WINSTON-SALEM, N.C. -- A Medicare policy designed to reduce the cost of treating precancerous skin lesions contradicts standard medical practice in the vast majority of cases, according to a study by researchers at the Westwood Squibb Center for Dermatology Research at Wake Forest University School of Medicine.
The policy can leave patients in pain and increase the risk that the lesions, called actinic keratoses, can develop into a form of skin cancer called squamous cell carcinoma, which can be fatal.
In a paper published today by the Journal of the American Academy of Dermatology, Steve Feldman, M.D., and others reported that dermatologists overwhelmingly prefer to treat such lesions by removing them immediately. Yet, Medicare policies give states the right to induce doctors into using other treatments first.
"In states such as Florida, Medicare will not reimburse doctors who remove lesions on the first visit, with a few exceptions," said Feldman, who is the center's director, and associate professor of dermatology at Wake Forest University. "They require that all actinic keratoses initially be treated with topical creams.
"But when you look at the data of how doctors typically treat actinic keratoses, we found that in almost 80 percent of the cases, doctors chose to remove the lesion on the initial visit."
In comparison, doctors chose to do nothing in 19 percent of initial visits. In 1.5 percent of the cases, doctors chose to use both topical creams and removal. Not once -- never -- did doctors apply topical creams only, as mandated under Medicare's rules in Florida.
Medicare policy leaves it up to the Medicare insurance carriers in
individual states to decide whether to implement the rule, said William O'Neill,
the director of practice issues for the American Academy of Dermatology. "What
causes frustration is this crazy quilt of states deciding this issue at their
own discreti
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Contact: Bob Conn, Mark Wright or Jim Steele
rconn@wfubmc.edu
336-716-4587
Wake Forest University Baptist Medical Center
1-Jan-1999