Analysis of Dermatologic Procedures Billed Independently by Non-Physician Practitioners in the United States

Publication date: Available online 15 September 2018

Source: Journal of the American Academy of Dermatology

Author(s): Qiaochu Qi, Brian P. Hibler, Brett Coldiron, Anthony M. Rossi

Abstract

Background

Non-physician practitioners (NPPS), including nurse practitioners (NPs) and physician assistants (PAs) are expanding their scope of practice outside of primary care and performing more procedures in dermatology.

Objective

To understand the scope and geographic pattern of practice by NPs and PAs in dermatology in the US.

Methods

Cross-sectional retrospective cohort analysis of dermatology practices in the 2014 Medicare Physician/Supplier Procedure Summary Master File, which reflects Part B carrier and durable medical equipment fee-for-service claims in the US.

Results

Over 4 million procedures were billed independently by NPs and PAs, which accounts for 11.51% of all. Injection, simple repair, and biopsy were the most commonly billed by non-physician practitioners, but complex procedures were also increasingly billed independently by NPs and PAs. Proportions of their claims are higher in the East Coast, Midwest, and Mountain states.

Limitations

Data is at the state level, limited to Medicare beneficiaries, and doesn't include billing incident-to physicians.

Conclusions

This study demonstrated the increasing scope of practice of NPs and PAs in dermatology, despite limited training and lack of uniform regulations. To ensure quality and safety of care, it is prudent to set benchmarks for proper supervision and utilization of procedures in dermatology.