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A Medicare cost comparison of minor cutaneous procedures by surgical setting
Maria M Marks1, Christopher B Yelverton, Phillip M Williford
1Department of Dermatology, Center for Dermatology Research, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157-1071 , USA.
Background:
Regulations that cause minor cutaneous procedures to be moved from the physician's office to an ambulatory surgery center (ASC) or hospital may have the potential to unnecessarily increase the costs of these procedures from the Medicare perspective.
Objective:
To investigate whether minor cutaneous procedures that could reasonably be performed in the office are being done in more intense settings (ASCs or hospitals), who is performing these procedures in alternative settings, and the cost of higher intensity settings.
Methods:
Medicare claims data on a number of minor cutaneous surgery procedures performed by various medical disciplines, the location in which the procedures were performed, and the ratio of minor procedures done in each surgical setting by specialty were obtained using the 1992-2000 Medicare Current Beneficiary Survey (MCBS). We used Medicare reimbursements as a measure of the cost of the procedure.
Results:
When compared by surgical setting, the mean charges for each minor cutaneous procedure were greatest when the procedure was performed in the hospital setting and least when performed in the office setting. Owing to surgical setting, dermatologists were the most cost-effective specialists for the performance of minor cutaneous procedures.
Conclusions:
Regulations that discourage office-based surgery could significantly increase medical care costs.
Insights
Moving minor skin procedures from doctor offices to hospitals or surgery centers increases costs. Dermatologists are the most cost-effective specialists for these procedures in office settings.
Area of Science:
- Dermatology
- Health Economics
- Health Policy
Background:
- Regulations may shift minor cutaneous procedures from physician offices to ambulatory surgery centers (ASCs) or hospitals.
- This shift has the potential to increase healthcare costs, particularly for Medicare beneficiaries.
Purpose of the Study:
- To determine if minor cutaneous procedures are being performed in higher-intensity settings (ASCs or hospitals) when office-based procedures are feasible.
- To identify the specialists performing these procedures in alternative settings.
- To analyze the cost implications of higher-intensity surgical settings.
Main Methods:
- Analysis of Medicare claims data from 1992-2000, including the Medicare Current Beneficiary Survey (MCBS).
- Examined minor cutaneous surgery procedures, their locations, and the ratio of procedures by specialty in different surgical settings.
- Medicare reimbursements were utilized as the primary metric for procedure costs.
Main Results:
- Procedures performed in hospital settings incurred the highest average charges, while office settings had the lowest.
- Dermatologists demonstrated the greatest cost-effectiveness for performing minor cutaneous procedures, relative to the surgical setting.
- The study identified a trend of increasing costs associated with moving procedures to more intensive care settings.
Conclusions:
- Regulations that restrict office-based minor cutaneous surgery may lead to significant increases in overall medical care expenditures.
- Promoting office-based procedures, particularly by cost-effective specialists like dermatologists, could mitigate unnecessary cost escalation.
- Policy considerations should account for the economic impact of surgical setting choices for minor dermatologic procedures.
