Assessing the Feasibility of an Alternative Payment Model for Mohs Micrographic Surgery at an Academic Center

Sogyong Auh; Pooja Chitgopeker; Josh Hammel; Nkanyezi Ferguson; Hillary Johnson-Jahangir; Marta Van Beek

doi:10.1097/DSS.0000000000002127

Back

Assessing the Feasibility of an Alternative Payment Model for Mohs Micrographic Surgery at an Academic Center

Journal article

Peer reviewed

Assessing the Feasibility of an Alternative Payment Model for Mohs Micrographic Surgery at an Academic Center

Sogyong Auh, Pooja Chitgopeker, Josh Hammel, Nkanyezi Ferguson, Hillary Johnson-Jahangir and Marta Van Beek

Dermatologic surgery, Vol.46(6), pp.735-741

06/01/2020

DOI: 10.1097/DSS.0000000000002127

PMID: 33555783

View Online

Abstract

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. To assess the feasibility of an alternative payment model for MMS and reconstruction. 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. 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. 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.

Feasibility Studies

United States

Academic Medical Centers - economics

Aged

Aged, 80 and over

Clinical Laboratory Techniques - economics

Clinical Laboratory Techniques - methods

Cost-Benefit Analysis

Dermatologic Surgical Procedures - economics

Episode of Care

Female

Health Care Costs

Hospital Costs

Humans

Male

Medicare - economics

Middle Aged

Mohs Surgery - economics

Patient Care Bundles - economics

Perioperative Care - economics

Reconstructive Surgical Procedures - economics

Retrospective Studies

Skin - pathology

Skin Neoplasms - economics

Skin Neoplasms - surgery

Specimen Handling - economics

Details

Title: Subtitle: Assessing the Feasibility of an Alternative Payment Model for Mohs Micrographic Surgery at an Academic Center
Creators: Sogyong Auh - Premier Dermatology, Crest Hill, Illinois.
Pooja Chitgopeker - Medical Dermatology Associates of Chicago, Chicago, Illinois.
Josh Hammel - The University of Texas Medical Branch at Galveston
Nkanyezi Ferguson - University of Iowa
Hillary Johnson-Jahangir - University of Iowa
Marta Van Beek - University of Iowa
Resource Type: Journal article
Publication Details: Dermatologic surgery, Vol.46(6), pp.735-741
DOI: 10.1097/DSS.0000000000002127
PMID: 33555783
ISSN: 1076-0512
eISSN: 1524-4725
Language: English
Date published: 06/01/2020
Academic Unit: Dermatology
Record Identifier: 9984296305302771

Metrics

18 Record Views