Trends and Scope of Dermatology Procedures Billed by Advanced Practice Professionals From 2012 Through 2015

Abstract

idlevel or advanced practiced professionals (APPs) such as nurse practitioners (NPs) and physician assistants (PAs) are often employed in specialty offices to extend access to care. Coldiron and Ratnarathorn 1 demonstrated that APPs also independently bill for a large number of procedures-nearly 5 million in the 2012 Medicare population, 55% of which were dermatologic. In this study, we examine how the scope and number of dermatologic procedures performed by APPs have continued to evolve from 2012 through 2015 in the Medicare population. Methods A longitudinal study was performed using the Medicare Provider Utilization and Payment Data: Physician and Other Supplier Public Use File from 2012 through 2015. 2 This data set contains approximately 100% of outpatient procedures paid by Medicare Part B, excluding only procedures received by fewer than 10 beneficiaries from a clinician, to protect patient confidentiality. Data entries are aggregated by Current Procedural Terminology codes and the National Provider Identifier and include the credentials of the clinician billing for the procedure. The total number of Medicare Part B enrollees each year is also included in the data. The study was exempt from review by the Summa Health System Institutional Review Board because all data are public and deidentified. Medicare reimburses NPs and PAs at 85% of the physician's rate. 3,4 Under certain circumstances, a nonphysician health care professional can bill for services performed under physician supervision at the full rate of reimbursement, but these services must be billed under the physician. We as-IMPORTANCE Advanced practice professionals (APPs) such as nurse practitioners and physician assistants independently perform a large number and variety of dermatologic procedures, but little is known about how the number and scope of these procedures have changed over time. OBJECTIVE To examine the trends in scope and volume of dermatology procedures billed by APPs over time.

Insurance Acceptance, Appointment Wait Time, and Dermatologist Access Across Practice Types in the US

“…Dermatology practice ownership by PE firms has been demonstrated to be associated with increased hiring of NPCs, and hypothesized to lead to an increased likelihood that these clinicians do not receive adequate supervision from the physicians who oversee them . While use of NPCs has broadly increased over time in dermatology clinics of varied practice type and geography, our results based on directly inquiring about clinician availability demonstrated that PE-owned clinics were more likely to offer appointments with NPCs than their geographically matched controls, a finding consistent with a recent study analyzing clinician use at PE-owned clinics …”

“…Private equity firms invest in dermatology practices and aim to enhance their financial performance, causing physicians to express concern that the fiduciary responsibility of PE firms may incentivize operational changes at dermatology practices that jeopardize access to or reduce the quality of care for patients . This can include increasing use of NPCs, whose reduced salaries and increased performance of billable procedures would benefit the financial goals of these firms .…”

“…Private equity firms invest in dermatology practices and aim to enhance their financial performance, causing physicians to express concern that the fiduciary responsibility of PE firms may incentivize operational changes at dermatology practices that jeopardize access to or reduce the quality of care for patients . This can include increasing use of NPCs, whose reduced salaries and increased performance of billable procedures would benefit the financial goals of these firms . In this study, we sought to (1) provide an updated analysis of dermatology appointment access and wait times for patients with different insurance types, and (2) compare dermatology appointment access and clinician availability between clinics with and without PE ownership.…”

Perception of Executive Order on Medicare Pay for Advanced Practice Providers: A Study of Comments From Medical Professionals

“…2 Despite the lack of formalized dermatologic training, APPs billed for 13.4% of all dermatology procedures submitted to Medicare in 2015. 12 Quality of Patient Care-In our study, physicians also voiced concern over reduced quality of patient care. In a review of 33,647 skin cancer screening examinations, PAs biopsied an average of 39.4 skin lesions, while dermatologists biopsied an average of 25.4 skin lesions to diagnose 1 case of melanoma.…”

A Retrospective Analysis of Trends in Non-physician Provider Billing in Dermatologic Surgery From 2016 to 2019

“…1 Subsequent studies have documented further expansion of procedures billed independently by NPPs in dermatology, but a paucity of data exists documenting NPP billing trends in dermatology beyond 2016. 2–4 This study explored NPP billing trends within procedural dermatology in the Medicare population from 2016 to 2019 to assess whether these trends mirrored billing in years before 2016.…”