Medicare Payment Trends May Hinder Access to Dermatology Services

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The median total charges submitted to Medicare increased, but there was not a significant increase in the actual amount paid from Medicare.
The median total charges submitted to Medicare increased, but there was not a significant increase in the actual amount paid from Medicare.

Trends in Medicare payments to dermatologists may be affecting practice patterns and reducing patient access, according to a retrospective study published in JAMA Dermatology.

Researchers analyzed records from the Medicare Provider Utilization and Payment Data: Physician and Other Supplier data set to assess changes in Medicare utilization by dermatologists from 2012 to 2015. Medicare providers, location of providers, number of services performed, unique treatment beneficiaries, submitted Medicare charges, and actual Medicare payments were characterized by either drug services or medical services.

Results indicated that the number of dermatologists utilizing Medicare increased by 6.2% over the 3-year time frame while the median number of services per clinician (=.98) and the median number of unique beneficiaries (=.80) remained the same. The median total charges submitted to Medicare increased (<.001), but there was not a significant increase in the actual amount paid from Medicare (=.47).

In regards to drug services, there was a significant increase in the median number of drug services provided, median number of unique beneficiaries, amount of charges submitted to Medicare, and the amount paid from Medicare (<.001, for all). In regards to medical services, there was only a significant increase in the median number of beneficiaries (=.01) and amount of submitted charges to Medicare (<.001). According to the Gini coefficient, there was a moderate and stable level of inequality for the total amount paid by Medicare with urban and metropolitan areas receiving more payments.

The limitations of this study include the limited time frame, the potential of insurance compensation, and possible billing by physician extenders.

In conclusion, these trends may affect patients' access to dermatologists if providers opt out of Medicare due to lack of payments. "[I]t is important to consider how Medicare payments can be optimized to maintain dermatologist access across the entire Medicare population," the study authors suggested. 

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Reference

Ya J, Ezaldein HH, Scott JF. Trends in Medicare utilization by dermatologists, 2012-2015 [published online December 19, 2018]. JAMA Dermatol. doi: 10.1001/jamadermatol.2018.4212

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