Utilization and Geographic Variation of Patch Testing Among Medicare Beneficiaries

Meyer, M. David; McDonald, H.R.; Lott, Jason P.; Watsky, Kalman L.

doi:10.1097/der.0000000000000190

Cited by 7 publications

(5 citation statements)

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“…Furthermore, it may also improve the accessibility of patch testing. According to 2014 Centers for Medicare & Medicaid Services data, patch testing is nationally underutilized based on the estimated prevalence of ACD . The use of objective measures may reduce the learning curve for patch test interpretation and remove a barrier for clinics to offer the test in their practice.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of positive patch test reactions using optical coherence tomography: A pilot study

Rajabi‐Estarabadi

Tsang

Nouri

et al. 2019

Skin Research and Technology

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Introduction Patch testing is the gold standard for evaluating allergic contact dermatitis (ACD), yet current interpretation methods are limited by their subjectivity and possible variability between observers. Optical coherence tomography (OCT) imaging enables noninvasive in vivo skin visualization and holds promise as an objective method of patch test interpretation. Objective To evaluate the micromorphological changes of patch test reactions and identify objective, quantitative OCT markers that correlate with clinically graded patch test reactions. Results A total of 25 patch test reactions (7 grade‐0, 4 grade‐1+, 14 grade‐2+) from 7 patients underwent OCT evaluation. Increased epidermal thickness and density was qualitatively observed in grade 1+ and grade 2+ allergic reactions while well‐demarcated, signal‐free cavities were observed in all grade 2+ reactions. Attenuation coefficients significantly increased across the three reaction grades (2.58 ± 0.092, 2.96 ± 0.121, 3.05 ± 0.065; P < 0.01). Cutaneous blood flow at 0.35 mm monotonically increased with reaction grade severity and blood measurements significantly differed across the three reaction grades (0.053 ± 0.011 mm/s, 0.078 ± 0.015 mm/s, and 0.121 ± 0.008 mm/s; P < 0.01). Conclusions and Relevance Attenuation coefficient and cutaneous blood flow at 0.35 mm correlate with clinically graded patch test reactions and hold promise as objective, quantitative markers. OCT may help dermatologists differentiate clinical scoring of allergic reactions in patch test and thereby improve their diagnostic accuracy and interpretation of patch test reactions.

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Section: Discussionmentioning

confidence: 99%

Evaluation of positive patch test reactions using optical coherence tomography: A pilot study

Rajabi‐Estarabadi

Tsang

Nouri

et al. 2019

Skin Research and Technology

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show abstract

“…There is one study of United States Medicare recipients reporting substantial utilization and geographical variation in patch testing. 11 As there are other public and private health insurance programmes in the United States, the authors note that further research is needed "across broader patient populations of varying sociodemographic characteristics". 11 The province of Ontario, Canada has a publically funded healthcare system with billings submitted to the Ontario Health Insurance Plan (OHIP).…”

Section: Introductionmentioning

confidence: 99%

“…11 As there are other public and private health insurance programmes in the United States, the authors note that further research is needed "across broader patient populations of varying sociodemographic characteristics". 11 The province of Ontario, Canada has a publically funded healthcare system with billings submitted to the Ontario Health Insurance Plan (OHIP). Within the OHIP billing system, there are two codes for patch test billing, one for work-related and one for non-work-related patch tests, providing a an opportunity to investigate work-related occurrences of patch testing specifically.…”

Section: Introductionmentioning

confidence: 99%

“…An alternative source of information is provided by health insurance data, particularly in jurisdictions with a government‐funded health system (single payer). There is one study of United States Medicare recipients reporting substantial utilization and geographical variation in patch testing . As there are other public and private health insurance programmes in the United States, the authors note that further research is needed “across broader patient populations of varying sociodemographic characteristics” …”

Section: Introductionmentioning

confidence: 99%

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Using health insurance administrative data to explore patch testing utilization in Ontario, Canada—An untapped resource

Arrandale

Holness

2019

Contact Dermatitis

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Background: Patch testing is the key diagnostic test for diagnosing allergic contact dermatitis, but there is limited information on the use of patch testing at the population level.Objectives: To utilize Ontario Health Insurance Plan (OHIP) data to analyse trends in the rate of patch testing in Ontario.Methods: Patch testing billing data submitted to the OHIP between 1992 and 2014 were analysed. Two patch test billing codes were investigated: one for work-related testing (G198), and one for non-work-related testing (G206). Rates of patch testing overall were calculated, and trends over time were described.Results: There were 51 576 patch test billings: 48 416 non-work-related and 3160 workrelated. The annual rate of non-work-related patch testing (G206) ranged from 11.9 per 100 000 people to 25.9 per 100 000 people, increasing over time. The rate of work-related patch testing (G198) ranged from 0.17 to 2.32 per 1 000 000 people, and was relatively stable.The overall distribution of billing by specialty was 70% dermatology, 19% other medical subspecialties, and 10% paediatrics and family medicine.Conclusions: Administrative health data can contribute to a more complete understanding of patch test utilization at the population level and, over time, can be used to track patch testing practices.

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“…4 Earlier studies have used the Medicare Public Use File (PUF) to demonstrate geographic variations in the utilization of patch testing between allergists and dermatologists. 5,6 Given the known differences in patch test utilization by geographic location using Medicare data, we wanted to investigate if rates of patch testing are influenced by provider demographics. Our analysis also investigates the longitudinal changes in patch test utilization by practitioner subspecialty.…”

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confidence: 99%

Trends in Patch Testing by Health Care Providers Among US Medicare Beneficiaries

Singh

Liszewski

2021

Dermatitis

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Background: Although patch testing has historically been done by dermatologists, allergists are also patch testing. Little is known about the current utilization of patch testing by medical specialists.Objective: The aim was to determine trends in utilization of patch testing in Medicare beneficiaries by various clinicians and demographics.Methods: Data from the 2012-2017 Medicare Public Use File were analyzed, including 82,241 total unique clinicians of whom 312 filed a patch testing claim.Results: Dermatologists had a steady share of patch tests (annual clinicians; annual patches) from 2012 (158; 258,735) to 2017 (199; 351,994), an increase of 25.9% and 36.0%, respectively. Allergists, however, had a marked increase in utilization of patch tests from 2012 (84; 62,498) to 2017 (187; 182,480), an increase of 122.6% and 192.0%, respectively. In multivariable logistic regression models, male dermatologists and allergists had increased odds of patch testing (P < 0.001 for both), as did clinicians in the Northeast and Southern United States (P ≤ 0.003 for both).Limitations: Data are only available for Medicare Part B patients; changes in utilization may be different for individuals, private insurance, or Medicare Advantage Plans.Conclusions: Relative to dermatologists, patch testing is increasing among allergists. Addressing barriers to patch testing may increase rates of patch testing by dermatologists.

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Utilization and Geographic Variation of Patch Testing Among Medicare Beneficiaries

Cited by 7 publications

References 1 publication

Evaluation of positive patch test reactions using optical coherence tomography: A pilot study

Evaluation of positive patch test reactions using optical coherence tomography: A pilot study

Using health insurance administrative data to explore patch testing utilization in Ontario, Canada—An untapped resource

Trends in Patch Testing by Health Care Providers Among US Medicare Beneficiaries

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