Study: Ongoing Inequities in Dermatology Productivity Metrics

Key Takeaways

• 2021 Medicare fee schedule updates increased average wRVUs for dermatology encounters but did not eliminate demographic disparities.
• Visits with younger, female, Asian, and Black patients generated significantly fewer wRVUs compared to older, male, and White patients.
• Procedures like biopsies and cryotherapy for premalignant lesions mediated many observed differences in wRVUs.

A new study in JAMA Dermatology revealed that while the 2021 Medicare physician fee schedule updates reduced inequities in work relative value units (wRVUs) for outpatient dermatology visits, significant disparities based on patient demographics persist.

Analyzing data from 89,656 encounters across three academic dermatology practices, the study researchers compared wRVUs generated before and after the 2021 fee updates. Mean wRVU per encounter increased from 1.44 to 1.80 following the fee changes (P  <  0.001). Adjusted analyses revealed continued disparities. Encounters with female patients generated fewer wRVUs than those with male patients (β, −0.11; 95% CI, −0.13 to −0.10). Younger patients also contributed fewer wRVUs vs. older patients, with each 10-year age increase associated with higher wRVUs (β, 0.04; 95% CI, 0.04 to 0.05).

Significant gaps were noted for encounters with Asian and Black patients compared to White patients, with Asian patient visits generating β, −0.12 fewer wRVUs (95% CI, −0.17 to −0.08) and Black patient visits generating β, −0.14 fewer wRVUs (95% CI, −0.17 to −0.11) (P  <  0.001 for both). These differences were partly mediated by procedures such as skin biopsies and cryotherapy for premalignant lesions.

"This study found that after the 2021 Medicare fee schedule updates, there was a persistent, albeit reduced, gap between wRVU productivity in outpatient dermatology visits for Asian and Black compared with White patients," the authors concluded. "These persisting differences were attributable to skin biopsies and cryotherapy of premalignant lesions."

Source:  Orenstein L, et al. JAMA Dermatology. 2024. Doi:10.1001/jamadermatol.2024.5286