Cutting Mohs payments

May 1, 2008

It may well take an act of Congress to modify a Medicare ruling that cuts by half Medicare reimbursements for Mohs surgery procedures - an issue that continues to stir controversy.

Key Points

National report - Controversy continues over the Centers for Medicare and Medicaid Services' (CMS) decision to cut by half reimbursements for some Mohs surgery procedures.

Some dermatologists say CMS's decision not only was hasty, arbitrary and even politically motivated, but that - far from saving money - the reductions are likely to cost more in the long run.

More importantly, they say the reductions may not be in the best interest of patients.

American Society for Mohs Surgery

"Consequently, when Mohs surgery and reconstruction are done on the same day, the lower valued of the two procedures, either the first-stage Mohs excision or the reconstruction, will be reimbursed at 50 percent of its contracted value.

"Second, third and greater stages of Mohs excision (codes 17312, 17314, 17315) will be reimbursed at full contracted rates, without any reduction. Reconstruction done on any day after the day of Mohs surgery will be reimbursed at the full contracted rates and is not subject to any reduction in payment."

The society adds that, since Medicare has made the move to cut reimbursements for Mohs, private insurers are likely to follow suit.

Statistics

According to Cincinnati dermatologist Brett Coldiron, M.D., a skin cancer specialist, the logic of the Medicaid cuts flies in the face of what he calls a skin cancer epidemic.

"I have data being prepared for publishing that shows a 38 percent increase in the number of skin cancers in the Medicare population in the last 12 years," says Dr. Coldiron, a dermatologist in private practice and clinical assistant professor of dermatology, University of Cincinnati.

"Coupled with a 12 percent overall increase in the number of beneficiaries, this means a total increase of 58 percent in the absolute number of skin cancers," he says.

And, Dr. Coldiron says, the efficacy of no skin cancer treatment compares with the 98 percent cure rate of Mohs surgery.

"Excision with frozen sections can get 93 percent to 95 percent cure rates, but costs much more than Mohs when the cost of the pathology - including reprocessing all the frozens - are factored in," he says.

"Also, excisions with frozens will not come anywhere close to Mohs cure rates when treating multiple recurrent tumors, aggressive tumors or deeply invasive tumors near the eyes, orbits and nose, or those with perineural invasion," Dr. Coldiron tells Dermatology Times.

Increase in Mohs surgery cases

Ironically, the success of Mohs surgery in treating skin cancer - and the resultant spike in the number of Mohs procedures - may have been at least partially responsible for Medicare's decision to reduce reimbursements, Dr. Coldiron says.

Some sources estimate that the number of Mohs surgery cases being billed to Medicare has increased by as much as 300 percent.

"I think they've made the cuts because the utilization has increased," he says.

"CMS is not much concerned about cure rates - or if they are, they haven't bothered to consider the implications in this case. They also cannot, or will not, compare total costs - that is, cost per episode of care," Dr. Coldiron says.