5-Year Follow-Up of a Physician Performance Feedback Report Intervention to Reduce Overuse and Excess Cost: A National Cohort Study.

Background: Mohs micrographic surgery efficiently treats skin cancer through staged resection, but surgeons' varying resection rates may lead to higher medical costs.

Objective: To evaluate the cost savings associated with a quality improvement.

Materials And Methods: The authors conducted a retrospective cohort study using 100% Medicare fee-for-service claims data to identify the change of mean stages per case for head/neck (HN) and trunk/extremity (TE) lesions before and after the quality improvement intervention from 2016 to 2021.

Evaluation of a Peer-to-Peer Data Transparency Intervention for Mohs Micrographic Surgery Overuse.

Importance: Mohs micrographic surgery (MMS) is a skin cancer treatment that uses staged excisions based on margin status. Wide surgeon-level variation exists in the mean number of staged resections used to treat a tumor, resulting in a cost disparity and question of appropriateness.

Objective: To evaluate the effectiveness of a behavioral intervention aimed at reducing extreme overuse in MMS, as defined by the specialty society, by confidentially sharing stages-per-case performance data with individual surgeons benchmarked to their peers nationally.

Understanding Mohs Micrographic Surgery: A Review and Practical Guide for the Nondermatologist.

The incidence and diagnosis of cutaneous malignancies are steadily rising. In addition, with the aging population and increasing use of organ transplant and immunosuppressive medications, subsets of patients are now more susceptible to skin cancer. Mohs micrographic surgery (MMS) has become the standard of care for the treatment of high-risk nonmelanoma skin cancers and is increasingly used to treat melanoma.

Use of Skin Biopsies Among Dermatologists.

Background: Skin biopsies are essential to establish a diagnosis in many skin diseases. Utilization has been increasing rapidly and represents a significant health care cost. There are no benchmarks or baselines to guide the practice of skin biopsies.

Outlier Practice Patterns in Mohs Micrographic Surgery: Defining the Problem and a Proposed Solution.

Importance: Outlier physician practices in health care can represent a significant burden to patients and the health system.

Objective: To study outlier physician practices in Mohs micrographic surgery (MMS) and the associated factors.

Design, Setting, And Participants: This retrospective analysis of publicly available Medicare Part B claims data from January 2012 to December 2014 includes all physicians who received Medicare payments for MMS from any practice performing MMS on the head and neck, genitalia, hands, and feet region of Medicare Part B patients.

Incidence Estimate of Nonmelanoma Skin Cancer (Keratinocyte Carcinomas) in the U.S. Population, 2012.

Importance: Understanding skin cancer incidence is critical for planning prevention and treatment strategies and allocating medical resources. However, owing to lack of national reporting and previously nonspecific diagnosis classification, accurate measurement of the US incidence of nonmelanoma skin cancer (NMSC) has been difficult.

Objective: To estimate the incidence of NMSC (keratinocyte carcinomas) in the US population in 2012 and the incidence of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) in the 2012 Medicare fee-for-service population.

Dermatologists perform the majority of cutaneous reconstructions in the Medicare population: numbers and trends from 2004 to 2009.

Background: Dermatologists are experts in skin cancer treatment. Their experience with cutaneous reconstruction may be underrecognized.

Objective: We sought to determine the percentage of skin reconstruction claims submitted to Medicare by dermatologists relative to other specialists.

Analysis of skin cancer treatment and costs in the United States Medicare population, 1996-2008.

Background: There is a skin cancer epidemic in the United States.

Objective: To examine skin cancer treatment modality, location, and cost and physician specialty in the Medicare population from 1996 to 2008.

Methods: Centers for Medicare and Medicaid Services databases were used to examine skin cancer treatment procedures performed for Medicare beneficiaries.

Scars after second intention healing.

Second intention healing (SIH) is useful for many defects after skin cancer removal. SIH decreases intraoperative morbidity and reduces procedure costs. Granulating wounds are rarely infected, have minimal pain or bleeding, and care is simple.

AAD/ACMS/ASDSA/ASMS 2012 appropriate use criteria for Mohs micrographic surgery: a report of the American Academy of Dermatology, American College of Mohs Surgery, American Society for Dermatologic Surgery Association, and the American Society for Mohs Surgery.

The appropriate use criteria process synthesizes evidence-based medicine, clinical practice experience, and expert judgment. The American Academy of Dermatology in collaboration with the American College of Mohs Surgery, the American Society for Dermatologic Surgery Association, and the American Society for Mohs Surgery has developed appropriate use criteria for 270 scenarios for which Mohs micrographic surgery (MMS) is frequently considered based on tumor and patient characteristics. This document reflects the rating of appropriateness of MMS for each of these clinical scenarios by a ratings panel in a process based on the appropriateness method developed by the RAND Corp (Santa Monica, CA)/University of California-Los Angeles (RAND/UCLA).

AAD/ACMS/ASDSA/ASMS 2012 appropriate use criteria for Mohs micrographic surgery: a report of the American Academy of Dermatology, American College of Mohs Surgery, American Society for Dermatologic Surgery Association, and the American Society for Mohs Surgery.

The appropriate use criteria process synthesizes evidence-based medicine, clinical practice experience, and expert judgment. The American Academy of Dermatology in collaboration with the American College of Mohs Surgery, the American Society for Dermatologic Surgery Association, and the American Society for Mohs Surgery has developed appropriate use criteria for 270 scenarios for which Mohs micrographic surgery (MMS) is frequently considered based on tumor and patient characteristics. This document reflects the rating of appropriateness of MMS for each of these clinical scenarios by a ratings panel in a process based on the appropriateness method developed by the RAND Corp (Santa Monica, CA)/University of California-Los Angeles (RAND/UCLA).

Mohs micrographic surgery utilization in the Medicare population, 2009.

Background: Mohs micrographic surgery (MMS) is the criterion standard treatment for high-risk skin cancers. Few data on current MMS Utilization are available.

Objective: To better understand current trends in MMS use in the Medicare population.

Determining the safety of office-based surgery: what 10 years of Florida data and 6 years of Alabama data reveal.

Background: This is a continued examination of 10 years of prospectively collected Florida in-office adverse event data and new comparable data from mandatory Alabama in-office adverse event data reporting.

Objective: To determine which office surgical procedures have resulted in reported complications.

Methods: This study is a compilation of mandatory reporting of office surgical complications by Florida and Alabama physicians to a central agency.

Outcome of 6 years of protocol use for preventing wrong site office surgery.

Background: Patient safety is emerging as an integral part of the overall strategy to improve health care in the United States. Wrong site surgery is correctly noted to be a sentinel event and great efforts must be made to avoid it.

Objective: We sought to determine the incidence of wrong site surgery after implementation of a preoperative protocol in patients presenting for treatment of skin cancer at a high-volume, Joint Commission-accredited, tertiary referral center for dermatologic surgery.

Mohs micrographic surgery for the treatment of cutaneous leiomyosarcoma.

Background: Cutaneous leiomyosarcoma is an extremely rare, malignant mesenchymal tumor of smooth muscle origin. Although generally considered a low-grade malignancy, there may be significant local invasion and subclinical extension. Rare cases of metastasis have been reported.

No end in sight: the skin cancer epidemic continues.

The incidence of nonmelanoma skin cancer (NMSC) continues to increase. Multiple reports from the United States and Europe suggest we are in the midst of an epidemic. European studies show substantial NMSC incidence increases during the last 2 decades.