A Medicare cost comparison of minor cutaneous procedures by surgical setting

Abstract

Background: Regulations that cause minor cutaneous procedures to be moved from the physician's office to an ambulatory surgery center (ASC) or hospital may have the potential to unnecessarily increase the costs of these procedures from the Medicare perspective. Objective: To investigate whether minor cutaneous procedures that could reasonably be performed in the office are being done in more intense settings (ASCs or hospitals), who is performing these procedures in alternative settings, and the cost of higher intensity settings. Methods: Medicare claims data on a number of minor cutaneous surgery procedures performed by various medical disciplines, the location in which the procedures were performed, and the ratio of minor procedures done in each surgical setting by specialty were obtained using the 1992–2000 Medicare Current Beneficiary Survey (MCBS). We used Medicare reimbursements as a measure of the cost of the procedure. Results: When compared by surgical setting, the mean charges for each minor cutaneous procedure were greatest when the procedure was performed in the hospital setting and least when performed in the office setting. Owing to surgical setting, dermatologists were the most cost-effective specialists for the performance of minor cutaneous procedures. Conclusions: Regulations that discourage office-based surgery could significantly increase medical care costs.

Keywords::

• ambulatory surgery center
• Medicare
• office-based surgery

Acknowledgement

The Center for Dermatology Research is supported by an educational grant from Galderma Laboratories, L.P.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.