Analysis of dermatologic procedures billed independently by nonphysician practitioners in the United States

Abstract

Background: Nonphysician 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 United States.

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 United States.

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

Limitations: Data were collected at the state level and limited to Medicare beneficiaries, and did not include billing incident to physicians.

Conclusions: This study demonstrated the increasing scope of practice of NPs and PAs in dermatology; this increase is alarming because of their limited training and the lack of uniform regulations guiding their practices. To ensure quality and safety of care, it is prudent to set benchmarks for proper supervision and utilization of procedures in dermatology.

Keywords: Medicare; dermatology; dermatology practice pattern; nonphysician practitioner; nurse practitioner; physician assistant.