Despite an initial decline, the number of house calls for dermatologic procedures within Medicare more than doubled between 2015 and 2023, thanks largely to an explosion between 2019 and 2023, according to a recent analysis. Driven mainly by nonphysician clinicians (NPCs), the growth is expected to continue, potentially improving access to care, provision of preventive services, and early identification of skin cancers, while possibly reducing total costs of care for homebound Medicare beneficiaries.

Hao Feng, MD, MHS, associate professor of dermatology at the University of Connecticut, Farmington, and his coinvestigators used “Medicare Physician/Supplier Procedure Summary” data from 2015 to 2023 to track provision of home-based medical care (HBMC) by dermatologists, primary care providers, general surgeons, plastic surgeons, and NPCs (physician assistants and nurse practitioners). Specifically, Feng and colleagues used “Place of Service Code 12” (care received in a private residence) to tally skin biopsies and shave removals, benign and premalignant destructions, malignant destructions, benign excisions, malignant excisions, intermediate and complex repairs, and intralesional injections in 2-year intervals. The study was published online in the Journal of the American Academy of Dermatology on August 9.

Procedures up 608.5%

Between 2015 and 2023, overall HBMC procedural volume increased 125.4%. Between 2015 and 2019, procedure totals declined 68.2%, followed by a 608.5% increase between 2019 and 2023. COVID-19-related restrictions and changing societal preferences may explain the upturn, the study authors wrote.

By provider, procedures done by NPCs rose 3.2-fold during the study period. In 2023, these clinicians performed 94.7% of all at-home procedures. Conversely, HBMC volume by dermatologists and Mohs surgeons decreased from 23.1% in 2015 to 1.4% in 2023. 

In characterizing home-based dermatologic care for the first time, Feng told Medscape Dermatology, researchers were somewhat surprised to see the extent to which NPCs have been the primary driver, particularly in recent years. But the impact of the study’s findings on dermatology practices, he said, remains unclear.

Physicians contributed few of the nearly 58,000 dermatologic procedures in the study, Feng said. “This tells us that most dermatologists are still delivering their services in the traditional office-based setting. However, we should also recognize that there is likely increased demand for home-based services delivered by nonphysicians.”

Meeting a Need

Asked to comment on the study findings, geriatrician Christina P. Prather, MD, said, “It’s exciting to see the increase in patient care being delivered in the home. It meets a need for our aging homebound population.” Prather is an associate professor of medicine and director of the Division of Geriatrics and Palliative Medicine at George Washington University School of Medicine and Health Sciences in Washington, DC. She was not involved with the study.

“As we strive to have a more age-friendly health system,” Prather added, “we need care delivered where people are, not just where it’s convenient for the healthcare system.” The fact that NPCs performed most interventions in the study is consistent with the emergence of specialty-based practices that see an opportunity in the community to deliver care cost-effectively with NPCs, she said.

Some practices, such as OnSite Dermatology, Boca Raton, Florida, and Dermatology House Calls, Anderson, South Carolina, focus exclusively on dermatologic issues. Others, such as Sickday Medical House Calls, New York City, provide dermatologic and other care. 

Although study data could not pinpoint what types of practices employ NPCs, Feng said most NPCs providing HBMC are likely not employed by dermatology practices. Due to logistical challenges and the revenue implications of seeing fewer patients per day than is possible in an office, he added, it is unlikely that dermatologists will provide substantially more HBMC going forward.

Value-Based Paradigm 

“We recognize it can be less efficient for any individual provider to go out and see members of the community,” Prather said. “It’s a very different workflow than a clinic-based practice.” However, she added that in programs such as the “Medicare Advantage Value-Based Insurance Design Model,” investment in dermatology house calls could align with greater system priorities.

A health system responsible for comprehensive patient outcomes, including total care costs, might generate less day-to-day revenue when practitioners see people in their homes instead of a busy clinic environment, said Prather. But such a system could save money by identifying lesions for earlier intervention and avoiding late disease presentations, she added.

“Dermatology can play an important role in earlier identification,” said Prather, “and for patients who may not be able to get into offices because of difficulty with mobility, transportation, or other access issues. In-home care can be life-changing.”

Regarding future trends, Feng said he expects the rapid 2019-2023 rate of increase in HBMC to continue. Additional dermatologic services that might lend themselves to house calls range from identifying and treating rashes to triaging those patients who need in-clinic visits, he said.

Prather added that dermatology services requiring little equipment or supplies, such as annual skin checks and urgent dermatologic concerns, might also lend themselves to the home environment.

No funding was secured for the study. Feng, his coauthors, and Prather reported having no relevant financial relationships.

John Jesitus is a Denver-based freelance medical writer and editor.