Fee‐for‐service and structural forces may drive racial disparities in
            <scp>US</scp>
            dermatology

Wang, Leo; Adelekun, Ademide; Taylor, Susan C.; Lipoff, Jules B.

doi:10.1111/bjd.19217

Cited by 6 publications

(5 citation statements)

References 6 publications

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“…Financial incentives for providing services for dermatologic conditions that primarily affect older White men may inadvertently change the dermatologist's choice of community in which to practice, reducing access to care for some groups and perpetuating structural racism. 19…”

Section: Discussionmentioning

confidence: 99%

“…In a clinic with an embedded Mohs surgery practice, the financial incentive for providing services to those who are most likely to develop NMSC is even higher. Financial incentives for providing services for dermatologic conditions that primarily affect older White men may inadvertently change the dermatologist’s choice of community in which to practice, reducing access to care for some groups and perpetuating structural racism …”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Differences in Outpatient Dermatology Encounter Work Relative Value Units and Net Payments by Patient Race, Sex, and Age

et al. 2021

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IMPORTANCE Clinical productivity measures may be factors in financial incentives for providing care to specific patient populations and thus may perpetuate inequitable health care.OBJECTIVE To identify the association of patient race, age, and sex with work relative value units (wRVUs) generated by outpatient dermatology encounters. DESIGN, SETTING, AND PARTICIPANTSThis cross-sectional study obtained demographic and billing data for outpatient dermatology encounters (ie, an encounter performed within a department of dermatology) from September 1, 2016, to March 31, 2020, at the Emory Clinic, an academic dermatologic practice in Atlanta, Georgia. Participants included adults aged 18 years or older with available age, race, and sex data in the electronic health record system. MAIN OUTCOMES AND MEASURESThe primary outcome was wRVUs generated per encounter.RESULTS A total of 66 463 encounters among 30 036 unique patients were included. Patients had a mean (SD) age of 55.9 (18.5) years and were predominantly White (46 575 [70.1%]) and female (39 598 [59.6%]) individuals. In the general dermatologic practice, the mean (SD) wRVUs per encounter was 1.40 (0.71). In adjusted analysis, Black, Asian, and other races (eg, American Indian or Native American, Native Hawaiian or Other Pacific Islander, and multiple races); female sex; and younger age were associated with fewer wRVUs per outpatient dermatology encounter. Compared with general dermatologic visits with White patients, visits with Black patients generated 0.27 (95% CI, 0.25-0.28) fewer wRVUs per encounter, visits with Asian patients generated 0.22 (95% CI, 0.20-0.25) fewer wRVUs per encounter, and visits with patients of other race generated 0.19 (95% CI, 0.14-0.24) fewer wRVUs per encounter. Female sex was also associated with 0.11 (95% CI, 0.10-0.12) fewer wRVUs per encounter, and wRVUs per encounter increased by 0.006 (95% CI, 0.006-0.006) with each 1-year increase in age. In the general dermatologic practice excluding Mohs surgeons, destruction of premalignant lesions and biopsies were mediators for the observed differences in race (56.2% [95% CI, 53.1%-59.3%] for Black race, 53.2% [95% CI, 45.6%-63.8%] for Asian race, and 53.6% [95% CI, 40.4%-77.4%] for other races), age (65.6%; 95% CI, 60.5%-71.4%), and sex (82.3%; 95% CI, 72.7%-93.1%). In a data set including encounters with Mohs surgeons, the race, age, and sex differences in wRVUs per encounter were greater than in the general dermatologic data set. Mohs surgery for basal cell and squamous cell carcinomas was a mediator for the observed differences in race (46.0% [95% CI, 42.6%-49.4%] for Black race, 41.9% [95% CI, 35.5%-49.2%] for Asian race, and 34.6% [95% CI, 13.8%-51.5%] for other races), age (49.2%; 95% CI, 44.9%-53.7%), and sex (47.9%; 95% CI, 42.0%-54.6%). CONCLUSIONS AND RELEVANCEThis cross-sectional study found that dermatology encounters with racial minority groups, women, and younger patients generated fewer wRVUs than encounters with older White male patients. This finding suggests that physicia...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Differences in Outpatient Dermatology Encounter Work Relative Value Units and Net Payments by Patient Race, Sex, and Age

et al. 2021

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“… 1 Increasing wRVUs generated for cognitive services may mitigate disparities in care. 3 , 4 Study limitations included lack of encounter length data, preventing time-motion analyses to characterize associations between wRVU and encounter length. 5 Despite manual review of random HD, encounters could have been miscategorized into wrong HDs.…”

Section: Dear Editormentioning

confidence: 99%

Outpatient dermatology clinic half days with more women, racial minority, and younger patients generate fewer work relative value units

Supapannachart

Wolner

Swerlick

et al. 2022

International Journal of Women’s Dermatology

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“…Studies have shown that Black patients are more likely to report a cost as an obstacle in obtaining dermatologic care, with a greater percentage of Black patients receiving insurance from government payers (Medicare and Medicaid). 25 , 26 Creadore and colleagues recently reported patients with Medicaid had less success getting appointments and longer appointment wait times than those with Medicare or Blue Cross/Blue Shield. With the increased reliance of telemedicine in dermatology due to the pandemic, there may be isolation of individuals without access to a computer.…”

Section: Racial Inequities In Dermatologymentioning

confidence: 99%

“… 27 There is some evidence that the Fee For Service reimbursement policies in US dermatology practice may promote procedures for a subset of the population and exacerbate disparities for ethnic minorities. 26 Therefore, if a patient’s dermatologic condition is not causing active functional impairment, they may be less likely to seek care.…”

Section: Racial Inequities In Dermatologymentioning

confidence: 99%

Coronavirus Disease 2019 and Race in Dermatology

Desai

McMichael

Khanna

2021

Dermatologic Clinics

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Coronavirus Disease 2019 disproportionately affects Black and Hispanic/Latino populations. Racial disparities inherently exist in dermatology because of underrepresentation of skin of color populations in literature, reduced access to care for minority populations, and low diversity within the specialty of dermatology itself. Lack of imagery in dermatology can have detrimental consequences for patients of color. Dermatologists should note and disseminate cutaneous manifestations of patients of color to combat current racial imbalances.

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Fee‐for‐service and structural forces may drive racial disparities in US dermatology

Cited by 6 publications

References 6 publications

Differences in Outpatient Dermatology Encounter Work Relative Value Units and Net Payments by Patient Race, Sex, and Age

Differences in Outpatient Dermatology Encounter Work Relative Value Units and Net Payments by Patient Race, Sex, and Age

Outpatient dermatology clinic half days with more women, racial minority, and younger patients generate fewer work relative value units

Coronavirus Disease 2019 and Race in Dermatology

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