Trends in Mohs Surgery From 1995 to 2010

Reeder, Virginia J.; Gustafson, Cheryl J.; Mireku, Kenyatta A.; Davis, Scott; Feldman, Steven R.; Pearce, Daniel J.

doi:10.1097/dss.0000000000000285

Cited by 31 publications

(16 citation statements)

References 11 publications

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“…ohs micrographic surgery (MMS), a procedure for skin cancer treatment that uses a series of resections to ensure a cancer-free margin while preserving normal tissue, is performed commonly on the head and neck, genitalia, hands, and feet in the United States and is increasingly being used for numerous skin cancers, including melanoma. 1 The effectiveness of MMS has been established, but individual physician practice variation in the mean stages performed per MMS case has not been studied. Unwarranted practice variation can result in unnecessary procedures or poor quality of care for patients.…”

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confidence: 99%

Outlier Practice Patterns in Mohs Micrographic Surgery

Krishnan¹,

Xu²,

Hutfless

et al. 2017

JAMA Dermatol

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IMPORTANCE Outlier physician practices in health care can represent a significant burden to patients and the health system. OBJECTIVE To study outlier physician practices in Mohs micrographic surgery (MMS) and the associated factors. DESIGN, SETTING, AND PARTICIPANTS This retrospective analysis of publicly available Medicare Part B claims data from January 2012 to December 2014 includes all physicians who received Medicare payments for MMS from any practice performing MMS on the head and neck, genitalia, hands, and feet region of Medicare Part B patients. MAIN OUTCOMES AND MEASURES Characteristics of outlier physicians, defined as those whose mean number of stages for MMS was 2 standard deviations greater than the mean number for all physicians billing MMS. Logistic regression was used to study the physician characteristics associated with outlier status. RESULTS Our analysis included 2305 individual billing physicians performing MMS. The mean number of stages per MMS case for all physicians practicing from January 2012 to December 2014 was 1.74, the median was 1.69, and the range was 1.09 to 4.11. Overall, 137 physicians who perform Mohs surgery were greater than 2 standard deviations above the mean (2 standard deviations above the mean = 2.41 stages per case) in at least 1 of the 3 examined years, and 49 physicians (35.8%) were persistent high outliers in all 3 years. Persistent high outlier status was associated with performing Mohs surgery in a solo practice (odds ratio, 2.35; 95% CI, 1.25-4.35). Volume of cases per year, practice experience, and geographic location were not associated with persistent high outlier status. CONCLUSIONS AND RELEVANCE Marked variation exists in the number of stages per case for MMS for head and neck, genitalia, hands, and feet skin cancers, which may represent an additional financial burden and unnecessary surgery on individual patients. Providing feedback to physicians may reduce unwarranted variation on this metric of quality.

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confidence: 99%

Outlier Practice Patterns in Mohs Micrographic Surgery

Krishnan¹,

Xu²,

Hutfless

et al. 2017

JAMA Dermatol

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“…In addition, the procedure is highly efficient, since the surgeon serves the simultaneous roles of oncologic surgeon, pathologist, and generally also reconstructive surgeon. Mohs micrographic surgery use has increased over the last decade owing to the procedure’s superior outcomes, its expanding application to melanoma, an emphasis of MMS in training programs, and increased rates of skin cancer …”

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Evaluation of a Peer-to-Peer Data Transparency Intervention for Mohs Micrographic Surgery Overuse

