Navigating Barriers to Patient Access and Reimbursement in Mohs Micrographic Surgery

BACKGROUNDInsurance 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.OBJECTIVETo assess the impact of cost-cutting policies on patients and physicians.METHODSA survey was electronically distributed to members of the American College of Mohs Surgery (ACMS).RESULTSThe 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.CONCLUSIONThe burden of restrictive health care policies will have long-term consequences for the patient-provider interaction and patient outcomes.