Patients spend more time with the physician for excision of a malignant skin lesion than for excision of a benign skin lesion.
BACKGROUND
Currently, there is a difference in reimbursement between excision of malignant and benign lesions. There is concern that there is not sufficient rationale for differential reimbursement for these two procedures.


OBJECTIVE
To assess whether there is a difference in physician work involved with excision of benign versus malignant skin tumors.


METHODS
We searched National Ambulatory Medical Care Survey data for visits at which excision of benign and malignant skin lesions was performed. We compared the time spent with the physician at these two types of visits. To exclude confounding issues unrelated to the excision that would affect the time of visit, we excluded visits at which multiple diagnoses were addressed.


RESULTS
The mean time spent with the physician at visits for excision of benign lesions was 22.9 +/- 1.0 minutes. The mean time spent with the physician at visits for excision of malignant lesions was 30.0 +/- 1.7, 30% longer (p<0.001). The longer time for excision of malignant lesions remained significant after controlling for age, gender, and race.


CONCLUSIONS
Excision of malignant lesions involves more physician work than does excision of benign lesions. Elimination of differential compensation for benign versus malignant skin lesion procedures would not enhance the accuracy of reimbursement. In the absence of any compelling rationale to change the existing differential reimbursement, the proposals to do so are not warranted.
Department of Dermatology and the Center for Dermatology Research, Wake Forest University School of Medicine, Winston-Salem, NC 27157-1071, USA. sfeldman@wfubmc.edu
Steven R
SR
Feldman
Fabian
F
Camacho
Phillip M
PM
Williford
Daniel M
DM
Siegel
Rajesh
R
Balkrishnan
Alan B
AB
Fleischer
D017050:Episode of Care; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012871:Skin Diseases / Q000601:surgery*; D012878:Skin Neoplasms / Q000601:surgery*; D013997:Time Factors