Cuesta mucho que las aseguradoras paguen los Mohs

 STORY OF THE WEEK

Published in Dermatology

Journal Scan / Research · November 14, 2019

Navigating Barriers to Access and Reimbursement for Mohs Surgery

Dermatologic Surgery

TAKE-HOME MESSAGE

• In a survey conducted among American College of Mohs Surgery members, 70% of the respondents reported having 1 to 2 employees dedicated to obtaining prior authorization (PA). Among the respondents, 50% report an average time of 30 minutes spent per PA. About half (49%) provided a financial disclosure prior to Mohs surgery. Many respondents reported screening patients for high-deductible policies and requested an advance deposit against the deductible. In the absence of an advance deposit, 60% reported difficulty obtaining payment for service.

• Many restrictive healthcare policies, which have been set to curb rising healthcare costs, may have long-term consequences for patient–doctor relationships and patient outcomes. Physicians should take an active role in helping patients with economic challenges and lobbying for solutions. Further studies are warranted to assess the extent to which the restrictive policies have led to complications from delayed or unmet treatment.

– InYoung Kim, MD, PhD

Abstract

BACKGROUND

Insurance companies have implemented new policies including excessive prior authorization (PA) requirements, high-deductible plans, and complicated billing structures in an effort to curb rising health care costs. Studies investigating the real-time impact on providers and patients are emerging, but few within the field of dermatology have been published.

OBJECTIVE

To assess the impact of cost-cutting policies on patients and physicians.

METHODS

A survey was electronically distributed to members of the American College of Mohs Surgery (ACMS).

RESULTS

The majority of respondents (78.2%) practiced in a private setting, with no other demographic differences. The majority of respondents (70%) dedicated 1 to 2 employees to obtaining PAs. Fifty percent reported an average time of 30 minutes spent per PA. Fifty-six percent of respondents obtained PA from private insurance before Mohs surgery, whereas only 24.5% obtained PA from Medicare. Forty-nine percent of practitioners provided patients with a financial disclosure prior to Mohs surgery. Moreover, many practitioners reported screening patients for high-deductible policies and request an advanced deposit against the deductible. Sixty percent reported difficulty obtaining payment for service in the absence of an advanced deposit.

CONCLUSION

The burden of restrictive health care policies will have long-term consequences for the patient-provider interaction and patient outcomes.

Dermatologic Surgery

Navigating Barriers to Patient Access and Reimbursement in Mohs Micrographic Surgery

Dermatol Surg 2019 Oct 11;[EPub Ahead of Print], AE Krausz, JR Manning, GL Vinelli, DH Ciocon 

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Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

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