Changing Dermatologic Procedural Patterns in the Medicare Population: A National Trend Analysis.
Journal
Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.]
ISSN: 1524-4725
Titre abrégé: Dermatol Surg
Pays: United States
ID NLM: 9504371
Informations de publication
Date de publication:
05 Jun 2024
05 Jun 2024
Historique:
medline:
5
6
2024
pubmed:
5
6
2024
entrez:
5
6
2024
Statut:
aheadofprint
Résumé
Dermatologists are trained in diagnostic and therapeutic procedures for cutaneous lesions, yet comparative trends for basic dermatologic procedures across dermatology providers are lacking at the national level. To trend common dermatologic procedures among general dermatologists, Mohs surgeons, primary care providers or primary care physicians (PCPs), and nonphysician clinicians (NPCs). Longitudinal analysis of 2016 to 2021 Medicare Public Use Files. Aggregate dermatologic procedural volume decreased 3.0%. Procedural volume declined among general dermatologists (-11.7%), Mohs surgeons (-16.7%), and PCPs (-41.7%) but increased among NPCs (+57.5%). The proportion of procedures by general dermatologists decreased substantially for premalignant destructions (-6.2%), skin biopsies and shave removals (-4.7%), and malignant excisions (-4.1%) and more notably in counties that were nonmetro (-7.1%), low in income (-6.1%), and with <4.0 dermatologists per 100,000 population (-7.0%). Aggregate procedural volume decreased across the study period with general dermatologists, Mohs surgeons, and PCPs performing a progressively smaller proportion. The increase in procedures by NPCs may help to address demand but underscores the value of formalized procedural training. The procedural decline by general dermatologists in rural and low-income counties and those with baseline dermatologist shortages may exacerbate existing unmet need. Primary limitation included lack of commercial data.
Sections du résumé
BACKGROUND
BACKGROUND
Dermatologists are trained in diagnostic and therapeutic procedures for cutaneous lesions, yet comparative trends for basic dermatologic procedures across dermatology providers are lacking at the national level.
OBJECTIVE
OBJECTIVE
To trend common dermatologic procedures among general dermatologists, Mohs surgeons, primary care providers or primary care physicians (PCPs), and nonphysician clinicians (NPCs).
METHODS
METHODS
Longitudinal analysis of 2016 to 2021 Medicare Public Use Files.
RESULTS
RESULTS
Aggregate dermatologic procedural volume decreased 3.0%. Procedural volume declined among general dermatologists (-11.7%), Mohs surgeons (-16.7%), and PCPs (-41.7%) but increased among NPCs (+57.5%). The proportion of procedures by general dermatologists decreased substantially for premalignant destructions (-6.2%), skin biopsies and shave removals (-4.7%), and malignant excisions (-4.1%) and more notably in counties that were nonmetro (-7.1%), low in income (-6.1%), and with <4.0 dermatologists per 100,000 population (-7.0%).
CONCLUSION
CONCLUSIONS
Aggregate procedural volume decreased across the study period with general dermatologists, Mohs surgeons, and PCPs performing a progressively smaller proportion. The increase in procedures by NPCs may help to address demand but underscores the value of formalized procedural training. The procedural decline by general dermatologists in rural and low-income counties and those with baseline dermatologist shortages may exacerbate existing unmet need. Primary limitation included lack of commercial data.
Identifiants
pubmed: 38837756
doi: 10.1097/DSS.0000000000004263
pii: 00042728-990000000-00832
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright © 2024 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.
Références
Hu W, Fang L, Ni R, Zhang H, et al. Changing trends in the disease burden of non-melanoma skin cancer globally from 1990 to 2019 and its predicted level in 25 years. BMC Cancer 2022;22:836.
Mazmudar RS, Sheth A, Tripathi R, Bordeaux JS, et al. Inflation-adjusted trends in Medicare reimbursement for common dermatologic procedures, 2007-2021. JAMA Dermatol 2021;157:1355–8.
Gronbeck C, Kodumudi V, Brodell RT, Grant-Kels JM, et al. Dermatology workforce in the United States - Part I: overview, transformations, and implications. J Am Acad Dermatol 2023;89:1–14.
Centers for Medicare and Medicaid Services. Medicare physician & other practitioners - by provider and service. Available from: https://data.cms.gov/provider-summary-by-type-of-service/medicare-physician-other-practitioners/medicare-physician-other-practitioners-by-provider-and-service. Accessed November 15, 2023.
United States Census Bureau. American Community Survey 5-Year Estimates. Available from: https://data.census.gov/table/ACSDT5Y2021.B01003?t=Population+Total&g=010XX00US$0500000&d=ACS+5-Year+Estimates+Detailed+Tables. Accessed September 15, 2023.
Nelson KC, Swetter SM, Saboda K, Chen SC, et al. Evaluation of the number-needed-to-biopsy metric for the diagnosis of cutaneous melanoma: a systematic review and meta-analysis. JAMA Dermatol 2019;155:1167–74.
American College of Graduate Medical Education. Case Log Minimums: Review Committee for Dermatology. Available from: https://www.acgme.org/globalassets/pfassets/programresources/caselogminimums.pdf. Accessed January 15, 2024.
Hing E, Hsiao CJ. In which states are physician assistants or nurse practitioners more likely to work in primary care? Jaapa 2015;28:46–53.
Young PA, Davis KE, Bae GH The elephant in the Exam Room: Emerging dermatology Qualifications of Different Stripes and types. Available from: https://practicaldermatology.com/articles/2022-mar/the-elephant-in-the-exam-room-emerging-dermatology-qualifications-of-different-stripes-and-types. Accessed April 22, 2023.