How Expensive Are Care Costs?

As many of you are aware, the recent rise in healthcare costs have placed a significant burden on patients seeking treatment, as well as those of you providing the treatment. When a patient’s insurance plan doesn’t cover a procedure, many will opt not to seek treatment because paying out of pocket isn’t an option. But, in some cases patients may not have a choice. They need to seek treatment when faced with the rising incidences of non-melanoma skin cancer (NMSC). With NMSC cases increasing, the cost of managing this cancer will also accelerate. Doctors and patients on Medicare/ Medicaid plans can be assured of more overwhelming healthcare costs. The Rise of NMSC In 2000, 1.3 million incidences of NMSC were reported and that number continues to rise, signaling a rise in the cost to Medicare. Recent findings — based on data collected at The Wake Forest University School of Medicine — on these malignancies might surprise you. • NMSC ranks fifth in cost expenditures to Medicare behind lung, breast, colon and prostate cancers. • If the cost of treating actinic keratoses were included, NMSC would almost equal the cost of managing breast cancer, according to the data collected. Using an episode of care model, the researchers obtained the data from ICD-9-CM and procedure codes associated with cancer costs as found in the Medicare Current Beneficiary Survey (MCBS) for the early- to mid-’90s. Keeping Costs Down According to Tamara Salam Housman, M.D., a research fellow in the department of dermatology at The Wake Forest University School of Medicine, what won’t surprise doctors is the rise of NMSC management costs if office-based surgery is limited, as potential legislation is currently suggesting. Dr. Housman points to data she and her research team gathered, finding that skin cancer removal in non-office settings costs two to 20 times more than it does when performed in office settings. Medicare costs will increase if regulations mandate that NMSC be managed in a regulated outpatient/ ambulatory facility or in the hospital rather than your current office setting. Per the MCBS data, cancers of lung, bronchus, colon, rectum, breast and prostate were up to 19 times more costly per affected patient as NMSC. Dr. Housman says, “. . . the key is to control the cost of caring for each individual case of NMSC and therefore keep down the total cost of managing this cancer. For example, even if the rise in cost is only $300 per case and assuming the incidence of NMSC doesn’t increase, overall cost could increase by $390 million annually,” Dr. Housman theorizes. The research showed Medicare payment per patient per year for NMSC to be around $400 to 500 per case. Considering this information, any rise in cost would be significant to Medicare patients and to doctors who may not be able to perform low-cost, in-office treatments for NMSC. Dr. Housman is not sure what potential legislation will do for reimbursement or for patients’ own payments. Looking Down The Road Wherever the legislation may lead, you can’t ignore the increase of NMSC. Currently, NMSC is associated with the older population — the aging Baby Boomer generation may impact the number of cases being treated per year. Though it’s still too early to tell, this generation’s impact will most likely be notable. Health care will suffer if regulations require treatment for NMSC in a hospital or in an accredited ambulatory surgery center. And perhaps the biggest losers of the cost increases are the most important — your patients. Editor’s Note: Special thanks to Tamara Salam Housman, M.D., who provided the data. Dr. Housman is a research fellow in the Department of Dermatology, Wake Forest University School of Medicine in Winston-Salem, NC.