Decreasing physician Medicare reimbursement for dermatology services

Abstract

To the Editor: Studies examining Medicare reimbursement in dermatology are limited. A comprehension of reimbursement trends could improve the understanding of changes in the clinical practice of dermatology and advance patient care. Using the Centers for Medicare and Medicaid Services website,1CMS Homepage | CMS.https://www.cms.gov/Date accessed: January 25, 2020Google Scholar we searched for commonly used dermatology services in the 2018 physician procedure/summary file. We queried the physician fee schedule look-up tool for facility and nonfacility pricing information for each current procedural terminology (CPT) code. Using the consumer price index for urban consumers, we adjusted for inflation by multiplying the 2000 reimbursement by the 2000 January inflation multiplier.2CPI Home: U.S. Bureau of Labor Statistics.https://www.bls.gov/cpi/Date accessed: January 25, 2020Google Scholar We also used weighted averages to appropriately adjust for differences in utilization. The weighted, adjusted average for physician reimbursement by Medicare for the included dermatology services decreased by 10% and 18% from 2000 to 2020 for nonfacility and facility prices, respectively. Of 20 codes included in our study, 10 decreased in nonfacility reimbursement from 2000 to 2020, while the other 10 codes increased in nonfacility reimbursement (Tables I and II).Table INonfacility reimbursement trends for commonly used dermatology services. Adjusted for inflation using consumer price index. Sorted by decreasing utilization based on 2018 Medicare utilization dataUtilization in 2018CPT codeCPT code description2000 reimbursement (unadjusted)2000 reimbursement (adjusted to 2020 USD)2020 reimbursementPercentage of change1460093217003Destruction of 2-14 skin growths13206−68%606862099213Established patient office or other outpatient visit, typically 15 minutes4772788%444874517000Destruction of skin growth507769−10%210326199214Established patient office or other outpatient visit, typically 25 minutes731111132%164986999212Established patient office or other outpatient visit, typically 10 minutes345347−10%160225117110Destruction of up to 14 skin growths517811852%86744895044Application of allergic extract skin patch, with a reaction analysis8126−55%86215699203New patient office or other outpatient visit, typically 30 minutes89136112−17%69261117004Destruction of 15 or more skin growths194296166−44%66647599202New patient office or other outpatient visit, typically 20 minutes639779−18%35104796910Skin application of tar and ultraviolet B or of petrolatum and ultraviolet B2335140302%25962613132Repair of wound (2.6-7.5 cm) of the forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet402614504−18%24002417262Destruction of malignant growth (1.1-2.0 cm) of the trunk, arms, or legs125190186−2%20810912032Repair of wound (2.6-7.5 cm) of the scalp, underarms, trunk, arms, and/or legs16725633431%19088311900Injection of up to 7 skin growths3858581%17726911602Removal of malignant growth (1.1-2.0 cm) of the trunk, arms, or legs1662532603%16149013121Repair of wound (2.6-7.5 cm) of the scalp, arms, and/or legs2894424543%15214396900Application of ultraviolet light to the skin16244171%13420011301Shaving of 0.6-1.0 cm of skin growth of the trunk, arms, or legs6610112827%12325369100Biopsy of the ear72110104−5%Average99152150−1%∗Percentage of change from average adjusted 2000 USD (weighted average adjusted 2000 USD) to average 2020 USD average (weighted average adjusted 2020 USD).Weighted average436659−10%∗Percentage of change from average adjusted 2000 USD (weighted average adjusted 2000 USD) to average 2020 USD average (weighted average adjusted 2020 USD).CPT Code, Current procedural terminology code; USD, US dollar.∗ Percentage of change from average adjusted 2000 USD (weighted average adjusted 2000 USD) to average 2020 USD average (weighted average adjusted 2020 USD). Open table in a new tab Table IIFacility reimbursement trends for commonly used dermatology services. Adjusted for inflation using consumer price index. Sorted by decreasing utilization based on 2018 Medicare utilization dataUtilization in 2018CPT codeCPT code description2000 unadjusted2000 adjusted2020Percentage of change1460093217003Destruction of 2-14 skin growths8132−83%606862099213Established patient office or other outpatient visit, typically 15 minutes3351535%444874517000Destruction of skin growth32495715%210326199214Established patient office or other outpatient visit, typically 25 minutes5482820%164986999212Established patient