• Myron Zhang, Jonathan Zippin, and Benjamin Kaffenberger.
• Department of Internal Medicine, Summa Akron City Hospital, Akron, Ohio.
• JAMA Dermatol. 2018 Sep 1; 154 (9): 1040-1044.

ImportanceAdvanced practice professionals (APPs) such as nurse practitioners and physician assistants independently perform a large number and variety of dermatologic procedures, but little is known about how the number and scope of these procedures have changed over time.ObjectiveTo examine the trends in scope and volume of dermatology procedures billed by APPs over time.Design, Setting, And ParticipantsA longitudinal study was conducted using the Medicare Provider Utilization and Payment Data: Physician and Other Supplier Public Use File from 2012 through 2015. The data encompass nearly all outpatient procedures paid by Medicare Part B in the United States and include the type of clinician under which procedures were billed.Main Outcomes And MeasuresFor each type of dermatology procedure, the total number performed by APPs and the total number performed by dermatologists each year.ResultsThe total number (and percentage) of all dermatologic procedures performed by APPs increased from 2.69 million of 30.7 million (8.8%) in 2012 to 4.54 million of 33.9 million (13.4%) in 2015. The most common procedures performed by APPs in 2015 were destructions of benign neoplasms (3.6 million), biopsies (788 834), and destructions of malignant neoplasms (48 982). The numbers of patch tests, removals of benign and malignant neoplasms, intermediate and complex repairs, flaps, and surgical pathologic specimen examinations by APPs also increased each year from 2012 through 2015.Conclusions And RelevanceThe number and scope of dermatologic procedures performed by APPs appear to be increasing over time. These procedures can be difficult and invasive. This study suggests that further studies are needed to determine what association these procedures have with patient outcomes and the potential need for more formal training.

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