Race, Sex, and Age Disparities in Outpatient Dermatology Encounter Work Relative Value Units and Net Payments Público

Abstract

This abstract and much of this thesis’ text were originally published in JAMA Dermatology.

 

Clinical productivity measures may influence financial incentives to cater to specific patient populations and perpetuate inequitable healthcare. To evaluate the relationship between work relative value units (wRVUs) generated by outpatient dermatology encounters and patient race, age, and sex, this retrospective cross-sectional study evaluated administrative billing data from The Emory Clinic in Atlanta, GA. The primary dataset included 66,463 general outpatient dermatology encounters among 30,036 unique patients that occurred between September 1, 2016 and March 31, 2020. Study patients had mean age of 55.9 (SD: 18.5) years, were predominantly female (59.6%) and white (70.1%). In the general dermatology practice, the mean wRVUs per encounter was 1.40 (SD: 0.71). In adjusted analysis, non-white race, female sex, and younger age were associated with fewer wRVUs per outpatient dermatology encounter. Compared to general dermatology visits with white patients, visits with Black patients generated 0.267 (95% CI: 0.254-0.280) fewer wRVUs/encounter, visits with Asian patients generated 0.221 (95% CI: 0.195-0.247) fewer wRVUs/encounter, and visits with patients of other race generated 0.191 (95% CI: 0.142-0.239) fewer wRVUs/encounter. Female sex was also associated with 0.111 (95% CI: 0.101-0.122) fewer wRVUs per encounter, and RVUs/encounter increased by 0.006 (95% CI: 0.006-0.006) with each 1-year increase in age. In the general dermatology practice excluding Mohs surgeons, destruction of premalignant lesions and biopsies were strong mediators for the observed race, age, and sex differences. In a dataset including encounters with Mohs surgeons, the race, age, and sex differences in wRVUs/encounter were greater than in the general dermatology dataset, and Mohs for basal cell and squamous cell carcinomas was a strong mediator for the observed race, age, and sex differences. This study demonstrated that dermatology encounters among persons of color, women, and younger patients generate fewer wRVUs than those with older white males. Physician compensation based on wRVUs may encourage provision of services that exacerbate differential access to care and dermatologic healthcare disparities.

Table of Contents

INTRODUCTION…………………………………………………………………………….1

BACKGROUND…………………………………………………………………..………….3

METHODS………………………………………………………………………………...….7

RESULTS………………………………………………………………………………...….13

DISCUSSION / CONCLUSIONS………………………………………………………..….16

REFERENCES…………………………………………………………………………...….20

TABLES/FIGURES………………………………………………………………………….24

About this Master's Thesis

Rights statement

• Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.

School	Laney Graduate School
Department	Clinical Research
Degree	M.S.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Health Care Management Health Sciences, General
Palavra-chave	health finance relative value units healthcare equity RVU healthcare disparities health equity health disparities health services research
Committee Chair / Thesis Advisor	Matthew Magee, Emory University
Committee Members	Robert Swerlick, Emory University Suephy Chen, Duke University Rachel Patzer, Emory University

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