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Area of Science:

  • Dermatology
  • Health Services Research
  • Surgical Oncology

Background:

  • Outlier physician practices can impose significant burdens on patients and healthcare systems.
  • Variations in surgical procedures, such as Mohs micrographic surgery (MMS), can lead to increased costs and potentially unnecessary interventions.

Purpose of the Study:

  • To investigate outlier physician practices in Mohs micrographic surgery (MMS).
  • To identify factors associated with outlier status in MMS procedures.

Main Methods:

  • Retrospective analysis of Medicare Part B claims data (2012-2014).
  • Included physicians performing MMS on specific body regions (head and neck, genitalia, hands, feet).
  • Defined outlier physicians as those with a mean number of stages 2 standard deviations above the mean; logistic regression analyzed associated physician characteristics.

Main Results:

  • Analyzed 2305 physicians performing MMS; mean stages per case was 1.74.
  • 137 physicians (6%) were high outliers in at least one year; 49 (35.8% of outliers) were persistent high outliers across all three years.
  • Persistent high outlier status was associated with solo practice (OR, 2.35; 95% CI, 1.25-4.35); case volume, experience, and location were not associated.

Conclusions:

  • Significant variation exists in the number of MMS stages for skin cancers in critical areas, potentially increasing patient financial burden and leading to unnecessary procedures.
  • Providing physician feedback on MMS stage variation may help reduce unwarranted practice variations and improve quality of care.