Mohs micrographic surgery utilization in the Medicare population, 2009

Area of Science:

• Dermatology
• Surgical Oncology
• Health Services Research

Background:

• Mohs micrographic surgery (MMS) is the gold standard for high-risk skin cancer treatment.
• Limited data exist on the current utilization patterns of MMS.

Purpose of the Study:

• To analyze current trends in Mohs micrographic surgery (MMS) utilization within the Medicare population.
• To assess the predictive value of a 5% Medicare claims sample for total MMS case volumes.

Main Methods:

• Analysis of the 2009 Medicare Limited Data Set Standard Analytic File (LDSSAF) and Physician Supplier Procedure Master File (PSPMF).
• Utilized a 5% claims sample to extrapolate total annual case volumes and provider performance.
• Examined types of Mohs surgery repairs, including complex closures, intermediate repairs, flaps, and skin grafts.

Main Results:

• Over 558,000 Mohs micrographic surgery (MMS) cases were performed in Medicare beneficiaries in 2009, averaging 1.75 stages per case.
• Melanoma and carcinoma in situ accounted for 0.3% and 1.3% of MMS cases, respectively.
• 65.8% of cases involved same-day MMS repairs, with complex repairs (48.7%) being most common, followed by flaps (32.4%).

Conclusions:

• The 5% LDSSAF is a reliable predictor of total Medicare Mohs surgery claim volumes and useful for modeling practice trends.
• Significant variation exists in the annual case volumes performed by individual Mohs micrographic surgery providers.
• Findings are based on Medicare Part B enrollees in 2009, with extrapolations representing predictions from sampled data.