopy assessment. Before sending consultation: Q1 (GP): Would you have referred this patient if teledermatology/teledermoscopy was not available? During consultation: Q2 (TD): Is a visit to the specialist necessary? After consultation: Q3 (GP): Do you refer this patient to a specialist? Q4 (GP): Are you and your patient helped with this teledermatology/teledermoscopy consultation? Q5 (GP): Have you learned from this teledermatology/teledermoscopy consultation? Teledermoscopy The second type of store-and-forward digital dermatology consultation is teledermoscopy (Figure 1.3). Teledermoscopy (or teledermatoscopy) is an extension of teledermatology and has been facilitated by the telemedicine organization since 2009. The teledermoscopy flow is similar to the regular teledermatology flow: the GP submits skin photographs to a TD for diagnosis or advice. However, in addition to detailed and overview photographs, the GP takes one or more digitalized dermoscopic images of the patient’s skin lesion with a dermoscope plus digital camera or a smartphone plus dermoscopy attachment. Dermoscopy is a noninvasive diagnostic tool for evaluating skin lesions. It allows GPs and dermatologists to closely visualize the skin and to gain a magnified view of details beneath the skin surface that is not visible to the naked eye. This technique is often used for the diagnosis of suspicious skin lesions, improves diagnostic efficacy for the screening of skin cancers, and can help GPs to discriminate between benign skin lesions or potentially life-threatening skin malignancies (melanoma) [56-58]. Early detection of melanoma is critical because the stadium of detection and treatment is one of the determinants for the 5-year survival of the patient [59].
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