1. Assessing the Feasibility of an Alternative Payment Model for Mohs Micrographic Surgery at an Academic Center
- Author
-
Nkanyezi N. Ferguson, Marta J. Van Beek, Sogyong Auh, Pooja Chitgopeker, Hillary Johnson-Jahangir, and Josh A. Hammel
- Subjects
Male ,medicine.medical_specialty ,Skin Neoplasms ,Cost-Benefit Analysis ,media_common.quotation_subject ,Dermatologic Surgical Procedures ,Episode of Care ,Dermatology ,Medicare ,Micrographic surgery ,Perioperative Care ,Specimen Handling ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Humans ,Medicine ,Hospital Costs ,health care economics and organizations ,Aged ,Retrospective Studies ,Skin ,media_common ,Aged, 80 and over ,Surgical repair ,Academic Medical Centers ,Episode of care ,Clinical Laboratory Techniques ,business.industry ,Retrospective cohort study ,Health Care Costs ,General Medicine ,Middle Aged ,Plastic Surgery Procedures ,Mohs Surgery ,Payment ,medicine.disease ,United States ,Confidence interval ,Medicare payment ,Surgery ,030220 oncology & carcinogenesis ,Feasibility Studies ,Female ,Skin cancer ,business ,Patient Care Bundles - Abstract
Background Mohs micrographic surgery (MMS) is a cost-effective treatment for nonmelanoma skin cancer that bundles costs for surgical excision, tissue processing, and histopathological interpretation. A comprehensive MMS bundle would include all aspects of an episode of care (EOC), including costs of reconstruction, preoperative, and postoperative care. Objective To assess the feasibility of an alternative payment model for MMS and reconstruction. Methods Retrospective chart review and payment analysis for 848 consecutive patients with 1,056 tumors treated with MMS. Average Medicare payment of an EOC was compared with bundles based on specific repair types. Results The bundle for a flap/graft repair averaged $1,028.08 (confidence interval [CI] 95% $951.37-1,104.79), whereas the bundle for a linear closure (LC) averaged $585.07 (CI 95% $558.75-611.38). The average bundle including all repairs was $730.05 (CI 95% $692.31-767.79), which was statistically significant from both the flap/graft and LC bundles. Conclusion Bundling surgical repairs with MMS based on an average payment does not represent the heterogeneity of the care provided and results in either underpayment or overpayment for a substantial portion of cases. Consequently, EOC payments bundling MMS and surgical repairs would inaccurately reimburse physicians for work completed. Current payment methodology allows for accurate payment for this already cost-effective therapy.
- Published
- 2020