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

Overview

Journal Dermatol Surg

Date 2024 Apr 5

PMID 38578837

Authors

Chen Dun

Christi M Walsh

Caitlin W Hicks

Thomas Stasko

Allison T Vidimos

Barry Leshin

Elizabeth M Billingsley

Brett M Coldiron

Richard G Bennett

Victor J Marks

Clark Otley

Howard W Rogers

Glenn D Goldman

John G Albertini

Martin A Makary

Affiliations

Soon will be listed here.

Abstract

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. They evaluated surgeon-level change in mean stages per case between the intervention and control groups, as well as the cost savings to Medicare over the same time period.

Results: A total of 2,014 surgeons performed Mohs procedures on HN lesions. Among outlier surgeons who were notified, 31 surgeons (94%) for HN and 24 surgeons (89%) for TE reduced their mean stages per case with a median reduction of 0.16 and 0.21 stages, respectively. Reductions were also observed among outlier surgeons who were not notified, reducing their mean stages per case by 0.1 and 0.15 stages, respectively. The associated total 5-year savings after the intervention was 92 million USD.

Conclusion: The implementation of this physician-led benchmarking model was associated with broad reductions of physician utilization and significant cost savings.

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