Skaggs R and Coldiron B. J Am Acad Dermatol 2020.
BACKGROUND: Skin biopsies are increasing at a rapid rate and some may be unnecessary. Although skin cancer incidence is rising, there is varied biopsy accuracy between dermatologists and Advanced Practice Professionals (APPs). A comparison of CPT code utilization for skin biopsy and skin cancer treatment over 18 years-time and comparison of provider types is needed. Excess skin biopsies increase healthcare costs and patient morbidity.
OBJECTIVE: To examine changes in skin biopsy and skin cancer treatment utilization rates per year in the Medicare fee-for-service (FFS) population and to compare skin biopsy utilization between dermatologists and APPs.
METHODS: Retrospective cross-sectional study of Medicare fee-for-service paid claims using the Centers for Medicare and Medicaid Services Physician Claims databases. We calculated the number of skin biopsies and skin cancer treatments in the Medicare FFS population from 1993-2016, and percent utilization by provider type from 2001-2016. Our primary outcome measurements were the number of skin biopsies and skin cancer treatments per 1000 Medicare FFS beneficiaries per year and the number of additional skin biopsies per 1000 Medicare FFS beneficiaries per year, or the difference in the number of skin biopsies and number of skin cancer treatments per 1000 Medicare FFS beneficiaries. Our secondary outcome measurements were skin biopsy to skin cancer treatment ratio and the number of procedures per 1000 Medicare FFS beneficiaries per year by provider type.
RESULTS: After adjusting for number of enrollees in Medicare fee-for-service population from 1993 to 2016, skin biopsies per 1000 Medicare FFS beneficiaries increased 153% (from 39.31 to 99.33) and skin cancer treatments per 1000 Medicare FFS beneficiaries increased 39% (from 34.67 to 48.26). Between 1993 and 2016 the skin biopsy to skin cancer treatment ratio increased 81% (from 1.134 to 2.058) and the number of additional biopsies per 1000 Medicare FFS beneficiaries increased 1001% (from 4.638 to 51.072) between 1993 and 2016. Utilization data by provider type is available from 2001-2016. The number of skin biopsies per 1000 Medicare beneficiaries performed by APPs increased from 0.82 to 17.19 or 1996% (NPs 2211%, PAs 1916%) and the number of biopsies by dermatologists increased by 41% from 53.98 to 76.17.
LIMITATIONS: Medicare claims data does not provide specific information regarding skin biopsy or skin cancer treatment utilization.
CONCLUSIONS AND RELEVANCE: The number of skin biopsies has risen 153% since 1993, while the number of skin cancer treatments have only increased 39%. Our data highlights the rise of biopsy utilization and the increase in biopsies that do not result in skin cancer diagnosis or treatment. This suggests APPs may be responsible for increasing the cost of skin cancer management by biopsying significantly more benign lesions than dermatologists.