2000 年至 2016 年美国医疗保险人群中基于办公室的皮肤科诊断程序利用情况。

Office-based dermatologic diagnostic procedure utilization in the United States Medicare population from 2000-2016.

机构信息

Department of Internal Medicine, Division of Dermatology, Albert Einstein College of Medicine, Bronx, NY, USA.

Department of Internal Medicine, Division of Dermatology, The Ohio State University Wexner Medical Center, Columbus, OH, USA.

出版信息

Int J Dermatol. 2019 Nov;58(11):1317-1322. doi: 10.1111/ijd.14448. Epub 2019 Apr 21.

DOI:10.1111/ijd.14448

PMID:31006848

Abstract

BACKGROUND

Potassium hydroxide preparations (KOH) and tissue examinations for ova and parasites (O&P) are cost-effective office-based tests. No studies have quantified their utilization and economic impact.

METHODS

The objective is to determine the billing patterns and costs of office-based diagnostic procedures in the Medicare population. We conducted a cross sectional study using the Part B National Summary Data File (2000-2016) and the Physician and Other Supplier Public Use File (2012-2015) released by the Centers for Medicare & Medicaid Services.

RESULTS

In 2016, the total number of claims among all providers was 28,432 (KOH) and 52,182 (O&P), representing a decrease since 2000 (KOH, -41.8%; O&P, -43.4%). The total claims for in-office procedures by dermatologists per 10,000 beneficiaries decreased between 2012 and 2015 (KOH, -18.8%; O&P, -26.6%). Fewer dermatologists submitted claims for the tests (KOH, -11.3%; O&P, -16.6%). The total single (SB) and multiple (MB) biopsy claims by dermatologists per 10,000 beneficiaries decreased between 2012 and 2015 (SB, -1.8%; MB, -2.7%). The 2016 aggregate payments (% change since 2000) for KOH and O&P were $163,127.75 (-60.4%) and $299,074.18 (-61.6%), respectively; for SB and MB, they were $240,047,487.98 (+142.3%) and $38,214,117.22 (+79.2%), respectively.

CONCLUSION

Fewer dermatologists submit claims for KOH and O&P each year. Future studies should evaluate whether this is due to a loss of cost-efficacy, and secondly, if it is related to decreased reimbursement, burdensome in-office laboratory regulations, or changing provider preferences.

摘要

背景

氢氧化钾制剂（KOH）和卵和寄生虫的组织检查（O&P）是具有成本效益的基于办公室的测试。没有研究量化其利用和经济影响。

方法

本研究旨在确定医疗保险人群中基于办公室的诊断程序的计费模式和成本。我们使用医疗保险和医疗补助服务中心发布的医疗保险部分 B 国家汇总数据文件（2000-2016 年）和医师和其他供应商公共使用文件（2012-2015 年）进行了横断面研究。

结果

2016 年，所有提供者的总索赔数为 28432 份（KOH）和 52182 份（O&P），自 2000 年以来有所下降（KOH，-41.8%；O&P，-43.4%）。 2012 年至 2015 年，皮肤科医生每 10000 名受益人的门诊程序总索赔额下降（KOH，-18.8%；O&P，-26.6%）。提交这些测试的皮肤科医生人数减少（KOH，-11.3%；O&P，-16.6%）。 2012 年至 2015 年，皮肤科医生每 10000 名受益人的单个（SB）和多个（MB）活检索赔额下降（SB，-1.8%；MB，-2.7%）。 2016 年，KOH 和 O&P 的总支付额（自 2000 年以来的变化百分比）分别为 16312775 美元（-60.4%）和 29907418.18 美元（-61.6%）； SB 和 MB 分别为 240047487.98 美元（+142.3%）和 38214117.22 美元（+79.2%）。