26307 Trends and factors associated with dermatology Medicare charges to payment ratios, 2012-2017

Abstract

Government-backed medical insurance plans have undergone significant changes in the last decade, but more information is needed to understand reimbursement trends, particularly for specialist medical services. The objective of this study was to identify the ratios of submitted dermatology service charges to allowed Medicare payments over the years. Further variables studied include regional or state variations, gender of provider, hierarchical condition category (HCC) risk scores of patient complexity, and number of services. Data were collected from publicly available Medicare Part B Provider Utilization and Payment Data: Physician and Other Supplier 2012-2017 datasets. All data analysis was performed on SAS 9.4 Statistical Software. Total dermatology related Medicare charges to payment ratios steadily increased over the years (1.77 [in 2012], 1.82 [2013], 1.87 [2014], 1.95 [2015], 2.02 [2016], and 2.06 [2017]). This suggests that for every $2.06 charged in 2017, dermatology providers could expect $1 of actual payment. When further stratified into medical services vs drug services, this upward trend remained for medical charges but drug service ratios have remained constant. There was also significant geographic variation in total Medicare charges to payment ratios as states in the Midwest (mean total ratio: 2.48) had higher charges to payment gaps than states in the Northeast (2.26), West (2.16), and South (1.99; P = .01). This study identifies trends and variables associated with dermatology Medicare payments. Providers may use this information to better understand changing payment structures in their own practices and hopefully these results can be valuable in future policy discussions.