Higher socioeconomic status of practice location, urban setting, and mean office visit level of service are associated with higher skin closure costs
DOI:
https://doi.org/10.5070/vtrz4w60Keywords:
cluster analysis, income, practice pattern, surgical repairAbstract
Excision of skin cancer may involve a closure that can substantially increase the total cost of care. Dermatologist-specific factors may predict closure billing. The objective was to identify characteristics that predict higher-than-expected closure costs following skin cancer excision. The study included general dermatologists who performed malignant excisions and closures in the 2022 United States Medicare population. K-means clustering was performed on each dermatologist’s cost difference and their mean size of malignant excisions. Dermatologist characteristics were compared between clusters and effect sizes were calculated to ensure substantial magnitudes of difference. Compared with dermatologists in low-cost clusters, dermatologists in high-cost clusters had higher office visit levels of service (P<0.0001) and practiced in postal codes with higher household incomes (P<0.0001), lower social deprivation scores (P<0.0001), and more urban areas (P<0.0001). For only small excision sizes, the high-cost cluster had more female dermatologists (P<0.0001). General dermatologists who billed for office visits at higher levels or practiced in more urban and affluent areas had higher skin cancer excision closure costs. The dermatologist practice patterns described here may help inform strategies to reduce the cost of surgical care for skin cancer.
Downloads
References
1. Wilson LS, Pregenzer M, Basu R, et al. Fee Comparisons of treatments for nonmelanoma skin cancer in a private practice academic setting. Dermatol Surg. 2012;38:570-584. [PMID: 22145798].
2. Wang DM, Morgan FC, Besaw RJ, Schmults CD. Dermatologists are the primary treating physicians of skin cancer in the United States Medicare population. J Am Acad Dermatol. 2018;79:578-580. [PMID: 29499290].
3. Shaffer CL, Feldman SR, Fleischer AB, Huether MJ, Chen GJ. The cutaneous surgery experience of multiple specialties in the Medicare population. J Am Acad Dermatol. 2005;52:1045-1048. [PMID: 15928623].
4. Chirikov VV, Stuart B, Zuckerman IH, Christy MR. Physician specialty cost differences of treating nonmelanoma skin cancer. Ann Plast Surg. 2015;74:93-99. [PMID: 2450388].
5. Kantor J. Surgical volume of dermatologists who do not perform Mohs micrographic dermatologic Surgery: a cross-sectional individual-level analysis using Medicare data. Dermatol Surg. 2020;46:1. [PMID: 31188146].
6. Gronbeck C, Feng H. Distribution of intermediate and complex skin repairs performed by dermatologists following updated 2020 coding guidelines. J Am Acad Dermatol. 2023;88:954-956. [PMID: 36436694].
7. Medicare Physician & Other Practitioners - Centers for Medicare & Medicaid Services Data. https://data.cms.gov/provider-summary-by-type-of-service/medicare-physician-other-practitioners. Accessed September 8, 2024.
8. National Downloadable File | Provider Data Catalog. https://data.cms.gov/provider-data/dataset/mj5m-pzi6. Accessed September 4, 2022.
9. Census Bureau Data. https://data.census.gov/. Accessed January 4, 2024.
10. Social Deprivation Index (SDI). https://www.graham-center.org/content/brand/rgc/maps-data-tools/social-deprivation-index.html. Accessed January 6, 2024.
11. USDA ERS - Rural-Urban Commuting Area Codes. https://www.ers.usda.gov/data-products/rural-urban-commuting-area-codes.aspx. Accessed September 4, 2022.
12. Woodie BR, Neltner SA, Pauley AG, Fleischer AB. Years of dermatology experience and geographic region are
associated with outlier performance of excision or destruction for nonmelanoma skin cancer. J Dermatol Treat. 2023;34:2192839. [PMID: 36932466].
13. Milligan GW, Cooper MC. A study of standardization of variables in cluster analysis. J Classif. 1988;5:181-204. [DOI: 10.1007/BF01897163].
