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Why appropriate use criteria for Mohs micrographic surgery?
Why appropriate use criteria for Mohs micrographic surgery? Brett Coldiron, MD, FACP, President, American College of Mohs Surgery,a and Paul Storrs, MD, FAAD, Past President, American Society for Mohs Surgeryb Cincinnati, Ohio, and Palos Heights, Illinois See related article on page 531 he Boards of the American Academy of Dermatology, the American College of Mohs Surgery, the American Society for Dermatologic Surgery Association, and the American Society for Mohs Surgery recently approved the extraordinary work of the Mohs Surgery Appropriate Use Criteria (AUC) Ad Hoc Task Force chaired by Dr Suzanne Connolly. The AUC are published in this edition of the Journal of the American Academy of Dermatology and concurrently in Dermatologic Surgery, and serve as a decisive statement for the proper use of Mohs micrographic surgery; they will be an invaluable resource for all ethical Mohs surgeons. The success of this document is underscored by the wide breadth of individuals involved in its development, including Mohs surgeons, medical dermatologists, and dermatopathologists from across the country, representing both academic and private practice. Importantly, the majority of the ratings panelists were not Mohs surgeons. The use of Mohs micrographic surgery for skin cancer has grown dramatically in the past 15 years, from approximately 1 in 20 skin cancers to approximately 1 in 4. This is partially a result of the skin cancer epidemic, and partially a result of the increase in the numbers of dermatologists who practice Mohs micrographic surgery, which increases the availability and treatment option of this technique. There were many very good reasons to develop these AUC. Although the availability of Mohs micrographic surgery has undoubtedly benefited patients who have skin cancer, there has been backlash at the federal level and by other third-party payers as use and the associated cost of the procedure has attracted notice. Any rapid increase in use is often automatically and incorrectly assumed to indicate that a procedure is overvalued. There is no recognition or allowance in
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the federal budget or in the Medicare payment pool for new money, even for epidemics. For this reason, when an epidemic occurs, the payment for addressing it must necessarily come from other physicians in the pool. This creates tremendous pressure and an antagonistic mentality across specialties, which may be clever from a federal budget viewpoint, but is destructive and illogical from a medical perspective, and counter to quality patient care. Mohs micrographic surgery has repeatedly been subject to review by the Centers for Medicare and Medicaid Services at the Relative Value Update Committee meetings, and will be discussed again in April 2013. Contractor medical directors throughout the Midwest, mid-Atlantic region, Southeast, and southern United States have unilaterally moved or proposed to eliminate coverage of Mohs micrographic surgery for tumors on the trunk and extremities. Other restrictions on Mohs micrographic surgery are also actively being explored. Insurance carriers need the guidance provided by the AUC. Within our specialty, there have also been questions about which tumors need Mohs micrographic surgery and which do not. All of these issues lead to questions about the indications for Mohs micrographic surgery, and its place in the dermatologist’s treatment skin cancer. In this issue of the Journal of the American Academy of Dermatology, Connolly et al elegantly and comprehensively outline the AUC for Mohs micrographic surgery. Read them carefully. Expect insurance coverage to soon be modeled on them. The importance of this document cannot be understated. The AUC for Mohs micrographic surgery will help to minimize inappropriate use, help quell utilization complaints at the local and federal level and, most importantly, help preserve this valuable and effective procedure for our patients with skin cancer.
From the Department of Dermatology, University of Cincinnati College of Medicine,a and Dermatology Associates of Illinois.b Funding sources: None. Conflicts of interest: None declared. Accepted for publication July 2, 2012. Reprint requests: Brett Coldiron, MD, Department of Dermatology, University of Cincinnati College of Medicine, 2034 Burnet Ave, Cincinnati, OH 45219-2420. E-mail: [email protected].
Published online September 7, 2012. J Am Acad Dermatol 2012;67:551. 0190-9622/$36.00 Ó 2012 by the American Academy of Dermatology, Inc. http://dx.doi.org/10.1016/j.jaad.2012.07.006
551
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the federal budget or in the Medicare payment pool for new money, even for epidemics. For this reason, when an epidemic occurs, the payment for addressing it must necessarily come from other physicians in the pool. This creates tremendous pressure and an antagonistic mentality across specialties, which may be clever from a federal budget viewpoint, but is destructive and illogical from a medical perspective, and counter to quality patient care. Mohs micrographic surgery has repeatedly been subject to review by the Centers for Medicare and Medicaid Services at the Relative Value Update Committee meetings, and will be discussed again in April 2013. Contractor medical directors throughout the Midwest, mid-Atlantic region, Southeast, and southern United States have unilaterally moved or proposed to eliminate coverage of Mohs micrographic surgery for tumors on the trunk and extremities. Other restrictions on Mohs micrographic surgery are also actively being explored. Insurance carriers need the guidance provided by the AUC. Within our specialty, there have also been questions about which tumors need Mohs micrographic surgery and which do not. All of these issues lead to questions about the indications for Mohs micrographic surgery, and its place in the dermatologist’s treatment skin cancer. In this issue of the Journal of the American Academy of Dermatology, Connolly et al elegantly and comprehensively outline the AUC for Mohs micrographic surgery. Read them carefully. Expect insurance coverage to soon be modeled on them. The importance of this document cannot be understated. The AUC for Mohs micrographic surgery will help to minimize inappropriate use, help quell utilization complaints at the local and federal level and, most importantly, help preserve this valuable and effective procedure for our patients with skin cancer.
From the Department of Dermatology, University of Cincinnati College of Medicine,a and Dermatology Associates of Illinois.b Funding sources: None. Conflicts of interest: None declared. Accepted for publication July 2, 2012. Reprint requests: Brett Coldiron, MD, Department of Dermatology, University of Cincinnati College of Medicine, 2034 Burnet Ave, Cincinnati, OH 45219-2420. E-mail: [email protected].
Published online September 7, 2012. J Am Acad Dermatol 2012;67:551. 0190-9622/$36.00 Ó 2012 by the American Academy of Dermatology, Inc. http://dx.doi.org/10.1016/j.jaad.2012.07.006
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