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Original Investigation
November 2018

Use and Cost of Actinic Keratosis Destruction in the Medicare Part B Fee-for-Service Population, 2007 to 2015

Author Affiliations
  • 1Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
  • 2Division of Dermatology, Atlanta Veterans Affairs Medical Center, Decatur, Georgia
  • 3Harvey L. Neiman Health Policy Institute, Reston, Virginia
  • 4School of Economics, Georgia Institute of Technology Ivan Allen College of Liberal Arts, Atlanta
  • 5Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
JAMA Dermatol. 2018;154(11):1281-1285. doi:10.1001/jamadermatol.2018.3086
Key Points

Question  How is the use and cost of actinic keratosis destruction changing in the aging population?

Findings  This billing claims analysis found that, in the Medicare Part B fee-for-service population, the estimated number of actinic keratosis lesions treated per 1000 beneficiaries increased from 917 in 2007 to 1051 in 2015, while mean inflation-adjusted payments decreased from $11 749 to $10 942 per 1000 beneficiaries owing to successive reimbursement cuts. In 2015, a total of 13.5% of actinic keratosis lesions were treated by independently billing nurse practitioners and physician assistants.

Meaning  Actinic keratosis appears to impose high and increasing levels of treatment burden in the aging population.

Abstract

Importance  Actinic keratosis is prevalent and has the potential to progress to keratinocyte carcinoma. Changes in the use and costs of actinic keratosis treatment are not well understood in the aging population.

Objective  To evaluate trends in the use and costs of actinic keratosis destruction in Medicare patients.

Design, Setting, and Participants  A billing claims analysis was performed of the Medicare Part B Physician/Supplier Procedure Summary Master Files and National Summary Data of premalignant skin lesion destructions performed from 2007 to 2015 among Medicare Part B fee-for-service beneficiaries.

Main Outcomes and Measures  Mean number of actinic keratosis lesions destroyed and associated treatment payments in 2015 US dollars estimated per 1000 Medicare Part B fee-for-service beneficiaries. Data analysis was performed from November 2017 to July 2018.

Results  More than 35.6 million actinic keratosis lesions were treated in 2015, increasing from 29.7 million in 2007. Treated actinic keratosis lesions per 1000 beneficiaries increased from 917 in 2007 to 1051 in 2015, while mean inflation-adjusted payments per 1000 patients decreased from $11 749 to $10 942 owing to reimbursement cuts. The proportion of actinic keratosis lesions treated by independently billing nurse practitioners and physician assistants increased from 4.0% in 2007 to 13.5% in 2015.

Conclusions and Relevance  This study’s findings suggest that actinic keratosis imposes continuously increasing levels of treatment burden in the Medicare fee-for-service population. Reimbursement decreases have been used to control rising costs of actinic keratosis treatment. Critical research may be warranted to optimize access to actinic keratosis treatment and value for prevention of keratinocyte carcinoma.

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