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. 2018 Sep 1;154(9):1040-1044.
doi: 10.1001/jamadermatol.2018.1768.

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

Myron Zhang  1   2 , Jonathan Zippin  2 , Benjamin Kaffenberger  3
Affiliations

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

Myron Zhang et al. JAMA Dermatol. .

Abstract

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.

Design, setting, and participants: A longitudinal study was conducted using the Medicare Provider Utilization and Payment Data: Physician and Other Supplier Public Use File from 2012 through 2015. The data encompass nearly all outpatient procedures paid by Medicare Part B in the United States and include the type of clinician under which procedures were billed.

Main outcomes and measures: For each type of dermatology procedure, the total number performed by APPs and the total number performed by dermatologists each year.

Results: The total number (and percentage) of all dermatologic procedures performed by APPs increased from 2.69 million of 30.7 million (8.8%) in 2012 to 4.54 million of 33.9 million (13.4%) in 2015. The most common procedures performed by APPs in 2015 were destructions of benign neoplasms (3.6 million), biopsies (788 834), and destructions of malignant neoplasms (48 982). The numbers of patch tests, removals of benign and malignant neoplasms, intermediate and complex repairs, flaps, and surgical pathologic specimen examinations by APPs also increased each year from 2012 through 2015.

Conclusions and relevance: The number and scope of dermatologic procedures performed by APPs appear to be increasing over time. These procedures can be difficult and invasive. This study suggests that further studies are needed to determine what association these procedures have with patient outcomes and the potential need for more formal training.

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Conflict of interest statement

Conflict of Interest Disclosures: None reported.

Figures

Figure.
Figure.. Frequency of Procedures Performed by Advanced Practice Professionals and Dermatologists From 2012 to 2015
A, Frequency of procedures by year billed by advanced practice professionals (eg, nurse practitioners and physician assistants). B, Frequency of procedures by year billed by dermatologists.
See this image and copyright information in PMC

References

    1. Coldiron B, Ratnarathorn M. Scope of physician procedures independently billed by mid-level providers in the office setting. JAMA Dermatol. 2014;150(11):1153-1159. - PubMed
    1. Centers for Medicare & Medicaid Services Medicare provider utilization and payment data: physician and other supplier. https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Tren.... Accessed September 8, 2017.
    1. Balanced Budget Act of 1997. Public Law 105–33. Sec 4511, Vol 111, Stat 442-444. 1997; https://www.gpo.gov/fdsys/pkg/PLAW-105publ33/pdf/PLAW-105publ33.pdf. Accessed January 20, 2018.
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