et al. 2019

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IMPORTANCE Mohs micrographic surgery (MMS) is a skin cancer treatment that uses staged excisions based on margin status. Wide surgeon-level variation exists in the mean number of staged resections used to treat a tumor, resulting in a cost disparity and question of appropriateness. OBJECTIVE To evaluate the effectiveness of a behavioral intervention aimed at reducing extreme overuse in MMS, as defined by the specialty society, by confidentially sharing stages-per-case performance data with individual surgeons benchmarked to their peers nationally. DESIGN, SETTING, AND PARTICIPANTS This nonrandomized controlled intervention study included 2329 US surgeons who performed MMS procedures from January 1, 2016, to March 31, 2018. Physicians were identified using a 100% capture of Medicare Part B claims. The intervention group included physicians affiliated with the American College of Mohs Surgery, and the control group included physicians not affiliated with the American College of Mohs Surgery. INTERVENTIONS Individualized performance reports were delivered to all outlier surgeons, defined by the specialty society as those with mean stages per case 2 SDs above the mean, and inlier surgeons in the intervention group. MAIN OUTCOMES AND MEASURES The primary outcome was surgeon-level change in mean stages per case between the prenotification (January 2016 to January 2017) and postnotification (March 2017 to March 2018) periods. A multivariable linear regression model was used to evaluate the association of notification with this surgeon-level outcome. The surgeon-level metric of mean stages per case was not risk adjusted. The mean Medicare cost savings associated with changes in practice patterns were calculated. RESULTS Of the 2329 included surgeons, 1643 (70.5%) were male and 2120 (91.0%) practiced in metropolitan areas. In the intervention group (n = 1045), 53 surgeons (5.1%) were outliers; in the control group (n = 1284), 87 surgeons (6.8%) were outliers. Among the outliers in the intervention group, 44 (83%) demonstrated a reduction in mean stages per case compared with 60 outliers in the control group (69%; difference, 14%; 95% CI of difference, −1 to 27; P = .07). There was a mean stages-per-case reduction of 12.6% among outliers in the intervention group compared with 9.0% among outliers in the control group, and outliers in the intervention group had an adjusted postintervention differential decrease of 0.14 stages per case (95% CI, −0.19 to −0.09; P = .002). The total administrative cost of the intervention program was $150 000, and the estimated reduction in Medicare spending was $11.1 million. CONCLUSIONS AND RELEVANCE Sharing personalized practice pattern data with physicians benchmarked to their peers can reduce overuse of MMS among outlier physicians.

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“…T he use of Mohs micrographic surgery (MMS) in the treatment of nonmelanoma skin cancer (NMSC) has increased dramatically over the past 2 decades. 1,2 MMS has been shown to have the highest cure rate for NMSC with few associated complications. 3,4 The most frequent complication of MMS is surgical site infection (SSI), with a reported incidence ranging from 0.07% to 4.34%.…”

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Results of a National Survey on the Definition of Surgical Site Infections After Mohs Micrographic Surgery

2023

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BACKGROUND There is no standardized definition of surgical site infections (SSI) after Mohs micrographic surgery (MMS) used in the clinical or research settings, which may contribute to heterogeneity in the differences in infection rates reported. OBJECTIVE To use an electronic survey of Mohs surgeons across the country to better understand how Mohs surgeons define SSI after MMS. METHODS A web-based survey was developed and distributed to Mohs surgeons. Respondents were asked to respond to several different scenarios that could represent SSI after MMS. RESULTS Of potential 1,500 respondents, 79 (5.3%) responded to the survey. Presentation of a surgical site with warmth, swelling, erythema, and pain at 7 days postoperatively resulted in 79.7% consensus of SSI. Surgical sites that were cultured and found to be Staphylococcus aureus-positive resulted in 100% agreement of SSI. There was no consensus regarding timing after MMS. CONCLUSION There is consensus on numerous aspects of SSI after MMS among Mohs surgeons, which may allow for development of standardized definition in the future.

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Trends in Mohs Surgery From 1995 to 2010

Abstract: There has been an upward trend in the use of Mohs surgery, particularly in the head and neck region where tissue preservation is essential.

Cited by 31 publications

References 11 publications

Outlier Practice Patterns in Mohs Micrographic Surgery

Outlier Practice Patterns in Mohs Micrographic Surgery

Evaluation of a Peer-to-Peer Data Transparency Intervention for Mohs Micrographic Surgery Overuse

Results of a National Survey on the Definition of Surgical Site Infections After Mohs Micrographic Surgery

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