DX / Differentials / DERMATOLOGY GROUPS

D-04 — MULTI-LOCATION MARKETING · DERMATOLOGY GROUPS

One playbook, different results by location — dermatology

Same brand, same fee schedule, four-fold spread

DIFFERENTIAL — LIKELY CAUSES, MOST LIKELY FIRST

1. 01

   Provider-level mix variance is the largest single driver and it hides inside a site average

   In dermatology, two physicians on the same fee schedule in the same building can produce completely different economics because they do different work. Site-level reporting averages that away, and the group then goes looking for a market explanation for a provider phenomenon.

   Across 12,616 dermatology-typed providers, Medicare allowed amount runs $26,773 at the 10th percentile, $188,072 at the median, and $777,069 at the 90th — a 29-fold spread inside one specialty code. And the top decile bills 4.1× the median on only 2.7× the patients: the spread is service mix, not catchment. A Mohs first stage allows $581.52; a destruction of a premalignant lesion beyond the first allows $6.22.

   CMS, Medicare Physician & Other Practitioners PUF by Provider and by Geography and Service, CY2024. Federal claims, Medicare fee-for-service only.

   NOT THIS IF — Your providers' code distributions are already tight and the variance is between sites with matched provider mix. Then look at intake and at catchment.

2. 02

   [COS] Utilization variance — the widest gap in the aesthetics data, reproduced inside one group

   Cosmetic revenue per location is mostly a function of how full the chairs are, and chair fill is set by booking behavior, not by demand. A group with one well-run site and four badly-scheduled ones will show a demand story on the P&L and a scheduling story on the calendar.

   Medspa staff utilization runs 38% at the median, 56% at the 75th percentile and 80% at the 90th — a 42-point gap Zenoti calls the widest of any vertical it measures. Revenue per location tracks it: $1,860,000 median, $2,340,000 at the 75th, $4,250,000 at the 90th — a 2.28× spread. The CY2024 series ran 47% / 64% / 78% on utilization and $1,035,229 / $1,776,829 / $3,219,354 on revenue per location.

   Zenoti, 2026 Beauty & Wellness Benchmark Report — medspa edition (CY2025); 2025 edition (CY2024). Aggregated platform transaction data from North America businesses; skews toward larger multi-location operators.

   NOT THIS IF — Utilization is tight across sites and revenue per location still varies four-fold. Then the difference is ticket and mix, not chair time — and that is a different fix.

3. 03

   Extender deployment differs by site and was never normalized

   Whether the screening, biopsy and destruction volume runs through a PA or through the physician changes both the cost of a schedule and the physician's availability for high-fee work. Groups rarely set this as a standard; each site inherits whatever its lead physician preferred.

   Nationally, PAs and NPs render 33.1% of tangential biopsies (11102) and 32.6% of first-lesion destructions (17000) — but 18 of 934,948 Mohs first stages. The extender-side workload benchmark: 21–30 patients per day is the most common volume (47% of dermatology PAs), median 32 scheduled face-to-face hours per week, median 42 full-body skin exams per week, 98% performing procedures and 80% providing surgical dermatology.

   CMS PUF by Provider and Service, CY2024 (code-level share by rendering provider type; CMS PA/NP provider types are not specialty-tagged, so this is a code-level share, not a practice staffing ratio). SDPA 2024 Practice Survey Report of Dermatology PAs, n=994, fielded Feb–Mar 2024 by Western Management Group; self-selected members.

   NOT THIS IF — Extender ratios are already standardized across sites and documented. Then this line is closed.

4. 04

   Site of service and payer mix were inherited with the building, not chosen

   Two sites doing identical clinical work can collect very different amounts because one bills office and one bills facility, or because one carries a payer mix nobody re-negotiated after the acquisition. It presents as unexplained site variance and it is not a demand problem at all.

   17311 allows $581.52 in office and $289.90 in facility — the same procedure at roughly half. Nationally 895,107 of 934,948 first-stage services are billed office, so the office rate is the specialty norm and a facility-billing site is the outlier absorbing the difference.

   CMS PUF by Geography and Service, CY2024, national rows with place-of-service split.

   NOT THIS IF — Place of service and payer mix are matched across the sites in question. Then the variance is operational.

5. 05

   Acquired sites keep running their own operating system

   Dermatology consolidation happened fast and recently, and an acquired practice arrives with its own scheduling logic, its own intake habits and its own provider culture. The brand changes on the sign; the operating system doesn't. Variance by acquisition vintage is the signature.

   184 physician-owned dermatology practices — roughly 381 clinics — were acquired by private equity between May 2012 and May 2018, by 17 PE-backed dermatology management groups; clinics spanned at least 30 states, with 138 of 381 (36%) in Texas and Florida. Annual deal counts ran 5 in 2012 to 59 in 2017. Today there are more than 3,000 active dermatology physician group practices in the US, and the largest — Forefront Dermatology at 339 physicians — has "nearly twice as many as any other."

   Tan S, Seiger K, Renehan P, Mostaghimi A, "Trends in Private Equity Acquisition of Dermatology Practices in the United States," JAMA Dermatology 2019 (method: five named financial databases plus DMG press releases; series ends mid-2018). Definitive Healthcare, "Largest dermatology physician group practices," data October 2025 — a vendor database built from claims and provider directories, not a government count.

   NOT THIS IF — Your sites are all de novo or all long-integrated and the variance still holds. Then it is not vintage.

HOW TO TELL THEM APART

How to tell these apart in your own numbers

Each of these is a measurement you can run yourself, without us.

WHAT RESOLVES EACH

What resolves this, and how you will know it resolved

Provider-level mix variance is the largest single driver and it hides inside a site average	Rx 04 · marketing attribution →	Per-provider, per-code, per-site — one readout, reconciled to collections. Almost every multi-site dermatology group reports at the site level and is therefore structurally unable to see its own largest source of variance.
[COS] Utilization variance — the widest gap in the aesthetics data, reproduced inside one group	Rx 03 · patient conversion →	Bring the low sites to the group's own median before bringing anyone to a benchmark. Narrowing internal spread is faster, cheaper and more defensible than chasing a percentile.
Extender deployment differs by site and was never normalized	Rx 04 · marketing attribution →	Reporting makes it visible. Standardizing it is a clinical and staffing decision that belongs to the group's medical leadership, and we would not present it as a marketing deliverable.
Site of service and payer mix were inherited with the building, not chosen	— →	Revenue cycle and contracting. We surface it and hand it over. If this is the whole of your variance, you do not need a marketing engagement and we would tell you so on the first call.
Acquired sites keep running their own operating system	Rx 03 · patient conversion →	Integration of intake, booking and scheduling is where brand-level consistency actually lives. Sequenced with Rx 02 so the acquired site's web presence and the group's stop contradicting each other.

HOW THIS DIFFERS BY SCALE

How this differs by scale

Single site	Not a multi-site question — but the same test applies between providers and between days of the week inside one building. Single sites have variance too; they just call it a personality.
Group	This is the native scale for this differential. The decisive move is reporting at the provider level rather than the site level, because dermatology's largest variance driver is what a given provider does, not where they do it.
Platform	Platforms accumulate operating systems the way they accumulate sites, and variance by acquisition vintage is the diligence question a buyer will ask — which makes dermatology group marketing at this scale an integration problem before it is a demand problem. A platform that can show compressing internal spread across a 24-month integration is telling a very different story than one showing a rising average.

OTHER PRESENTATIONS — DERMATOLOGY GROUPS

• The schedule is full and the number stopped moving
• Cost per consult is climbing — and cost per encounter was never measured
• The demand is already in the building
• How much of this survives the surgeon leaving the room?