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Variation seen in number of stages per case of Mohs micrographic surgery

There was a marked variation in the number of stages per case of Mohs micrographic surgery of head and neck, genitalia, hands and feet skin cancers, according to study results published in JAMA Dermatology.

Researchers used Medicare Part B claims data to conduct a retrospective analysis between 2012 and 2014 of 2,305 individual billing physicians (66.8% male) who received Medicare payments for performing Mohs micrographic surgery (MMS). The surgeries were performed on the head, neck, genitalia, hands and feet regions of the patients.

The mean number of stages per case was 1.47 (range, 1.09-4.11).

Physicians with a mean number of stages for MMS of 2 standard deviations greater than the mean number of all physicians billing MMS were defined as outlier physicians.

They found that 137 physicians were outlier physicians, with a mean of 2.41 stages per case in at least one of three of the years examined. Forty-nine physicians (35.8%) were persistent high outliers in all three years.

Physicians in solo practice had a 2.35-times likelihood of a persistent high outlier status (OR = 2.35; 95% CI, 1.25-4.35).

Sex, practice experience, case volumes, American College of Mohs Surgery membership, practice in an Accreditation Council for Graduate Medical Education training site or geographic location were not associated with persistent high outlier status.

“Our analysis demonstrates marked individual physician practice variation in the mean stages per case for MMS of head and neck, genitalia, hands and feet skin cancers,” the researchers wrote.

“While the effectiveness of MMS has been well demonstrated, outliers may negate this benefit for patients,” the researchers concluded. “Because of both the cost and morbidity that outliers and overuse of Mohs surgery can impose on patients and the health care system, physicians must proactively address the underlying causes contributing to these issues.” – by Bruce Thiel

Disclosure: The researchers report no relevant financial disclosures.