office or other outpatient visit, typically 10 minutes233527−24%160225117110Destruction of up to 14 skin growths34527136%86744895044Application of an allergic extract skin patch, with a reaction analysis8126−55%86215699203New patient office or other outpatient visit, typically 30 minutes7912079−35%69261117004Destruction of 15 or more skin growths151231103−55%66647599202New patient office or other outpatient visit, typically 20 minutes528052−34%35104796910Skin application of tar and ultraviolet B or of petrolatum and ultraviolet B2335123254%25962613132Repair of wound (2.6-7.5 cm) of the forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet332507324−36%24002417262Destruction of malignant growth (1.1-2.0 cm) of the trunk, arms, or legs92140118−16%20810912032Repair of wound (2.6-7.5 cm) of the scalp, underarms, trunk, arms, and/or legs1291972012%19088311900Injection of up to 7 skin growths264032−20%17726911602Removal of malignant growth (1.1-2.0 cm) of the trunk, arms, or legs122186171−8%16149013121Repair of wound (2.6-7.5 cm) of the scalp, arms, and/or legs332507276−46%15214396900Application of ultraviolet light to the skin162424−2%13420011301Shaving of 0.6-1.0 cm of skin growth of the trunk, arms, or legs477155−23%12325369100Biopsy of the ear456955−21%Avg8212595−24%Weighted Avg324840−18%∗Percentage of change from average adjusted 2000 USD (weighted average adjusted 2000 USD) to average 2020 USD average (weighted average adjusted 2020 USD).Avg, Average; CPT Code, current procedural terminology code.∗ Percentage of change from average adjusted 2000 USD (weighted average adjusted 2000 USD) to average 2020 USD average (weighted average adjusted 2020 USD). Open table in a new tab CPT Code, Current procedural terminology code; USD, US dollar. Avg, Average; CPT Code, current procedural terminology code. Our study demonstrates a substantial decrease in the weighted, adjusted average facility and nonfacility Medicare reimbursement for commonly used services in dermatology. Nonfacility Medicare payment rates experienced a smaller decrease when compared with facility payment rates. This is of note as dermatology is mainly an office-based, nonfacility specialty. Interestingly, despite decreasing Medicare reimbursement rates, dermatologist salaries maintained their growth, with a recent study conducted from 2013 to 2018 reporting an overall median salary increase of 20% for women and 9% for men.3Sachdeva M. Price K.N. Hsiao J.L. Shi V.Y. Gender and rank salary trends among academic dermatologists.Int J Womens Dermatol. 2020; 6: 324-326Google Scholar Major changes in reimbursement for individual codes are largely due to changes in valuation by the relative-value scale update committee. However, the overall 10% nonfacility and 18% facility decreases in the Medicare reimbursement observed in this study was likely influenced by an inflation rate of nearly 53% from 2000 to 2020. In tandem, the conversion factor did not keep up with inflation, decreasing from $36.61 in 2000 to $36.09 in 2020. If the conversion factor had increased according to the 52% increase in inflation from 2000 to 2020, the estimated current value of the conversion factor would have been $55.95. Besides these changes, health care policy changes have aimed to decrease reimbursement as well, such as the 2% sequestration enacted in 2012.4Davis P.A. Medicare and budget sequestration. Congr Res Serv.https://fas.org/sgp/crs/misc/R45106.pdfGoogle Scholar The decrease in the Medicare reimbursement seen in our study is not unique to dermatology. For example, emergency medicine reported an average adjusted Medicare reimbursement decrease of 29% from 2000 to 2020.5Pollock J.R. Bollig T.R. Haglin J.M. Sandefur B.J. Rappaport D.E. Lindor R.A. Medicare reimbursement to physicians decreased for common emergency medicine services from 2000 to 2020.Ann Emerg Med. 2020; 76: 615-620Google Scholar In summary, our findings demonstrate a substantial decrease in inflation-adjusted reimbursement for dermatologists from 2000 to 2020. It is imperative to evaluate how the trends in payment may continue to affect access to care in dermatology, especially in the Medicare population. A limitation of our study is the exclusion of codes that did not exist in either 2000 or 2020, such as micrographic surgery codes that were created in 2007. In addition, we recognize that dermatologists perform other medical services not included in our analysis. Lastly, our study relied on volume data from 2018 to calculate a weighted average, and we were not able to compare volume changes from 2000 to 2020. None disclosed.