Dermatologist Characteristics Associated With Outlier Performance of Destruction for Benign Lesions

Background: Destruction of a benign skin lesion should not be billed to Medicare if the lesion is solely a cosmetic concern. Reducing unnecessary benign destructions could lower Medicare costs.

Objective: Evaluate benign destruction rates relative to premalignant destruction rates and identify factors associated with frequent benign destruction among dermatologists.

Methods: This study analyzed 2022 Medicare benign and premalignant destructions procedure counts for dermatologists.

Results: Of the included 5,605 dermatologists, 180 (3.2%) were outliers, performing benign destructions at a rate exceeding 1.18 per premalignant destruction. Forty-nine (0.9%) were extreme outliers, with ratios above 1.76. Dermatologists with over 26 years of practice were more likely to be outliers or extreme outliers, whereas those in the West had lower odds. Reducing outlier benign destruction rates to the 80th percentile could save Medicare $1.17 million, with potential savings of up to $10.3 million if applied broadly.

Conclusion: A small number of dermatologists bill for benign destructions at high rates. Targeted educational interventions may reduce unnecessary Medicare expenditures.