A Medicare cost comparison of minor cutaneous procedures by surgical setting

Marks, Maria M.; Yelverton, Christopher B.; Williford, Phillip M.; Teuschler, Hoa; Coloe, Jacquelyn; Chen, John; Feldman, Steven R.

doi:10.1080/09546630902936760

Cited by 3 publications

(4 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Medicare data have been used previously to determine the systemic costs of treating keratinocyte cancers in Australia, although this is the first study to determine costs per patient, and across different clinical settings. A study based on US Medicare data found that the average cost for each skin cancer treated in hospital was five times more than the costs for treating skin cancers in private clinical rooms (US$645 vs US$128) . While we found similarly that hospital admissions result in higher costs, we found smaller relative differences between the clinical settings.…”

Section: Discussioncontrasting

confidence: 63%

Keratinocyte cancer excisions in Australia: Who performs them and associated costs

et al. 2019

View full text Add to dashboard Cite

Background/Objective: To describe the clinical settings in which keratinocyte cancers are excised in Queensland and describe the types of practitioners who excise them; to examine costs; and to identify predictors of hospital admission. Methods:We used linked data for participants from the QSkin study (n = 43 794), including Medicare claims and Queensland hospital admissions relating to treatment episodes for incident keratinocyte cancers from July 2011 to June 2015. We used multinomial logistic regression to measure associations between demographic and clinical characteristics and treatment setting. The median costs of Medicare claims (AU$) were calculated.Results: During 4 years of follow-up, there were 18 479 skin cancer excision episodes among 8613 people. Most excisions took place in private clinical rooms (89.7%), the remainder in hospitals (7.9% private; 2.4% public). Compared with other anatomical sites, skin cancers on the nose, eyelid, ear, lip, finger or genitalia were more likely to be treated in hospitals than in private clinical rooms (public hospital OR 5.7; 95%CI 4.5-7.2; private hospital OR 8.3; 95% CI 7.3-9.4). Primary care practitioners excised 83% of keratinocyte cancers, followed by plastic surgeons (9%) and dermatologists (6%). The median Medicare benefit paid was $253 in private clinical rooms and $334 in private hospitals. Out-of-pocket payments by patients treated in private hospitals were fourfold higher than those in private clinical rooms ($351 vs $80).Conclusions: Most keratinocyte cancers are excised in primary care, although more than 10% of excisions occur in hospital settings.

show abstract

Section: Discussioncontrasting

confidence: 63%

Keratinocyte cancer excisions in Australia: Who performs them and associated costs

et al. 2019

View full text Add to dashboard Cite

show abstract

“…In addition to safety, outpatient surgery under local anesthesia avoids the additional cost of an operating facility, administration of anesthesia, and postoperative recovery 15,49,50 . Although cost‐effectiveness was not a factor included in this study, the cost‐effectiveness of outpatient MMS has been well established 15,20–22,49,50 …”

Section: Discussionmentioning

confidence: 99%

Preoperative Expectations and Values of Patients Undergoing Mohs Micrographic Surgery

Chuang¹,

Leach²,

Wheless

et al. 2011

Dermatologic Surgery

View full text Add to dashboard Cite

show abstract

“…3,4 The unadjusted mean cost of treating NMSC has been found to differ by 200% to 500% among primary care physicians, dermatologists, otolaryngologists, and plastic surgeons. 3 Additionally, given that all specialists are reimbursed the same amount per procedure code, a recent paper by Marks et al 5 has suggested that dermatologists should be considered the most cost-effective specialty treating NMSC as they perform almost all of their procedures in the office (compared to plastic surgeons and otolaryngologists, who treat NMSC patients in hospital or ambulatory surgical center settings). Marks et al 5 concluded that more severe NMSC cases were unjustifiably treated in more costly settings such as hospitals or ambulatory centers despite finding higher mean Charlson Comorbidity Index scores of 2.03, 2.65, and 3.02 for NMSC patients treated in an office, ambulatory surgical center, or a hospital, respectively.…”

mentioning

confidence: 98%

“…3 Additionally, given that all specialists are reimbursed the same amount per procedure code, a recent paper by Marks et al 5 has suggested that dermatologists should be considered the most cost-effective specialty treating NMSC as they perform almost all of their procedures in the office (compared to plastic surgeons and otolaryngologists, who treat NMSC patients in hospital or ambulatory surgical center settings). Marks et al 5 concluded that more severe NMSC cases were unjustifiably treated in more costly settings such as hospitals or ambulatory centers despite finding higher mean Charlson Comorbidity Index scores of 2.03, 2.65, and 3.02 for NMSC patients treated in an office, ambulatory surgical center, or a hospital, respectively. Interpretation of the results reported by the aforementioned studies is limited as they summed costs of the entire episode over all specialties involved and did not control for confounding factors such as patient demographics or disease severity that may require more specialized, and thus more costly, care.…”

mentioning

confidence: 98%

Physician Specialty Cost Differences of Treating Nonmelanoma Skin Cancer

Chirikov¹,

Stuart²,

Zuckerman³

et al. 2015

Annals of Plastic Surgery

View full text Add to dashboard Cite

Specialty-related cost differences for the treatment of nonmelanoma skin cancer (NMSC) have been previously reported but without taking into account confounding factors. Using a previously validated model for NMSC episode of care, episodes were identified in the Medicare Current Beneficiary Survey claims 2005 to 2007. A γ regression with log link model estimated the effect of physician exposure on total episode costs controlling for sociodemographics, health status and comorbidities, treatment and repair procedures, as well as tumor size and location. Treatment-related NMSC episodes (1285) were identified. In the unadjusted model, episodes managed by generalists were associated with 36% lower costs, those by otolaryngologists/plastic surgeons with 82% higher costs, and those by multiple specialists with 111% higher costs, compared to dermatologists. Cost differences were substantially reduced in the adjusted regression analysis; compared to dermatologists, episodes managed by generalists were associated with 20% lower costs (P < 0.0001), whereas otolaryngologists/plastic surgeons and multiple specialists were associated with 20% (P < 0.01) and 11% (P = 0.02) higher costs, respectively. Overall, comparison between unadjusted and adjusted estimates suggests that controlling for severity and treatment modalities explains most of the specialty cost differences. Our estimates could be subject to residual confounding due to selection bias and the limitations to using claims data to characterize an NMSC episode of care. Adjusting for the severity of the disease and other confounders, our study found much smaller specialty-related cost differences for the management of NMSC than previously reported unadjusted estimates.

show abstract

A Medicare cost comparison of minor cutaneous procedures by surgical setting

Abstract: Regulations that discourage office-based surgery could significantly increase medical care costs.

Cited by 3 publications

References 18 publications

Keratinocyte cancer excisions in Australia: Who performs them and associated costs

Keratinocyte cancer excisions in Australia: Who performs them and associated costs

Preoperative Expectations and Values of Patients Undergoing Mohs Micrographic Surgery

Physician Specialty Cost Differences of Treating Nonmelanoma Skin Cancer

Contact Info

Product

Resources

About