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Dermatology Online Journal

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Cost-effectiveness of skin biopsies performed by non-physician clinicians for Medicare beneficiaries


An increasing number of non-physician clinicians (NPCs) are providing dermatologic care. We compared the cost-effectiveness of skin biopsies performed by dermatologists and dermatology NPCs using publicly-available Medicare claims data and numbers needed to biopsy (NNBs) published in the literature. We estimated that dermatology NPCs performed slightly greater mean numbers of skin biopsies per beneficiary (0.51 versus 0.47) at a lower payment per biopsy ($44.93 versus $55.10) as compared to dermatologists. However, we estimated a higher mean cost per malignancy diagnosed by dermatology NPCs relative to dermatologists (range based on literature NNB values, $39.08 to $190.23). This translated to a $16.7M-$43.3M aggregate cost of additional, benign biopsies performed by NPCs on Medicare beneficiaries. Although this preliminary analysis has several limitations, including the reliance on NNB values for calculations, it likely highlights the importance of training, education, and supervision to promote diagnostic accuracy. Further investigation is needed so that the potential cost of additional skin biopsies performed by NPCs can be appropriately weighed against the improvement in dermatologic access by including NPCs in the dermatology workforce.

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