Use of Skin Cancer Procedures, Medicare Reimbursement, and Overall Expenditures, 2012-2017

The treatment of skin cancers represents a growing share of healthcare expenditures. However, little is known about how variations in payment rates relate to the use of different skin cancer procedures. This study describes recent trends in payment rates, use rates, and overall expenditures for skin cancer procedures in the Medicare Part B population. In this ecological study, we used the Medicare Physician Supplier and Other Provider Public Use File (POSPUF) to analyze trends in Medicare payment rates, use rates, and overall Medicare expenditures for skin cancer procedures from 2012 to 2017. We adjusted reimbursement rates for inflation by converting payment amounts into units of 2017 dollars. From 2012 to 2017, overall inflation-adjusted Medicare expenditure on skin cancer procedures increased 9%. Over this time period, inflation-adjusted Medicare reimbursement rates declined for each procedure class, with the exception of shave excision. Concurrently, the use rate of Mohs micrographic surgery increased 21%, while the use rate for all other skin cancer procedure classes declined. In summary, the results of this study suggest that increased use of Mohs has displaced use of other skin cancer procedures in the Medicare population.