Marked Variation in Number of Stages Per Case for Mohs Surgery

Correlation for persistent high outlier status with performing Mohs surgery in a solo practice


WEDNESDAY, May 3, 2017 (HealthDay News) -- There is considerable variation in the number of stages per case for Mohs micrographic surgery (MMS), according to a study published online April 28 in JAMA Dermatology.

Aravind Krishnan, from Johns Hopkins School of Medicine in Baltimore, and colleagues conducted a retrospective analysis of publicly available Medicare Part B claims data from January 2012 to December 2014 to study outlier physician practices for MMS and associated factors. Data were included for 2,305 physicians who received Medicare payments for MMS from any practice performing MMS on the head and neck, genitalia, hands, and feet. Outlier physicians were defined as those whose mean number of stages for MMS was two standard deviations greater than the mean.

The researchers found that the mean number of stages per MMS case was 1.74 and the median was 1.69; the range was 1.09 to 4.11. One hundred thirty-seven physicians were greater than two standard deviations above the mean in at least one of the three years assessed; 49 physicians (35.8 percent) were outliers in all three years. There was a correlation between persistent high outlier status and performing Mohs surgery in a solo practice (odds ratio, 2.35). There was no correlation for volume of cases per year, practice experience, and geographic location with persistent high outlier status.

"Providing feedback to physicians may reduce unwarranted variation on this metric of quality," the authors write.

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