Dermatology Inpatient Consultations Remain Significantly Underused

Although dermatology inpatient consultations may generate substantial value and cost savings for the healthcare system, they remain significantly underused, researchers reported in a study published the Journal of the European Academy of Dermatology and Venereology.

The investigators assessed the use of inpatient dermatology consultations in the Medicare population and created a financial model with sensitivity analyses to estimate the potential cost-savings resulting from these consultations.

The 2017 Medicare Physician and Other Supplier Public Use File was used to combine the volume of services, average payment, and number of dermatologists who billed for at least 11 inpatient evaluation and management (E&M) services. Payments for inpatient services were calculated as a percentage of total annual Medicare payments, including outpatient and inpatient, for each dermatologist.

The AHRQ Healthcare Cost and Utilization Project (HCUP) database was used to estimate the number of skin-related hospitalizations in 2017, length-of-stay (LOS) per admission, and the average hospital costs per hospitalization for Medicare-eligible populations. The researchers also conducted a literature search to identify published estimates of LOS reductions associated with inpatient dermatology consultations.

In 2017, 290 dermatologists (2.5%) billed Medicare for inpatient E&M services and provided consultation on 6312 hospital admissions for 6081 patients. Total Medicare payments for dermatologist inpatient E&M services were $1.4 million ($4862 per dermatologist) for the year. Dermatologists received an average of $213,268 in total Medicare payments for combined inpatient and outpatient services, and inpatient E&M payments accounted for 2.2% of their annual Medicare collections, it was noted.

Dermatologists were consulted on 4.6% of skin-related Medicare hospitalizations in 2017, estimated the researchers. According to published LOS reductions associated with dermatology consultation, the investigators’ model estimated that dermatology consultation resulted in $19.0 million to $38.3 million in Medicare cost savings in 2017, which represents a 13.5- to 27.2-fold return on the $1.4 million that Medicare paid to dermatologists for inpatient E&M.

The investigators suggested that policymakers develop payment models that make it financially feasible for dermatologists to participate in inpatient care, including increasing reimbursements for inpatient teledermatology in Medicare, and that hospitals could provide salary support for inpatient dermatologic care.

The researchers noted that their study is limited by only including dermatologists who billed Medicare for at least 11 inpatient services and citing LOS reduction estimates from single-institution studies. Also, their model did not account for admissions that could be avoided by dermatologic consultations in emergency departments.

“Future studies should combine financial analyses with clinical data to elucidate the effects of inpatient dermatology services on costs and patient outcomes, as well as define the specific diagnoses for which dermatologic consultations enhance value-based-care,” the study authors commented.

Reference

Puri P, Wiggins M, Yousif M, et al. Evaluating the potential cost-savings from inpatient dermatology consultations. J Eur Acad Dermatol Venereol. Published online August 9, 2021. doi:10.1111/jdv.17595