14. Sullivan GM, Feinn R. Using effect size—or why the P value is not enough. J Grad Med Educ. 2012;4:279-282. [PMID: 23997866].
15. Cohen J. The Concepts of Power Analysis. In:Statistical Power Analysis for the Behavioral Sciences. 2nd ed. Routledge Academic; 1988. p. 8-14.
16. Alam M, Helenowksi IB, Cohen JL, et al. Association between type of reconstruction after Mohs micrographic surgery and surgeon-, patient-, and tumor-specific features: a cross-sectional study. Dermatol Surg. 2013;39:51-55. [PMID: 23199073].
17. Manternach T, Housman TS, Williford PM, et al. Surgical treatment of nonmelanoma skin cancer in the Medicare population. Dermatol Surg. 2003;29:1167-1169. [PMID: 14725656].
18. Chren MM, Sahay AP, Sands LP, et al. Variation in care for nonmelanoma skin cancer in a private practice and a veterans affairs clinic. Med Care. 2004;42:1019-1026. [PMID: 15377935].
19. Neal DE, Feit EM, Etzkorn JR. Patient preferences for the treatment of basal cell carcinoma: A mapping review of discrete choice experiments. Dermatol Surg. 2018;44:1041. [PMID: 30045140].
20. Micieli R, Alhusayen R. Changes in the practice patterns and demographics of Ontario dermatologists. J Cutan Med Surg. 2018;22:390-399. [PMID: 29519145].
21. Peck GM, Wang Y, Fleischer AB, Lipner SR. Practice region and density, male sex, and specialty predict frequent performers of nail biopsies. J Am Acad Dermatol. 2023;88(3):688-690. [PMID: 35817331].
22. Aggarwal P, Neltner SA, Fleischer AB. Risk factors that are associated with outliers in Mohs micrographic surgery in the national Medicare population, 2018. Dermatol Surg. 2022;48:181. [PMID: 34923533].
23. Krishnan A, Xu T, Hutfless S, et al. Outlier practice patterns in Mohs micrographic surgery: Defining the problem and a proposed solution. JAMA Dermatol. 2017;153:565-570. [PMID: 28453605].
24. Stratman H, Stratman EJ. Assessment of percentage of women in the dermatology workforce presenting at American Academy of Dermatology annual meetings, 1992-2017. JAMA Dermatol. 2019;155:384-386. [PMID: 30725100].
25. Moore R, Zilinskas K, Tarabishy S, Herrera FA. Patterns in academic cosmetic surgery practice: Population differences and procedure preferences. Ann Plast Surg. 2022;88:S490-S494. [PMID: 35690944].
26. Fogel AL, Hogan S, Dover J. Surgical dermatology and private equity: A review of the literature and discussion. Dermatol Surg. 2022;48:339. [PMID: 34985045].
27. Overview of the Medicare Physician Fee Schedule Search | CMS. https://www.cms.gov/medicare/physician-fee-schedule/search/overview. Accessed January 7, 2024.
28. Aggarwal P, Knabel P, Fleischer AB. United States burden of melanoma and non-melanoma skin cancer from 1990 to 2019. J Am Acad Dermatol. 2021;85:388-395. [PMID: 33852922].
29. Smith ES, Feldman SR, Fleischer AB, Leshin B, McMichael A. Characteristics of office-based visits for skin cancer. Dermatologists have more experience than other physicians in managing malignant and premalignant skin conditions. Dermatol Surg. 1998;24:981-985. [PMID: 9754086].
30. Albertini JG, Wang P, Fahim C, et al. Evaluation of a peer-to-peer data transparency intervention for Mohs micrographic surgery overuse. JAMA Dermatol. 2019;155:906-913. [PMID: 31055597].
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Brad R Woodie, Allison E Spraul, Justin A Freking, Kyle P Rismiller, Scott A Neltner, Alan B Fleischer Jr (Author)
This work is licensed under a Creative Commons Attribution 4.0 International License.
