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Improvement Needed in Immediate Access to VA Skin Cancer Care in Midwest, East Coast


In a presentation at the current American College of Mohs Surgery meeting, Jennifer G. Powers, MD, highlights the needed improvement for immediate access to skin cancer care for VA patients, noting a 33 day average wait time compared to the VAs optimal goal of 28 days.

Community care skin cancer referral times were less timely than Veterans Affairs’ (VA) optimal goal of 28 days for specialty care, in at least 2 tertiary VA care centers in the Midwest and East Coast, according to an abstract presented at the American College of Mohs Surgery meeting being held this week in Philadelphia, Pennsylvania.

Jennifer G. Powers, MD, of the University of Iowa, Dermatology, presented the data, which was based on a retrospective chart review of 175 patients referred by the VA for community care in the Midwest VA System, and 203 in the East Coast VA system between October 1, 2020, and May 15, 2021.

“Skin cancer…affects 4% of VHA patients,” Powers told the audience, with “skin cancer and related damage costing about $366 million or a $60 billion budget.”

Included case patients were identified “using community care [CC] referral logs with ICD-10 diagnoses screened for relevance to skin cancer.” She noted that miles to treatment centers from patient homes varied between the Midwest and East Coast cohort, with average drive times being significantly higher in the Midwest, she said, which obviously could impact uptake of treatment.

Average wait times from referral to appointment date was similar for both groups at about 33 days in the Midwest (n = 71) and 30 days in the East Coast patient cohort, however, time from biopsy to treatment for CC Mohs was very different, from 32.8 days in the Midwest group to 66 days on the East Coast. Powers noted that follow up notes were often incomplete in both groups, in about 15% of cases in the Midwest group and 21% of cases in the East Coast group.

“It’s wonderful that veterans have treatment choices, but it’s also worth looking at the balancing message, which is that sometimes there are miscommunication issues here,” Powers said.

Appropriate use criteria were being followed was common. In 100% of cases in both areas, however, only about 60% of the health care providers were ACMS certified.

Powers said that future study areas could incorporate more VA areas to do a comparison of areas and to hone in on addressing some of the more problematic areas, like missing notes.

Training for CC mohs surgeons did not match that of tertiary VA onsite providers.


Powers JG, Munjal A, Bhate C, et al. Skin in the game: community care management of procedures for skin cancer, a retrospective comparative study at two tertiary veterans affairs centers. Presented at: American College of Mohs Surgery. May 12-15, 2022. Philadelphia, PA.

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