32948 Characteristics of physicians accepting Medicaid for Mohs micrographic surgery: A cross-sectional analysis

Abstract

Medicaid beneficiaries face significant barriers to accessing dermatologic care nationally. There is a paucity of data regarding Medicaid beneficiary access to Mohs micrographic surgery (MMS), the preferred treatment for the increasing incidence of skin cancers. In this cross-sectional analysis of all physicians performing MMS in the United States, we sought to characterize the extent and characteristics of Mohs surgeons accepting Medicaid. Our sample included all physicians who billed more than 10 MMS procedures based on the 2017 Medicare Provider Utilization data, as well as the MMS fellowship graduates from 2017 to 2020. Medicaid acceptance status was determined by searching publicly available state-specific Medicaid provider directories and verified by phone call to the physician’s practice. Our results suggest that the majority (60.5%) of physicians performing MMS do not accept Medicaid. Medicaid acceptance stratified by physician sex, practice setting, geographic region, years since medical school graduation, median household income in county of practice and density of Mohs surgeons in county of practice showed statistically significant intergroup differences (P < .05). Our findings reveal potential gaps in access to MMS for socioeconomically disadvantaged populations. Patient access to MMS may be dictated by patient insurance, individual surgeon or location characteristics. Disparities in access to MMS may ultimately yield disproportionately worse health outcomes for the Medicaid beneficiary population.