High Dermatologist Areas Associated With Increased Medicare Utilization, Costs

According to a recent presentation at the AAD 2018 Annual Meeting measured the impact of dermatologist density on Medicare costs and utilization throughout the United States.

“Shortage of US dermatologists impacts access to care and patient outcomes,” Sally Y Tan, MPH, of the Harvard Medical School and  the Harvard TH Chan School of Public Health, and colleagues wrote. “This problem is further exacerbated by their uneven geographic distribution.” 

In order to characterize the impact of variation in dermatologist density on utilization by Medicare patients, the researchers conducted a cross sectional study using data from the 2013 Medicare Provider Utilization and Payment Database. They then calculated the ratios of dermatologists per population and utilization per the population of geographic areas across the United States.

Initial results showed that in 10,391 dermatologists billed 28 million Medicare patients for a total of $2.21 billion in 2013. 

They determined that significant variation in dermatologist density exists across the country. Furthermore, they found that costs and utilization were impacted by this variation. In geographic areas with the lowest amount of dermatologist density, the mean billed per patient amount was $15.87, vs $92.02 in the highest dermatologist density areas. 

The researchers also found that each increase of 10 dermatologists per person aged older than 65 years in a given geographic area was associated with a $14.81 increase in Medicare spending.

Ms Tan and colleagues concluded that innovative solutions are needed to address this issue.

“Training additional dermatologists without addressing maldistribution may promote inefficiency,” they wrote. “Cannibalization may occur between competing clinicians in the highest density areas. Further research is needed into how such unwarranted variations in care affect patient outcomes and whether incentives can redistribute dermatologists to better align with areas of clinical need.”

—David Costill