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Multicenter Study
. 2018 Nov 1;154(11):1281-1285.
doi: 10.1001/jamadermatol.2018.3086.

Use and Cost of Actinic Keratosis Destruction in the Medicare Part B Fee-for-Service Population, 2007 to 2015

Howa Yeung  1 , Marissa L Baranowski  1 , Robert A Swerlick  1   2 , Suephy C Chen  1   2 , Jennifer Hemingway  3 , Danny R Hughes  3   4 , Richard Duszak Jr  5
Affiliations
Multicenter Study

Use and Cost of Actinic Keratosis Destruction in the Medicare Part B Fee-for-Service Population, 2007 to 2015

Howa Yeung et al. JAMA Dermatol. .

Abstract

Importance: Actinic keratosis is prevalent and has the potential to progress to keratinocyte carcinoma. Changes in the use and costs of actinic keratosis treatment are not well understood in the aging population.

Objective: To evaluate trends in the use and costs of actinic keratosis destruction in Medicare patients.

Design, setting, and participants: A billing claims analysis was performed of the Medicare Part B Physician/Supplier Procedure Summary Master Files and National Summary Data of premalignant skin lesion destructions performed from 2007 to 2015 among Medicare Part B fee-for-service beneficiaries.

Main outcomes and measures: Mean number of actinic keratosis lesions destroyed and associated treatment payments in 2015 US dollars estimated per 1000 Medicare Part B fee-for-service beneficiaries. Data analysis was performed from November 2017 to July 2018.

Results: More than 35.6 million actinic keratosis lesions were treated in 2015, increasing from 29.7 million in 2007. Treated actinic keratosis lesions per 1000 beneficiaries increased from 917 in 2007 to 1051 in 2015, while mean inflation-adjusted payments per 1000 patients decreased from $11 749 to $10 942 owing to reimbursement cuts. The proportion of actinic keratosis lesions treated by independently billing nurse practitioners and physician assistants increased from 4.0% in 2007 to 13.5% in 2015.

Conclusions and relevance: This study's findings suggest that actinic keratosis imposes continuously increasing levels of treatment burden in the Medicare fee-for-service population. Reimbursement decreases have been used to control rising costs of actinic keratosis treatment. Critical research may be warranted to optimize access to actinic keratosis treatment and value for prevention of keratinocyte carcinoma.

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Conflict of interest statement

Conflict of Interest Disclosures: None reported.

Figures

Figure 1.
Figure 1.. Mean Number of Actinic Keratosis Lesions Destroyed per 1000 Medicare Beneficiaries by Clinician Specialties (2007-2015)
Mean actinic keratosis destructions per 1000 Medicare beneficiaries increased from 917.2 lesions in 2007 to 1051.1 lesions in 2015. The proportion of lesions treated by independently billing nonphysician clinicians increased from 4.0% to 13.5% during the period from 2007 to 2015.
Figure 2.
Figure 2.. Medicare National Payment Amounts by Actinic Keratosis (AK) Destruction Claims and Mean AK Destruction Allowable Charges and Payments by 1000 Beneficiaries (2007-2015)
Medicare national payment amount for the destruction of the first AK lesion decreased by 11% per year in 2014 and 2015, while that for the destruction of 15 or more lesions decreased by 15% in 2014. Mean payments for AK destructions per 1000 beneficiaries increased from $11 749 in 2007 to $13 233 in 2011, plateaued at $13 134 until 2014, and then decreased to $10 942 in 2015. HCPCS indicates Healthcare Common Procedure Coding System.
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Comment in

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