LB714 Differences in utilization of field therapy of Actinic Keratoses by varying practitioner type

Abstract

We aimed to characterize trends in management of field cancerization of actinic keratoses by dermatologists and other clinicians. The 2013-2018 Medicare Public Use File and Physician Compare Tool were analyzed, including 116,441 unique clinicians. Specialties included dermatologists, primary care physicians (PCPs), and advanced practice providers (APPs). Claims of cryosurgery (Healthcare Common Procedure Coding System codes 17000, 17003, and 17004), topical therapies (fluorouracil, imiquimod, or ingenol mebutate), and photodynamic therapy (PDT) were compared. Utilization of each treatment modality was measured as a percentage of all field therapy claims filed. Mean proportions (standard deviation) of individual clinicians were compared. Utilization of each modality was compared versus practitioner type. Longitudinal analyses were performed by calendar year. Statistical significance for all analyses was determined using one-way analysis of variance. PCPs had the greatest mean proportion of cryosurgery (94.9% [21.3%], P<0.0001) vs. dermatologists (93.2% [19.7%]) or APPs (92.2% [22.7%]). APPs most often prescribed topical treatments (7.3%% [22.4%]), while PDT was most utilized by dermatologists (0.6% [3.2%]). Longitudinally, use of cryosurgery decreased from 2013 to 2018 for every specialty (P£0.0005 for all). Use of topicals increased for dermatologists and APPs (P<0.0001 for both) but decreased for PCPs (P=0.0035). PDT use decreased for dermatologists and APPs (P<0.0001 for both) but not PCPs (P=0.95). Our findings demonstrate an important practice gap for non-dermatologists managing field cancerization of actinic keratoses. It may be helpful to educate PCPs on more effective and tolerable therapies than cryosurgery of ill-defined actinic damage. Among dermatologists and APPs, it appears that topical therapies are becoming more prevalent in comparison with cryosurgery or PDT for field cancerization. This may perhaps represent changing reimbursement rates set by Medicare as well as availability of more tolerable topical treatments.