BUFFALO, N.Y. – It's not exactly a secret that Medicare reimbursement rates have been declining for years. A University at Buffalo medical student with an interest in health economics who plans to go into dermatology wanted to see how those declines are affecting the specialty he plans to pursue.
The result was a paper published last month in JAMA Dermatology . Joshua Kent, a fourth-year student in the Jacobs School of Medicine and Biomedical Sciences at UB, is lead author. Co-authors are Daniel C. Malone, PhD, Larisa J. Geskin, MD, professor of dermatology and internal medicine at Columbia University Medical Center, and Celine M. Schreidah, MD, of New York-Presbyterian Hospital.
In their analysis of Medicare reimbursements for dermatologic procedures from 2007 to 2026, Kent and his co-authors found a decline of 29% in inflation-adjusted reimbursement, a dramatic spike, especially compared to the 4.8% decline that a previous analysis of reimbursements in dermatology had found from 2007 to 2021.
Significant changes over time
"I was generally aware of declining inflation-adjusted Medicare reimbursement across several medical specialties, so I suspected that dermatology might be experiencing similar trends," Kent says. "However, I didn't appreciate the magnitude or consistency of the declines until we conducted our analysis. Seeing the results made me realize just how significant these changes have been recently."
Kent began with a literature review to understand how researchers had previously studied Medicare reimbursement trends; he and his co-authors then used publicly available Medicare reimbursement data to evaluate changes over time. He says the combined expertise of his co-authors allowed them to approach the question from both an economic and a clinical perspective.
"I was fortunate to work with two outstanding mentors, Dr. Dan Malone, and Dr. Larisa J. Geskin," he says. "Dr. Malone is an expert in health economics, pharmacoeconomics, and health outcomes research, and his expertise was invaluable in developing our analytical approach and interpreting the economic implications of our findings. Dr. Geskin is an internationally recognized expert in cutaneous lymphoma and cutaneous oncology. She brought the clinical perspective necessary to understand why these reimbursement trends matter to practicing dermatologists and their patients."
The paper shows that the years 2021 to 2026 were particularly consequential because consumer prices rose by 20% while the conversion factor, the formula established by Congress to calculate Medicare reimbursements to clinicians, was declining for several years before improving somewhat this year.
Access to care
Kent's interest in dermatology developed during medical school, particularly through his clinical experiences and research in cutaneous oncology. "One of the most important lessons I've learned is that even the most effective treatment has limited value if a patient cannot access it," he says. That fact has driven his simultaneous interest in how care is paid for.
"I became interested in health economics because I realized how much decisions about reimbursement, cost-effectiveness and resource allocation shape the care physicians can actually provide," he says. While he says it isn't common for physicians to be formally trained in the analytical methods used to inform those decisions, he wanted to develop that expertise.
Kent explains that Medicare reimbursement is particularly important in dermatology since the specialty relies heavily on procedures, including biopsies, excisions and treatments for skin cancer. "Changes in reimbursement can influence the financial sustainability of providing these services and, ultimately, patients' access to care," he says.
The study was designed to characterize reimbursement trends rather than establish the specific causes behind them, but Kent notes that naturally the factors driving these trends are of critical interest.
"Our findings align with trends reported across many other medical specialties, suggesting this is part of a broader issue in Medicare physician reimbursement rather than something unique to dermatology," he says.
Kent says that dermatology is particularly interesting because so much dermatologic care involves office-based procedures. "Reimbursement changes could therefore have a particularly meaningful impact on how care is delivered," he says.
And while, as a student, he cautions that he can't claim to know the full clinical consequences of these changes, he is aware of several potential concerns. "Dermatology already faces significant challenges with appointment availability and patient access, particularly in certain geographic areas and underserved communities," he says. "If reimbursement continues to decline relative to the costs of providing care, practices may face increasing financial pressure. Over time, this could influence decisions about insurance participation, staffing or the availability of certain procedures. Our study does not establish that declining reimbursement has already reduced access to dermatologic care, but it raises important questions about whether these trends could contribute to future access challenges."
An MD candidate in the Jacobs School's Class of 2027, Kent is applying for residency in dermatology. He is also a former Research Fellow at the Columbia University Irving Medical Center and an award recipient of the 2025 American Society of Hematology Physician-Scientist Award.
